October 8, 2025
Written By
Michael Minh Le
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You’re interested in being a doctor, specifically one that focuses on lungs and breathing, but beyond that, you don’t know how to do that. How do you become a pulmonologist? How long does it take? What’s the first step?
This guide lays out exactly what you need to know: what pulmonologists really do, how they differ from cardiologists and respiratory therapists, the full education and training timeline from college to fellowship, what life in this specialty looks like, and whether it’s truly the right fit for you.
And if med school is your next goal, the work starts now. But how do you make sure what you’re doing will matter on your application? The best way is to study applications that have already earned acceptances. That’s why, at Premed Catalyst, we created an Application Database that gives you unlimited access to 8 real AMCAS applications that earned acceptances to top medical schools. And it’s completely free.
Get your free resource here and reverse engineer what works.
Your respiratory system is everything that helps you breathe. That’s your nose, throat, windpipe, lungs, and all the tiny tubes and sacs inside those lungs that trade carbon dioxide for oxygen. That process? It keeps every single cell in your body alive.
No oxygen, no life.
A pulmonologist is a doctor who specializes in that entire system. Think of them as mechanics for your body’s airways. They diagnose, treat, and manage everything that messes with your ability to breathe.
You’ve probably heard people say things like “lung doctor” or “chest specialist.” Those nicknames? They miss the full picture. Pulmonologists don’t just deal with lungs in isolation. They understand how lung problems affect, and are affected by, your heart, your brain, your sleep, your immune system.
So what do pulmonologists actually treat? Everything from asthma and COPD, to lung infections, sleep apnea, interstitial lung disease, and even lung cancer. And yes, long COVID too.
And here’s the part most people don’t realize: a huge number of pulmonologists are also critical care doctors. That means they’re the ones running the ICU, managing life support machines, putting in breathing tubes, and making minute-by-minute decisions when someone’s lungs or even their entire body is failing.
Pulmonologists don’t work in a vacuum. They’re part of a much bigger ecosystem of healthcare professionals who all deal with different parts of the body or different parts of the breathing process. But not all “breath experts” do the same thing.
Let’s clear up the differences between pulmonologists and a few other key players in the world of medicine.
Pulmonologists and cardiologists work side by side all the time because your lungs and heart are a team. The lungs bring in oxygen. The heart pumps it everywhere else. Air and blood. That’s the duo.
So what’s the difference between what these doctors do?
Pulmonologists specialize in the airway. That’s the movement of oxygen into the body and carbon dioxide out. Cardiologists specialize in the highway. That’s the blood vessels and heart that transport that oxygen.
When someone’s short of breath, it could be a lung problem (like pneumonia or asthma) or a heart issue (like heart failure). Pulmonologists figure out what’s clogging the air. Cardiologists figure out what’s blocking the flow.
Here’s another common confusion: what’s the difference between a pulmonologist and a respiratory therapist (RT)?
Both deal with breathing. But they’re not the same.
A pulmonologist is a physician (MD or DO). They’re someone who went through medical school, residency, and often fellowship training. They diagnose, prescribe, and make the call on complex treatment plans.
A respiratory therapist is an allied health professional who works directly with patients, often in hospitals, ICUs, and emergency departments. RTs are the hands-on experts when it comes to managing ventilators, giving breathing treatments, and making sure a patient’s oxygen levels stay where they need to be.
Think of it this way: the pulmonologist writes the treatment plan. The respiratory therapist carries out the treatment plan.
Becoming a pulmonologist takes over a decade of school, training, and clinical experience. It’s not a quick path, but for the right person, it’s 100% worth it.
Let’s walk through every step, from undergrad to becoming a board-certified lung and ICU expert.
Your first step? Get a Bachelor’s degree while completing your premed requirements. That means classes in:
You can major in anything, whether that’s biology, chemistry, psychology, or even history, but most students choose science-heavy majors to align with the prereqs.
And your GPA and MCAT score matter. A lot. You’ll need at least a 3.7+ GPA and an MCAT in the 510+ range to be competitive for top med schools.
Med school AdComs aren’t just looking for numbers. They’re looking for a cohesive story.
Your clinical hours, research, leadership, and volunteering all need to point to a theme, not just a bunch of random boxes you checked. If you’re interested in pulmonary or ICU medicine, let that show in your experiences.
You’ll need to write a strong personal statement that ties your journey together, respond to secondary essays that show mission-fit, submit letters of recommendation from doctors or professors who know you well, and show emotional intelligence in the interview.
It’s competitive, but if your narrative is authentic and focused, you’ll stand out.
Years 1–2 are mostly classroom-based. You’ll learn anatomy, physiology, pharmacology, pathology, and everything else foundational to medicine. Around the end of your second year, you’ll take USMLE Step 1, a high-stakes exam that helps determine your residency options.
Years 3–4 are your clinical rotations. You’ll actually work in hospitals. You’ll rotate through internal medicine, surgery, pediatrics, OB-GYN, psychiatry, and more. This is also where you can start getting exposure to pulmonology, especially through internal medicine and ICU rotations. You’ll also take USMLE Step 2 during this time.
To become a pulmonologist, you first need to complete an internal medicine residency. That’s three years of non-stop training in how to diagnose and manage adult patients.
You’ll handle complex medical cases, work overnight shifts, and be thrown into the chaos of the ICU early. Expect to build sharp diagnostic instincts and develop clinical confidence fast. You’ll learn to juggle multiple patients, think critically under pressure, and manage everything from sepsis to shortness of breath.
After residency, you apply for a pulmonary and critical care medicine fellowship, which is usually 2 to 3 years long. This is the deep dive.
You’ll become an expert in:
Many fellows also choose to subspecialize even further in:
At the end, you’ll take the American Board of Internal Medicine (ABIM) exams to become board-certified in pulmonary medicine (and critical care, if applicable).
So what does a pulmonologist actually do all day?
The short answer: a little bit of everything.
The longer answer? It depends on your setting: hospital, clinic, ICU, academic center, or private practice.
Here’s a breakdown of what you can expect:
Procedural time can be built into your schedule, whether you’re hospital-based or in private practice. You’ll do bronchoscopies, thoracenteses, and biopsies either in a dedicated procedure suite or bedside in the ICU.
Most pulmonologists also take turns doing consults. So you may be paged to evaluate patients throughout the hospital for new or worsening respiratory symptoms.
Pulmonologists aren’t just diagnosticians. They’re proceduralists. Over time, you’ll get comfortable with:
You’re not in the OR every day like a surgeon, but you are doing hands-on procedures that can be life-changing and sometimes life-saving.
Pulmonologists don’t fly solo. You’re constantly collaborating with:
Pulmonology isn’t just a rewarding specialty. It’s one with strong job security and room to grow. Let’s break down what you can expect in terms of salary, demand, and long-term career flexibility.
In the U.S., pulmonologists typically earn $300,000 to $450,000+ per year, depending on experience, location, and subspecialty. Those who double as critical care physicians or work in high-demand urban centers can earn significantly more, especially if they take on ICU night shifts or work in private groups.
Factors that impact salary:
The demand for pulmonologists is growing, and fast.
Here’s why:
In short? People need help breathing, and that need isn’t going away.
Pulmonology also offers one of the most flexible and customizable careers in medicine.
You can:
Pulmonology is a deeply meaningful specialty, but it’s not without its hard edges. For all the life-saving moments and technical mastery, there are real challenges that don’t always get airtime in med school brochures.
Here’s what you should know before committing to the field.
You’re often the one helping patients manage chronic illnesses they’ll never fully recover from, like COPD, pulmonary fibrosis, and end-stage lung cancer. In the ICU, you’ll witness deaths despite doing everything right. Families will look to you for answers you may not always have. Over time, that emotional weight adds up, especially if you don’t establish strong boundaries or a support system.
Pulmonology, especially paired with critical care, means making high-stakes decisions fast. One missed diagnosis, one delayed procedure, one wrong call in the ICU, and the outcome can be devastating. If you’re on call, you’re always on alert. It’s rewarding, but the pressure never fully disappears.
You’ll be doing bronchoscopies, biopsies, thoracenteses, and other interventions that are essential and risky. Complications can happen. You need precise skill, deep focus, and steady hands even on your most sleep-deprived days. Not everyone thrives under that kind of physical and mental load.
The pandemic didn’t just test ICUs. It reshaped the field. Many pulmonologists are now dealing with a surge of long COVID patients, new forms of respiratory dysfunction, and increased ventilator dependence. The science is evolving, but in the meantime, the caseload is heavier and less predictable.
If you're dual-certified in pulmonary and critical care, balance can feel impossible. ICU weeks are intense and all-consuming. Even outpatient pulmonologists often carry consult pagers, do procedures between clinics, and have unpredictable patient needs. Burnout isn’t just possible. It's common.
Pulmonology doesn’t get the same spotlight as cardiology or dermatology. It’s not flashy, not heavily featured in pop culture, and often misunderstood. If you’re hoping for prestige or recognition, this may not be the field for you.
Every time you scope a patient’s lungs or manage a coughing, hypoxic person in the ER, you’re exposed. Tuberculosis, COVID, flu, RSV. You’re face-to-face with airborne pathogens regularly. PPE helps, but the occupational risk is real.
Pulmonology isn’t for everyone, and that’s okay. But if you’re drawn to complex medicine, real impact, and aren’t afraid of a few chaotic days (and nights), it might be exactly the right fit.
Knowing what the path looks like is only half the battle. The real challenge? Getting into medical school in the first place.
And let’s be honest: average won’t cut it. A 3.6 GPA and 506 MCAT might be the statistical norm, but they won’t get you in. Not if you don’t also have a powerful story, a cohesive narrative, and experiences that actually mean something.
That’s why, at Premed Catalyst, we created an Application Database. It’s a completely free resource that gives you full access to 8 real AMCAS applications that got into some of the most competitive medical schools in the country. No fluff. Just real essays.
If you want to stop guessing and start building an application that gets noticed, get your free resource here.
