HowellJolly has the right attitude to be a pulmonologist, and probably should become one. As a practicing pulmonary/CCM physician, I have done hospitalist work, ER work, been a critical care physician in a hospital setting (basically a CCM/hospitalist), and practiced in an Acute Care group, private practice, and now a multispecialty group practice. I have done the gamut of pulm/CCM and sleep medicine, and have directed my own sleep lab.
Here's the honest evaluation of what Pulmonary doc does. In the office, you'll see pts with chronic cough, COPD, rarely see a new asthmatic, evaluate lung nodules and masses, hemoptysis, shortness of breath, and pulmonary infiltrates. You'll also see those with recurrent pneumonia. There will be a handful of pts applying for disability (unless you choose to make this a major part of your practice), and you'll see pts with sleep disorders, which is an extremely satisfying part of the practice. In the hospital, you'll see anyone in the ICU, manage all the vents, and follow those pts to the floor up until discharge. You'll see most pts with COPD. You'll handle all the medical urgencies, and have a close working relationship with the ER docs and surgeons. The pulmonologist is generally the super-hospitalist/acute care medicine/critical care medicine guy, and if you had to have just one type of specialty in the hospital, pulmonary would probably be your first choice. Because of his long working hours, the pulmonologist us usually well-respected by the other subspecialties who generally call call the pulmolologist in to handle anyone acutely ill in the hospital, and to manage the pts postoperatively.
Pulmonologists are usually sought out when there are difficult to understand diseases or pts without a diagnosis, because they are so used to handling multi-organ system disease in the ICU (brain, lungs, heart, kidney, GI) prior to calling in a specialist.
Pulmonary has it's branches as well: sleep medicine, transplant medicine, acute care medicine, disability work.
If you enjoy taking care of lung-renal syndromes, and find rare diseases fascinating, then you'll enjoy pulmonary. I'm also finding that the pulmonologist is one of a dying breed of doctors who truly understand and apply the principles of physiology in their daily practice.
Because of the nature of the profession, pulmonlolgists (especially if they aren't part of a multispecialty group) generally feel as though they need to cover most hospitals in an area (for fear of encroachment on their pt practice) and, as a result, tend to be spread pretty thin. Time management as a pulmonary person is very difficult, and you'll be beeped at all hours of the night when you're on call. It pretty much has the worst life style of any of the IM subspecialties hands down.
Whereas pulmonologists handle the broad range of problems in internal medicine better than any of the medical subspecialties (with the possible exception of renal and heme-onc), cardiology has become more procedure oriented, and is definitely a "single organ" subspecialty. Cardiologists usually won't write orders on anything outside their subspecialty, and pulmonary is just the opposite. So Cardiology tends to be more cut and dried and has better time boundaries. And, yes, because of the procedure orientation, cardiology is definitely more lucrative.
But when was the last time you heard a cardiologist say: "Hey, let me tell you about this great case of chest pain I saw the other day?" For me, the emphasis on just one organ would get old after awhile. I definitely find pulmonary medicine to be fascinating 25 yrs out of med school.
