Thoughts on 2 yr pulmonary disease fellowships

[Purulent_Sputum]

For those interested in bronchoscopy procedures, but not critical care, is this a good option?

1. Is it difficult to get a job w/ just a pulm disease fellowship? I heard a lot of groups only want pulm/crit people.
2. How does bronchoscopy training compare between pulm vs. pulm/crit fellowship?
2. How are the procedure volumes compared to cards and GI? Is there enough EBUS and ENB to go around? Since reimbursement is skewed towards procedures, it'd be nice if my income doesn't go down w/ more training
3. Thoughts on the future of bronchoscopy? I'm interested in robotic assisted bronchoscopy and bronchoscopic lung volume reduction.

Any other insight outside of these questions would also be appreciated. Thanks!

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[intmed2014]

As someone who has gone through the job cycle past year- I would say overwhelming amount of jobs require you to fill critical care role at least 1 week out of a month. I don’t think many private groups want to hire new graduates who will not be boarded in CC and not able to share call among the physicians in the practice.

The demand for bronchoscopy is simply not there compared to cardiology/GI purely because the procedural demand is not equivalent and remuneration is far from equivalent. I think IP can carve out a niche field for EBUS/ENB/Robotics but in my experience the support for these endeavors is mainly in large academic centers where other sub-specialities have to subsidize your salary. The structure in private practice has not yet evolved to accommodate clinicians inclined to do this sort of work as of yet. I think the future of bronchoscopy is bright but it may not be enough (alone) to sustain doctors starting out in next few years.

Other pulm only sub-specialities (ILD, transplant, PH) are likely also looking at narrower job market but may be able to find what they are looking for if willing to compromise on location.

 

[the argus]

For those interested in bronchoscopy procedures, but not critical care, is this a good option?

1. Is it difficult to get a job w/ just a pulm disease fellowship? I heard a lot of groups only want pulm/crit people.
2. How does bronchoscopy training compare between pulm vs. pulm/crit fellowship?
2. How are the procedure volumes compared to cards and GI? Is there enough EBUS and ENB to go around? Since reimbursement is skewed towards procedures, it'd be nice if my income doesn't go down w/ more training
3. Thoughts on the future of bronchoscopy? I'm interested in robotic assisted bronchoscopy and bronchoscopic lung volume reduction.

Any other insight outside of these questions would also be appreciated. Thanks!

1. The majority of pulmonary jobs will want/expect critical care coverage. Pulm only jobs are available but will be more limited by geography, practice model, etc. Some groups will cover small hospitals with open ICUs, so critical care is not technically required but you will have to be comfortable managing vents, etc.

2. Completely dependent on the institution. There are only 20ish pulm-only programs left nationally, I would assume the bronch training varies considerably among those programs.

2nd 2. Again, completely dependent on the institution and the region. In larger markets, EBUS/nav will be dominated by interventional pulmonary trained docs because they are available. Smaller markets might not have IP docs, but you will run into issues with enough EBUS/nav volume to make it worthwhile.

3. Robotic bronchoscopy will take on a larger role in diagnosing and treating early stage lung cancer. We routinely drive out to the pleura with our ION robot, there are not many nodules you can't get to. IR percutaneous biopsies will likely be relegated to people too chronically ill to undergo general anesthesia. Local bronchoscopic therapy for early stage cancers is in the pipeline (pre-procedure PET confirms disease only in lung, robotic bronch to sample nodule, rapid onsite cytology confirms NSCLC, staging EBUS negative, robot bronch for local therapy of nodule). BLVR is great but the inclusion criteria is so narrow that it likely will never be a huge part of your practice.

It sounds like you would want a 2 year pulm fellowship followed by a year of IP. Not having critical care may limit your options for IP as some programs have ICU coverage built into the training program.