How does interventional pulm differ from regular pulm?

[neoevolution]

Is the extra fellowship needed to learn "advanced diagnostic and therapeutic bronchoscopy, as well as advanced minimally invasive pleural procedures," or are those things that are taught in general pulm fellowships and the extra year is just for more exposure? What are jobs like for interventional pulm too? Is it likely that interventional pulm will branch off like interventional cards has?

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[maverickdoc]

EBUS/Super D is not IP anymore especially EBUS which is now routinely done and is the Dx modality of choice for lung cancer staging. Exclusive IP ( no ICU work, only seeing lung cancer pts in office) is still mostly confined to large academic centers and includes stenting, lasers , cryo, rigids, perc trachs etc . The demand is there and the field is expanding. There are close to 40 IP spots available every yr and I think 3-4 go unfilled which means you are more likely than not to find a spot. Larger centers like BIDMC, Penn are obviously very competitive.
The biggest issue with IP is that the reimbursement is poor. My fellowship PD told me that the dept. has to pay a part of our IP attending's salary since he does not generate enough revenue to justify his salary. The hospital/dept is happy to do that to keep the cancer pts in house. Do it if you really want to , you will be marketable and the demand is only going to go up. But expect to take a pay cut. Also , some places expect you to still provide some ICU / night coverage.
PCCM is very lucrative these days but IP, not so much

 

[Bobblehead]

You'll need the extra year for rigid bronchs and pretty much anything involving "therapy" (stents, cryo, laser, etc.) since that's not part the standard pulm/ccm procedural competencies. Anything else that you can do through a flexible fiberoptic scope (+EBUS) you should be able to pick up in the standard 3-4 years.

 

[Phantomrih]

Sorry to revive this a year later, but wanted to know if you included both PCCM and IP at a large institution that could provide a robust patient population (i.e. academic hospital) then would that generate a large boost in salary? It's hard to find median salaries for PCCM, they seem all over the place.

Also, is it possible to do peds PCCM and then IP? Thanks!

 

[CCM-MD]

Sorry to revive this a year later, but wanted to know if you included both PCCM and IP at a large institution that could provide a robust patient population (i.e. academic hospital) then would that generate a large boost in salary? It's hard to find median salaries for PCCM, they seem all over the place.

Also, is it possible to do peds PCCM and then IP? Thanks!

Academic institutions will pay crap. If you are looking for money, that is probably not the direction you want to head in. Reliable medians for pulmonary alone, critical care alone, and pulmonary/critical care are available - MGMA and AMGA surveys have huge sample sizes. You can find the AMGA medians for free with some creative googling. Haven't seen any numbers for interventional pulmonary.

 

[jdh71]

Theoretically, you could just see pre-bronch pateints, which should all be level 5 visits by the time you document imaging, PFTs, and labs, perhaps 8-12 of these folks per day. And then fill the rest of your time with just NAVs and EBUS, you could probably pay your salary. But that kind of set up, if it exists, would be rare and personally unheard of by me. I'm one of two guys doing these types of cases in a "metro" type of area of 600-700k and if it was just me, I still wouldn't be able to fill my schedule like I suggested above. There just isn't enough work. While I agree in a very general sense there is increasing demand for IP procedures, I STRONGLY disagree there is any kind of demand for interventional pulmonologists and 40 IP super fellow spots per year will only further dilute the individual case-load to the point where most will either be relatively "incompetent" or simply give it up. The amount of rigid cases: laser, stents, and valves, etc should really go to guys who are doing a lot, not a few per year. No partner is going to want to try and handle your laser or stent complication from Friday after you went out of town for the weekend anyway. I wouldn't recommend an extra year of fellowship to anyone for IP. If you have an interest in NAV/EBUS develop your practice while working, which is very doable. If you have an interest in more advanced techniques do the training and plan to stay in academics.

 

[SRT 1983]

I agree with most of what jdh said except that I have seen IP trained people in private practice. They have 1/2 OR days and work in the ICU/office like everybody else. But you have to get rid of the mindset that you can get away by doing only IP especially in private practice . Lots of interventional GIs/ cardiology in private practice do general GI / cardiology. Surgeons are not in the OR all the time , this is not that different.
Reimbursement for IP procedures is poor though but you can use your expertise to leverage the admin to pay you more to keep those cancer pts in house.
There are free/paid webinars available on AABIP's website that are hosted by stalwarts of IP and are very informative. If you really want to do only hand core therapeutic IP , stay in academics , I attended Dr Mullon's webinar last yr and from what I remember the median salary for IP was around 270K , do not know the specifics.

 

[polylux]

What are the stronger IP programs out there? I heard of a fellow at Wake Forest or ECU (forget which one) that ended up having to take a second fellowship because they didn't get enough volume at their first fellowship.

 

[jdh71]

What are the stronger IP programs out there? I heard of a fellow at Wake Forest or ECU (forget which one) that ended up having to take a second fellowship because they didn't get enough volume at their first fellowship.

Cleveland Clinic is probably the tippy top of this game.

Basically anywhere you have a lot of lung transplant. Because those are the cases that get weird. You need to see weird. Lots of weird. You also need to make sure you have the thoracic surgeons not only washing their hands of the rigid work but also willing to back you up in a problem. Without all of that? I wouldn't bother.

 

[maverickdoc]

BIDMC , UPenn, MSKCC, MD Anderson , Mayo