CHESTThought Leader BlogWhy I Chose an Interventional Pulmonology Fellowship

Why I Chose an Interventional Pulmonology Fellowship

By: Van Holden, MD

This post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from current trainees in leadership with CHEST.

“Hi, this is Van returning a page for IP.”

“Is this IR pulmonary? I have a new consult for you.”

Advances in technology have rapidly expanded the field of interventional pulmonary medicine. With this growth, the question of what exactly interventional pulmonology is arises. I recall my initial exposure while on the IP consult service. I thought “L EBUS” was some sort of bronchoscopy on the left side of the lung instead of linear endobronchial ultrasound. This was quickly sorted out (to the amusement of the bronchoscopy suite staff).

“Are we doing radial or linear EBUS?”

My response: “The lesion is on the left side, so I guess the L EBUS.

Interventional pulmonology includes advanced diagnostic and therapeutic modalities and pleural disease management. This unique blend of medical and procedural training captivated me. I was in awe of the immediate improvements in respiratory symptoms that patients reported after their central airway obstruction was alleviated.

For patients who wanted to know their diagnosis prior to surgical lung resection, navigational bronchoscopy and radial EBUS have made diagnosing 1 cm pulmonary nodules possible. (I’ve even listened to the bantering between my attendings regarding who has gotten the smallest nodule!) Radial incisions for tracheal stenosis, tumor debulking of endoluminal malignancy, whole lung lavage for pulmonary alveolar proteinosis, management of complicated pleural spaces, and bronchopleural fistula—everything fascinated me. 

I was excited to learn the technical challenges of the various procedures as well as the clinical reasoning behind when not to do something. In addition, the care of complex airway diseases and thoracic malignancies fostered education and collaboration across disciplines. The support from surgical specialties, anesthesiology, and oncology was unmatched.  

By the end of the IP rotation, I was enthralled and considering whether or not to pursue an additional fellowship in interventional pulmonology. I spoke with several people who were already practicing in the field and inquired about the quality of life, practice set-ups, and training opportunities. I also discussed this potential new endeavor with my family and friends. 

In particular, I was concerned about what another fellowship would mean for my husband and me. Would we both consider relocating yet again? Or would my husband continue his current job and we would live separately for a year? Could we delay settling into a permanent home? What would be a realistic work-life balance in the future? 

I realized that many of these questions were similar to the ones I had when considering applying for a pulmonary and critical care fellowship. The reasoning now was the same—at the end of the day, it is the great sense of fulfillment and satisfaction with what I’m doing that makes just one extra year of fellowship worth it.

I have fortunately matched for IP fellowship at Beth Israel Deaconess Medical Center/MGH, and my husband and I are looking forward to this new chapter in Boston.

A special thanks to Drs. Ashutosh Sachdeva and Ed Pickering for their guidance and support.

Van Holden, MD 2017Dr. Van Holden is a graduate of the University of Kansas School of Medicine. She completed an internal medicine residency and a chief residency at Rutgers-RWJMS in New Brunswick, NJ. She is currently a chief PCCM fellow at University of Maryland Medical Center. Her research interests include evaluating outcomes from a dedicated lung mass clinic and improving the interhospital transfer handoff process.