What's with all the Pulm-CC?

[ResidentMD]

I see a lot of people on the Official IM rank thread this year wanting to do Pulm-CC - almost disproportionately more than the other subspecialties. What's up with this? Anything different this year? Any predicted changes with the new healthcare reforms?

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[jdh71]

I see a lot of people on the Official IM rank thread this year wanting to do Pulm-CC - almost disproportionately more than the other subspecialties. What's up with this? Anything different this year? Any predicted changes with the new healthcare reforms?

Maybe because it is awesome!

 

[medschoolplease]

I think it does seem that more people are interested in pulm/cc, even in my class of graduates. Do you think that pulm/cc will become as competitive as gi or cards?

 

[jdh71]

I think it does seem that more people are interested in pulm/cc, even in my class of graduates. Do you think that pulm/cc will become as competitive as gi or cards?

No.

But most people will see it as a better way to make a living than general medicine, and with Hospitalist medicine not being all that it was once thought it was cracked up to be, I think people are finding this to be a nice way to still practice a lot of general medicine across a spectrum at the edges of the physiology. Intensivist shift type work is mildly driving some of this as well.

Mostly I think it's a reaction to all of the bull**** that a general IM doc has to deal with - all the responsibility and paper work with none of the glory or pay. Who wants to be a bitch for the rest of their lives?

 

[AZhopeful]

No.

But most people will see it as a better way to make a living than general medicine, and with Hospitalist medicine not being all that it was once thought it was cracked up to be, I think people are finding this to be a nice way to still practice a lot of general medicine across a spectrum at the edges of the physiology. Intensivist shift type work is mildly driving some of this as well.

Mostly I think it's a reaction to all of the bull**** that a general IM doc has to deal with - all the responsibility and paper work with none of the glory or pay. Who wants to be a bitch for the rest of their lives?

Yeah- I'm not a pulm doc and don't know much about its future reimbursement, etc, but I AM one of those guys on the official IM rank thread who is interested in pulm for a lot of the reasons jdh said. I love love love the physiology, and I really like that the inpatient/ICU practice allows you to take care of many organ systems(maybe even an entire person?)- like general medicine but without the general med BS. Maybe it's just different BS...

 

[WorkaholicsAnon]

Yeah- I'm not a pulm doc and don't know much about its future reimbursement, etc, but I AM one of those guys on the official IM rank thread who is interested in pulm for a lot of the reasons jdh said. I love love love the physiology, and I really like that the inpatient/ICU practice allows you to take care of many organ systems(maybe even an entire person?)- like general medicine but without the general med BS. Maybe it's just different BS...

yeah i would say different BS--like death and end-of-life care issues that i didn't want to deal with as much, taking people off vents etc. And just seeing people zonked out on the vents for weeks at a time--too hard emotionally for me. Also during code situations I am able to keep my cool but inside i get way too stressed out. Too much of that and i get burnt out like a crisp. I prefer pre-empting and avoiding codes, so I think i'm better suited to the floors

That said i really like the subject material of CCM.


Power to u guys!!!!

 

[jdh71]

yeah i would say different BS--like death and end-of-life care issues that i didn't want to deal with as much, taking people off vents etc. And just seeing people zonked out on the vents for weeks at a time--too hard emotionally for me. Also during code situations I am able to keep my cool but inside i get way too stressed out. Too much of that and i get burnt out like a crisp. I prefer pre-empting and avoiding codes, so I think i'm better suited to the floors

That said i really like the subject material of CCM.

Power to u guys!!!!

I have many fellow residents who feel like yourself - "that cool and all, but not for me". I think if you can wrap your mind and emotions around the notion that really, really, really sick people die, then you're good for CCM. One other thing I appreciate is that I ALWAYS have a disposition, Jesus or the Floor.

From my way of thinking . . . MORE power to guys like you.

 

[carrigallen]

One other thing I appreciate is that I ALWAYS have a disposition, Jesus or the Floor

it may be a small point, but it is rarely quite like this. There are stepdowns, institutional transfers, LTACS with care requirements to meet, insurance coverage for specialty care. ICU LOS is a consideration in some management decisions.

 

[WorkaholicsAnon]

I have many fellow residents who feel like yourself - "that cool and all, but not for me". I think if you can wrap your mind and emotions around the notion that really, really, really sick people die, then you're good for CCM. One other thing I appreciate is that I ALWAYS have a disposition, Jesus or the Floor.

From my way of thinking . . . MORE power to guys like you.

LOL @ Jesus or the Floor. It's true though...

it may be a small point, but it is rarely quite like this. There are stepdowns, institutional transfers, LTACS with care requirements to meet, insurance coverage for specialty care. ICU LOS is a consideration in some management decisions.

I guess all of those would be lumped under "the Floor".

 

[jdh71]

it may be a small point, but it is rarely quite like this. There are stepdowns, institutional transfers, LTACS with care requirements to meet, insurance coverage for specialty care. ICU LOS is a consideration in some management decisions.

Actually it's not common that you have to deal with the above rather than the converse as you stated, though it happens, sure. The exceptions don't invalidate the rule they emphasize it.

 

[StevenRF]

A soon the be IM resident also interested in pulm cc.

For me its mostly the patients. I'd rather deal with fewer more complicated patients than churning and burning on the floor... goals of care discussions rather than trying to dispo rocks. The pathophys is awesome too, and I always seem to learn more on ICU rounds. You can keep your skills up on procedures. A hospitalist will pull ~150k, while a CC attending will pull 2-4 times that with about the same workload.

Most places are moving to shift work for the ICU and dedicated intensivists, so I figure the lifestyle will be marginally better than what it is now with higher demand, and after I burn out I can move to a comfy pulm clinic or sleep medicine.

I will say though, liver transplant SICU is the most depressing thing ever.

 

[mig26x]

No.

But most people will see it as a better way to make a living than general medicine, and with Hospitalist medicine not being all that it was once thought it was cracked up to be, I think people are finding this to be a nice way to still practice a lot of general medicine across a spectrum at the edges of the physiology. Intensivist shift type work is mildly driving some of this as well.

Mostly I think it's a reaction to all of the bull**** that a general IM doc has to deal with - all the responsibility and paper work with none of the glory or pay. Who wants to be a bitch for the rest of their lives?

I'm a hospitalist and I dont deal with that much paperwork, in fact the most amount of paperwork that I deal with are the one's from the progress notes. There's people call case managers that they deal with all the paper work and then I sign them (transfer sheet to other hospital, ALF/SNF paperwork, excuses to work/school) and they also deal with 90% of the social stuff.

But I agree, intensivist work is pretty awesome.

 

[mig26x]

A soon the be IM resident also interested in pulm cc.

For me its mostly the patients. I'd rather deal with fewer more complicated patients than churning and burning on the floor... goals of care discussions rather than trying to dispo rocks. The pathophys is awesome too, and I always seem to learn more on ICU rounds. You can keep your skills up on procedures. A hospitalist will pull ~150k, while a CC attending will pull 2-4 times that with about the same workload.

Most places are moving to shift work for the ICU and dedicated intensivists, so I figure the lifestyle will be marginally better than what it is now with higher demand, and after I burn out I can move to a comfy pulm clinic or sleep medicine.

I will say though, liver transplant SICU is the most depressing thing ever.

Take another look at hospitalist salary and you will be surprise. Base is >170K's in alot of places and then RVU's and core measures can take that 75-100K above it. But yes and of course--> intensivist earn more.

 

[Bostonredsox]

I love the icu so much I would bring a sleeping bag to work if my wife would let me. Crossing fingers for a straight 2 year cc fellowship. I'll leave the outpatient pulm to jdh and Hernandez . And the hospitalist job would be great if all I saw was extremely sick patients instead of all the old gomers and their chronic constipation...but then I'd be back in the icu

 

[lungdocCA]

I am starting my 11th year out of training. I loved Pulmonary and Cardiac physiology but quickly found out the day to day practice is terrible. GI, Nephrology, and Cardiology are without a doubt better specialties. I am sorry but Pulmonary is a bad field; high litigation and risk, poor compensation relative to other specialties, terrible call and bad lifestyle. Office Pulmonary can be impossible with high overhead. Hospitalists are replacing us on the more easy Critical Care hospital work. I see this as a dying field; one can't justify 3 years of training for this field. I renewed my Pulmonary Boards for the last time. I will basically work as a Hospitalist. In all fairness California is probably the worst place to practice.

 

[Bostonredsox]

I am starting my 11th year out of training. I loved Pulmonary and Cardiac physiology but quickly found out the day to day practice is terrible. GI, Nephrology, and Cardiology are without a doubt better specialties. I am sorry but Pulmonary is a bad field; high litigation and risk, poor compensation relative to other specialties, terrible call and bad lifestyle. Office Pulmonary can be impossible with high overhead. Hospitalists are replacing us on the more easy Critical Care hospital work. I see this as a dying field; one can't justify 3 years of training for this field. I renewed my Pulmonary Boards for the last time. I will basically work as a Hospitalist. In all fairness California is probably the worst place to practice.

disheartening. I would agree somewhat with the outpatient pulm as compared with GI and cards. But I don't think hospitalists are replacing CCM docs, I think they are fulfilling the role because the hospitals cant get CCM docs. The majority of pulm/cc I have met prefer to be in the clinic not chained to the ICU, they cover it because they're obligated too. Their are very few CCM who just want to be in the unit full time. Fortunately, therein lies my future job security in the unit

 

[codeb1ue]

I am starting my 11th year out of training. I loved Pulmonary and Cardiac physiology but quickly found out the day to day practice is terrible. GI, Nephrology, and Cardiology are without a doubt better specialties. I am sorry but Pulmonary is a bad field; high litigation and risk, poor compensation relative to other specialties, terrible call and bad lifestyle. Office Pulmonary can be impossible with high overhead. Hospitalists are replacing us on the more easy Critical Care hospital work. I see this as a dying field; one can't justify 3 years of training for this field. I renewed my Pulmonary Boards for the last time. I will basically work as a Hospitalist. In all fairness California is probably the worst place to practice.

This really is depressing to hear, especially since I'm planning to apply next year for it.

Just curious, why is there such high liability as a pulm doc compared to any other subspecialty like GI, Cards?

 

[jdh71]

disheartening. I would agree somewhat with the outpatient pulm as compared with GI and cards. But I don't think hospitalists are replacing CCM docs, I think they are fulfilling the role because the hospitals cant get CCM docs. The majority of pulm/cc I have met prefer to be in the clinic not chained to the ICU, they cover it because they're obligated too. Their are very few CCM who just want to be in the unit full time. Fortunately, therein lies my future job security in the unit

This really is depressing to hear, especially since I'm planning to apply next year for it.

Just curious, why is there such high liability as a pulm doc compared to any other subspecialty like GI, Cards?

Bah! Don't listen to him. Sounds bitter. Pay's good for pulm/cc basically everywhere except SoCal, San Fran, and the East Coast. I know a guy in hte midwest clearing over 300k, working in a group of 12, with a rotating schedule as follows: one week in 12 of hospital consults, one week in 12 of ICU (you're the guy 24/7 for the whole week - get your unit fix), and the rest of the time is eat what you kill in the clinic for the other 10 weeks (basically work as much [assuming space and time] or little as you want). He loves it. Just one anecdote to trump the previous anecdote. Bottom line: there will be practice situations that sucks ballz. There will be give and take, especially with respect to location. But I think that the field is WIDE open right now and there is still plenty of room for a critical care specialist even if hospitalists are taking care of some things in an open ICU - let them, they'll consult you for the hard and complicated stuff or simply don't take a job anywhere where they have an open ICU. Take a little personal responsibility and it goes a long way.

 

[Bostonredsox]

How much of the east coast has bad pay? Maine all the way down to Florida with the Carolinas, Ga, Va and everything included?

 

[jdh71]

How much of the east coast has bad pay? Maine all the way down to Florida with the Carolinas, Ga, Va and everything included?

Baltimore to Boston you can expect a pay cut. And "bad' is relative. It's not like you're getting paid like an out-patient provider.

 

[Moozy]

Baltimore to Boston you can expect a pay cut. And "bad' is relative. It's not like you're getting paid like an out-patient provider.

I agree with jdh71. The field is wide open and the pay is pretty decent. I have offers for 310K plus from most of midwest locations. This is for Pulm/CC though. Some have 1 week ICU followed by 3 weeks Pulm clinic.. some have open ICU therefore you are on-call every 7th or 8th day (depending on the no. of partners in group) and have pulm clinic daily.

I am new at this and am still exploring but it seems that you earn much more than this. A lot of pvt practices want EBUS and some training in IP especially with cancer therapy and they hope you can establish such a care at their center. That has added perks. All in all; I think it is a rewarding field provided you chose it for the right reasons.

 

[Handsome88]

.

 

[jdh71]

Sorry for the bump. But I don't want to start a new thread for this.

My first choice is Cardiology, but being an IMG this is only a dream and may never happen. On the other hand, since I do not want to be "a bitch for the rest of my life", don't really like IM, is it possible to enter Pulm/CCM without much research experience in that field specifically? How much should an IMG like myself have to show particular interest in Pulm/CCM?

In other words, is it Cardio or bust, or can I safely fall back on Pulm/CCM if I apply?

P.S. Looked at stats and it shows that for IMGs: ~30% of applicants to Cards matched to Cards, while ~50% of applicants to Pulm/CC matched to Pulm/CC.

I'm going to be very honest with you here . . . one thing us pulm guys detest are the cardio fan boys who coudln't get in and now want to do pulm/cc, because we're "ok enough to do". So if you're going to make a play, apply to both, which will mean more money and more interviews (if your program will allow it), and don't apply to both at the same institution, ever. You will need two separate personal statements and letters of rec from from different pools of physicians - make sure you PD knows you are apply to two different places and to keep his letter non-specific (ie. instead of Dr. Handsome88 would make an excellent cardiology fellows, he says, Dr. Handsome88 would make an excellent fellow for any training program . . . whatever). If all of your research is in cardio, you will need to explain that in your PS and be prepared to discuss why you are no longer interested in cardio and just LOVE pulmonary now - make up an epiphany story. Make sure you LOVE pulm more than critical care.

Alternatively, you could go cards or bust with the next application cycle, and then apply to just straight critical care after if you don't match. IM critical care fellowship is kind of a no-man's land of wanderers and they are much more understanding and sympathetic (and need their spots filled).

Good luck.

 

[kvnjcb]

I'm going to be very honest with you here . . . one thing us pulm guys detest are the cardio fan boys who coudln't get in and now want to do pulm/cc, because we're "ok enough to do". So if you're going to make a play, apply to both, which will mean more money and more interviews (if your program will allow it), and don't apply to both at the same institution, ever. You will need two separate personal statements and letters of rec from from different pools of physicians - make sure you PD knows you are apply to two different places and to keep his letter non-specific (ie. instead of Dr. Handsome88 would make an excellent cardiology fellows, he says, Dr. Handsome88 would make an excellent fellow for any training program . . . whatever). If all of your research is in cardio, you will need to explain that in your PS and be prepared to discuss why you are no longer interested in cardio and just LOVE pulmonary now - make up an epiphany story. Make sure you LOVE pulm more than critical care.

Alternatively, you could go cards or bust with the next application cycle, and then apply to just straight critical care after if you don't match. IM critical care fellowship is kind of a no-man's land of wanderers and they are much more understanding and sympathetic (and need their spots filled).

Good luck.

How come it's not possible to apply to only pulm/cc in the next cycle? Maybe back-up with straight CCM at the same time.

 

[jdh71]

How come it's not possible to apply to only pulm/cc in the next cycle? Maybe back-up with straight CCM at the same time.

You can do what you want, but your CV will SCREAM, "I wanted to do cardio" based on your publications and the timing will be suspect. Pulm/CC PD's aren't stupid. You may even find a match, but you'll easily move down at least a tier or two as far as programs are concerned. You've got to remember there are ALWAYS more applications than spots at the better programs. They look for reasons NOT to invite you, they have to - can't interview everyone.