Respirology

[Diceroll2011]

Money?

Lifestyle?

Job Opportunities?

Competitiveness?

[Handsome88]

Also interested. (Bump)

[seeking1]

I, too, am interested in this specialty. Does anyone know more about it?

[Handsome88]

Seriously? Doesn't anybody know anything about resp?

[BK47]

Also interested, would appreciate any comments. (Bump)

[A-Stark]

Let's see... the lifestyle issue depends a lot on the kind of practice you have. If you don't care about being attached to a hospital to do procedures (bronchs, EBUS, etc.) and can avoid doing much medicine call, it should be pretty good. Sleep medicine is lucrative as part of outpatient practice. Resp is somewhere in the middle in terms of remuneration for IM specialties, and depending on your practice and how much of it involves bronchs it will vary.

 

Can't really speak to competitiveness, but it's certainly not bad.

[Pool Rat]

Middle of the road pay wise, most people would likely bill 200-400 a year.

 

Lifestyle related inpatient work is pretty good; call is relatively light with few calls in the middle of the night and most inpatient consult services are also relatively slow (which is good for lifestyle, less so for billing).

 

If you work at a centre that admits to Resp, then your week on service will be similar, in most cases, to a week on a general medicine unit, but not quite as bad (usually).

 

Your lifestyle when doing outpatients is, like in any medicine speciality, up to you. However you don't need to run a super busy clinic to make reasonable money. As previously noted, sleep medicine plays well (although since the main risk factor for OSA is obesity, and I'm pretty sure we, as a nation, are just on the cusp of turning our lives around and all becoming super fit, so demand may go down in the next 20 years (or is it the opposite?))

 

There job market is currently friendly with openings both in the community and at academic centres in most provinces. But like anything, it's hard to say what it will be like in 5-7 years, when most current med students will be entering the job market. For now though, it has among the most favourable job markets in medicine (internal or otherwise).

 

For competitiveness, it has hovered around 1 applicant to 1 spot, give or take a few people, since CARMs was introduced for the subspecialty match. This means as long as you're not limited by geography, you'll likely get a spot.

[BK47]

Thanks guys!

[Opiner]

There is so little on online forums relating to respirology in Canada that I thought I should post my opinion here, which goes beyond the questions asked. I realize the thread is years old, but maybe someone will find this useful. I am a respirology fellow (R5), and will be pursuing a mixed practice of respirology and general internal medicine. Almost everything posted on forums relates to Pulmonary-Critical Care, which is a combined fellowship offered in the US, and most American pulmonologists (usually known as respirologists here) are dual-trained. The combined fellowship was standard in Canada until about the late 1990’s, when it was replaced by a dedicated 2-year respirology fellowship. Critical care is a separate, 2-year program that can be entered from virtually any specialty, including core internal medicine, provided the prerequisite rotations are taken. Respirology graduates are required to apply to CCM through CaRMS and do 2 additional years of training to have critical care credentials. The result of this difference between Canada and the US is that you will find many Canadian respirologists who have specifically chosen respirology and enjoy their practice. In contrast, some American graduates see their pulmonary training merely as a stepping-stone to critical care, and pulmonary medicine something to do during the weeks they are not in the ICU. A minority of Canadian respirologists will pursue critical care training, partly because of the extended length of training and the very unfavourable job market in this country, which has been discussed in other forums. In small, peripheral centres, a critical care fellowship is not generally required to work in the ICU, and you will find respirologists and general internists. Maybe this will change due to the under-employment of critical care graduates.

 

The subspecialties of respirology in Canada include: airways disease, bronchiectasis, interstitial lung disease, pulmonary hypertension, lung transplantation, pulmonary rehabilitation, interventional pulmonary medicine and chronic ventilation/neuromuscular diseases. Tuberculosis and cystic fibrosis can be entered from respirology or infectious diseases. Sleep medicine can be entered from respirology, psychiatry or general internal medicine. A general respirologist will usually see a mixture of airways disease, interstitial lung disease, undifferentiated masses (or other imaging findings) requiring diagnostic workup, chronic lung infections and sleep-disordered breathing. They also perform bronchoscopies and chest tube insertion, including indwelling, tunneled catheters for malignant effusions. Patients are almost always referred by a family physician and do not self-refer. It is true that a large proportion of patients will have asthma or COPD. The field of asthma is changing rapidly with the advent of biologic agents.

 

Respirologists are required to interpret tests of lung function, and medical students will have seen PFT and methacholine challenge tests. Other tests include: cardiopulmonary exercise testing (CPET), indirect calorimetry, 6-minute walk test, and tests of respiratory muscle strength. Many general respirologists can interpret home sleep apnea tests, but this may be province-specific. They assist with the interpretation of chest imaging, which can be challenging, as radiologists are unable to put findings into clinical context.

 

There are numerous advantages of respirology. It is a sufficiently “general” speciality that allows you to maintain your general internal medicine skills. Respiratory physiology is based on physics, meaning the explanations for diseases often make logical sense within a mechanical system. Similarly, tests of lung function can be interpreted in an objective and quantitative way, and you can get a lot of information from them. There is a large burden of respiratory disease in the community, and the specialty is growing despite reduced smoking rates. There is a procedural aspect, which can be quite advanced if you subspecialize in interventional pulmonary. You have the ability greatly to improve patients’ quality of life through the management of dyspnea, sleep-disordered breathing, etc. You will find that Canadian respirologists value professionalism and compassion, and this comes across in their interactions with patients and other healthcare providers. Job availabilities are still good, even without further subspecialization. You can choose to do outpatient or a mixture of hospital and outpatient, but it is nice to be associated with a hospital for bronchoscopy. The competitiveness of the match is moderate and varies by year. Usually, candidates who interview at multiple sites in different provinces will match successfully while those who are geographically limited are taking quite a risk. Remuneration varies by province, but is quite good and usually more than average for medical subspecialties. Do not make your decision based on payment; every Canadian physician makes enough money, so choose something that appeals to your natural strengths, and do not forget the other (more important?) reasons you became a physician.