As a medical student, do you ever wonder what it’s like to specialize in preventive medicine? Meet L. Wesley Aldred, MD, a pulmonary and critical care medicine physician and a featured doctor in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in pulmonary and critical care medicine might be a good fit for you.
The AMA’s Specialty Guide simplifies medical students’ specialty selection process, highlight major specialties, detail training information, and provide access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.
Learn more with the AMA about the medical specialty of pulmonary disease and critical care medicine.
“Shadowing” Dr. Aldred
Specialty: Pulmonary and critical care medicine.
Practice setting: Multispecialty group practice.
Employment type: A private practice employed by Hattiesburg Clinic, which is a member of the AMA Health System Program. The program provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: Four.
A typical day and week in my practice: Our practice is designed so that if we are in the intensive care unit (ICU), we are dedicated to it for the entire day. During my ICU shifts (on days), we work from 7 a.m. to 5 p.m., and on nights, the shift is 5 p.m. to 7 a.m. On days when we are not in the ICU, we split our time between clinic duties and procedures and inpatient consults, typically from 8 a.m. to 5 p.m.
I spend around 10 weeks per year in the ICU on day shifts and three weeks per year on night shift. When covering the ICU, weekends are part of the schedule—otherwise, weekends are off. With in-house night ICU coverage, there is no call after 5 p.m.
The most challenging and rewarding aspects of pulmonary and critical care medicine: In the clinic, I typically help patients with lung cancer, which has a staggering mortality rate. Additionally, caring for patients who are critically ill means confronting mortality regularly, which is inherently challenging.
Despite the challenges, it is rewarding to guide patients and their families through severe illness towards dignified end-of-life care.
The impact burnout has on pulmonary and critical care medicine: The burnout rate in pulmonary and critical care is very high, especially for physicians solely focused on critical care. This leads to difficulty keeping physicians in positions long term.
How Hattiesburg Clinic is reducing physician burnout: Our clinic sent out a large survey to help gauge burnout levels and explore ways it could be combated. One of the things I’ve found in private practice is that you get disconnected from your fellow physicians and, recognizing the importance of camaraderie, we have implemented more frequent social outings among physicians.
How my lifestyle matches, or differs from, what I had envisioned: My practice aligns well with the way I wanted to practice medicine. I prioritized joining a group that dedicated time in the ICU and didn’t try to balance clinic and ICU care in the same day. Critical care medicine demands nights, weekends and holidays, but my practice’s size is large enough to reduce the burden.
This practice has fit my family well; I got married in my first year of medical school, had my first child during my intern year, my second during my third year of residency and my third during my first year of fellowship. There is never a perfect time to start a family in medicine, so if you want a family, then I would recommend not waiting for that perfect time.
Skills every physician in training should have for pulmonary and critical care medicine but won’t be tested for on the board exam: The ability to communicate effectively with families without using medical terminology. In the ICU, there is no room for miscommunication or parsing of words. Families want to know what you are thinking and what is happening to their family members. Be real with them.
One question physicians in training should ask themselves before pursuing pulmonary and critical care: Can I deal with losing a large proportion of my patients, and do I have a support system outside of work to help me through it?
Books, podcasts or other resources every medical student interested in pulmonary and critical care medicine should be reading:
- Every Deep-Drawn Breath, by E. Wesley Ely, MD, MPH, a pulmonary and critical care physician at Vanderbilt University Medical Center, delves into the long-term effects of critical illness, transforming practice.
- The Checklist Manifesto, by Atul Gawande, MD, challenges physicians to embrace checklists for improved patient care.
- "The Curbsiders" podcast does a wonderful job of explaining the formation of differential diagnoses.
Additional advice I would give to students who are considering pulmonary and critical care: Medicine is an ever-changing landscape and politics outside of medicine play a huge role. Be a part of the political machine that is happening around you. Join your professional organizations and advocate for yourself, your colleagues and your patients. If you don’t do it, no one else will.
