As a medical student, do you ever wonder what it’s like to specialize in pulmonology? Meet Ajanta Patel, MD, a pediatric pulmonologist and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in pulmonary medicine might be a good fit for you.
“Shadowing” Dr. Patel (@ajantapatel)
Specialty: Pediatric pulmonology.
Practice setting: Academic institution.
Employment type: Employed by hospital.
Years in practice: Two.
A typical day and week in my practice: I do both clinic and inpatient service; in addition, I see specialty patients at an affiliated hospital. As a pediatric pulmonologist, I care for some unique patients—children with lung abnormalities, premature babies with underdeveloped lungs, children living on ventilators—and I see a lot of children with asthma who haven’t been able to achieve control. It’s an incredibly full and rewarding line of work with incredibly complex and fascinating patients.
I’m also privileged to work in an academic institution, which means I have scholarly work outside of my clinical work. Doing this work means I split my time about 50/50 between clinical and non-clinical work. In my non-clinical time, I work on medical education and quality improvement projects.
The most challenging and rewarding aspects of pediatric pulmonology: As consultants and specialists, we see patients who have struggled to find relief through common approaches or first line therapy. We also see rare diseases and very complicated patients, and in those cases, we often don’t have enough data to tell us what’s best in every situation.
In my field, it’s often a challenge to know what is the “right” thing to do. I have to combine lung anatomy and physiology, my knowledge of the literature, and my clinical judgement. It takes listening well and being empathetic, and the more I do this, I am developing pattern recognition. I’ve helped children get severe asthma under control by realizing they had a learning deficit that made it hard to remember to take medicine.
I’ve also properly and thoroughly examined a child, listened to their story, and taken away a diagnosis of asthma to the correct diagnoses of pectus excavatum or recurrent pneumothoraces. I feel I am still practicing the “art” of medicine, and I feel lucky to be doing that as much as I do.
Three adjectives to describe the typical pediatric pulmonologist: Curious, patient and persistent.
How my lifestyle matches, or differs from, what I had envisioned: My clinical work differs because I thought I would be a general physician. However, my work today actually lines up pretty well with what I envisioned those activities feeling like. I do both inpatient and outpatient practice (which ironically, many generalists no longer do!). I see very rare cases and very common cases; I meet some patients once and some for many years. I rely equally on patient history, physical exams and diagnostic testing to guide me. So, in those ways the clinical work has the elements I wanted!
While everyone is different, it’s very important to know yourself when thinking about your long-term. I am now quite glad I did not go into a field that would require overnight work or night shifts. In medical school I enjoyed surgery very much and did well on the rotation, but I was suffering physically from the hours.
Emergency medicine also disrupted my sleep pattern, and I knew I wouldn’t do well long term with that. Today, because I’ve built a work schedule that doesn’t drain me out, I’m able to do things I couldn’t do if I was exhausted—speak articulately, network with others, write profession emails. These skills helped me become an AMA Delegate, which is something I’m incredibly proud of. No matter what clinical work you do, being able to function well is important to your long-term success.
Skills every physician in training should have for pediatric pulmonology but won’t be tested for on the board exam: You’ll never adequately be tested on your ability to listen to what people are trying to tell you. You’ll also never be tested on your ability to problem solve. Machines and the internet can give you a differential and management plan, but to treat real patients (especially little ones and complex ones), you have to listen, think, discuss, and make a plan.
One question physicians in training should ask themselves before pursuing pediatric pulmonology: Are you OK with sputum?
Books every medical student interested in pediatric pulmonology should be reading: You probably won’t decide to be a pediatric pulmonologist early in medical school, but if you are considering pulmonology or critical care, do not throw away your copy of John West’s Pulmonary Physiology. You’ll need to read it several times and you will learn more each time.
For anyone doing specialty pediatrics, I would recommend The Spirit Catches You and You Fall Down by Anne Fadiman. It taught me a lot about listening. Finally, if you find yourself rotating in either the neonatology intensive-care unit or pediatric ICU during medical school, buy a clinical handbook (Lange for NICU) and bring it with you the first day. Pediatrics is a different world from adult medicine and it will help you immensely to get oriented to pediatric thinking.
The online resource students interested in pediatric pulmonology should follow: Most of my information is either from the American Academy of Pediatrics and its digital resources, or the American Thoracic Society and its journals.
Quick insights I would give students who are considering pediatric pulmonology: If you like lungs and kids, this is the place for you. You will not get bored and your patients will make it awesome.
Mantra or song to describe life in pediatric pulmonology: The word “breathe” has a nice double entendre, and we sometimes use it for the double meaning.
More about choosing a specialty
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®.
