The Discipline
Pulmonary medicine is the subspecialty of internal medicine that focuses on the diagnosis and management of disorders of the respiratory system, including the lungs, upper airways, thoracic cavity, and chest wall. Although most common respiratory problems are treated by general internists and other specialty physicians, internists practicing pulmonary medicine (often referred to as “pulmonologists”) are frequently called upon to help diagnose unknown disorders and assist in managing difficult, unusual, or complicated diseases of the respiratory system.
Pulmonologists have expertise in structural, inflammatory, infectious, and neoplastic 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. Diseases commonly evaluated and treated by pulmonologists include asthma, chronic obstructive lung disease (COPD), emphysema, lung cancer, interstitial and occupational lung diseases, complex lung and pleural infections including tuberculosis, pulmonary hypertension, and cystic fibrosis. Some pulmonologists focus on sleep-disordered breathing (such as sleep apnea) and may provide diagnostic and therapeutic services in sleep laboratories.
Some pulmonologists practice in dedicated pulmonary medicine practices or as part of a multidisciplinary group practice and provide consultative services for other physicians and follow patients with respiratory disease longitudinally. Others may work within hospitals to provide patient care and consultative services. Because pulmonologists have expertise in respiratory failure and complex interventions such as mechanical ventilation, they frequently oversee medical intensive care units in hospitals. As this role involves care of critically ill patients, training in pulmonary medicine is often coupled with training in critical care medicine. This dual training uniquely qualifies critical care pulmonologists (sometimes called “intensivists”) for work in intensive care units.
Training
For pulmonary disease training alone, a two year fellowship is required following completion of a three year basic internal medicine residency, after which trainees are eligible for certification in pulmonary disease through the American Board of Internal Medicine.
For combined pulmonary and critical care programs, fellowship training requires three years of training following completion of a three year basic internal medicine residency. The American Board of Internal Medicine offers separate certificates in pulmonary disease medicine and in critical care following completion of the fellowship.
Training Positions
In the 2019-2020 academic year, there are 20 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in pulmonary disease with 73 trainees. There are also 179 ACGME-accredited training programs with 1,994 trainees in pulmonary disease and critical care medicine.
Major Professional Societies
- American College of Chest Physicians
- American Thoracic Society
Back to the November 2019 issue of ACP IMpact