Respirology

[jojoz]

Hello!

I just have a question about Respirology as an IM subspecialty. I'm just about to start IM residency and am starting to think about what I might want to subspecialize in. I am interested in respirology but wanted to know more about what this is like as a career ... i.e. what is the lifestyle/salary like? is it mostly outpatient or inpatient? is it necessary to do further fellowships/masters if you ultimately want to practice in a large city (either central or in suburbs)? is it competitive to get into a subsequent critical care fellowship ... and do some respirologists split their practice between resp and icu?

Just another quick question: I'm also interested in GIM and am wondering how feasible it is to use this as a back-up ... i.e. initially gun for a subspecialty with this as a back-up option in case you later realize that the subspecialty isn't what you want or you don't get into the program of your choice?

Thanks so much!!!

[strider2004]

Maybe I can help you with this. I'm currently a respirology fellow at UBC. My unbiased opinion is that respirology is an up & coming field that will see a great deal of growth over the next 5-10 years.

In terms of your clinical practice, it will likely be a mixture of clinic, ward, and procedures such as bronchoscopy and thoracentesis. You will see a lot of bread and butter resp like COPD, asthma but will also get challenging cases like teasing out the different types of ILD. Lung cancer will always be around and there are new technologies to try to detect cancers at earlier stages. There is a gradual trend to slowly pull the procedures back from interventional radiology so you will see more respirologists doing U/S guided thoracenteses and biopsies of peripheral lung nodules that previously required CT-guidance.

Lifestyle is what you make of it. Some respirologists have a bit of general medicine ward mixed into their practice and this will help keep your skills up. In regards to ICU, there is a growing trend to have dedicated intensivists in the ICU and now we are not able to combine our fellowships. If you want to do resp and icu, you will now have to do a two-year fellowship in each as opposed to the previous combined 3-year fellowship.

To work in an academic centre, you will likely need to do extra specialization past your resp fellowship but there are many large community hospitals that are looking for respirologists without a subspecialization.

By matching into internal medicine, you have been granted 4 years of funding which guarantees you a GIM license in the end. So basically, you'll be a licensed internist regardless of how you do in the sub-match in the end...as long as you pass your exam! That being said, to be a general internist in an academic hospital...often a special skill is required then as well. I hope this helps.

 

Alex

[jojoz]

Thanks Alex. That was really helpful. I am actually starting IM at UBC so maybe I will see you out there!