Subspecialty Careers: Pulmonary Disease
The Discipline
From the word pulmo, Latin for "lung." Pulmonary medicine is the diagnosis and management of disorders of the lungs, upper airways, thoracic cavity, and chest wall. The pulmonary specialist has expertise in neoplastic, inflammatory, and infectious disorders of the lung parenchyma, pleura and airways; pulmonary vascular disease and its effect on the cardiovascular system; and detection and prevention of occupational and environmental causes of lung disease. Other specialized areas include respiratory failure and sleep-disordered breathing.
Procedures
Important procedural skills include arterial blood gas sampling and interpretation, flexible bronchoscopy and related bronchoscopic procedures, endotracheal intubation, spirometry and peak flow assessment, pulmonary artery catheterization and interpretation, thoracentesis, pleural biopsy, placement and management of chest tubes, ventilator management, progressive exercise testing, and complete pulmonary function testing.
Training
Pulmonary Disease fellowship training can be obtained either through a combined Pulmonary and Critical Care fellowship (the most common path) or through a Pulmonary fellowship alone. Combined programs require three years of accredited training beyond internal medicine residency. The three years must include a minimum of 18 months of clinical training (at least nine months of Pulmonary training and nine months of Critical Care training).
Pulmonary Disease fellowship training without Critical Care requires two years of accredited training beyond internal medicine residency. Of the two years, a minimum of 12 months must include clinical training in the diagnosis and management of a broad spectrum of pulmonary diseases.
Certification
The American Board of Internal Medicine offers separate certificates in Pulmonary Disease and in Critical Care.
Training Positions
For the 2011-2012 academic year, there were 137 ACGME-accredited combined training programs with 1,446 active positions in Pulmonary Disease and Critical Care Medicine, and there were 20 ACGME-accredited training programs with 80 active positions in Pulmonary Disease alone.
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