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Pulmonologists vs. Cardiologist???

Discussion in 'Other Subspecialties' started by IsMD4me, Jul 7, 2008.

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  1. IsMD4me

    IsMD4me 2+ Year Member

    Apr 20, 2008
    Which one, in anyone's opinion, is the better career to look forward to? If I can get any real world experience or explanations as to a day in the life of each, that would be appreciated as well.

    P.S. I searched the forums...didn't find much..

    Thanks in advance!!
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  3. doc20

    doc20 5+ Year Member

    Oct 20, 2007
    yes I would also like some input on this topic, specially to me both of them seem very closely related systems and are equally intriguing.
  4. TopsyKrett

    TopsyKrett 5+ Year Member

    Sep 24, 2007
    i as well an interested in these topics also
  5. Rogue_Leader

    Rogue_Leader Silent Sentinel 5+ Year Member

    Jul 15, 2004
    You might as well ask about the differences between doctors and lawyers. There isn't going to be a typical "cardiologist" day. A general cardiologist is going to be much different than an interventional cardiologist, who is goign to be different than a an EP specialist, to say nothing of whether you do only outpatient work vs hospital work. On the pulmonologist side, you could do outpatient pulmonary medicine, or you can be involved in allergy/immunology, or sleep medicine, to say nothing of Critical Care medicine. I think you'll have to be more specific if you want any useful information, unless someone feels like writing an 8 page essay on the topic.
  6. Gastrapathy

    Gastrapathy no longer apathetic Lifetime Donor 10+ Year Member

    Feb 27, 2007
    They both suck. You really want to be a Gastroenterologist.

    Seriously, this is an impossible question to answer from a premed. No offense, but you just lack the context for a meaningful comparison. My advice, don't decide what you want to do before you've done it. If you go into your surgical rotations as a "medicine guy", they just won't be as interested in you and vice versa.
  7. McLovin

    McLovin 5+ Year Member

    Aug 17, 2007
    I agree with Gastropathy. It all depends on which you find more interesting and can envision yourself doing the rest of your life.

    Of course, if you want to go into fellowship straight out of residency, you have to apply at the start of your 2nd year. Which means you have to spend your first years getting to know the right attendings, setting up research, etc. Which means you have to figure out what you think you'd like to specialize in before you start internship.

    so good luck with that!
  8. IsMD4me

    IsMD4me 2+ Year Member

    Apr 20, 2008
    Thanks Gastrapathy...that makes a lot of sense....thanks for all the comments as well.
    I just want to plan ahead as much as possible. I know I want to go into Internal Medicine but I could and should be open to other fields. I just want to calculate the opportunity costs before I make the big plunge into the medical school track..:confused:
  9. realideamen

    realideamen IM Resident

    Aug 20, 2008
    If you're basing your decision to go to med school on how much money you'll make don't even bother applying. You will be miserable and you can make more money doing something much easier.
  10. howelljolly

    howelljolly 7+ Year Member

    Aug 30, 2007
    Pulmonology vs. Cardiology

    Pulmonology gets the same amount of work, half of the pay, and none of the respect.
  11. RTrain

    RTrain National Merit Finalist 2+ Year Member

    Aug 18, 2007
    I would have to disagree with that (not that I'm biased, or anything...). PCCM docs do work very hard, but they can titrate the amount of critical care practice they want to do which will be a major determinant of work hours. As for the respect - just read any thread here addressing "Who's the smartest doc in the hospital?" or "If you were stuck on a desert island with just one specialist, who would it be?" or whatever, and PCCM will come up again and again. They may not command abject awe, but they know their sh*t and folks know that.
  12. howelljolly

    howelljolly 7+ Year Member

    Aug 30, 2007
    OK, let me bump this thread
    I'm wondering about pulmonology as a specialty (leaving the CCM aside). I'm really interested in pulmonary physiology from basic to applied clinical science. Bronchoscopies and an occasional Swan-Ganz are just the right amount of procedures for me. And, im interested in the pathologies as well... all of them. And thats what my concern is.

    I'm interested in COPD and Asthma, but ive never met an obstructive disease patient that couldnt be managed by an internist. Honestly, Im not THAT interested. Im more interested in lung CA, sarcoidosis, pulmonary vascular disease, rheumatological lung disease and pulmonary-renal syndromes, as well as pre/post lung surgery patients. I dont think Ive seen an ILD patient, or a lung transplant patient yet, but Im interested in them too. I'm less interested in common things, and more interested in very rare diseases or dead patients.

    Whats the Pulmonology world like in the treatment of these patients? Does pulmonology even get to treat these patients?

    To draw an analogy, Endocrinology is a very interesting field, but the specialty itself can be mundane. All of the interesting endocrine dysfunctions that grab my attention are treated by nephrology, neurology, and ob/gyn/REI, and all endocrinologists are left with is DM and thyroids.

    I know only one interventional pulmonologist - he sees lung CA patients all day, every day. All of the other pulmonologists I know do mostly CCM. Ive never asked them what they do on their consult time...

    Will I be doomed to a life of COPD clinic, while all of my interesting patients are managed by cardiology, rheumatology, and CT surgery?
  13. turbostar


    Dec 30, 2008
    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.
  14. howelljolly

    howelljolly 7+ Year Member

    Aug 30, 2007
    Wow... over 400 views later....

    thanks for that post.

    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.


    Could you elaborate on this statement? How, when, and where would something like this happen? Something I dont much like about general internal medicine is that often your patient is pre-diagnosed, and you're stuck on routine management. But to me, diagnosis is never "routine"
  15. RxnMan

    RxnMan Who, me? A doctor? Moderator Emeritus 7+ Year Member

    I agree, and it's one of the sticking points (for me) between EM and CCM.

    thread hijack :hijacked:

    I like examining undifferentiated pts. I like putting together the history and physical into a continuous picture (mostly EM). But I'm also interested in physiology (realm of P/CCM, as outlined in the posts above). :mad:

    Both deal with large amounts of info/testing, both require a broad clinical knowledge, both can have shift work, both are moderately procedure-heavy, both can have profound effects on their pts, and both deal with sick pts. P/CCM has a longer training path, but it also has better ties to the research I find interesting. I don't know how to choose (because of my school's scheduling, I don't get elective time until just before it's time to apply for residencies). If someone can answer HJ's question, maybe it'll help me decide.

    /end thread hijack
  16. Isoprop

    Isoprop Fascinating, tell me more 5+ Year Member

    Oct 15, 2007
    is this true of both pulm-only and pulm/crit docs? it's hard for me to imagine a non-CCM trained physician working in an ICU setting.
  17. howelljolly

    howelljolly 7+ Year Member

    Aug 30, 2007
    Yes, if someone can answer HJ's question, it will also help HJ decide between EM and P/CCM
  18. arjun29

    arjun29 2+ Year Member

    Jul 22, 2008
    Nice thread here, my take on this

    To start with I am biased against EM: to me it is glorified traige (I know that may be over statement). But they do good job with trauma patients from what I see. Yes they do make diagnosis but most often it is partial.
    For me the fun is really to make a pt health in all respects including treatment. Most of the patients I see as resident presently has only partial diagnosis from ER. It's the IM who work it out completely. EM makes the easy diagnosis like COPD/CHF ex, Acute Coronary, DKA and stuff like this. I have two pts with hypercalcemia in the last 2 months and they don't know what his final diagnosis is - one ended up multiple myeloma, the other hyperpara. Other example - mass in lung. 50% of the cases diagnosed in ER and the rest 50% by IM.
    If you are interested in some surgical stuff and trauma stuff then surely EM is for you.
    Personally I like to diagnose and treat as well and that's what that clinches me to IM (not leave with diagnosis).
    I am applying for P/CCM fellowship now. I don't have full experience of these two though I did rotate through both and loved both of them. For me the ultimate physician is the critical care guy whoz well regarded everywhere. Pul has interesting cases every often and I loved brochoscopy suite.
    Thats my take (but again as I said I am biased).
  19. Aloha Kid

    Aloha Kid Senior Member 10+ Year Member

    Mar 9, 2001
    Yup this is sure true! About 50% of the time EM docs don't even make diagnosis. Don't beat on the ED docs, it's just not in their job description. If it was your mom in the ED with chest pain what would you like the doc to do, R/O ACS or check to make sure she doesn't have Sarcoidosis first.

    In keeping with the main topic. I have great respect for Pulm/CC docs. EM has more in common with critical care docs than any other IM specialty. Most Pulm/CC docs I know work their tail off. A month rotation for them usually includes 1-2 weeks of critical care, then 1-2 weeks on pulmonary consult service, then perhaps 1-2 weeks in the office. They do more, see more, and handle more. Not quite the same for cardiologists. Really quite boring if you enjoy more than one organ system.
  20. Sleepmd


    Jan 29, 2009
    CCM is not a single man's territory..
    You can do CCM fellowship even after ER residency...
    that will make you boarded in ER and CCM and then you can play with all your options to see what suits your interests and lifestyle..
    You can also do CCM (pure CCM without Pulm) after an IM residency...
    And ya of course...you can always do CCM after an anesthesia residency or even a surgical residency...
    So you can see that you can approach CCM from various directions...
    However in a Job marekt you may be preferred by different groups or practices depending on your background i.e job market for Pulm/CCM may be little diferent than that of Anesthesia/CCM or IM/CCM or ER/CCM...
    I am a Internist finishing Sleep fellowship and going into Pulm/CCM fellowship but planning to work as an intensivist somewhere in south (where intensivist programs are popular in most hospitals) on a shift work schedule just like Hospitalits....
  21. Trifling Jester

    Trifling Jester Senior Member 10+ Year Member

    Jun 22, 2003
    The Big Easy
    I do not think you can be boarded in CCM after doing ER. They have fellowships but my understanding is that they are not allowed to sit for the boards.

    -The Trifling Jester
  22. chartero

    chartero 7+ Year Member

    Oct 30, 2007

    The section's FAQ and site are interesting.

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