Specialty choice after the Spanish national residence entrance examination, Médico Interno Residente (MIR), is often used as a proxy for professional attractiveness. Although Pulmonology is perceived as being selected increasingly late, ranks should be interpreted in the context of the expanding residency offer.1 Over the last decade, total and Pulmonology positions increased in parallel, with Pulmonology representing 1.68–1.84% of all positions (Fig. 1A). When adjusted for the total number of positions, no marked structural deterioration was observed; the last rank remained stable at approximately 70–76% of the total offer (Fig. 1B).
Evolution of MIR residency positions and Pulmonology selection over the last 10 years (2017–2026). (A) Shows the total number of MIR and Pulmonology positions offered, while (B) shows the first and last MIR ranks choosing Pulmonology, expressed as absolute ranks and relative positions within each call.
This is noteworthy, as Pulmonology brings together features that should make it attractive: acute and chronic care, complex diagnostic reasoning, management of respiratory failure, interventional procedures, pulmonary function testing, sleep medicine, thoracic oncology, pleural disease, multidisciplinary decision-making and close patient contact. The specialty has advanced rapidly, with robotic and navigational bronchoscopy, new therapeutic strategies for airway diseases, interstitial lung diseases and pulmonary hypertension, complexity of acute respiratory care in the intermediate care unit, and initiatives such as the CASSANDRA lung cancer screening project.2
Despite its appeal, Pulmonology is rarely chosen by top-ranked MIR candidates.
This mismatch may reflect changing preferences, shaped by perceived career prospects, private practice opportunities, work-life balance and on-call burden. Among medical specialties, Cardiology and Gastroenterology may remain more attractive because they are perceived as having a clearer procedural, technological and research-oriented identity. Pulmonology may be limited by insufficient undergraduate exposure to its technical and multidisciplinary areas, uneven access to research and innovation across training centers, and overlap with other specialties.
Improving the attractiveness of Pulmonology should start before preferences are consolidated. First, respiratory medicine needs greater social visibility. Public outreach initiatives, such as traveling educational campaigns,3 awareness tours such as the “No Es Normal Tour”4 and community workshops such as Madrid Respira, organized by Neumomadrid,5 may present respiratory health as a modern, innovative and socially relevant field.
Second, respiratory medicine should be taught by pulmonologists whenever possible, and undergraduate exposure should be more structured and practical. Clinical rotations are often decisive in shaping specialty preferences. Students should have an active role during these rotations and be exposed, under supervision, to the technological and procedural dimensions of the specialty. Workshops on chest-drain simulation, lung ultrasound, bronchoscopy, respiratory support and pulmonary function testing could show what contemporary Pulmonology involves.
Third, students should be informed about free or reduced registration fees for national and European respiratory meetings, with student-focused sessions and mentorship. Promoting final-year projects and undergraduate research in Pulmonology, supported by society awards, could strengthen early academic links MIR preparation academies and post-exam workshops before residency selection may also help candidates understand the specialty beyond stereotypes.
Finally, residents are influential ambassadors. Supporting them, improving teaching culture and making training environments more visible, humane and academically stimulating may be among the most effective strategies to attract future pulmonologists.
Recent data do not support a worsening in the relative selection of Pulmonology; the challenge is to show the specialty as clinically complex, procedural, technological, multidisciplinary and central to the future of medicine.
Ethics considerationsNot applicable, as this article does not involve human participants, identifiable personal data, or experimental interventions. Therefore, ethics committee approval was not required.
Artificial intelligence involvementArtificial intelligence tools were used during the preparation of this manuscript for grammar correction and language refinement. All content was subsequently reviewed and validated by the authors to ensure accuracy and scientific integrity.
Informed consentThis article does not involve human participants, identifiable personal data, patient-level information, or any experimental intervention. Therefore, informed consent was not required.
FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors’ contributionsAll authors made substantial contributions to the conception, acquisition and interpretation of data; contributed to drafting the manuscript and critically revised it; and approved the final version submitted for publication.
Conflicts of interestThe authors declare no conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript.
