It seems the experience and expertise are so widely variable and in my experience, even in the same hospital system. I was diagnosed with BE 12 years ago from my PCP hearing something in my lungs, sending me for a chest x-ray which was inconclusive with the radiologist recommending a CT scan where the mild BE with nodules showed up. However, my PCP told me it was "idiopathic" and nothing needed to be done since I was asymptomatic. Just repeat CT scans every 6 months for 2 years to make sure the nodules were stable (which they were). Eventually when I was diagnosed with Crohn's disease which is associated with BE, I started also going to a general pulmonologist to track the BE more closely. But, nothing was done until I started developing a chronic dry cough. My (now new) PCP was persistent in not letting that go (thank you!) and eventually I ended up at the NYU Bronchiectasis & NTM program. Eventually a CT reading said "consistent with MAC". The general pulmonologist sent me for a series of induced sputum tests which were negative (but also very small samples, I was barely producing anything then). But guess what? My previous PCP and general pulmonologist were also part of the same large NYU system here in NYC, a top hospital nationally, and although caring and highly competent overall, they were not proactive about the BE at all. I had no idea until my GI doctor was one who referred me, that there was a bronchiectasis program in the very health care system that was taking care of me. I believe I was either percolating NTM for a while, or was infected around the time I finally ended up with bronchiectasis-knowledgeable doctors because when they sent me to chest (respiratory) therapy and I started producing more sputum, it has been positive every since.
I have no idea how to understand such a wide divergence in knowledge in the profession. It seems that it's doctors who "take an interest" who end up educating themselves and each other and that's pretty random!