Psychiatrists in Sleep

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I am a psychiatrist. Last year I got trained in sleep medicine at a fairly reputable program however it has been very difficult to find a job in sleep medicine.

Although finding a job in psychiatry has been easy, it is frustrating that even places that do sleep will not let me do it because im a psychiatrist. They only want pulmonologists and sometimes neurologists. Most arent even aware psychiatrists could do sleep medicine.

I would love to hear other people's experiences on this issue because I am beginning to think that doing sleep as a psychiatrist is a big mistake unless you want to move to a very rural area in a state like south dakota.

ugh definitely not what I wanted to hear, or read rather. I'm a psychiatry resident who is planning on pursuing a sleep fellowship. Are you looking for full-time sleep positions or something where you'd be combining sleep with psych part of the time?

Sorry to hear your struggle. Not that this is easy but you could open your own clinic eventually instead of working for someone. You might have to work in psych for awhile to build up enough start up money. You could also offer your services to companies that work in sleep like, sleep apnea, mattresses, etc...

For what it's worth, the sleep medicine department at Mayo is staffed by pulmonologists, neurologists and psychiatrists. I can't imagine it's the only place that does so.

Anyway, I was just doing a quick search on psychiatrists in sleep medicine, and here's a guy who made it work:

http://www.sleeplessincolumbus.com/drsaribalas.html

Sleep medicine certainly sounds like a very interesting field with a lot of potential for research, new discoveries and treatments. Not sure yet what I'm going to shoot for, but sleep medicine is definitely an interest. And while it seems nice that you can approach it from a number of residencies, perhaps it's not an even playing field in the end.

Good luck!

If you are looking for an academic career, the Univ of MS (Jackson, Mississippi) has a psychiatry-dominated sleep center. the Univ of Pittsburgh (western Psych) has both psychiatry and pulmonary sleep programs. Dartmouth is also friendly towards psychiarists. Private practice careers for sleep psychiatrists is an issue I have blogged about in the past. It is hard for a psychiatrist to go right away into 100% sleep medicine, but it is something that can be done over a few years.

I know Hennepin has trained a few psychiatrists from their program the last few years, FWIW.

Any luck finding a sleep medicine job as a psychiatrist?

I'm currently doing a sleep fellowship and am job hunting. Any tips?
Would I have better luck at academic centers than private sleep centers?

I'm a third year, and was heavily considering going the Psych to Sleep Medicine route. Would this be a bad idea given the content of this thread? Safer to go with Neuro, instead?

Originally Posted by Sartre79

I'm a third year, and was heavily considering going the Psych to Sleep Medicine route. Would this be a bad idea given the content of this thread? Safer to go with Neuro, instead?

Isn't it safest to go IM to Pulm/CC to Sleep?

Originally Posted by Bethanechol

Isn't it safest to go IM to Pulm/CC to Sleep?

Meh...5 yrs vs. 7 yrs (especially considering the income loss that comes with those two years and accruing interest). I think I would gamble on Neuro vs. that route. But what about Psych v. Neuro with plans to go into sleep?

Originally Posted by Sartre79

But what about Psych v. Neuro with plans to go into sleep?

it's a little easier to get into a sleep fellowship as a neurologist than as a psychiatrist. Once you're done with fellowship, career opportunities are approx equal- the easiest way to do it would be to join a large psychiatry or neuro group and gradually build up the sleep part of your practice-

Update:

I just took a job in psychiatry. I was offered a couple of jobs in sleep that fell through due to the economy. The jobs in psychiatry were just much better.

Responding to above posts: Academic jobs are not that difficult to come by however they pay about 25-40% of what I am making as a psychiatrist depending on equivalent work hours.

I am trying to teach at an University medical center as a volunteer professor but don't know how that will work out. I am focusing on enjoying life as a psychiatrist.

What I have learned though is that the demand is for:
1) Pulm trained, preferably Pulm CC
2) Neurologists
3) Internists
4) Others such as pediatricians even have it easier.

This is in the community only.
Academic centers want well rounded programs and are looking to hire psychiatrists. That being said, 85K a year doesn't go very far in California.

Originally Posted by Sartre79

I'm a third year, and was heavily considering going the Psych to Sleep Medicine route. Would this be a bad idea given the content of this thread? Safer to go with Neuro, instead?

I am hoping that in a few years the landscape will change as the mandatory fellowship will create more opportunities for psychiatrists.
That being said, right now the picture is bleak. However, psychiatry is very highly in demand and you can take your pick of where you want to work. Neurology is not as in demand.

If you just want to do sleep, internal medicine may be the best option with a program that gives you lots of electives that you can focus on pulmonary, neurology, psychiatry and sleep.

I completed a FP/Psych residency and a Adult/Peds sleep medicine fellowship. I got a 100% sleep(employment) job which paid more than I could have earned as a psychiatrist. I am venturing to go out on my own. Scary?.... yeah! but what do I have to lose? Employment is cool for some but not me....for some reason most sleep labs are owned by non physicians... RRTs, RNs and business men. I see no reason why any sleep trained psychiatrist should be nervous as long as you can get a psych job any day to fall back on. You will rarely see an ad for a sleep/psychiatrist. Since most of your patients are obese,have DM, HTN have insomnia and are fatigued... what more do you want? We all want someone else to do the start up of the practice. Come on guys.. send your patients to a nearby lab and arrange to read ALL your studies. Start small and efficiently. Take a sleep hx in your psych evals. With effective screening on the 15- 20 pts you see per day in out patients... how many PSGs do you think you will generate in a month?

The fear/burden of school loans repayments paralyzes entrepreneural fervours. I think Obama just paid off his last school loan note 1 year ago!!

Originally Posted by hyoglossus

I Since most of your patients are obese,have DM, HTN have insomnia and are fatigued... what more do you want? We all want someone else to do the start up of the practice. Come on guys.. send your patients to a nearby lab and arrange to read ALL your studies. Start small and efficiently. Take a sleep hx in your psych evals. With effective screening on the 15- 20 pts you see per day in out patients... how many PSGs do you think you will generate in a month?

Good advice

That is good advice for those who have the ability to send their patients locally to a sleep center and own large private practices. Even if I had my own practice the local centers are mostly owned by large corporations that will not allow me to read my own studies. Until I can build my own lab, it is not really feasable for me.
I didn't just try for a couple of days and give up. I looked into this for almost 2 years quite diligently and haven't given up hope yet but lets not be falsely optimistic.

I am not saying it is completely hopeless...just that compared to other specialities you start off with a serious handicap.

I have to say that it does seem discouraging but the question is... how many sleep labs referrals can you generate monthly? I am certain that there are some smaller IDTFs that will allow you read your own studies as long as they can bill for the test.
If you are in a major city will numerous health systems like Philadelphia, except they have an open lab where any BC sleep doc can read his own sleep study referrals it may be difficult to read studies.

You may also want to look to partnering with some FPs or cardiologists to ease the financial burden of a sleep practice. Have you been credentialled as sleep physician as well as psychiatrist? What limitations have you been faced in the past 2 years

Word on the street I've been hearing at academic institutions is that any sleep center worth your while will have a multidisciplinary approach to sleep.

Internist, Pulm, Neruo, Psych, Counselors, etc.....

Sleep is too complex to say and it is too narrow of thinking that all they want to do are OSA studies. Also, consider looking into work for parasomnias and such.

Consider spreading word of mouth where you'll be setting up clinic, that sleep problems can come see you in clinic and you can go from there. Start small and work your way up!

-

manicsleep, it seems that things haven't changed much since you finished your sleep fellowship when it comes to finding a Psychiatry/Sleep position. I just started looking for a job (I will be done with my fellowship in July), and the vast majority of the positions on the market are for pulmonologists and neurologists :-(

i can see the preference, in terms of training, an employer might be seeking when pref is given to pulm...but why neuro over psych?

Originally Posted by clement

i can see the preference, in terms of training, an employer might be seeking when pref is given to pulm...but why neuro over psych?

People out there are still less aware that Psychiatrists go to Sleep Medicine.


During my interview trail I was pretty much the only psychiatrist in all my interviews. My experience so far is that most applicants are coming from neurology.

Originally Posted by Manicsleep

Update:

I just took a job in psychiatry. I was offered a couple of jobs in sleep that fell through due to the economy. The jobs in psychiatry were just much better.

Responding to above posts: Academic jobs are not that difficult to come by however they pay about 25-40% of what I am making as a psychiatrist depending on equivalent work hours.

I am trying to teach at an University medical center as a volunteer professor but don't know how that will work out. I am focusing on enjoying life as a psychiatrist.

What I have learned though is that the demand is for:
1) Pulm trained, preferably Pulm CC
2) Neurologists
3) Internists
4) Others such as pediatricians even have it easier.

This is in the community only.
Academic centers want well rounded programs and are looking to hire psychiatrists. That being said, 85K a year doesn't go very far in California.

85k a year in an academic center is quite dishearting.... PAs and NPs make more in general medicine. I hope they at least said okay to moonlight when they offered it to you.

Originally Posted by Faebinder

85k a year in an academic center is quite dishearting.... PAs and NPs make more in general medicine. I hope they at least said okay to moonlight when they offered it to you.

I didn't take it. Restarted my psychiatry practice and built up. Now I am doing 40 hours a week sleep with some psychiatry as well and another psychiatrist does about 15 hours but will start about 30 hours starting next week now that he is boarded as of today.

We hope to hire another sleep psychiatrist within a year or 2.

Originally Posted by hyoglossus

Come on guys.. send your patients to a nearby lab and arrange to read ALL your studies.

Would a lab even agree to evaluate the patient and have YOU read the study?? Wouldn't they have their own sleep-trained practitioners?

A Sleep Psychiatrist is an interesting topic. Sleep is getting a lot of buzz in news lately, concerning the recent death of Whitney Houston. I was previously under the impression that celebrities such as Elvis, Michael, Heath Ledger, and Anna Nicole Smith were addicts and died from an out of control addiction. However a recent CNN special I saw mentioned that although these celebrities likely had addiction issues, their main concern was that they couldn't sleep.
I think a Psychiatrist, particularly one that is comfortable with addictions, can have a very nice niche that can tailor well in certain affluent areas. Then again, wealthy patients will pay top dollar to get the "right" meds and Psychiatrists in nature, will usually avoid controlled medications as much as possible. Any chance of Hypnosis making a revival?

Originally Posted by Fastball32

A Sleep Psychiatrist is an interesting topic. Sleep is getting a lot of buzz in news lately, concerning the recent death of Whitney Houston. I was previously under the impression that celebrities such as Elvis, Michael, Heath Ledger, and Anna Nicole Smith were addicts and died from an out of control addiction. However a recent CNN special I saw mentioned that although these celebrities likely had addiction issues, their main concern was that they couldn't sleep.
I think a Psychiatrist, particularly one that is comfortable with addictions, can have a very nice niche that can tailor well in certain affluent areas. Then again, wealthy patients will pay top dollar to get the "right" meds and Psychiatrists in nature, will usually avoid controlled medications as much as possible. Any chance of Hypnosis making a revival?

I don't know of hypnosis, but certainly CBT is a modality that has been used for sleep improvement.

Originally Posted by Fastball32

A Sleep Psychiatrist is an interesting topic. Sleep is getting a lot of buzz in news lately, concerning the recent death of Whitney Houston. I was previously under the impression that celebrities such as Elvis, Michael, Heath Ledger, and Anna Nicole Smith were addicts and died from an out of control addiction. However a recent CNN special I saw mentioned that although these celebrities likely had addiction issues, their main concern was that they couldn't sleep.
I think a Psychiatrist, particularly one that is comfortable with addictions, can have a very nice niche that can tailor well in certain affluent areas. Then again, wealthy patients will pay top dollar to get the "right" meds and Psychiatrists in nature, will usually avoid controlled medications as much as possible. Any chance of Hypnosis making a revival?

I don't think you have create a niche to do sleep. Sleep is multi disciplinary and treatment of insomnia is probably best done behaviorally. Psychiatrists are also pretty good at PTSD, nightmares etc.

Anways, sleep apnea is not that complicated and its not all pulmonary. There is a lot of anatomy, neuro and even psychiatry (try motivating people to wear that mask) involved in it. A psychiatrist who does a fellowship in sleep should be as well trained as any other physician who has done a fellowship and better than those who haven't done one.

...

Originally Posted by Indodo

Anways, sleep apnea is not that complicated and its not all pulmonary. There is a lot of anatomy, neuro and even psychiatry (try motivating people to wear that mask) involved in it. A psychiatrist who does a fellowship in sleep should be as well trained as any other physician who has done a fellowship and better than those who haven't done one.

a pulmonary background would help when a pt needs something more than standard cpap/bilevel. The downloads from a bipap S/T or SV machine can be pretty complicated to interpret, and I don't know a sleep textbook/article (aimed at the non-pulmonologist) that has any significant info about these machines (that discusses the practicalities rather than just the indications)

Psychiatrists make excellent sleep physicians and are really needed. I would argue OSA is the easiest of the major sleep disorders and is largely going to home testing. The techs diagnose it correctly 95% of the time.

Insomnia is way more common and a lot more difficult than bland OSA. Reading full montage studies for parasomnias also takes more skill, not to mention the subsequent treatment. Pediatric sleep and narcolepsy can also be challenging and interesting.

I'm a psychiatry resident and I'm curious about a Sleep Fellowship. I hear bad things about the job market, though, for Psychiatry-trained Sleep Specialists. I would like to have control over where I live, so that's another challenge for me. I don't consider myself an entrepreneur, and have only a small degree of interest in working in an academic center.

So for the Psychiatry-trained Sleep Specialists: Would you do the fellowship again if you knew then what you know now?

Interested in an answer from someone knowledgeable about the above question as well.

Originally Posted by BobA

I'm a psychiatry resident and I'm curious about a Sleep Fellowship. I hear bad things about the job market, though, for Psychiatry-trained Sleep Specialists. I would like to have control over where I live, so that's another challenge for me. I don't consider myself an entrepreneur, and have only a small degree of interest in working in an academic center.

So for the Psychiatry-trained Sleep Specialists: Would you do the fellowship again if you knew then what you know now?

bump

Would love to know as well

Originally Posted by BobA

I don't consider myself an entrepreneur.

this would be a problem for a psychiatrist planning a career in sleep. While you don't necessarily need to start up your own sleep lab, you would likely need to own your own practice and feel comfortable negotiating relationships with sleep labs.

There are still some 100% sleep jobs out there for non-entrepeneurs, but these are decreasing over time.

It's difficult to answer if I would still do the fellowship again. I would cause I love sleep but the impact to your pocket and the difficulty of finding a job that involves psychiatry and sleep is getting to me now. It's only my second month in the fellowship. More feedback towards the end.

Still havent found a job btw, where are my colleagues by now already have a few interviews lined up.

are your colleagues from other specialties? (I'm assuming they are)

Originally Posted by Faebinder

It's difficult to answer if I would still do the fellowship again. I would cause I love sleep but the impact to your pocket and the difficulty of finding a job that involves psychiatry and sleep is getting to me now. It's only my second month in the fellowship. More feedback towards the end.

Still havent found a job btw, where are my colleagues by now already have a few interviews lined up.

If you're interested in academia, you may want to look into Dartmouth. I recently saw an ad for a faculty position

Yeah getting a bit more luck now. Will look into Dartmouth. Though I remember the winter there when i interviewed one time up there for residency.... Pretty ugly.