Abid Butt1*, Rodrigo Cavallazzi2 and Umair Gauhar2
1Department of Critical Care Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia 2Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, Department of Medicine, University of Louisville, KY, USA
Received: 25 May, 2016;Accepted: 02 July, 2016;Published: 04 July, 2016
Abid Butt, MD, FCCP, Department of Critical Care Medicine, King Faisal Specialist Hospital & Research Center Riyadh, Kingdom of Saudi Arabia, Tel: +966 11 442 4731; E-mail:
Butt A, Cavallazzi R, Gauhar U (2016) Interventional Pulmonology in 2015: A Survey of Practice Patterns and Future Directions of this Emerging Field. Arch Pulmonol Respir Care 2(1): 020-023.
© 2015 Butt A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Interventional pulmonology; Survey; Practice patterns
Background: Interventional Pulmonology (IP) training through formal fellowship programs have become increasingly popular over the last several years. There is a dearth of data on the current practice of IP in the United States. The objective of this study was to identify the practice patterns of current IP practitioners.
Methods: We sent a survey to the members of the American Association of Bronchology and Interventional Pulmonology (AABIP) – the largest association of American IP practitioners. We analyzed the responses and stratified the responses to compare, when possible, how the practice patterns of the IP fellowship trained physicians varied from those who did not undergo formal fellowship training.
Results: We received a reply from 97 individuals. There was a noticeable difference in the practice patterns of respondents who had undergone fellowship training in IP versus those who had not, particularly with respect to volume and diversity of procedures performed. A small percentage of respondents appeared responsible for most of the advanced therapeutic procedures as well as ongoing research in the field of IP.
Conclusions: Our study is, to our knowledge, the first to capture the state of affairs of practicing Interventional Pulmonologists in the US. Our survey raises hopes as well as concerns about the benefits associated with an additional year of training in IP. We feel this survey will serve as an important aid for IP practitioners, fellowship directors, and IP fellows (both current and future) to further define clinical and research priorities and to foresee any future challenges in the field.
Interventional pulmonology (IP) is a relatively new but rapidly expanding branch of Pulmonology. While some of the tools used by Interventional Pulmonologists are decades old (e.g. the flexible bronchoscope was introduced in 1968) , the field’s recent popularity appears to stem from the rapid proliferation of technically advanced diagnostic tools. Modern bronchoscopic equipment such as endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB) have revolutionized the management of many pulmonary diseases and have been thoroughly validated , in lung cancer staging and diagnosis of pulmonary parenchymal abnormalities. There has also been a resurgence of interest in advanced therapeutic bronchoscopy particularly rigid bronchoscopy. This interest has driven a dramatic increase in the number of training positions offering dedicated 12-month IP training in North America. As an illustration, there were 5 such programs , listed with the American Association of Bronchology and Interventional Pulmonology (AABIP) in 2007. By the 2015-2016 training year, this number had increased to 26, an increase of more than 500%. Despite the significantly increased number of training positions, it remains unclear whether this was in response to an unmet demand or whether these supra-specialized graduates were vfinding themselves in positions where they were unable to utilize all the skills they had acquired in the additional year(s) of training. The goal of our survey was to bridge this gap in our knowledge and gain an understanding of the current practice paradigm of IP practitioners in the United States.
Materials and Methods
Our study is a cross-sectional analysis of Interventional Pulmonology Practitioners using a web-based survey (www.surveymonkey.com). We did not obtain Institutional Board Review approval as there was no question pertained to private patient information. The survey was sent to members of the American Association of Bronchology and Interventional Pulmonology (AABIP) after soliciting feedback on the survey design and question content from the AABIP leadership. The AABIP was chosen as the forum for the survey as it is the largest organization of American practitioners of Interventional Pulmonology. Recipients of the survey were asked to fill out a questionnaire on their IP training (whether via a formal fellowship or self-directed), current practice, the scope and volume of procedures they currently performed, the use of sedation and anesthesia in their endoscopy suite, as well as satisfaction with their career choice. Question formats included multiple choice, matrix scale rating as well as single and multiple free text entries.
We performed descriptive analyses for all variables included in the study. Median and interquartile range are reported for continuous variables. Proportions are reported for categorical variables. Statistical inference was performed to compare participants with IP fellowship training from those without it. We used the Wilcoxon Rank-Sum (Mann-Whitney) test for comparing continuous variables, and the Fisher’s exact test for comparing categorical variables. We carried out all statistical analysis with Stata 10 (Stata Corp, College Station, Texas). As some respondents did not answer every question in the survey, the sample size for individual questions differed across the survey. Answers from one respondent were removed from the final analysis after it was noticed that the responses appeared contradictory or not relevant to the question being asked. When an individual answer was given in the form of a range, the median value was used for statistical analysis purposes. In the few instances where an answer was given as >x then x+1 was used for analysis purposes.
The survey was answered by 97 individuals, of whom 26% (25 of 97) had dedicated fellowship training in IP (hereafter referred to as Formal IP Trainees (FIPT)) while the remainder (Non-IP Trainees or NIPT) acquired their skills during or after their Pulmonary and Critical Care Fellowship (PCCF).
Matching into IP fellowships
The FIPT reported that 90% (18 of 20) matched into an IP fellowship program within a year of applying, and that 85% (17 of 20) started their IP training immediately following their PCCF.
Obtaining privileges to perform IP procedures
For the FIPT, 42% (7 of 19) obtained privileges to perform the procedures they were trained in immediately, with 89% (17 of 19) getting them within 3 months of starting. The remaining two had to wait for 6 and 12 months to get full privileges. On the other hand, only 18% (8 of 45) of the NIPT obtained IP privileges immediately, with 66% (34 of 45) getting privileges within 3 months of starting. 24% (11 of 45) of the NIPT had to wait for more than 3 months, with the range being four to thirty-five months to obtain full IP privileges. IP skills training workshops proved popular among NIPT respondents, with 84% (56 of 67) reporting attending such training. Whether this was related to privileging needs was unclear.
Clinical practice of IP
The breakdown of clinical time and practice setup is listed in Table 1 and Figure 1 respectively. Note that there was no statistical difference in the practice setup of the two groups.