Any Updates For Sleep and Psych?

[clement]

Is Sleep a lost cause? Seems like some older posts on this forum suggest the job market is not so hot for psychiatrists, that is, even if you do a fellowship at, say, the same esteemed institution as a pulm or neurologist...Save maybe rural gigs?

Secondly, I heard you tend to get the *difficult* end-of-the-line patients who've reached the point where everyone else has seen them because they're seeking benzos and amphetamines.

Is there more hope in academic prospects vs clinical then? That by itself would limit options even more, I imagine.

---

Members don't see this ad.

 

[clement]

hmmm 262 views and no input? Maybe I should be more specific...How and where's the job market for a psych sleep fellowship grad? <insert chirping crickets>

 

[clement]

I suppose it's safe to say, the sleep forum is fast asleep.

 

[michaelrack]

It is getting more difficult to get a good 100% sleep job straight out of fellowship, maybe more so for psychiatrists.

However, it is still possible to gradually develop a good sleep career, even for psychiatrists. I am a psychiatrist who did this.

 

[danielmd06]

I agree with Dr. Rack.

100% sleep jobs straight out of fellowship are much, much less common than combination practices for sleep/pulmonary and sleep/neurology. The combination practices for psych/IM/FP/etc were even rarer from what I saw (but examples are still out there).

When push came to shove, the practices I interviewed at seemed much more interested in someone with a neurology background (or pulmonary) than the other residencies. However, having a neurology background myself this could have been a self-fufilling statement (ie the people who interviewed me did so because they wanted neurology and skewed my perception).

Last year on my own interview trail I had a total of nine accepted interviews and I turned down four due to time constraints. All were 100% sleep with the exception of two which were combination neuro/sleep. There were probably another four or so that I sent my CV to and didn't get an invite.

There is certainly a market out there for pure sleep practices. I suggest shopping around at www.aasmnet.org and selecting the job board tab.

My advice is to look for sleep jobs on sleep medicine websites and sleep medicine journals. If you look on neurology sites and neurology journals you only find the combination jobs...I would assume the same holds true for psych also.

Good luck. Its a fun job to have.

 

[k488k488]

I agree with danielmd06 and Dr. Rack. I am pulm/cc/sleep. I have a pure sleep job now, and absolutely love it. I responded to an ad on the AASM website. Indeed, most sleep jobs are combination practices. However, IF YOU ARE GEOGRAPHICALLY UNINHIBITED (which I was/am), there are probably enough pure sleep jobs out there, and if you hook up with entrepreneurs or non-neuro/pulm practices who want to start a sleep lab (becoming increasingly less profitable, if at all), they will always need a boarded sleep doc to be the director.

 

[watto]

Secondly, I heard you tend to get the *difficult* end-of-the-line patients who've reached the point where everyone else has seen them because they're seeking benzos and amphetamines.

I am doing sleep and psych with a local group that prioritizes the treatment of insomnia as part of their holistic approach. They are one of the only local sleep groups that are able to provide my type of services, which are in fairly high demand since no one else wants to do it...I LIKE seeing the quote unquote "difficult" patients. If you have the proper tools and support the countertransference can be kept to a minimum and the outcomes can still be good.

My suggestion would be to find your niche in sleep / psych and market yourself as being added value to a group that can use your services as a comparative advantage.

 

[michaelrack]

I am doing sleep and psych with a local group that prioritizes the treatment of insomnia as part of their holistic approach. They are one of the only local sleep groups that are able to provide my type of services, which are in fairly high demand since no one else wants to do it...I LIKE seeing the quote unquote "difficult" patients. If you have the proper tools and support the countertransference can be kept to a minimum and the outcomes can still be good.

My suggestion would be to find your niche in sleep / psych and market yourself as being added value to a group that can use your services as a comparative advantage.

Sounds like you are adding a lot of value to the group. Are your insomnia services being subsidized with income from the sleep studies?

 

[watto]

Sounds like you are adding a lot of value to the group. Are your insomnia services being subsidized with income from the sleep studies?

Nope am doing standard E/M coding for my pts though will also be reading sleep studies and billing for them accordingly.

 

[clement]

well sure i'm biased, but it is surprising that sleep fellowships to some degree haven''t been more psych dominated. what i had heard recently is that the field is becoming somewhat less desirable for the pulm route, likely given the number of years of training vs maybe the future of sleep labs, and that neuro is the it one right now. however, given the current and foreseeable demand for psych in general (aging boomers etc), it'd make sense that psych would be much more present in sleep.

bottom line, is it worth it to do a fellowship right now though, knowing you may very well not have a pure sleep gig for a few years after finishing + geographic limitations, if big cities are saturated, or mention of continued pulm and neuro preference? is it safe to assume that big cities on two coasts are where it's tougher to find jobs?

also is liability any different here for psych and pts with comorbidities that predispose them to o/d-ing on sleep meds or with possible histories of addiction? i guess it depends on who your practice sees.

 

[michaelrack]

bottom line, is it worth it to do a fellowship right now though, knowing you may very well not have a pure sleep gig for a few years after finishing + geographic limitations, if big cities are saturated, or mention of continued pulm and neuro preference? is it safe to assume that big cities on two coasts are where it's tougher to find jobs?
.

Sleep (doing a fellowship) is still an economically rational choice if you plan to develop a career based primarily on reading sleep studies/treating sleep apnea.

It's only a 1 year fellowship, so docs who have other goals won't lose to much $ by pursuing it.

 

[clement]

Sleep (doing a fellowship) is still an economically rational choice if you plan to develop a career based primarily on reading sleep studies/treating sleep apnea.

It's only a 1 year fellowship, so docs who have other goals won't lose to much $ by pursuing it.

it's not unheard of among my colleagues to have debts in the neighborhood of $300K in residency.
this is what makes fellowship tricky, knowing the gen job prospects are great right out of residency + fear of not finding a position for 6+ months, but one year of fellowship, well...one can do part-time gen psych and pursue the sleep job hunt.

 

[clement]

so this is the part i've always pondered: while it seems like traditionally the job prospects recruit more neuro than psych for sleep, residency-wise, neurology is a year of medicine, lots of stroke mgmt...then the sleep fellowship. as much as I love neuro, going through that and then sleep vs psych and then sleep (not saying all psych residencies are "chill" either but...still). Then of course your job prospects aren't necessarily as flexible s/p fellowship with a psych residency. so give or take??

 

[danielmd06]

so this is the part i've always pondered: while it seems like traditionally the job prospects recruit more neuro than psych for sleep, residency-wise, neurology is a year of medicine, lots of stroke mgmt...then the sleep fellowship. as much as I love neuro, going through that and then sleep vs psych and then sleep (not saying all psych residencies are "chill" either but...still). Then of course your job prospects aren't necessarily as flexible s/p fellowship with a psych residency. so give or take??

So you're saying you want to do sleep medicine, and are considering which residency would be the better path between neuro and psych? And you are concerned not just about sleep fellowship prospects, but about the residency itself, and job prospects after graduation from fellowship based upon your residency choice?

The answer is...they're just very different in terms of job scope, types of patients, etc...

-Neuro is very objective/anatomy based in terms of the exam, serological testing, and imaging, whereas psych is more interview-based. Neuro tends to be much more objective (ie there is a stroke on the MRI) than psych...but still has it's share of subjectivity. If you prefer objective > subjective complaints from your patients then neuro might be better. If you prefer subjective > objective complaints then you might like psych better.

-They are both the same amount of training time (4 yrs) plus the 1 yr fellowship. Neuro includes a year of IM (which I think is important for sleep).

-Neuro would be considered the harder residency by most folks. More inpatient and ciritical care medicine, more sick patients, more complicated physical examination, more emergencies, more wakeups on-call in the middle of the night, more dependence upon imaging and testing, etc.

-I cannot comment on which background is preferred by sleep fellowship follks. I presume it depends on both the institution and the applicant themself.

-Neuro has better job prospects out of training financially (I included a link with a thread posting MGMA info for 2010 - http://forums.studentdoctor.net/showthread.php?t=817247). I can't speak to just plain job opportunities (locations and so forth) but I can tell you that as a neurologist I got hundreds and hundreds of job interveiw offers via email and to this day I still get phone voicemails from headhunters desperately trying to find neurologists. As a neurologist, you can live pretty much anywhere you want and pretty much pick the type of job you want. Everyone seems to want a neurologist these days. Everyone. And they'll pay.

-My own experience as a neurology-trained sleep physician was that neuro was very sought after and I had plenty of 100% sleep job offers right out of the starting gate. I cannot comment on psych for this because I don't know.

-When you finish your sleep training, expect as a psych-trained person to be able to be to go-to person for the psych-related sleep phenomenon such as hypersomnia (without positive MSLT or PSG), and the insomnias. As a neuro-trained person, you should expect to be the go-to person for neuro-related sleep phenomenon such as RLS, parasomnias, seizures, and hopefully speak with some authority about EEG findings on the PSG. I prefer the neuro-related sleep stuff myself...

Hope that helped. Good luck.

 

[michaelrack]

Then of course your job prospects aren't necessarily as flexible s/p fellowship with a psych residency.

correct. 100% sleep jobs are available (but becoming less common) for either primary specialty. However, it is a lot easier find/create a position that combines neuro and sleep than psych and sleep.

 

[michaelrack]

Is
Is there more hope in academic prospects vs clinical then? That by itself would limit options even more, I imagine.

If you are interested in a academic psych/sleep career check out the Univ of Mississipi sleep fellowship in Jackson MS.

 

[shan564]

Thanks for resurrecting this thread, Dr. Rack.

I was just wondering - might you have any particular advice for a 4th-year student strongly considering a career in the psychiatric side of sleep medicine? Should I be looking at any particular psych residency programs where I might have good exposure to sleep (particularly in research)?

 

[michaelrack]

Thanks for resurrecting this thread, Dr. Rack.

I was just wondering - might you have any particular advice for a 4th-year student strongly considering a career in the psychiatric side of sleep medicine? Should I be looking at any particular psych residency programs where I might have good exposure to sleep (particularly in research)?

I would advise doing your psych residency at a university that has a strong sleep fellowship that is psychiatry-friendly (either psychiatry-based or interdisciplinary). Check out U of MS in Jackson Mississippi. Also Western psych (pittsburgh) and dartmouth. Also I think the place in philadelphia where Doctor Dogramji (sp?) is at is psychiatry-based.

During residency, do some sleep rotations and try to present a research poster at the annual sleep meeting.

 

[shan564]

Cool, thanks for the advise. I hadn't looked at Mississippi yet, so maybe I should spend some time on their website.

I'm actually thinking I'll shoot for one of the combined med/psych programs... do you think that puts you in a better place to apply for a sleep fellowship? That's what you did, right? Or would it be better to do a general psych residency and use the extra elective time for sleep rotations?

Thanks again!

 

[michaelrack]

I'm actually thinking I'll shoot for one of the combined med/psych programs... do you think that puts you in a better place to apply for a sleep fellowship? That's what you did, right? Or would it be better to do a general psych residency and use the extra elective time for sleep rotations?

!

either way is fine, maybe a slight advantage to med/psych, although if did a sleep research poster during psych residence that would equalize things or maybe give you a small advangtage over med/psych without any research.

 

[shan564]

either way is fine, maybe a slight advantage to med/psych, although if did a sleep research poster during psych residence that would equalize things or maybe give you a small advangtage over med/psych without any research.

That seems reasonable. In addition to the elective time, since general psych residency is shorter overall, I could possibly use that extra time to do sleep research.

Do you think the reputation of the residency program is relevant at all for that purpose? I'm an IMG, so I probably won't get into med/psych at Duke or Emory, and I'll likely end up at SIU or another smaller-name program. Would I be better off for a sleep fellowship if I were to go to a place like WashU or UIC or some other bigger-name program (btw, I'm not closed to the Midwest, but those are probably the places that I'll rank high in ERAS).

 

[michaelrack]

That seems reasonable. In addition to the elective time, since general psych residency is shorter overall, I could possibly use that extra time to do sleep research.

Do you think the reputation of the residency program is relevant at all for that purpose? I'm an IMG, so I probably won't get into med/psych at Duke or Emory, and I'll likely end up at SIU or another smaller-name program. Would I be better off for a sleep fellowship if I were to go to a place like WashU or UIC or some other bigger-name program (btw, I'm not closed to the Midwest, but those are probably the places that I'll rank high in ERAS).

as long as you go to a place where you can get some research done, I don't think it matters too much

 

[Faebinder]

From my stand point. So far it's been impossible to get anything in the NE that is sleep 100% or psychiatry and sleep combination. Wish I was not limited to the northeast. My co-fellow is a neuron and is having a much better luck but we aren't aiming at the same areas.

I'm probably gonna have to do psychiatry 100% when I'm done with the fellowship. If you are interested in the NE or Florida, I would rethink the sleep medicine career as you may have some serious trouble finding a position.

 

[Shikima]

I'm in the same boat as Feabinder. Too many contracts have failed due to the fear over the threat from any form of intrusion of someone coming in to do sleep. In one case, I was accused that I wouldn't do enough Psych which is laughable when you really think about it.

No, the pulmonolgists have it neatly wrapped up unless you've got a good backing from a health system as a neurologist. FP/IM haven't seen the light yet in recognizing and understanding how complimentary it can be to have a such a specialist to join their group, share OH expenses and the only qualifier is gaining access to a sleep lab or they don't understand your role that you can provide because it's too perplexing and there isn't enough time in 2 minutes to sell yourself when pitching the idea.

I welcome critical feedback but for now, I may just head to the VA and say screw it and only do PTSD.

 

[michaelrack]

A sleep psychiatrist is not going to get a sleep/psych or 100% sleep job handed to them in the location of their choice.

I have to drive 100 miles back and forth between the 2 labs I am medical director of.

Sleep psychiatrists need to be flexible in location requirements. It doesn't hurt to be able and willing to invest some cash (or sign a personal loan guarantee) to start up or financially stabilize a sleep lab.

An entrepeneurial nature is a big plus for sleep psychiatrists (not an obsession with $, but a willingness to create your own job/position).

 

[Shikima]

A sleep psychiatrist is not going to get a sleep/psych or 100% sleep job handed to them in the location of their choice.

I have to drive 100 miles back and forth between the 2 labs I am medical director of.

Sleep psychiatrists need to be flexible in location requirements. It doesn't hurt to be able and willing to invest some cash (or sign a personal loan guarantee) to start up or financially stabilize a sleep lab.

An entrepeneurial nature is a big plus for sleep psychiatrists (not an obsession with $, but a willingness to create your own job/position).

QFT.

There is a lot of compromise that must come with this, and creative thinking. Fortunately, the education we provide in the process of selling ourselves along the way is will hopefully show that sleep is a multi-dimentional process at times.

That's what I want to believe at times. But finding a place that will allow 25-50% sleep medicine will be a remarkable feat and looking in the most unusual spots helps until there is that moment where you can develop a vested interest in opening ones own lab!

 

[Shikima]

Cool, thanks for the advise. I hadn't looked at Mississippi yet, so maybe I should spend some time on their website.

I'm actually thinking I'll shoot for one of the combined med/psych programs... do you think that puts you in a better place to apply for a sleep fellowship? That's what you did, right? Or would it be better to do a general psych residency and use the extra elective time for sleep rotations?

Thanks again!

I wanted to give you two other programs which are multidisciplinary in nature: LSU in Shreveport and the Cleveland Clinic. Look those up also.

 

[shan564]

I wanted to give you two other programs which are multidisciplinary in nature: LSU in Shreveport and the Cleveland Clinic. Look those up also.

Good to know. I actually had an interview invitation at Cleveland Clinic, but somehow all of their interview slots filled up before I responded. Seems strange, since I responded within a few hours... but it took the PC several days to get back to me, so I'm concerned that she might have overlooked my email initially and then was unable to make a spot for me later...

 

[Shikima]

Good to know. I actually had an interview invitation at Cleveland Clinic, but somehow all of their interview slots filled up before I responded. Seems strange, since I responded within a few hours... but it took the PC several days to get back to me, so I'm concerned that she might have overlooked my email initially and then was unable to make a spot for me later...

Check out the Medical College of Wisconsin too.

 

[prterosh]

I am full-time practicing general pediatrician. I am in practise since last 7 years. I developed interest in sleep medicine while dealing with variety of sleep and behavior disorders in kids. I also worked with sleep doc. for 2 months to get the real life experience. I am wondering how is the scope for me? I am looking for a general sleep pracise and not necesarily just peds.
thanks

 

[michaelrack]

I am full-time practicing general pediatrician. I am in practise since last 7 years. I developed interest in sleep medicine while dealing with variety of sleep and behavior disorders in kids. I also worked with sleep doc. for 2 months to get the real life experience. I am wondering how is the scope for me? I am looking for a general sleep pracise and not necesarily just peds.
thanks

I am not clear exactly what you are asking, but if you are asking what type of sleep medicine you could do without doing a 1 year sleep fellowship (rather than the chances of getting into a sleep fellowship), here is my answer:

With your experience, you would be an attractive candidate to be hired by some sleep practices- to see patients. You wouldn't be able to read sleep studies, which would limit your income. However, for 40 hrs/week outpt practice with minimal call, you could expect to make in the 155-195k range. It might take a little while and some creativity, because hiring a non-sleep/non-pulm doc isn't traditional.

 

[prterosh]

Thanks for your response Dr. Rack. Your prompt responses are really vital for this forum. I didn't make myself clear. I applied for sleep fellowship and I am already matched for 2013 fellowship. I was wondering what are my prospect as a sleep doc with PEDS background. What would be my earning potential? I am looking to be a general sleep doc with PEDS emphasis.

 

[michaelrack]

Thanks for your response Dr. Rack. Your prompt responses are really vital for this forum. I didn't make myself clear. I applied for sleep fellowship and I am already matched for 2013 fellowship. I was wondering what are my prospect as a sleep doc with PEDS background. What would be my earning potential? I am looking to be a general sleep doc with PEDS emphasis.

There are 2 hard things about ped sleep medicine:

1) dealing with kids (and their parents)

and

2) interpreting ped sleep studies. I did a fair amount of this when I worked at a university, but gradually stopped in private practice. There are too many borderline cases and the EtCO2 meter never seems to work right....

I assume you are good at #1 and assuming you learn #2 during fellowship (and not all general sleep fellows get a lot of exposure to peds sleep studies during fellowship),
this is my speculation regarding your career prospects:

You would be an attractive candidate to a large sleep group, of primarily adult docs, that was seeking to initiate or enlarge a pediatric sleep component of their practice. You could probably get a salary in the upper 200k range initially.

I would encourage you to learn the technical aspects of ped sleep medicine- if you want to do it right you are going to have to sometimes help the tech troubleshoot problems with the EtCO2 monitor.

-----

Others with more recent experience in hunting for a sleep position may have more info about potential starting salaries..

 

[prterosh]

Thanks. What is the best way to look for job? Are there any particular job postings? I checked on AASM website, the job listings are very minimal. Since its only one year fellowship, I think job search has to be started early.
Second question is , how is the scene in California?

 

[danielmd06]

Thanks. What is the best way to look for job? Are there any particular job postings? I checked on AASM website, the job listings are very minimal. Since its only one year fellowship, I think job search has to be started early.
Second question is , how is the scene in California?

The AASM website is actually a pretty good place to look. You'll find the job postings their go in cycles of feast and famine.

Otherwise, you may find postings in the sleep journals (though SLEEP and the Journal of Clinical Sleep Medicine have been exclusively in electronic format lately). I seem to recall reading that the JCSM is going to soon be once again available in print, though. Additionally, since you seem to have a preference of where you want to be, you can search the local neurology/pulmonary/multispecialty/etc groups, or check local hospital postings for private and academic facilities in your desired areas.

I remember seeing job postings on specific hospital websites that weren't elsewhere.

 

[prterosh]

Thank you for your response.
What salary To expect for academic setting vs private group? Can I be employed and just interpret sleep studies for third party labs?

 

[michaelrack]

Can I be employed and just interpret sleep studies for third party labs?

1. Your employer probably isn't going to like you reading studies for 3rd party labs

2. just reading studies- not often available anymore, although occasionally short term opportunities arise. If you are reading studies, the sleep lab is going to want you to see patients.

 

[danielmd06]

Thank you for your response.
What salary To expect for academic setting vs private group? Can I be employed and just interpret sleep studies for third party labs?

I will guess that for academics you could expect a starting salary of $150-200k. Private practice would be higher.

It's doubtful that you could practice as just a doctor reading sleep studies. I suppose there are a couple of people who do this, and the AASM website perennially had one or two people posting that they would read PSG's remotely for a "reduced price." I don't know how successful these people actually are. Like Mike said, wherever you read the studies, people are going to want you to actually see the patients. That's sort of the whole point.

 

[shan564]

Hello everybody,

Thanks for your previous help/advice about sleep and psych. I'm just finishing up my residency interviews, so I thought I'd ask for your opinions on the programs that would be most likely to let me into their sleep programs. I think my top choices are WashU, Mayo, and Cleveland Clinic. I know that all three have allowed psychiatrists into their sleep programs in the past, but I don't know if it's common/expected.

Thanks again!

 

[Faebinder]

Hello everybody,

Thanks for your previous help/advice about sleep and psych. I'm just finishing up my residency interviews, so I thought I'd ask for your opinions on the programs that would be most likely to let me into their sleep programs. I think my top choices are WashU, Mayo, and Cleveland Clinic. I know that all three have allowed psychiatrists into their sleep programs in the past, but I don't know if it's common/expected.

Thanks again!

We just filled an unfilled position in our program about a week ago. I say this because I know who got the position and our program will select the person most dedicated to sleep medicine and I hope that's the case out there in other programs. Some resident/fellows don't appear really dedicated to the subspecialty.

Side note: I did pick up 3 positions and finally I'm going to accept one of them. This one does 90% psychiatry and 10% sleep medicine.

 

[shan564]

Cool, thanks for the advice. Would you mind me asking what program you're at?

 

[bmedclinic]

Hello All-
I'm a clinical psychology PhD student who intends to graduate in Aug 2014. I don't have much experience in sleep medicine (and it was a few years ago) but have always been interested in sleep medicine. I'm looking to do a postdoc in sleep medicine and looking for advice. I cannot be very competative with many postdocs because of my lack of experience.. so I was wondering if anyone knows of postdocs that may be less well known and open to my lack of behavioral sleep med experience, I'd really appreciate either a response in this thread or a PM. Location isnt a factor. I'll go wherever and do whatever to get a chance at a postdoc where I can work in sleep.

Thanks
bmedclinic

 

[Doublj01]

Hi everyone!

Im a 3rd yr medical student and Im interested in sleep medicine but I also want to do FM. I saw the sleep medicine is open to FM residents. Can anyone provide any input into what I can start doing now as a student to make myself stand out as a great candidate when I apply to fellowship? How much harder is it as an FM doc to get into sleep?