CHEST Physician

The average physician makes $352,000, and some earn well into the $500,000s. So, doctors don’t have to worry about money, right?

You know the answer to that.

One thing all physicians have in common about money, says James M. Dahle, MD, FACEP, founder of The White Coat Investor, is that they don’t receive any training in business, personal finance, or investing throughout their schooling or careers unless they seek it out. This leaves many unprepared to make the best investing and money-saving decisions, while others get too frustrated about their lack of knowledge to even dip their toe into the investing pool.

Exhibit A: Four out of 10 physicians have a net worth below $1 million, according to the Medscape Physician Wealth & Debt Report 2023. Elizabeth Chiang, MD, PhD, an oculoplastic surgeon and a physician money coach at Grow Your Wealthy Mindset, notes that many of those doctors are over age 65, “which means they essentially can’t retire.”

And that’s just one pain point.

Physicians have money concerns specific to their profession and background. Luckily, some fellow doctors also serve as financial and wealth advisors just for other doctors. We sought out a few to get their advice--and fixes--for common physician blind spots.

Blind Spot #1

The early lean years skew doctors’ money outlook. “We have an extended training period, which commonly consists of taking on a large amount of debt, followed by 3 to 8 years of being paid a modest salary, and then finally a large boost in income,” explains Dr. Chiang. This can lay a shaky foundation for the earning years to come, and as a result, a lot of doctors just don’t think about money in healthy ways. Once their incomes increase, physicians may be surprised, for example, that making a multiple six-figure salary means paying six figures in taxes.

The Fix

Treat financial health like physical health. That means money cannot be a taboo subject. “The misguided mindset is that we didn’t become physicians to make money, we did it to help people,” explains Jordan Frey, MD, creator of the blog, The Prudent Plastic Surgeon.

Dr. Frey acknowledges that the desire to help is certainly true. But the result is a false idea that “to think about our personal finances makes us a worse doctor.”

Blind Spot #2

Because doctors know a lot about one thing (medicine), they might assume they know a lot about everything (such as investing). “Totally different fields with a different language and different way to think about it,” Dahle explains. This overconfidence could lead to some negligent or risky financial decisions.

The Fix

Educate yourself. There are several books on personal finance and investing written by physicians for physicians. Dr. Chiang recommends The Physician Philosopher’s Guide to Personal Finance, by James Turner, MD; Financial Freedom Rx, by Chirag Shah, MD, and Jayanth Sridhar, MD; and The Physician’s Guide to Finance, by Nicholas Christian and Amanda Christian, MD. There are also podcasts, blogs, and courses to help educate doctors on finance, such as the Fire Your Financial Advisor course by The White Coat Investor.

Blind Spot #3

Undersaving. Retirement saving is one thing, but 24% of doctors say they don’t even put money away in a taxable savings account, according to the Wealth & Debt Report.

Cobin Soelberg, MD, JD, a board-certified anesthesiologist and founder and principal advisor with Greeley Wealth Management, is the treasurer of his anesthesiology group. “I get to see every month how much people are saving, and even on an anesthesiologist salary, where everyone’s making about $400,000 a year, a lot of people are not saving anything, which is crazy.”

Undersaving can be both a time issue and a mindset one.

Time: Doctors often start investing in their retirement accounts later than the average professional, says Dr. Chiang. “A lot of physicians will max out their 401k or 403b,” she explains. “But if you’re putting in $20,000 a year and only starting when you’re in your early 30s, that’s not enough to get you to retirement.”

Mindset: Doctors also see people of all ages who are sick, dying, and injured. “They all know someone who worked hard and saved and then dropped dead at 55,” explains Dr. Dahle. This, he says, can lead to a bit of a “you only live once” attitude that prioritizes spending over saving.

The Fix

Shoot for 20%. If you can’t save 20% of your gross now, strive to get to that point. Think of it as telling a patient they have to change their behavior or trouble will come - not if, but when. “Develop a written investing plan and then stick with it through thick and thin,” says Dr. Dahle. “Once you have a reasonable plan, all you have to do is fund it adequately by saving 20% of your gross income, and a doctor will easily retire as a multimillionaire.”

Blind Spot #4

Bad investment strategies. Thirty-six percent of doctors experience their largest financial losses from lousy investments, according to the Wealth & Debt Report. Meanwhile, 17% of PCPs and 12% of specialists say they haven’t made any investments at all. That’s a terrible mix of doing the wrong thing and doing a worse thing.

The Fix

Don’t overthink investing, but don’t underthink it either. “As high-income earners, doctors just don’t need to take this high level of risk to reach their financial goals,” Dr. Frey says. A good investment plan doesn’t require you to time the stock market or predict individual stock winners. Consider what Vanguard founder Jack Bogle once said about investing: “Be bored by the process but elated by the outcome.”

Dr. Frey suggests going super-simple: index funds. Ignore investing strategies with actively managed mutual funds or individual stocks, as well as risky alternative investments such as cryptocurrency and angel investments. Everyone assumes doctors have money to burn, and they will push sketchy investment ideas at them. Avoid.

Blind Spot #5

Not taking debt seriously enough. The average medical student debt is $250,000 and can exceed $500,000, says Dr. Soelberg. Many doctors spend the first 10 to 20 years of their careers paying this off. Today’s graduates are paying more than 7% on their loans.

And it’s not just student debt: 39% of physicians carry five or more credit cards, and 34% have mortgages larger than $300,000 (with half of those are more than than $500K), per the Wealth & Debt Report.

The Fix

Treat debt like cancer. It’s a lethal enemy you can’t get rid of right away, but a steady, aggressive, long-term attack will have the best results. Dr. Soelberg suggests allocating the most you can afford per month, whether that’s $1000 or $5000, toward debt. Raise the amount as your income grows. Do the same with your 401k or retirement plan. Whatever is left, you can spend. Five to 10 years later, you will realize, “Wow. I’m debt free.”

Blind Spot #6

Not putting in the work to improve your situation. Seventy-one percent of doctors admit they haven’t done anything to reduce major expenses, according to the Wealth & Debt Report. Are you leaving major money on the table?

The Fix

Audit yourself in major areas like housing and taxes. While the average professional may need to put 10% to 20% down on a home, physicians can qualify for physician mortgage loans and can often put down 3% or less, says Dr. Chiang. If you can afford the higher mortgage payment, excess savings earmarked for a larger down payment can be put toward debt or invested.

Another trick, if you’re able, is to seek an area that is less in demand at a higher salary. “Physicians in places like New York City or San Francisco tend to make less than physicians in the Midwest or the South,” Dr. Chiang explains. A colleague of hers moved to rural Pennsylvania, where he made a high salary and had a low cost of living for 3½ years, paid off his student debt, and then relocated to an area where he wanted to live long term.

As for taxes, become familiar with tax law. Research things like, “What is considered a business expense for doctors?” says Brett Mollard, MD, a diagnostic radiologist who provides financial advice to younger physicians. “What will your estimated total tax burden be at the end of the year? Will you need to make extra payments to prevent owing a large sum of money from underpaying or to avoid tax penalties?”

Blind Spot #7

Living like a rock star on a doctor’s income. Getting caught up in trying to live the same lifestyle as your colleagues is a classic bear trap. “Sitting in the doctor’s lounge, it’s so crazy,” Dr. Soelberg says. He describes conversations like, “‘Where did you go on your trip?’ ‘What new toys are you buying?’” There’s pressure to live up to an image of what a doctor’s life is supposed to look like before you’ve sorted the basic things like paying off debt.

The Fix

Live like a resident even if you haven’t been one for years, at least until you’re in a better financial position. “You’re already used to living a life of lower means, and you’re an expert when it comes to delaying gratification,” says Dr. Mollard. “Do it a little longer.” Live frugally and spend only on things that bring you joy. “A lot of physicians are trying to be really rich in all areas of their life instead of the ones that actually matter to them,” Dr. Soelberg says. Identify what’s important to you and only splurge on that.

Blind Spot #8

Never asking for help. The right financial planner can provide expert help. Emphasis on right. “Doctors can be very trusting of other professionals, even when they should not be,” says Dr. Dahle. He notes that in financial services, many people masquerade as knowledgeable advisors who are really just salespeople. While legitimate financial advisors strive to make their clients money, they are also ultimately out to line their pockets and love to work with physician salaries. Thus, doctors can end up working with financial planners that don’t specifically understand their situations or end up taking too much from their clients.

The Fix

Find a planner who specializes in, or at least understands, physicians. Ask them how they make money, says Dr. Chiang. If someone hesitates to tell you about their fee structure or if it sounds like a lot, shop around and ask colleagues for recommendations.

“Ultimately, the path to wealth is to create and grow the margin between what you make and what you spend,” says Dr. Frey. Throw some investing into the mix and physicians can set themselves up on a path for a stress-free financial life.


A version of this article appeared on Medscape.com.

The average physician makes $352,000, and some earn well into the $500,000s. So, doctors don’t have to worry about money, right?

You know the answer to that.

One thing all physicians have in common about money, says James M. Dahle, MD, FACEP, founder of The White Coat Investor, is that they don’t receive any training in business, personal finance, or investing throughout their schooling or careers unless they seek it out. This leaves many unprepared to make the best investing and money-saving decisions, while others get too frustrated about their lack of knowledge to even dip their toe into the investing pool.

Exhibit A: Four out of 10 physicians have a net worth below $1 million, according to the Medscape Physician Wealth & Debt Report 2023. Elizabeth Chiang, MD, PhD, an oculoplastic surgeon and a physician money coach at Grow Your Wealthy Mindset, notes that many of those doctors are over age 65, “which means they essentially can’t retire.”

And that’s just one pain point.

Physicians have money concerns specific to their profession and background. Luckily, some fellow doctors also serve as financial and wealth advisors just for other doctors. We sought out a few to get their advice--and fixes--for common physician blind spots.

Blind Spot #1

The early lean years skew doctors’ money outlook. “We have an extended training period, which commonly consists of taking on a large amount of debt, followed by 3 to 8 years of being paid a modest salary, and then finally a large boost in income,” explains Dr. Chiang. This can lay a shaky foundation for the earning years to come, and as a result, a lot of doctors just don’t think about money in healthy ways. Once their incomes increase, physicians may be surprised, for example, that making a multiple six-figure salary means paying six figures in taxes.

The Fix

Treat financial health like physical health. That means money cannot be a taboo subject. “The misguided mindset is that we didn’t become physicians to make money, we did it to help people,” explains Jordan Frey, MD, creator of the blog, The Prudent Plastic Surgeon.

Dr. Frey acknowledges that the desire to help is certainly true. But the result is a false idea that “to think about our personal finances makes us a worse doctor.”

Blind Spot #2

Because doctors know a lot about one thing (medicine), they might assume they know a lot about everything (such as investing). “Totally different fields with a different language and different way to think about it,” Dahle explains. This overconfidence could lead to some negligent or risky financial decisions.

The Fix

Educate yourself. There are several books on personal finance and investing written by physicians for physicians. Dr. Chiang recommends The Physician Philosopher’s Guide to Personal Finance, by James Turner, MD; Financial Freedom Rx, by Chirag Shah, MD, and Jayanth Sridhar, MD; and The Physician’s Guide to Finance, by Nicholas Christian and Amanda Christian, MD. There are also podcasts, blogs, and courses to help educate doctors on finance, such as the Fire Your Financial Advisor course by The White Coat Investor.

Blind Spot #3

Undersaving. Retirement saving is one thing, but 24% of doctors say they don’t even put money away in a taxable savings account, according to the Wealth & Debt Report.

Cobin Soelberg, MD, JD, a board-certified anesthesiologist and founder and principal advisor with Greeley Wealth Management, is the treasurer of his anesthesiology group. “I get to see every month how much people are saving, and even on an anesthesiologist salary, where everyone’s making about $400,000 a year, a lot of people are not saving anything, which is crazy.”

Undersaving can be both a time issue and a mindset one.

Time: Doctors often start investing in their retirement accounts later than the average professional, says Dr. Chiang. “A lot of physicians will max out their 401k or 403b,” she explains. “But if you’re putting in $20,000 a year and only starting when you’re in your early 30s, that’s not enough to get you to retirement.”

Mindset: Doctors also see people of all ages who are sick, dying, and injured. “They all know someone who worked hard and saved and then dropped dead at 55,” explains Dr. Dahle. This, he says, can lead to a bit of a “you only live once” attitude that prioritizes spending over saving.

The Fix

Shoot for 20%. If you can’t save 20% of your gross now, strive to get to that point. Think of it as telling a patient they have to change their behavior or trouble will come - not if, but when. “Develop a written investing plan and then stick with it through thick and thin,” says Dr. Dahle. “Once you have a reasonable plan, all you have to do is fund it adequately by saving 20% of your gross income, and a doctor will easily retire as a multimillionaire.”

Blind Spot #4

Bad investment strategies. Thirty-six percent of doctors experience their largest financial losses from lousy investments, according to the Wealth & Debt Report. Meanwhile, 17% of PCPs and 12% of specialists say they haven’t made any investments at all. That’s a terrible mix of doing the wrong thing and doing a worse thing.

The Fix

Don’t overthink investing, but don’t underthink it either. “As high-income earners, doctors just don’t need to take this high level of risk to reach their financial goals,” Dr. Frey says. A good investment plan doesn’t require you to time the stock market or predict individual stock winners. Consider what Vanguard founder Jack Bogle once said about investing: “Be bored by the process but elated by the outcome.”

Dr. Frey suggests going super-simple: index funds. Ignore investing strategies with actively managed mutual funds or individual stocks, as well as risky alternative investments such as cryptocurrency and angel investments. Everyone assumes doctors have money to burn, and they will push sketchy investment ideas at them. Avoid.

Blind Spot #5

Not taking debt seriously enough. The average medical student debt is $250,000 and can exceed $500,000, says Dr. Soelberg. Many doctors spend the first 10 to 20 years of their careers paying this off. Today’s graduates are paying more than 7% on their loans.

And it’s not just student debt: 39% of physicians carry five or more credit cards, and 34% have mortgages larger than $300,000 (with half of those are more than than $500K), per the Wealth & Debt Report.

The Fix

Treat debt like cancer. It’s a lethal enemy you can’t get rid of right away, but a steady, aggressive, long-term attack will have the best results. Dr. Soelberg suggests allocating the most you can afford per month, whether that’s $1000 or $5000, toward debt. Raise the amount as your income grows. Do the same with your 401k or retirement plan. Whatever is left, you can spend. Five to 10 years later, you will realize, “Wow. I’m debt free.”

Blind Spot #6

Not putting in the work to improve your situation. Seventy-one percent of doctors admit they haven’t done anything to reduce major expenses, according to the Wealth & Debt Report. Are you leaving major money on the table?

The Fix

Audit yourself in major areas like housing and taxes. While the average professional may need to put 10% to 20% down on a home, physicians can qualify for physician mortgage loans and can often put down 3% or less, says Dr. Chiang. If you can afford the higher mortgage payment, excess savings earmarked for a larger down payment can be put toward debt or invested.

Another trick, if you’re able, is to seek an area that is less in demand at a higher salary. “Physicians in places like New York City or San Francisco tend to make less than physicians in the Midwest or the South,” Dr. Chiang explains. A colleague of hers moved to rural Pennsylvania, where he made a high salary and had a low cost of living for 3½ years, paid off his student debt, and then relocated to an area where he wanted to live long term.

As for taxes, become familiar with tax law. Research things like, “What is considered a business expense for doctors?” says Brett Mollard, MD, a diagnostic radiologist who provides financial advice to younger physicians. “What will your estimated total tax burden be at the end of the year? Will you need to make extra payments to prevent owing a large sum of money from underpaying or to avoid tax penalties?”

Blind Spot #7

Living like a rock star on a doctor’s income. Getting caught up in trying to live the same lifestyle as your colleagues is a classic bear trap. “Sitting in the doctor’s lounge, it’s so crazy,” Dr. Soelberg says. He describes conversations like, “‘Where did you go on your trip?’ ‘What new toys are you buying?’” There’s pressure to live up to an image of what a doctor’s life is supposed to look like before you’ve sorted the basic things like paying off debt.

The Fix

Live like a resident even if you haven’t been one for years, at least until you’re in a better financial position. “You’re already used to living a life of lower means, and you’re an expert when it comes to delaying gratification,” says Dr. Mollard. “Do it a little longer.” Live frugally and spend only on things that bring you joy. “A lot of physicians are trying to be really rich in all areas of their life instead of the ones that actually matter to them,” Dr. Soelberg says. Identify what’s important to you and only splurge on that.

Blind Spot #8

Never asking for help. The right financial planner can provide expert help. Emphasis on right. “Doctors can be very trusting of other professionals, even when they should not be,” says Dr. Dahle. He notes that in financial services, many people masquerade as knowledgeable advisors who are really just salespeople. While legitimate financial advisors strive to make their clients money, they are also ultimately out to line their pockets and love to work with physician salaries. Thus, doctors can end up working with financial planners that don’t specifically understand their situations or end up taking too much from their clients.

The Fix

Find a planner who specializes in, or at least understands, physicians. Ask them how they make money, says Dr. Chiang. If someone hesitates to tell you about their fee structure or if it sounds like a lot, shop around and ask colleagues for recommendations.

“Ultimately, the path to wealth is to create and grow the margin between what you make and what you spend,” says Dr. Frey. Throw some investing into the mix and physicians can set themselves up on a path for a stress-free financial life.


A version of this article appeared on Medscape.com.

The average physician makes $352,000, and some earn well into the $500,000s. So, doctors don’t have to worry about money, right?

You know the answer to that.

One thing all physicians have in common about money, says James M. Dahle, MD, FACEP, founder of The White Coat Investor, is that they don’t receive any training in business, personal finance, or investing throughout their schooling or careers unless they seek it out. This leaves many unprepared to make the best investing and money-saving decisions, while others get too frustrated about their lack of knowledge to even dip their toe into the investing pool.

Exhibit A: Four out of 10 physicians have a net worth below $1 million, according to the Medscape Physician Wealth & Debt Report 2023. Elizabeth Chiang, MD, PhD, an oculoplastic surgeon and a physician money coach at Grow Your Wealthy Mindset, notes that many of those doctors are over age 65, “which means they essentially can’t retire.”

And that’s just one pain point.

Physicians have money concerns specific to their profession and background. Luckily, some fellow doctors also serve as financial and wealth advisors just for other doctors. We sought out a few to get their advice--and fixes--for common physician blind spots.

Blind Spot #1

The early lean years skew doctors’ money outlook. “We have an extended training period, which commonly consists of taking on a large amount of debt, followed by 3 to 8 years of being paid a modest salary, and then finally a large boost in income,” explains Dr. Chiang. This can lay a shaky foundation for the earning years to come, and as a result, a lot of doctors just don’t think about money in healthy ways. Once their incomes increase, physicians may be surprised, for example, that making a multiple six-figure salary means paying six figures in taxes.

The Fix

Treat financial health like physical health. That means money cannot be a taboo subject. “The misguided mindset is that we didn’t become physicians to make money, we did it to help people,” explains Jordan Frey, MD, creator of the blog, The Prudent Plastic Surgeon.

Dr. Frey acknowledges that the desire to help is certainly true. But the result is a false idea that “to think about our personal finances makes us a worse doctor.”

Blind Spot #2

Because doctors know a lot about one thing (medicine), they might assume they know a lot about everything (such as investing). “Totally different fields with a different language and different way to think about it,” Dahle explains. This overconfidence could lead to some negligent or risky financial decisions.

The Fix

Educate yourself. There are several books on personal finance and investing written by physicians for physicians. Dr. Chiang recommends The Physician Philosopher’s Guide to Personal Finance, by James Turner, MD; Financial Freedom Rx, by Chirag Shah, MD, and Jayanth Sridhar, MD; and The Physician’s Guide to Finance, by Nicholas Christian and Amanda Christian, MD. There are also podcasts, blogs, and courses to help educate doctors on finance, such as the Fire Your Financial Advisor course by The White Coat Investor.

Blind Spot #3

Undersaving. Retirement saving is one thing, but 24% of doctors say they don’t even put money away in a taxable savings account, according to the Wealth & Debt Report.

Cobin Soelberg, MD, JD, a board-certified anesthesiologist and founder and principal advisor with Greeley Wealth Management, is the treasurer of his anesthesiology group. “I get to see every month how much people are saving, and even on an anesthesiologist salary, where everyone’s making about $400,000 a year, a lot of people are not saving anything, which is crazy.”

Undersaving can be both a time issue and a mindset one.

Time: Doctors often start investing in their retirement accounts later than the average professional, says Dr. Chiang. “A lot of physicians will max out their 401k or 403b,” she explains. “But if you’re putting in $20,000 a year and only starting when you’re in your early 30s, that’s not enough to get you to retirement.”

Mindset: Doctors also see people of all ages who are sick, dying, and injured. “They all know someone who worked hard and saved and then dropped dead at 55,” explains Dr. Dahle. This, he says, can lead to a bit of a “you only live once” attitude that prioritizes spending over saving.

The Fix

Shoot for 20%. If you can’t save 20% of your gross now, strive to get to that point. Think of it as telling a patient they have to change their behavior or trouble will come - not if, but when. “Develop a written investing plan and then stick with it through thick and thin,” says Dr. Dahle. “Once you have a reasonable plan, all you have to do is fund it adequately by saving 20% of your gross income, and a doctor will easily retire as a multimillionaire.”

Blind Spot #4

Bad investment strategies. Thirty-six percent of doctors experience their largest financial losses from lousy investments, according to the Wealth & Debt Report. Meanwhile, 17% of PCPs and 12% of specialists say they haven’t made any investments at all. That’s a terrible mix of doing the wrong thing and doing a worse thing.

The Fix

Don’t overthink investing, but don’t underthink it either. “As high-income earners, doctors just don’t need to take this high level of risk to reach their financial goals,” Dr. Frey says. A good investment plan doesn’t require you to time the stock market or predict individual stock winners. Consider what Vanguard founder Jack Bogle once said about investing: “Be bored by the process but elated by the outcome.”

Dr. Frey suggests going super-simple: index funds. Ignore investing strategies with actively managed mutual funds or individual stocks, as well as risky alternative investments such as cryptocurrency and angel investments. Everyone assumes doctors have money to burn, and they will push sketchy investment ideas at them. Avoid.

Blind Spot #5

Not taking debt seriously enough. The average medical student debt is $250,000 and can exceed $500,000, says Dr. Soelberg. Many doctors spend the first 10 to 20 years of their careers paying this off. Today’s graduates are paying more than 7% on their loans.

And it’s not just student debt: 39% of physicians carry five or more credit cards, and 34% have mortgages larger than $300,000 (with half of those are more than than $500K), per the Wealth & Debt Report.

The Fix

Treat debt like cancer. It’s a lethal enemy you can’t get rid of right away, but a steady, aggressive, long-term attack will have the best results. Dr. Soelberg suggests allocating the most you can afford per month, whether that’s $1000 or $5000, toward debt. Raise the amount as your income grows. Do the same with your 401k or retirement plan. Whatever is left, you can spend. Five to 10 years later, you will realize, “Wow. I’m debt free.”

Blind Spot #6

Not putting in the work to improve your situation. Seventy-one percent of doctors admit they haven’t done anything to reduce major expenses, according to the Wealth & Debt Report. Are you leaving major money on the table?

The Fix

Audit yourself in major areas like housing and taxes. While the average professional may need to put 10% to 20% down on a home, physicians can qualify for physician mortgage loans and can often put down 3% or less, says Dr. Chiang. If you can afford the higher mortgage payment, excess savings earmarked for a larger down payment can be put toward debt or invested.

Another trick, if you’re able, is to seek an area that is less in demand at a higher salary. “Physicians in places like New York City or San Francisco tend to make less than physicians in the Midwest or the South,” Dr. Chiang explains. A colleague of hers moved to rural Pennsylvania, where he made a high salary and had a low cost of living for 3½ years, paid off his student debt, and then relocated to an area where he wanted to live long term.

As for taxes, become familiar with tax law. Research things like, “What is considered a business expense for doctors?” says Brett Mollard, MD, a diagnostic radiologist who provides financial advice to younger physicians. “What will your estimated total tax burden be at the end of the year? Will you need to make extra payments to prevent owing a large sum of money from underpaying or to avoid tax penalties?”

Blind Spot #7

Living like a rock star on a doctor’s income. Getting caught up in trying to live the same lifestyle as your colleagues is a classic bear trap. “Sitting in the doctor’s lounge, it’s so crazy,” Dr. Soelberg says. He describes conversations like, “‘Where did you go on your trip?’ ‘What new toys are you buying?’” There’s pressure to live up to an image of what a doctor’s life is supposed to look like before you’ve sorted the basic things like paying off debt.

The Fix

Live like a resident even if you haven’t been one for years, at least until you’re in a better financial position. “You’re already used to living a life of lower means, and you’re an expert when it comes to delaying gratification,” says Dr. Mollard. “Do it a little longer.” Live frugally and spend only on things that bring you joy. “A lot of physicians are trying to be really rich in all areas of their life instead of the ones that actually matter to them,” Dr. Soelberg says. Identify what’s important to you and only splurge on that.

Blind Spot #8

Never asking for help. The right financial planner can provide expert help. Emphasis on right. “Doctors can be very trusting of other professionals, even when they should not be,” says Dr. Dahle. He notes that in financial services, many people masquerade as knowledgeable advisors who are really just salespeople. While legitimate financial advisors strive to make their clients money, they are also ultimately out to line their pockets and love to work with physician salaries. Thus, doctors can end up working with financial planners that don’t specifically understand their situations or end up taking too much from their clients.

The Fix

Find a planner who specializes in, or at least understands, physicians. Ask them how they make money, says Dr. Chiang. If someone hesitates to tell you about their fee structure or if it sounds like a lot, shop around and ask colleagues for recommendations.

“Ultimately, the path to wealth is to create and grow the margin between what you make and what you spend,” says Dr. Frey. Throw some investing into the mix and physicians can set themselves up on a path for a stress-free financial life.


A version of this article appeared on Medscape.com.

TOPLINE:

Heavy secondhand smoke (SHS) exposure is associated with severe headache or migraine in adults who have never smoked, with effects of exposure varying depending on body mass index (BMI) and level of physical activity, new research shows.

METHODOLOGY:

Investigators analyzed data on 4,560 participants (median age, 43 years; 60% female; 71.5% White) from the 1999-2004 National Health and Nutrition Examination Survey.

Participants were aged 20 years or older and had never smoked.

Migraine headache status was determined by asking whether participants experienced severe headaches or migraines during the previous 3 months.

SHS exposure was categorized as unexposed (serum cotinine levels <0.05 ng/mL and no smoker in the home), low (0.05 ng/mL ≤ serum cotinine level <1 ng/mL), or heavy (1 ng/mL ≤ serum cotinine level ≤ 10 ng/mL).

TAKEAWAY:

In all, 919 (20%) participants had severe headaches or migraines.

After adjustment for demographic and lifestyle factors (including medication use), heavy SHS exposure was positively associated with severe headache or migraine (adjusted odds ratio [aOR], 2.02; 95% CI, 1.19-3.43).

No significant association was found between low SHS exposure and severe headaches or migraine (aOR, 1.15; 95% CI, 0.91-1.47).

In participants who were sedentary (P=.016) and those with a BMI <25 (P=.001), significant associations between SHS and severe headache or migraine were observed.

IN PRACTICE:

Noting a linear dose-response relationship between cotinine and severe headaches or migraine, the investigators write, “These findings underscore the need for stronger regulation of tobacco exposure, particularly in homes and public places.”

SOURCE:

Junpeng Wu, MMc, and Haitang Wang, MD, of Southern Medical University in Guangzhou, China, and their colleagues conducted the study. It was published online in Headache.

LIMITATIONS:

The study could not establish causal relationships between SHS and migraine or severe headache. In addition, the half-life of serum cotinine is 15-40 hours and thus this measure can reflect only recent SHS exposure.

DISCLOSURES:

The study was not funded. The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Heavy secondhand smoke (SHS) exposure is associated with severe headache or migraine in adults who have never smoked, with effects of exposure varying depending on body mass index (BMI) and level of physical activity, new research shows.

METHODOLOGY:

Investigators analyzed data on 4,560 participants (median age, 43 years; 60% female; 71.5% White) from the 1999-2004 National Health and Nutrition Examination Survey.

Participants were aged 20 years or older and had never smoked.

Migraine headache status was determined by asking whether participants experienced severe headaches or migraines during the previous 3 months.

SHS exposure was categorized as unexposed (serum cotinine levels <0.05 ng/mL and no smoker in the home), low (0.05 ng/mL ≤ serum cotinine level <1 ng/mL), or heavy (1 ng/mL ≤ serum cotinine level ≤ 10 ng/mL).

TAKEAWAY:

In all, 919 (20%) participants had severe headaches or migraines.

After adjustment for demographic and lifestyle factors (including medication use), heavy SHS exposure was positively associated with severe headache or migraine (adjusted odds ratio [aOR], 2.02; 95% CI, 1.19-3.43).

No significant association was found between low SHS exposure and severe headaches or migraine (aOR, 1.15; 95% CI, 0.91-1.47).

In participants who were sedentary (P=.016) and those with a BMI <25 (P=.001), significant associations between SHS and severe headache or migraine were observed.

IN PRACTICE:

Noting a linear dose-response relationship between cotinine and severe headaches or migraine, the investigators write, “These findings underscore the need for stronger regulation of tobacco exposure, particularly in homes and public places.”

SOURCE:

Junpeng Wu, MMc, and Haitang Wang, MD, of Southern Medical University in Guangzhou, China, and their colleagues conducted the study. It was published online in Headache.

LIMITATIONS:

The study could not establish causal relationships between SHS and migraine or severe headache. In addition, the half-life of serum cotinine is 15-40 hours and thus this measure can reflect only recent SHS exposure.

DISCLOSURES:

The study was not funded. The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Heavy secondhand smoke (SHS) exposure is associated with severe headache or migraine in adults who have never smoked, with effects of exposure varying depending on body mass index (BMI) and level of physical activity, new research shows.

METHODOLOGY:

Investigators analyzed data on 4,560 participants (median age, 43 years; 60% female; 71.5% White) from the 1999-2004 National Health and Nutrition Examination Survey.

Participants were aged 20 years or older and had never smoked.

Migraine headache status was determined by asking whether participants experienced severe headaches or migraines during the previous 3 months.

SHS exposure was categorized as unexposed (serum cotinine levels <0.05 ng/mL and no smoker in the home), low (0.05 ng/mL ≤ serum cotinine level <1 ng/mL), or heavy (1 ng/mL ≤ serum cotinine level ≤ 10 ng/mL).

TAKEAWAY:

In all, 919 (20%) participants had severe headaches or migraines.

After adjustment for demographic and lifestyle factors (including medication use), heavy SHS exposure was positively associated with severe headache or migraine (adjusted odds ratio [aOR], 2.02; 95% CI, 1.19-3.43).

No significant association was found between low SHS exposure and severe headaches or migraine (aOR, 1.15; 95% CI, 0.91-1.47).

In participants who were sedentary (P=.016) and those with a BMI <25 (P=.001), significant associations between SHS and severe headache or migraine were observed.

IN PRACTICE:

Noting a linear dose-response relationship between cotinine and severe headaches or migraine, the investigators write, “These findings underscore the need for stronger regulation of tobacco exposure, particularly in homes and public places.”

SOURCE:

Junpeng Wu, MMc, and Haitang Wang, MD, of Southern Medical University in Guangzhou, China, and their colleagues conducted the study. It was published online in Headache.

LIMITATIONS:

The study could not establish causal relationships between SHS and migraine or severe headache. In addition, the half-life of serum cotinine is 15-40 hours and thus this measure can reflect only recent SHS exposure.

DISCLOSURES:

The study was not funded. The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.

The American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) have issued an updated guideline for preventing and optimally managing atrial fibrillation (AF).

The 2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation was published online in the Journal of the American College of Cardiology and Circulation.

“The new guideline has important changes,” including a new way to classify AF, Jose Joglar, MD, professor of cardiac electrophysiology at UT Southwestern Medical Center in Dallas, Texas, and chair of the writing committee, said in an interview.

The previous classification was largely based only on arrhythmia duration and tended to emphasize specific therapeutic interventions rather than a more holistic and multidisciplinary management approach, Dr. Joglar explained.

The new proposed classification, using four stages, recognizes AF as a disease continuum that requires a variety of strategies at different stages, from prevention, lifestyle and risk factor modification, screening, and therapy.

Stage 1: At risk for AF due to the presence of risk factors

Stage 2: Pre-AF, with evidence of structural or electrical findings predisposing to AF

Stage 3: AF, including paroxysmal (3A), persistent (3B), long-standing persistent (3C), successful AF ablation (3D)

Stage 4: Permanent AF

The updated guideline recognizes lifestyle and risk factor modification as a “pillar” of AF management and offers “more prescriptive” recommendations, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities.

“We should not only be telling patients they need to be healthy, which doesn’t mean much to a patient, we need to tell them precisely what they need to do. For example, how much exercise to do or how much weight to lose to have a benefit,” Dr. Joglar said in an interview.

The good news for many people, he noted, is that coffee, which has had a “bad reputation,” is okay, as the latest data show it doesn’t seem to exacerbate AF.

The new guideline continues to endorse use of the CHA2DS2-VASc score as the predictor of choice to determine the risk of stroke, but it also allows for flexibility to use other calculators when uncertainty exists or when other risk factors, such as kidney disease, need to be included.

With the emergence of “new and consistent” evidence, the guideline also emphasizes the importance of early and continued management of patients with AF with a focus on maintaining sinus rhythm and minimizing AF burden.

Catheter ablation of AF is given a class 1 indication as first-line therapy in selected patients, including those with heart failure with reduced ejection fraction.

That’s based on recent randomized studies that have shown catheter ablation to be “superior to pharmacological therapy” for rhythm control in appropriately selected patients, Dr. Joglar told this news organization.

“There’s no need to try pharmacological therapies after a discussion between the patient and doctor and they decide that they want to proceed with the most effective intervention,” he added.

The new guideline also upgrades the class of recommendation for left atrial appendage occlusion devices to 2a, compared with the 2019 AF Focused Update, for use of these devices in patients with long-term contraindications to anticoagulation.

It also provides updated recommendations for AF detected via implantable devices and wearables as well as recommendations for patients with AF identified during medical illness or surgery.

Development of the guideline had no commercial funding. Disclosures for the writing group are available with the original articles.

A version of this article appeared on Medscape.com.

The American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) have issued an updated guideline for preventing and optimally managing atrial fibrillation (AF).

The 2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation was published online in the Journal of the American College of Cardiology and Circulation.

“The new guideline has important changes,” including a new way to classify AF, Jose Joglar, MD, professor of cardiac electrophysiology at UT Southwestern Medical Center in Dallas, Texas, and chair of the writing committee, said in an interview.

The previous classification was largely based only on arrhythmia duration and tended to emphasize specific therapeutic interventions rather than a more holistic and multidisciplinary management approach, Dr. Joglar explained.

The new proposed classification, using four stages, recognizes AF as a disease continuum that requires a variety of strategies at different stages, from prevention, lifestyle and risk factor modification, screening, and therapy.

Stage 1: At risk for AF due to the presence of risk factors

Stage 2: Pre-AF, with evidence of structural or electrical findings predisposing to AF

Stage 3: AF, including paroxysmal (3A), persistent (3B), long-standing persistent (3C), successful AF ablation (3D)

Stage 4: Permanent AF

The updated guideline recognizes lifestyle and risk factor modification as a “pillar” of AF management and offers “more prescriptive” recommendations, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities.

“We should not only be telling patients they need to be healthy, which doesn’t mean much to a patient, we need to tell them precisely what they need to do. For example, how much exercise to do or how much weight to lose to have a benefit,” Dr. Joglar said in an interview.

The good news for many people, he noted, is that coffee, which has had a “bad reputation,” is okay, as the latest data show it doesn’t seem to exacerbate AF.

The new guideline continues to endorse use of the CHA2DS2-VASc score as the predictor of choice to determine the risk of stroke, but it also allows for flexibility to use other calculators when uncertainty exists or when other risk factors, such as kidney disease, need to be included.

With the emergence of “new and consistent” evidence, the guideline also emphasizes the importance of early and continued management of patients with AF with a focus on maintaining sinus rhythm and minimizing AF burden.

Catheter ablation of AF is given a class 1 indication as first-line therapy in selected patients, including those with heart failure with reduced ejection fraction.

That’s based on recent randomized studies that have shown catheter ablation to be “superior to pharmacological therapy” for rhythm control in appropriately selected patients, Dr. Joglar told this news organization.

“There’s no need to try pharmacological therapies after a discussion between the patient and doctor and they decide that they want to proceed with the most effective intervention,” he added.

The new guideline also upgrades the class of recommendation for left atrial appendage occlusion devices to 2a, compared with the 2019 AF Focused Update, for use of these devices in patients with long-term contraindications to anticoagulation.

It also provides updated recommendations for AF detected via implantable devices and wearables as well as recommendations for patients with AF identified during medical illness or surgery.

Development of the guideline had no commercial funding. Disclosures for the writing group are available with the original articles.

A version of this article appeared on Medscape.com.

The American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) have issued an updated guideline for preventing and optimally managing atrial fibrillation (AF).

The 2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation was published online in the Journal of the American College of Cardiology and Circulation.

“The new guideline has important changes,” including a new way to classify AF, Jose Joglar, MD, professor of cardiac electrophysiology at UT Southwestern Medical Center in Dallas, Texas, and chair of the writing committee, said in an interview.

The previous classification was largely based only on arrhythmia duration and tended to emphasize specific therapeutic interventions rather than a more holistic and multidisciplinary management approach, Dr. Joglar explained.

The new proposed classification, using four stages, recognizes AF as a disease continuum that requires a variety of strategies at different stages, from prevention, lifestyle and risk factor modification, screening, and therapy.

Stage 1: At risk for AF due to the presence of risk factors

Stage 2: Pre-AF, with evidence of structural or electrical findings predisposing to AF

Stage 3: AF, including paroxysmal (3A), persistent (3B), long-standing persistent (3C), successful AF ablation (3D)

Stage 4: Permanent AF

The updated guideline recognizes lifestyle and risk factor modification as a “pillar” of AF management and offers “more prescriptive” recommendations, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities.

“We should not only be telling patients they need to be healthy, which doesn’t mean much to a patient, we need to tell them precisely what they need to do. For example, how much exercise to do or how much weight to lose to have a benefit,” Dr. Joglar said in an interview.

The good news for many people, he noted, is that coffee, which has had a “bad reputation,” is okay, as the latest data show it doesn’t seem to exacerbate AF.

The new guideline continues to endorse use of the CHA2DS2-VASc score as the predictor of choice to determine the risk of stroke, but it also allows for flexibility to use other calculators when uncertainty exists or when other risk factors, such as kidney disease, need to be included.

With the emergence of “new and consistent” evidence, the guideline also emphasizes the importance of early and continued management of patients with AF with a focus on maintaining sinus rhythm and minimizing AF burden.

Catheter ablation of AF is given a class 1 indication as first-line therapy in selected patients, including those with heart failure with reduced ejection fraction.

That’s based on recent randomized studies that have shown catheter ablation to be “superior to pharmacological therapy” for rhythm control in appropriately selected patients, Dr. Joglar told this news organization.

“There’s no need to try pharmacological therapies after a discussion between the patient and doctor and they decide that they want to proceed with the most effective intervention,” he added.

The new guideline also upgrades the class of recommendation for left atrial appendage occlusion devices to 2a, compared with the 2019 AF Focused Update, for use of these devices in patients with long-term contraindications to anticoagulation.

It also provides updated recommendations for AF detected via implantable devices and wearables as well as recommendations for patients with AF identified during medical illness or surgery.

Development of the guideline had no commercial funding. Disclosures for the writing group are available with the original articles.

A version of this article appeared on Medscape.com.

CHEST 2023 in Honolulu kicked off for Network Leadership during the Council of Networks meeting. Leadership from the seven Networks presented their plans for CHEST 2023, participation in proposed guidelines, CHEST projects completed over the past year, and other accomplishments.

We congratulated our Network leaders – Margaret Pisani, Council of Networks Vice-chair, who was awarded the Roger C. Bone Memorial Lecture in Critical Care; and Jean Elwing, Chair of the Pulmonary Vascular & Cardiovascular Network, for being awarded the Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology. CHEST 2023 included excellent educational content by the Networks, including two Network highlights per each of the seven Networks, as well as an Experience CHEST submission from each of the 22 sections.

We also had the opportunity to meet face-to-face at the Network Open Forums, the Network Mixer, and the inaugural Fellow-in-Training Mixer in the Trainee Lounge. We saw a lot of familiar faces at these events, and 182 new individuals also signed up to become Network members.

There will be one final Council of Networks leadership meeting in December prior to our leadership transition in January.

We thank outgoing Network chairs, Dr. Marcos Restrepo of the Chest Infections & Disaster Response Network, Dr. Christopher Carroll of the Critical Care Network, Dr. Debbie Levine of the Diffuse Lung Disease & Lung Transplant Network, and Dr. Carolyn D’Ambrosio of the Sleep Medicine Network, for their leadership and hard work dedicated to the Networks that have greatly benefited from their service.



Cassie Kennedy, MD, FCCP – Chair, Council of Networks

Margaret Pisani, MD, MPH, FCCP – Vice-Chair, Council of Networks

CHEST 2023 in Honolulu kicked off for Network Leadership during the Council of Networks meeting. Leadership from the seven Networks presented their plans for CHEST 2023, participation in proposed guidelines, CHEST projects completed over the past year, and other accomplishments.

We congratulated our Network leaders – Margaret Pisani, Council of Networks Vice-chair, who was awarded the Roger C. Bone Memorial Lecture in Critical Care; and Jean Elwing, Chair of the Pulmonary Vascular & Cardiovascular Network, for being awarded the Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology. CHEST 2023 included excellent educational content by the Networks, including two Network highlights per each of the seven Networks, as well as an Experience CHEST submission from each of the 22 sections.

We also had the opportunity to meet face-to-face at the Network Open Forums, the Network Mixer, and the inaugural Fellow-in-Training Mixer in the Trainee Lounge. We saw a lot of familiar faces at these events, and 182 new individuals also signed up to become Network members.

There will be one final Council of Networks leadership meeting in December prior to our leadership transition in January.

We thank outgoing Network chairs, Dr. Marcos Restrepo of the Chest Infections & Disaster Response Network, Dr. Christopher Carroll of the Critical Care Network, Dr. Debbie Levine of the Diffuse Lung Disease & Lung Transplant Network, and Dr. Carolyn D’Ambrosio of the Sleep Medicine Network, for their leadership and hard work dedicated to the Networks that have greatly benefited from their service.



Cassie Kennedy, MD, FCCP – Chair, Council of Networks

Margaret Pisani, MD, MPH, FCCP – Vice-Chair, Council of Networks

CHEST 2023 in Honolulu kicked off for Network Leadership during the Council of Networks meeting. Leadership from the seven Networks presented their plans for CHEST 2023, participation in proposed guidelines, CHEST projects completed over the past year, and other accomplishments.

We congratulated our Network leaders – Margaret Pisani, Council of Networks Vice-chair, who was awarded the Roger C. Bone Memorial Lecture in Critical Care; and Jean Elwing, Chair of the Pulmonary Vascular & Cardiovascular Network, for being awarded the Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology. CHEST 2023 included excellent educational content by the Networks, including two Network highlights per each of the seven Networks, as well as an Experience CHEST submission from each of the 22 sections.

We also had the opportunity to meet face-to-face at the Network Open Forums, the Network Mixer, and the inaugural Fellow-in-Training Mixer in the Trainee Lounge. We saw a lot of familiar faces at these events, and 182 new individuals also signed up to become Network members.

There will be one final Council of Networks leadership meeting in December prior to our leadership transition in January.

We thank outgoing Network chairs, Dr. Marcos Restrepo of the Chest Infections & Disaster Response Network, Dr. Christopher Carroll of the Critical Care Network, Dr. Debbie Levine of the Diffuse Lung Disease & Lung Transplant Network, and Dr. Carolyn D’Ambrosio of the Sleep Medicine Network, for their leadership and hard work dedicated to the Networks that have greatly benefited from their service.



Cassie Kennedy, MD, FCCP – Chair, Council of Networks

Margaret Pisani, MD, MPH, FCCP – Vice-Chair, Council of Networks

Using small-volume rather than standard-volume collection tubes to draw blood for laboratory testing may reduce the incidence of anemia and the need for red blood cell (RBC) transfusion in intensive care units (ICUs), according to a new study. The change does not appear to impair biospecimen sufficiency for lab analysis.

In addition, by reducing blood transfusion during ICU admission by about 10 units per 100 patients, the change may enable hospitals and health systems to sustain blood product supply during ongoing worldwide shortages.

“It doesn’t take long working in a hospital or being a patient or family member to realize how much blood we take to do lab work. As a result, patients may develop anemia and low RBC counts, which can be associated with worse health outcomes,” lead author Deborah Siegal, MD, a hematologist at the Ottawa Hospital and associate professor of medicine at the University of Ottawa, said in an interview.

“Unfortunately, the majority of the blood we take is discarded as waste,” she said. “Here’s an opportunity to move the needle on reducing anemia in hospitalized patients, where the benefit also doesn’t come at a cost.”

The study was published online in JAMA.
 

Reducing Blood Loss

Among ICU patients with critical illness, there is a high prevalence of anemia, Siegal noted. More than 90% of these patients have some degree of anemia after a 3-day stay. Typically, RBC transfusions are given to correct the low blood counts, and as many as 40% of ICU patients receive at least one RBC transfusion. Anemia and RBC transfusion are each associated with adverse outcomes, including higher mortality and longer ICU and hospital stays.

Although anemia in critically ill ICU patients can have several causes, blood sampling can be substantial because of the need to draw multiple tubes several times per day. During 8 days in an ICU, the amount of blood drawn equals about 1 unit of whole blood, the authors noted, and ICU patients often struggle to increase RBC production and compensate for blood loss.

Even then, only 10% of the blood collected is required for lab testing; the remaining 90% is often discarded as waste, the authors noted. Small-volume tubes (1.8 to 3.5 mL), which are designed to draw about 50% less than standard-volume tubes (4 to 6 mL) by using less vacuum strength, are of the same size and cost as standard-volume tubes, and the collection technique is the same. They are produced by the same manufacturers and are compatible with existing lab equipment.

Siegal and colleagues conducted a stepped-wedge cluster randomized trial to test the switch to small-volume tubes in 25 adult medical-surgical ICUs in Canada between February 2019 and January 2021. They analyzed data from more than 27,000 patients admitted to the ICU for 48 hours or longer. ICUs were randomly assigned to switch from standard-volume tubes to small-volume tubes for lab testing. The research team primarily assessed RBC transfusion in units per patient per ICU stay, as well as hemoglobin decrease during ICU stay, length of stay in the ICU and hospital, mortality in the ICU and hospital, and specimen tubes with insufficient volume for testing.

In a primary analysis of 21,201 patients, which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference between tube-volume groups in RBC units per patient per ICU stay (relative risk [RR], 0.91). However, there was an absolute reduction of 7.24 RBC units per 100 patients per ICU stay in the small-volume group.

In addition, in a prespecified secondary analysis of 27,411 patients, RBC units per patient per ICU stay significantly decreased (RR, 0.88) after the switch to small-volume tubes, and there was an absolute reduction of 9.84 RBC units per 100 patients per ICU stay.

Overall, the median decrease in transfusion-adjusted hemoglobin wasn’t significantly different in the primary analysis but was lower in the secondary analysis. The frequency of specimens with insufficient volume for testing was low (≤0.03%) before and after the transition to small-volume tubes.

About 36,000 units of blood were given to ICU patients during the study period. The use of small-volume tubes may have saved about 1500 RBC units, the authors estimated.

“This could be an important way to help preserve the supply of blood products for patients who need them, including those undergoing cancer treatment, surgery, trauma, or other medical illnesses,” Siegal said. “The other great aspect is that this was implemented by people on the ground in the ICUs, and it’s still in use in most of those hospitals today.”

The investigators noted the need to study the switch in other patient populations, such as non-ICU hospitalized patients or outpatient settings. For instance, ICU patients often have central venous or arterial catheters for blood draws, but small-volume tubes can be used with venipuncture and could lead to additional benefits there as well.
 

Implementing Change

Commenting on the findings for this article, Lisa Hicks, MD, a hematologist at St. Michael’s Hospital and associate professor of medicine at the University of Toronto, said, “Routinely collecting smaller volumes of blood for diagnostic testing appears to be feasible and does not cause problems with inadequate sampling. Whether this strategy decreases transfusion is more complicated.” Hicks did not participate in the study.

“At the end of the day, we still don’t know with certainty whether reduced-volume blood collection tubes decrease transfusion burden in ICU patients — it’s possible that there are so many other factors driving down hemoglobin in this population that the impact of blood collection volume is modest to negligible,” she said. “On the other hand, it’s also possible that there is an important impact that was masked by the relatively short ICU stays in the included population.”

Hicks has researched ways to reduce unnecessary diagnostic phlebotomy in ICUs. She and colleagues found that targeting clinicians’ test ordering behavior can decrease blood draws and RBC transfusions.

“What we now know, thanks to Siegal et al, is that we don’t need to collect nearly as much blood from our ICU patients as we do, raising the question of which strategy should really be standard,” she said. “My vote goes for more blood in the patient and less in the bin.”

The study was funded by a peer-reviewed grant from the Academic Health Sciences Centers AFP Innovation Fund/Hamilton Academic Health Sciences Organization and the Hamilton Health Sciences Research Institute through the Population Health Research Institute. Siegal, who is supported by a Tier 2 Canada Research Chair in Anticoagulant Management of Cardiovascular Disease, reported honoraria for presentations paid indirectly to her institution from BMS-Pfizer, AstraZeneca, Servier, and Roche outside of the submitted work. Hicks reported no relevant financial relationships.

A version of this article appeared on Medscape.com.

Using small-volume rather than standard-volume collection tubes to draw blood for laboratory testing may reduce the incidence of anemia and the need for red blood cell (RBC) transfusion in intensive care units (ICUs), according to a new study. The change does not appear to impair biospecimen sufficiency for lab analysis.

In addition, by reducing blood transfusion during ICU admission by about 10 units per 100 patients, the change may enable hospitals and health systems to sustain blood product supply during ongoing worldwide shortages.

“It doesn’t take long working in a hospital or being a patient or family member to realize how much blood we take to do lab work. As a result, patients may develop anemia and low RBC counts, which can be associated with worse health outcomes,” lead author Deborah Siegal, MD, a hematologist at the Ottawa Hospital and associate professor of medicine at the University of Ottawa, said in an interview.

“Unfortunately, the majority of the blood we take is discarded as waste,” she said. “Here’s an opportunity to move the needle on reducing anemia in hospitalized patients, where the benefit also doesn’t come at a cost.”

The study was published online in JAMA.
 

Reducing Blood Loss

Among ICU patients with critical illness, there is a high prevalence of anemia, Siegal noted. More than 90% of these patients have some degree of anemia after a 3-day stay. Typically, RBC transfusions are given to correct the low blood counts, and as many as 40% of ICU patients receive at least one RBC transfusion. Anemia and RBC transfusion are each associated with adverse outcomes, including higher mortality and longer ICU and hospital stays.

Although anemia in critically ill ICU patients can have several causes, blood sampling can be substantial because of the need to draw multiple tubes several times per day. During 8 days in an ICU, the amount of blood drawn equals about 1 unit of whole blood, the authors noted, and ICU patients often struggle to increase RBC production and compensate for blood loss.

Even then, only 10% of the blood collected is required for lab testing; the remaining 90% is often discarded as waste, the authors noted. Small-volume tubes (1.8 to 3.5 mL), which are designed to draw about 50% less than standard-volume tubes (4 to 6 mL) by using less vacuum strength, are of the same size and cost as standard-volume tubes, and the collection technique is the same. They are produced by the same manufacturers and are compatible with existing lab equipment.

Siegal and colleagues conducted a stepped-wedge cluster randomized trial to test the switch to small-volume tubes in 25 adult medical-surgical ICUs in Canada between February 2019 and January 2021. They analyzed data from more than 27,000 patients admitted to the ICU for 48 hours or longer. ICUs were randomly assigned to switch from standard-volume tubes to small-volume tubes for lab testing. The research team primarily assessed RBC transfusion in units per patient per ICU stay, as well as hemoglobin decrease during ICU stay, length of stay in the ICU and hospital, mortality in the ICU and hospital, and specimen tubes with insufficient volume for testing.

In a primary analysis of 21,201 patients, which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference between tube-volume groups in RBC units per patient per ICU stay (relative risk [RR], 0.91). However, there was an absolute reduction of 7.24 RBC units per 100 patients per ICU stay in the small-volume group.

In addition, in a prespecified secondary analysis of 27,411 patients, RBC units per patient per ICU stay significantly decreased (RR, 0.88) after the switch to small-volume tubes, and there was an absolute reduction of 9.84 RBC units per 100 patients per ICU stay.

Overall, the median decrease in transfusion-adjusted hemoglobin wasn’t significantly different in the primary analysis but was lower in the secondary analysis. The frequency of specimens with insufficient volume for testing was low (≤0.03%) before and after the transition to small-volume tubes.

About 36,000 units of blood were given to ICU patients during the study period. The use of small-volume tubes may have saved about 1500 RBC units, the authors estimated.

“This could be an important way to help preserve the supply of blood products for patients who need them, including those undergoing cancer treatment, surgery, trauma, or other medical illnesses,” Siegal said. “The other great aspect is that this was implemented by people on the ground in the ICUs, and it’s still in use in most of those hospitals today.”

The investigators noted the need to study the switch in other patient populations, such as non-ICU hospitalized patients or outpatient settings. For instance, ICU patients often have central venous or arterial catheters for blood draws, but small-volume tubes can be used with venipuncture and could lead to additional benefits there as well.
 

Implementing Change

Commenting on the findings for this article, Lisa Hicks, MD, a hematologist at St. Michael’s Hospital and associate professor of medicine at the University of Toronto, said, “Routinely collecting smaller volumes of blood for diagnostic testing appears to be feasible and does not cause problems with inadequate sampling. Whether this strategy decreases transfusion is more complicated.” Hicks did not participate in the study.

“At the end of the day, we still don’t know with certainty whether reduced-volume blood collection tubes decrease transfusion burden in ICU patients — it’s possible that there are so many other factors driving down hemoglobin in this population that the impact of blood collection volume is modest to negligible,” she said. “On the other hand, it’s also possible that there is an important impact that was masked by the relatively short ICU stays in the included population.”

Hicks has researched ways to reduce unnecessary diagnostic phlebotomy in ICUs. She and colleagues found that targeting clinicians’ test ordering behavior can decrease blood draws and RBC transfusions.

“What we now know, thanks to Siegal et al, is that we don’t need to collect nearly as much blood from our ICU patients as we do, raising the question of which strategy should really be standard,” she said. “My vote goes for more blood in the patient and less in the bin.”

The study was funded by a peer-reviewed grant from the Academic Health Sciences Centers AFP Innovation Fund/Hamilton Academic Health Sciences Organization and the Hamilton Health Sciences Research Institute through the Population Health Research Institute. Siegal, who is supported by a Tier 2 Canada Research Chair in Anticoagulant Management of Cardiovascular Disease, reported honoraria for presentations paid indirectly to her institution from BMS-Pfizer, AstraZeneca, Servier, and Roche outside of the submitted work. Hicks reported no relevant financial relationships.

A version of this article appeared on Medscape.com.

Using small-volume rather than standard-volume collection tubes to draw blood for laboratory testing may reduce the incidence of anemia and the need for red blood cell (RBC) transfusion in intensive care units (ICUs), according to a new study. The change does not appear to impair biospecimen sufficiency for lab analysis.

In addition, by reducing blood transfusion during ICU admission by about 10 units per 100 patients, the change may enable hospitals and health systems to sustain blood product supply during ongoing worldwide shortages.

“It doesn’t take long working in a hospital or being a patient or family member to realize how much blood we take to do lab work. As a result, patients may develop anemia and low RBC counts, which can be associated with worse health outcomes,” lead author Deborah Siegal, MD, a hematologist at the Ottawa Hospital and associate professor of medicine at the University of Ottawa, said in an interview.

“Unfortunately, the majority of the blood we take is discarded as waste,” she said. “Here’s an opportunity to move the needle on reducing anemia in hospitalized patients, where the benefit also doesn’t come at a cost.”

The study was published online in JAMA.
 

Reducing Blood Loss

Among ICU patients with critical illness, there is a high prevalence of anemia, Siegal noted. More than 90% of these patients have some degree of anemia after a 3-day stay. Typically, RBC transfusions are given to correct the low blood counts, and as many as 40% of ICU patients receive at least one RBC transfusion. Anemia and RBC transfusion are each associated with adverse outcomes, including higher mortality and longer ICU and hospital stays.

Although anemia in critically ill ICU patients can have several causes, blood sampling can be substantial because of the need to draw multiple tubes several times per day. During 8 days in an ICU, the amount of blood drawn equals about 1 unit of whole blood, the authors noted, and ICU patients often struggle to increase RBC production and compensate for blood loss.

Even then, only 10% of the blood collected is required for lab testing; the remaining 90% is often discarded as waste, the authors noted. Small-volume tubes (1.8 to 3.5 mL), which are designed to draw about 50% less than standard-volume tubes (4 to 6 mL) by using less vacuum strength, are of the same size and cost as standard-volume tubes, and the collection technique is the same. They are produced by the same manufacturers and are compatible with existing lab equipment.

Siegal and colleagues conducted a stepped-wedge cluster randomized trial to test the switch to small-volume tubes in 25 adult medical-surgical ICUs in Canada between February 2019 and January 2021. They analyzed data from more than 27,000 patients admitted to the ICU for 48 hours or longer. ICUs were randomly assigned to switch from standard-volume tubes to small-volume tubes for lab testing. The research team primarily assessed RBC transfusion in units per patient per ICU stay, as well as hemoglobin decrease during ICU stay, length of stay in the ICU and hospital, mortality in the ICU and hospital, and specimen tubes with insufficient volume for testing.

In a primary analysis of 21,201 patients, which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference between tube-volume groups in RBC units per patient per ICU stay (relative risk [RR], 0.91). However, there was an absolute reduction of 7.24 RBC units per 100 patients per ICU stay in the small-volume group.

In addition, in a prespecified secondary analysis of 27,411 patients, RBC units per patient per ICU stay significantly decreased (RR, 0.88) after the switch to small-volume tubes, and there was an absolute reduction of 9.84 RBC units per 100 patients per ICU stay.

Overall, the median decrease in transfusion-adjusted hemoglobin wasn’t significantly different in the primary analysis but was lower in the secondary analysis. The frequency of specimens with insufficient volume for testing was low (≤0.03%) before and after the transition to small-volume tubes.

About 36,000 units of blood were given to ICU patients during the study period. The use of small-volume tubes may have saved about 1500 RBC units, the authors estimated.

“This could be an important way to help preserve the supply of blood products for patients who need them, including those undergoing cancer treatment, surgery, trauma, or other medical illnesses,” Siegal said. “The other great aspect is that this was implemented by people on the ground in the ICUs, and it’s still in use in most of those hospitals today.”

The investigators noted the need to study the switch in other patient populations, such as non-ICU hospitalized patients or outpatient settings. For instance, ICU patients often have central venous or arterial catheters for blood draws, but small-volume tubes can be used with venipuncture and could lead to additional benefits there as well.
 

Implementing Change

Commenting on the findings for this article, Lisa Hicks, MD, a hematologist at St. Michael’s Hospital and associate professor of medicine at the University of Toronto, said, “Routinely collecting smaller volumes of blood for diagnostic testing appears to be feasible and does not cause problems with inadequate sampling. Whether this strategy decreases transfusion is more complicated.” Hicks did not participate in the study.

“At the end of the day, we still don’t know with certainty whether reduced-volume blood collection tubes decrease transfusion burden in ICU patients — it’s possible that there are so many other factors driving down hemoglobin in this population that the impact of blood collection volume is modest to negligible,” she said. “On the other hand, it’s also possible that there is an important impact that was masked by the relatively short ICU stays in the included population.”

Hicks has researched ways to reduce unnecessary diagnostic phlebotomy in ICUs. She and colleagues found that targeting clinicians’ test ordering behavior can decrease blood draws and RBC transfusions.

“What we now know, thanks to Siegal et al, is that we don’t need to collect nearly as much blood from our ICU patients as we do, raising the question of which strategy should really be standard,” she said. “My vote goes for more blood in the patient and less in the bin.”

The study was funded by a peer-reviewed grant from the Academic Health Sciences Centers AFP Innovation Fund/Hamilton Academic Health Sciences Organization and the Hamilton Health Sciences Research Institute through the Population Health Research Institute. Siegal, who is supported by a Tier 2 Canada Research Chair in Anticoagulant Management of Cardiovascular Disease, reported honoraria for presentations paid indirectly to her institution from BMS-Pfizer, AstraZeneca, Servier, and Roche outside of the submitted work. Hicks reported no relevant financial relationships.

A version of this article appeared on Medscape.com.

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.