Practice Models for Pulmonary Subspecialties

[doctorkid]

Hi all,

I am a PGY-3 interested in going into PCCM. Applications are coming due soon so I've been thinking long and hard about what I want my career to look like. I'm especially interested in PCCM because I love the flexibility in Pulm vs Crit and all the subspecialties therein. I'm deciding if I want an academic or private career. I think a lot of what draws me to PCCM intellectually are the subspecialties, but I'm not convinced that I want the highly competitive academic lifestyle with the research implications or the enormous pay cut to be an academic *clinician*. Obviously private jobs exist for pulm and crit, broadly. What's the private practice outlook for the subspecialties such as Interventional Pulm and Pulmonary Hypertension, or even Lung Transplant? I've always thought that these specialties require a tertiary setting to maintain enough volume to sustain a practice, but I've also heard some folks saying that (IP and PH specifically) could use more people in the private sector providing that care because they're not actually rare enough to need a tertiary setting but most general pulmonologists aren't comfortable providing that care themselves(ie. starting IV vasodilators or doing rigid bronchoscopy, etc) so they refer out.

Thanks in advance for your insight.

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[chessknt]

There is a pulm subforum this should be moved to.

Private practice will never be able to focus on IP/PH alone so if you cant see yourself dealing with routine cases (COPD, chronic cough, asthma) then you should consider either academia or another field. Cant do transplant in PP in any meaningful fashion to my knowledge.

Starting a bona-fide PH program that goes beyond oral medications is going to be a massive undertaking if there isnt already a framework in place. Vasodilator pumps require significant educational barriers and have frequent complications. You need to have both other physicians and RNs who are comfortable sharing call for emergencies with these sick patients and know how to deal with the innumerable insurance issues. Trying to do your own RHC might put you up against cardiology as well (which is more valuable to a healthcare systemic than pulmonology).

IP is generally a net loss in income since the procedures tend to bill for **** for the amount of time they take compared to just regular bronchs but can be a draw for a PP to keep patients in a practice. There are some exceptions (pleuroscopy off the top of my head) but you'll be encroaching on CT surgery which can have political consequences that you will always lose since CT surgery=$$$.