pulmonologist salary

[thechase]

After graduating pccm fellowship- if you choose to do pulm alone, whats the salary look like?

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[spacegun]

For whatever it's worth, here are MGMA medians for "Pulmonary Medicine: General" (2019 but based on 2018 data):

Eastern: $348,291
Midwest: $380,000
Southern: $374,131
Western: $366,000

 

[Doc Doc Doc Goose]

For whatever it's worth, here are MGMA medians for "Pulmonary Medicine: General" (2019 but based on 2018 data):

Eastern: $348,291
Midwest: $380,000
Southern: $374,131
Western: $366,000

How does that compare to pulm/ICU salaries ??? sorry to hijack the thread

 

[thechase]

For whatever it's worth, here are MGMA medians for "Pulmonary Medicine: General" (2019 but based on 2018 data):

Eastern: $348,291
Midwest: $380,000
Southern: $374,131
Western: $366,000

Thank you @spacegun ! Surprisingly high, wonder the difference if you do sleep vs interventional pulm on top (and forgo icu).

 

[spacegun]

How does that compare to pulm/ICU salaries ??? sorry to hijack the thread

I think the link also mentions pulm/ccm salary medians too.

 

[spacegun]

Thank you @spacegun ! Surprisingly high, wonder the difference if you do sleep vs interventional pulm on top (and forgo icu).

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?

 

[chessknt]

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.

 

[thechase]

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?

 

[spacegun]

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?

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.

 

[the argus]

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.

 

[jdh71]

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?

groce

why

 

[jdh71]

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.

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.

 

[chocomorsel]

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.

So only one week inpatient a month? To include pulm consults that week? And then five outpatient days?

 

[spacegun]

So only one week inpatient a month? To include pulm consults that week? And then five outpatient days?

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.

 

[chocomorsel]

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.

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.

 

[spacegun]

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.

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.

 

[chocomorsel]

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.

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.

 

[spacegun]

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.

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

 

[CCM-MD]

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.

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

 

[jdh71]

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)

 

[CCM-MD]

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)

By the time I'm tired of my ICU week its time usually time for my week off

 

[jdh71]

By the time I'm tired of my ICU week its time usually time for my week off

 

[chessknt]

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.

 

[jdh71]

I can also work part time seeing pulm pretty much indefinitely (assuming cognition) and still bring in a six figure salary.

 

[CaliPCCSM]

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.

 

[scoopdaboop]

Mean is furthest left. Median is highlighted. This is 2020 MGMA from 2019 data

 

[CCM-MD]

View attachment 336975

Mean is furthest left. Median is highlighted. This is 2020 MGMA from 2019 data

These numbers are from the 2019 report based on 2018 data. Its gone up.