pulmonologist salary

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thechase

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After graduating pccm fellowship- if you choose to do pulm alone, whats the salary look like?
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thechase said:
Thank you @spacegun ! Surprisingly high, wonder the difference if you do sleep vs interventional pulm on top (and forgo icu).
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If I remember correctly, @pulmdoc used to say pulm and ccm are becoming more separate from each other, to where people who like outpatient more could do pulm/sleep as a good combination, while people who like inpatient more could do ccm only, and people who want both inpatient and outpatient as options could still do pulm/ccm. Hopefully he can comment about pulm /sleep/interventional some more?
 
Sleep is always optional pulm but (under current reimbursement) significantly increases revenue due to fast easy followups and sleep study reading. Sleep is in short supply so you will frequently be the only person doing it and have unlimited access to patients that take 5 minutes to see so you can massively increase outpt productivity, far more than pulmonary.

CCM billing will always be much higher than any outpatient billing but tends to be controlled by hospitals and paid on a shift rate basis.
 
This is a general question - but can people still pick up hospitalist shifts on the side if doing pulm/sleep clinic ? I assume if you remain IM boarded, nothing would stop you?
 
thechase said:
This is a general question - but can people still pick up hospitalist shifts on the side if doing pulm/sleep clinic ? I assume if you remain IM boarded, nothing would stop you?
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I think you could pick up hospitalist shifts, but you could also pick up MICU or even outpatient pulm shifts (e.g., locums).

N=1. I know a pulm/ccm attending in the Midwest. He told me used to do about 1 week ICU on/off with inpatient pulm consults per month and picked up ~4-5 days outpatient pulm each month (locums). He said this made him $700k for the first few years after residency/fellowship.

He then switched to 1 week ICU on/off only with inpatient pulm consults, but no outpatient at all (he didn't like outpt), and makes $500k+.

He said he doesn't like outpatient pulm, but if he did outpt pulm only (no ICU, no inpt pulm), then he thinks it'd be easy to make at least $300k and even $400k is attainable, according to him.

You could just do hospitalist (IM only, no fellowship) and make about $300k. I think that's fairly common.
 
Remember that to actually do sleep (i.e. read sleep studies) you need to be boarded in sleep medicine which requires a dedicated 1 year fellowship. Depending on location you can still potentially see sleep patients in clinic if not boarded.

If you're sure you have no interest in critical care you can do a 2 year pulm-only fellowship (~20 programs nationally) followed by a year of sleep to minimize training time.
 
the argus said:
Remember that to actually do sleep (i.e. read sleep studies) you need to be boarded in sleep medicine which requires a dedicated 1 year fellowship. Depending on location you can still potentially see sleep patients in clinic if not boarded.

If you're sure you have no interest in critical care you can do a 2 year pulm-only fellowship (~20 programs nationally) followed by a year of sleep to minimize training time.
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You can learn to read sleep studies if you have an interest and your partners are willing to teach you. Cant sit for boards obviously.
 
spacegun said:
I think you could pick up hospitalist shifts, but you could also pick up MICU or even outpatient pulm shifts (e.g., locums).

N=1. I know a pulm/ccm attending in the Midwest. He told me used to do about 1 week ICU on/off with inpatient pulm consults per month and picked up ~4-5 days outpatient pulm each month (locums). He said this made him $700k for the first few years after residency/fellowship.

He then switched to 1 week ICU on/off only with inpatient pulm consults, but no outpatient at all (he didn't like outpt), and makes $500k+.

He said he doesn't like outpatient pulm, but if he did outpt pulm only (no ICU, no inpt pulm), then he thinks it'd be easy to make at least $300k and even $400k is attainable, according to him.

You could just do hospitalist (IM only, no fellowship) and make about $300k. I think that's fairly common.
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So only one week inpatient a month? To include pulm consults that week? And then five outpatient days?
 
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chocomorsel said:
So only one week inpatient a month? To include pulm consults that week? And then five outpatient days?
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He told me he's in the ICU a week on/off so ~14 days a month + pulm consults. Then 4-5 outpt days but he said he didn't like outpt so he stopped. To be fair, this in a smaller Midwest city.
 
spacegun said:
He told me he's in the ICU a week on/off so ~14 days a month + pulm consults. Then 4-5 outpt days but he said he didn't like outpt so he stopped. To be fair, this in a smaller Midwest city.
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Ok. Well your post wasn’t clear so I was wondering if it was just one week. Sounds about right because he was working a lot. Average full time is mid 400s for W2 as an employee. Or it used to be before Covid. As an independent contractor who does their own billing, hell the sky is probably the limit.
Actually I would make that much if I worked that much and added 5 days a month of Anesthesia. This is locums though.
I know some PulmCCM doc are making way more but they work a lot as well and are independent.
 
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chocomorsel said:
Ok. Well your post wasn’t clear so I was wondering if it was just one week. Sounds about right because he was working a lot. Average full time is mid 400s for W2 as an employee. Or it used to be before Covid. As an independent contractor who does their own billing, hell the sky is probably the limit.
Actually I would make that much if I worked that much and added 5 days a month of Anesthesia. This is locums though.
I know some PulmCCM doc are making way more but they work a lot as well and are independent.
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Even if there's no difference in money, I think pulm/ccm is a good way to go for someone who likes ccm. Especially because it gives you options including outpatient and the (relative) independence that comes with that. I think having more options is important to consider especially with future uncertainties.
 
spacegun said:
Even if there's no difference in money, I think pulm/ccm is a good way to go for someone who likes ccm. Especially because it gives you options including outpatient and the (relative) independence that comes with that. I think having more options is important to consider especially with future uncertainties.
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I hated IM due to the social work and redundancy of outpatient it entailed.
But if you do like IM, or can stomach the three year residency for the fellowship, then yes, totally agree.
Having your own clinic and your own patients is priceless.
 
chocomorsel said:
I hated IM due to the social work and redundancy of outpatient it entailed.
But if you do like IM, or can stomach the three year residency for the fellowship, then yes, totally agree.
Having your own clinic and your own patients is priceless.
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By the way it's crazy how competitive pulm/ccm is now, according to the most recent NRMP fellowship match data for 2020:

91.5% Infectious Disease
88.2% Nephrology
85.1% Hospice and Palliative Care
84.6% Geriatrics
82.9% Endocrinology
81.8% Allergy and Immunology
75.8% Hematology and Oncology
72.3% Cardiology
70.3% Rheumatology
67.3% Pulmonary and Critical Care
62.7% Gastroenterology
 
spacegun said:
Even if there's no difference in money, I think pulm/ccm is a good way to go for someone who likes ccm. Especially because it gives you options including outpatient and the (relative) independence that comes with that. I think having more options is important to consider especially with future uncertainties.
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Agree. Pulm adds a variety of options including ability to deescalate from the ICU over time. But gotta do clinic. I fall into the group that dislikes clinic. Y’all weirdo clinic lovers can have fun with that :hardy:
 
If you can find a relative 50/50 pulm/cc job you’ll find that when you’re kind of fed up with clinic it’s time for the unit again and when you’re happy for a break from early mornings, long hours, nights, and weekends, you have a few weeks in clinic again. I enjoy some bronch based biopsy work too which you really only get through pulm (a lot of the CT surgeons can do this too I suppose but it’s not really worth their time)
 
jdh71 said:
If you can find a relative 50/50 pulm/cc job you’ll find that when you’re kind of fed up with clinic it’s time for the unit again and when you’re happy for a break from early mornings, long hours, nights, and weekends, you have a few weeks in clinic again. I enjoy some bronch based biopsy work too which you really only get through pulm (a lot of the CT surgeons can do this too I suppose but it’s not really worth their time)
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By the time I'm tired of my ICU week its time usually time for my week off :laugh:
 
In my experience pulmonary adds variety in exchange for less time off than straight CC. Pay is variable and highly dependent on compensation structure but in general straight CCM is going to pay more per hour than pulm because you generate more units and the hospital has to pay you a base amount just to show up to keep the hospital open whereas pulmonary they get away with a (usually bad) unit compensation rate that you have to work your tail off to get near what CCM pays (plus uncompensated work like answering other provider's emails, pt phone calls, prior auth stuff depending on setup). From a pure money perspective pulmonary is not a great choice but can offer fulfillment in a different vein than CCM does.
 
My group in California has worked 7 days of ICU followed by 5 days of clinic and then 9 days off for years. Our pay has been in the 350-500 k range. I usually was in the latter range. A lot of time to expend with family. Some years I made 600K+ but not sure that will continue.
 
1620995123006.png


Mean is furthest left. Median is highlighted. This is 2020 MGMA from 2019 data
 
chessknt said:
With CC changes this doesnt surprise me. Seeing 2 follow ups in an hour generates more RVUs than 103 minutes of CC time plus any PFTs you do. Bronchs generate way more RVUs than CC per unit time.
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Good to know! Thank you for sharing the information!!
 
What are the wRVUs and $/wRVU? This answers the question of how much work are you doing for the pay. Thats the bottom line IMO.

For the “Critical Care: Intensivist” category on MGMA (all practice types), the numbers are: Mean 490k (153/wRVU), median 478k (113/wRVU), 75th 558k (165/wRVU) and 90th 647k (325/wRVU). I’m curious what they are for pulmonary, I would bet the $/wRVU is lower for pulm, which means the folks at the 75-90th percentile are working more to make that pay.

The private/physician owned category is going to be eventually eliminated due to the slashing reimbursement and overall trend towards employment, I’ve seen several pulmonary practices shut down in the west region over the past few years due to increasing overhead and decreasing reimbursement from CMS. So I would be cautious looking at those numbers and letting that influence specialty selection.
 
CCM-MD said:
What are the wRVUs and $/wRVU? This answers the question of how much work are you doing for the pay. Thats the bottom line IMO.

For the “Critical Care: Intensivist” category on MGMA, the numbers are: Mean 490k (153/wRVU), median 478k (113/wRVU), 75th 558k (165/wRVU) and 90th 647k (325/wRVU). I’m curious what they are for pulmonary, I would bet the $/wRVU is lower for pulm, which means the folks at the 75-90th percentile are working more to make that pay.
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Yes Pulm works more hrs but less weekends and nights.
 
CCM-MD said:
What are the wRVUs and $/wRVU? This answers the question of how much work are you doing for the pay. Thats the bottom line IMO.

For the “Critical Care: Intensivist” category on MGMA (all practice types), the numbers are: Mean 490k (153/wRVU), median 478k (113/wRVU), 75th 558k (165/wRVU) and 90th 647k (325/wRVU). I’m curious what they are for pulmonary, I would bet the $/wRVU is lower for pulm, which means the folks at the 75-90th percentile are working more to make that pay.

The private/physician owned category is going to be eventually eliminated due to the slashing reimbursement and overall trend towards employment, I’ve seen several pulmonary practices shut down in the west region over the past few years due to increasing overhead and decreasing reimbursement from CMS. So I would be cautious looking at those numbers and letting that influence specialty selection.
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1739685228253.png

443/5739=77/wRVU
452/5071=89/wRVU

However I would say it is an error to think more wrvus=working harder. Again I can see 2 new clinic patients with 2 full lung function tests in an hour=(2.6+0.6)*2=6.4 vs. 4.5 for 103 mins of CC care. A cancer workup bronch with navigation and EBUS staging takes about 100 minutes (or less...) and is worth about 15 wRVUs.
 
Total wRVUMedian75th90th
Critical Care: Intensivist4213 (478k)6027 (558k)7769 (647k)
Pulmonary: General5739 (443k)7815 (534k)9868 (712k)
Pulmonary: Critical Care5071 (452k)6961 (558k)8991 (674k)

I used the hospital owned numbers above, 1800 more wRVUs for pulmonary alone at the 75th to get paid less than CC alone, and 2100 more wRVUs to make 60k more at the 90th. The physician owned numbers make even less sense, more than double the wRVUs at the 90th percentile (essentially working 2 jobs) to make 130k more. It’s a bad deal no matter how you slice it.

Clinic is not all sunshine and rainbows, it’s just a different flavor of pain. Clinic patients and outpatient procedures come with the responsibility of ongoing care. The work never ends. My wife is an endocrinologist so I have lived through all the joys of clinic, no thank you. Give me a intubated patient in the unit any day over a new whiny clinic patient who doesn’t want to do anything to help themselves. Critical care you’re done when you’re out the door.
 
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Does anyone have heme-onc numbers? Burnt out fellow looking for a light at the end of the tunnel.
 
Sharing some PMCC and Heme-Onc #s from Marit - this is a community powered anonymous salary sharing project started on Reddit to create a people powered version of MGMA. Works on a give-to-get model, so you have to share yours to unlock access
Median / Average
PM - $433k / $445k
PMCC - $513k / $493k
Heme-Onc - $525k / $610k

You can see all specialties and detailed salaries here
 
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