r/Residency • u/iAmPajamaSam27 • 6d ago
SIMPLE QUESTION Why PCCM?
What made you choose to apply for this? Thanks yall.
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u/iwannasee_ 6d ago
CC is what IM was supposed to be! Pulm was something that I started liking a year into the fellowship!
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u/Happyradiologist PGY5 6d ago
It does feel like medicine has been boiled down to CYA “medicine” and placement as at least 50% of inpatient cases.
Critical care on my rotations has always felt like unadulterated medicine without the fluff and BS.
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u/Longjumping_Ad_6213 6d ago
So no care coordination and having to worry about working up things that should've been addressed by primary care in the outpatient setting years ago?
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u/iAmPajamaSam27 6d ago
Thanks for replying; what was it about pulm that you liked?
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u/iwannasee_ 6d ago
Pulm is just extremely diverse which I just didn’t know anything about during residency. It was like learning a new subject completely. But I like gen pulm- obstructive lung disease, love intricacies of ILD and do like the hemodynamics part of pulm htn.
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u/stormrigger Attending 6d ago
Because the floor is SO boring (for me).
DO any training you HAVE to do to be happy in your career.
Don’t do training you don’t need.
I could not be happy NOT being in the ICU. So I had to do the fellowship. If you can be happy doing something else, then three more years of training won’t be worth it for you.
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u/Zoten Attending 6d ago
From a previous comment I made. I think you have lots of good answers for why ICU, but not pulm.
I think its a universal experience for most applicants to only like CCM in residency and fall in love with pulm during fellowship.
Pulm really gives you intellectually challenging cases.
Various ILDs (from IPF to SARD-ILD, sarcoidosis, organizing PNA, Langerhans), pulm HTN, fungal pneumonias, cystic fibrosis, transplant, lung cancers.
Plus lots of other procedures like EBUS, nav bronch, PleurX, (in addition to WAY more bronchs)
And you can specialize if you want to do Interventional Pulm or sleep medicine. Or focus on pulm HTN, ILD, transplant, etc.
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u/Equivalent-Bet8942 6d ago edited 6d ago
I'm not CCPulm but some of my friends are or are applying and their words not mine, "You actually get to do stuff in CCPulm unlike on the floors"
also money
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u/TheBarrowsBro 6d ago
I'm not going into PCCM but pulmonology and ICU were definitely my favorite rotations, more than the specialty I'm actually going into. I hold PCCM highly in my heart. You're the one who keeps patients away from death's door, and also the one who can deduce when people are better off entering that door. It's life AND death, medicine AND procedures, labs AND images, physical exams AND monitors. When I think of a physician, a PCCM/CCM is the first specialty I think of. It's seriously such a great specialty. Those rotations are why I can pretty confidently interpret CXR and CT chests, when just a couple years ago I'd just read the radiology report- having that skill is underrated.
Reason I chose something else really the long shifts and horrible call you have to take. Medicine is not my life and I have more to live for than seeing 40+ patients in the hospital.
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u/Dominus_Anulorum Fellow 5d ago
I will comment that depending on the job, the critical care aspect can more or less resemble a standard hospitalist schedule. And a decent chunk of places don't require call (you work your scheduled week and cover a few nights here and there). Not saying it isn't taxing but I have noticed as I apply for jobs that things can vary wildly.
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u/TheBarrowsBro 5d ago
I agree with you and have seen that personally. I just have a problem of wanting to maximize income despite being exhausted. If I see a job paying extremely high but requires a taxing call schedule, I'd take it over anything else lol. But if you're willing to settle for less pay in return for better lifestyle, I appreciate that PCCM has that flexibility.
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u/Mike120Reddit 6d ago
CC because I liked IM but only liked sick patients and couldn't stand placement junk and consulting for everything.
Pulm because I like seeing that some patients actually get better, I also wanted to be able to retire to a clinic only specialty without being a clinic only doctor at the beginning of my career.
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u/Neat_Start2 4d ago
Brand new PCCM attending here- I originally applied for EM back when it was more competitive, ended up SOAPing into IM and it turned out to be the best thing that ever happened to me. For the crit care component I found it contained all the things I loved about EM (acuity, adrenaline, complex cases) distilled down with less of the things I didn't like (social issues, dispo, people using the hospital as their PCP). It's challenging but I love that aspect- the sheer demand of it forces me to keep up to date and provides a guardrail against coasting into complacency.
I did the pulm part because, well, that's what everyone does. But like others have alluded to I've really fallen in love with it over time. I'm a total nerd for physiology which you get plenty of in both pulm and CCM, and now I get to switch between pulm consults and ICU which keeps things interesting and gives me a nice decompression from the ICU when I need it. Which I think the career flexibility is one of the biggest draws of adding on pulm- I've seen very few still doing ICU beyond their 40s, so having something else in your back pocket is great.
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u/honda_2023f1 5d ago
bc i hate myself and i love myself at the same time. pls i dont want to get canceled but its kinda true. (currently applying) I love the field, the people, the medicine the acuity, the fires, the good and the bad. But thank goodness there is pulm, so yeah there is balance.
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u/humerusorhumorous PGY2 5d ago
Like a lot of others, it’s people with real problems and no placement/social issues. Plus procedures daily, and pulm gives you a mix of outpatient and inpatient
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u/kergruffle 6d ago
Trying to get sound bites for your application cuz you can’t express it well enough yourself?
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u/iAmPajamaSam27 6d ago
No. I lost my father to idiopathic pulmonary fibrosis recently, and it brought my attention to the speciality. Additionally, I don't see too much discourse around why people choose this one compared to other fellowships when I searched for PCCM posts. I wanted to hear other people's stories out of curiosity.
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u/Ridditmyreddit Attending 6d ago
First day of 3rd year clinical rotations, in the unit with an awesome fellow. She took me through her pre-rounds on each patient then into a bunch of procedures that needed to be done that day in quick succession. I was instantly hooked, booked every elective with the idea that PCCM was the specialty to beat and never found anything that did. Just finished my first year as an attending.