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Why Pulmonary & Critical Care Medicine

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Mehta chose the field of Pulmonary and Critical Care Medicine and why it is a great field for all.

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I am a pulmonary & critical care physician at an academic institution. My path to this career wasn’t a straight line. I took a detour, which I would like to stress is 100% ok. I took an ICU elective my fourth year of medical school and while I didn’t have the medical context to understand much going on, I became familiar with terms I wouldn’t have otherwise immediately understood: reporting ins and outs, checking appropriate central line placement, how to report vent settings and a patient’s most recent ABG.

Turns out my first rotation as an intern was in a busy ICU. After spending the first week figuring out how to place admission orders in a new EMR, and becoming comfortable ordering an acceptable Tylenol dose for a fever without asking my resident, I turned to the actual ICU care. I was enthralled at the intersection of patient physiology and nuances that ICU physicians picked up on. The zebra diagnoses were fascinating, and the patient care highly rewarding. Although I knew I loved ICU care, I wasn’t 100% sure I wanted to spend my entire life doing it, so after residency I did a hospitalist year. A hospitalist year is one where you serve as an internal medicine attending on the inpatient service only doing admissions, daily notes, and discharges. During that time, I met some amazing physicians, learned how to be an attending and learned how to make decisions swiftly and independently. That year taught me how to efficiently round on 15-22 patients myself, and this came in handy as a first year fellow on a busy consult service of 22 patients. Though I loved my hospitalist year, I yearned for patient care in the ICU and made the decision to apply to pulmonary/critical care and haven’t looked back since. I’m obviously biased, but I think I’m in the best profession!

5 Reasons You Should Consider Pulmonary/Critical Care

1. ICU Medicine

The fast paced, quick thinking is what attracts most of us to this field. You get to be great at procedures, save lives when able, use critical thinking skills and treat and find what others may not think of. Achieving Return of Spontaneous Circulation (ROSC) after a cardiac arrest* on the young pregnant female is indescribable. You still require the knowledge of all organ physiology and while you may have consultant help, you are the frontline and need to have a deep understanding of neurology, cardiology, pulmonary, hepatology, nephrology and even surgery (when to call them at least!) What you learn throughout the years however is the humanism of the ICU: while we can't save everyone, we can give them a dignified passing and our best efforts. It is incredibly humbling.

2. Pulmonary Medicine

Most people go into this field for the ICU and know very little about pulmonary medicine before fellowship, myself included. I came out of fellowship however, fascinated by pulmonary medicine. It is cerebral, complex and all encompassing. Identifying a pattern on an abnormal ct chest can actually define other systemic illnesses in a patient that have not been diagnosed. You really are an expert in pulmonary physiology and pathology.

3. Career Flexibility

You can just want to do icu medicine the rest of your life? Be an intensivist! Just want to work nights in the icu the rest of your life? Be a nocturnist! Just want to do pulmonary clinic? Be an outpatient pulmonologist! Love the mix of inpatient and outpatient medicine? Do ICU and pulmonary consults on the inpatient side and do pulmonary clinic on the side. Just want to do procedures? Be an intensivist or interventional pulmonologist and do bronchs, EBUS, or navigational bronchs! The skills you garner in fellowship make you incredibly marketable so take advantage of that and find a job that fits your needs!

4. Shift work

Many people shun the possibility of a career in critical care because of high burn out or long hours. The truth is, many if not all, ICU jobs are now shift work based. That makes having and being present for a family possible. It also gives you that aspirational concept we call “work life balance”.

5. Job Security

This past year has shown us that nothing is guaranteed, even in medicine. One thing is for sure in this field: people will covet your skills, and not just during a pandemic. We have an ever aging population and these patients get critically ill. They are living longer and developing chronic pulmonary diseases. A 2000 article in JAMA titled COMPACCS estimated a shortfall for cc physicians equal to 22% of demand by 2020 and 35% by 2030. The shortfall of pulmonary physicians would increase to 35% by 2020 and 46% by 2030. That was before a global pulmonary/critical care pandemic.

Despite the long road of training (3 years of internal medicine, 3 years of pulmonary/critical care fellowship), I truly believe I am absolutely in the most rewarding field (I know I'm obviously biased!) and can't highly recommend this career pathway enough!

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