To the Editor:
Over the last decade, we have seen the emergence of interventional pulmonology (IP) to the main stream of Medicine. The initial crop of IP physicians and literature surrounding this field was either related to endobronchial ultrasound for mediastinal adenopathy or placement of stents in the airways. But recently renewed interest in rigid bronchoscopy for advanced endoscopic tracheal surgeries, thoracoscopy, and percutaneous thoracic biopsies have stretched the canvass of the field into many nontraditional areas. This new development on one hand has provided tremendous benefits for patient care, but has also raised questions in the minds of many thoracic surgeons.
Navigational bronchoscopy and stereotactic body radiation therapy has certainly reduced the need for surgical lung biopsies. In a health care environment where all of us are facing a tightening financial belt, this means a fight for the bread and butter. If we hear many upbeat interventional pulmonologist, they think that the field of pulmonary medicine is essentially going through the same transition as gastroenterology went 2 to 3 decades ago, where newer endoscopic modalities have greatly reduced the need to perform exploratory laparotomies.
It is not an uncommon sight to see an increasing number of thoracic surgeons doing hand on courses for interventional bronchoscopies. This competition has led to problems for many of new IP graduates, who look to start their career. This is especially true for institutions where advanced endoscopy suites does not exist, which means many of these folks end up using operating room for their procedures, where they are generally considered “outsiders,” “Medicine people,” or “cough doctors.”
I think we can solve this problem, by understanding our roles precisely. Many of these young IP graduates need to understand that a 1 year fellowship and a board certification will not make them a thoracic surgeon and give them a license to perform a thoracoscopy for every effusion, or go after every nodule they see in the lung. It is also critically important to recognize that many of us will have to rely on general pulmonary and critical care practice to make the 2 ends meet.
Similarly our thoracic surgery colleagues need to realize an increasing role of invasive pulmonologist in the diagnosis and palliative care of thoracic oncology patients and complicated airway disorders. Together as a team we can produce a win-win situation for our patients and ourselves. Many leading institutions have introduced the concept of a multidisciplinary team, with assigned roles, to solve this problem.
My advice to young fellows will be to be very careful when they are looking for a job. It is important to ask questions regarding access to operating room, current referral pattern, structure of the tumor board, and most importantly meet thoracic surgeons in person. These simple steps might go a long way in making a successful career.
Muhammad K. Perwaiz, MD
SUNY Stony Brook University Hospital, Stony Brook, NY