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Subspecialty Careers: Highlights about Careers in Internal Medicine: 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
As of December 2009 there were 134 ACGME-accredited combined training programs with 1,273 active positions in Pulmonary Disease and Critical Care Medicine, and there were 21 ACGME-accredited training programs with 76 active positions in Pulmonary Disease alone. For combined training programs in Pulmonary Disease and Critical Care Medicine, 31% of the trainees were female, and 50% were US medical graduates. For training programs in Pulmonary Disease alone, 25% of the trainees were female, and 14% were US medical graduates.

Practice
Approximately 48% of the graduates of combined programs enter clinical practice in the United States, and 36% enter academic medicine.

Major Professional Societies

  • American College of Chest Physicians
    3300 Dundee Road
    Northbrook IL 60062-2348
    (847) 498-1400
    www.chestnet.org

  • American Thoracic Society
    61 Broadway
    New York, NY 10006-2755
    (212) 315-8600
    www.thoracic.org

Major Publications

Back to October 2010 Issue of IMpact

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