As said before, part of pulmonary fellowship is spent on inpatient consults in addition to ICU duties. Most fellowships only require 1 to 2 half days of clinic per week for their fellows. The combination of pulmonary and critical care allows some flexibility and with the current job market, it is likely that one could find a shoe that fits so to speak. But hey, I suppose a little clinic is as unbearable for some as working the ER is for others. It also may add a little to help some avoid the "treat 'em and street 'em" mentality which, like the ER, plagues some ICUs. A goodly number of former ICU patients become pulmonary or chronic medicine patients.KGUNNER1 said:IMGforNEURO,
About Eidolon6's comments about straight CCM. It is true that there are more pulm/ccm jobs out there. But I would NOT recommend doing pulm/ccm if you don't like office work. I could not stand PFT's, lung ca workups, COPD etc... Office based medicine was not in my bag. I was not going to waste 2.5 yrs to get only 6 months of ICU training. That's just my 2 cents.
I think there are a fair amount of regional differences concerning both the scope of CCM training, especially that which is combined with pulmonary. Pitt is unique (and impressive) in a lot of ways because it espouses such multidisciplinary training and has such a large CCM physical plant and faculty. I think at most other academic places, CCM, through IM, is more closely tied to pulmonary and the embracing of CCM training can vary quite widely from place to place.KGUNNER1 said:Along the same line, if you like the surgical patient, it is rare (not unheard of) to have a pulmonologist rounding in a SICU. It is quite common to have a multidisciplinary trained IM/CCM rounding in a SICU right along side the Anesth/CCM and Surgeon/CCM. Personally I like this patient population. The surgical patients that get sick have a fascinating inflammatory response and it is fun balancing their chronic disease state with their acute surgical process. They usually get better and go home rather quickly (neurosurg excluded)
I couldn't agree with you more!! Another worrisome revelation. While knowing about the intensivist shortage and subsequent staffing crisis we are facing, the ABIM has recently closed its doors for all of those who were trained in another base specialty and now want formal CC training. Before, up to 25% of any IM based specialty could have non-IM based fellows in their fellowship. They weren't board eligible, but they could at least get the training.I think the more worrisome thing is that 70-80% of ICUs are currently run without a CCM trained or certified MD and recent data in NEJM and JAMA suggests cost and morbidity/mortality are reduced in closed ICUs with intensivist coverage. That in itself speaks volumes about the market available for all types of folks with advanced CCM training.
No need to. Not taken out of context at all. I just wanted to emphasize that the future needs intensivists comfortable with ALL types of critically ill patients. Most traditional pulmonologists I know are a little uncomfortable with the complex surgical pt. You know there's more to it than being a "Vent Jockey". That paradigm would fit nicely in the SICU 10 yrs ago, but there have been some big changes in the last 10 yrs. and us nonsurgeons need to be more involved in patient care than what was done in the past.I certainly don't dispute what you are saying KGunn and apologize if it seems that way.
In many places the pulmonary section primarily manages all pulmonary hypertension including initial diagnosis (except the echo of course) with right heart catherization (it's just a PA catheter after all, a staple of critical care), drug management, and follow-up. So if you know you're really interested in pulmonary HTN (not just theoretically but have had prolonged exposure to that patient population) you could certainly find training programs that manage their own pulmonary hypertension population.I just found this old thread, and wanted to resuscitate it.
How do youall like Pulmonology? Im really interested in it. I really dig this less common things like ILD, pulm-renal syndromes, and pulmonary HTN. Will a pulmonologist be able to wrestle a pulmonary HTN patient away from the cardiology service every once in a while?
It will be difficult if not impossible to get a fellowship that is Pulm only. Ditto for a job, at least coming straight out of fellowship. After a few years (like 10 or 20), you will probably be able to shift your focus to outpatient/consult Pulm, without having to pull ICU coverage as well.What's your idea about Pulmonary without critical care ?
In terms of job market, does someone get limited without being CC board certified ?
Dont many academic programs have a 2 year-only Pulm fellowship (e.g. UColorado)? Of course, it is in your best interest to do the 3 year, because otherwise you would also have to do a 2 year CC fellowship later.It will be difficult if not impossible to get a fellowship that is Pulm only. Ditto for a job, at least coming straight out of fellowship. After a few years (like 10 or 20), you will probably be able to shift your focus to outpatient/consult Pulm, without having to pull ICU coverage as well.
There are a few, but it's becoming more rare. CCM alone is much more popular. This is primarily because of the push to staff ICUs with CC trained physicians.Dont many academic programs have a 2 year-only Pulm fellowship (e.g. UColorado)? Of course, it is in your best interest to do the 3 year, because otherwise you would also have to do a 2 year CC fellowship later.