Curious why no one is interested in Sleep Med?

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freudianslip said:
Sleep medicine is a phenomenal field. Just curious why there isn't more discussion on it (i.e. what its like, fellowship opportunties etc.)
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It's fascinating, but most of the docs I know working in the field are not psychiatrists, but rather pulmonologists.
 
I like the idea of sleep medicine but no very little about it. I am aware it is a pulmonology dominated field but does any one know why? I assume it's b/c there is such a high likely hood for apnea that they (pulmonologists) developed the testing to diagnose a disease they often treat. It seems like any Dr. Doe could set up and run a sleep center (from a business standpoint) but I have no insight as to pay source hangups and related treatment issues.

Anyone have any info??
 
masterofnone said:
I like the idea of sleep medicine but no very little about it. I am aware it is a pulmonology dominated field but does any one know why? I assume it's b/c there is such a high likely hood for apnea that they (pulmonologists) developed the testing to diagnose a disease they often treat. It seems like any Dr. Doe could set up and run a sleep center (from a business standpoint) but I have no insight as to pay source hangups and related treatment issues.

Anyone have any info??
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You're basically right, there is little oversight. I know two FP docs who run a sleep lab. They rely upon RPSGTs (registered polysomnographic techs) to do the scoring and then refer the patient to a home health agency for CPAP. It seems pretty lucrative if you can get into a market that is not already served by one or more labs, which is beginning to be more and more difficult.
 
Non- sleep docs running sleep labs will change because rules for reimbursement will soon include require board certified Sleep Physicians to interpret the studies.

I expect many sleep centers to close or clamour for Board certified sleep docs to become Directors of their centers to comply with these rules.

As far as the earlier post, it is true that Pulmonologists play a huge and important role in Sleep, but the field is varied now and different sleep disorders thta stress psychiatric comorbidity and neurological disease is gaining more attention. You can get into a sleep fellowship if you are a psychiatrist. I did.
 
I think sleep medicine sounds pretty interesting, too, but I don't know much about it. What were your reasons for choosing it, freudian?

If you want to tell us a little about what the field is like, I'd be more than happy to learn.
 
I second Sophie...please enlighten those of us interested (or just give us a couple of recommended links about the profession 😀)

Thanks!
 
freudianslip, congrats on getting accepted into a sleep medicine fellowship.

i've heard that these fellowships are quite competitive to get, especially for psych residents (i don't know if times have changed on this front).

did you have any special attributes on your CV (i.e. sleep research, great board scores, chief resident of psych residency, prestigious psych residency, sleep medicine electives, or stay at your home institution for your sleep fellowship)?

any insight would be greatly appreciated b/c many of us think sleep medicine is clearly a fascinating field!
 
Well,
I am at Mayo and started with my interest beginning of my second year and actively began to research the field. I started to talk to the Sleep physicians, 4 of whom split their time between Sleep and Psychiatry. We have a phenomenal center that includes 10 pulmonologists, 5 neurologists and 4 psychiatrists in additon to great Technologists and nursing.

I soon began research with one of the staff and should be able to publish within the next year and present the results at the next Sleep meeting. In addition, I told my program director about doing a sleep elective in my 3rd year and spent a month at the Sleep Disorders clinic. I have to say that it was some of the beast learning I have ever had. I think the staff liked me and received good evaluations. I also joined the AASM and went to the last national meeting and regional meetings as well. I also worked hard in my residency and recieved strong LORs. I think the combination of my proven interest and performance on electives helped a lot.

Sleep is an exciting, emerging field of study and like psychiatry it is on the verge of great discovery. I know that being here at Mayo certainly helped my chances of getting in here and most likely would have helped open doors elsewhere especially in sleep becasue of its reputation (recommendation for future applicants). But I believe if you are strongly committed, you will find a spot.
 
Therapist4Chnge said:
What are the chances they'll call it a Slumber Party? 😉

-t
Click to expand...

:laugh:

freudianslip: Do you know of any good resources for learning more about the field of sleep medicine, and more specifically, what it's like (schedule, procedures, etc) being a sleep medicine doctor?
 
to sophie:

I know you were waiting for an answer from freudianslip, but thought of answering this since I worked in the field for many years until I joined the residency program I am in.

You could find some very good learning resources if you join the AASM (American Academy for Sleep Medicine) or go to their yearly conferences; this year it was in Minneapolis. But, that would cover the academic part of the discipline. The best experience you could get in terms of procedures, schedule, etc. is actually if you get to spend some time in a sleep center ( a really good one), both daytime and nighttime. As to the role of pulmonologists vs. psychiatrists in the field of sleep medicine and sleep centers seen as "sleep-apnea mills", that's an entirely different more political and less academic discussion.

If you need specific titles of books you would like to read for a start, let me know.
 
I second Slope. I joined AASM early on and went to meetings. It became a part of my psychiarty training as I was very careful in eliciting histories from my patients when it came to their sleep.

Spend some time in an elective. Give yourself a month so you can experience a variety of cases apart from Sleep Breathing Disorders
 
I am also on the road to the sleep med fellowship. I spent intern year reading about various sleep-related topics of interest to me, wrote a review paper at the end of the year, continue to read and develop research ideas through second year, and am leaving time free in my PGY3 and 4 years for a sleep clinic elective. Your early years of residency are also a good time to reach out to mentors in the area who can offer advice, teach, etc.
 
I talked to 3 psychiatrists and residents specifically about sleep fellowship on Wednesday. They said it's almost impossible for psych residents to acquire a sleep fellowship because there are not many positions and PD's have traditionally taken pulm. and neuro residents over psych residents. The reason for this discrimination is due to political reasons. Psych residents from strong programs will obviously improve their chances but may have no better chance that pulm residents from average to below average programs. Most PD's come from pulmonology backgrounds and they tend to favor their own. In their view, pulmonologists do 3 years of medicine and 3 years of critical care/pulmonology before applying so they feel their residents are more qualified than someone who does 4 years of psych. I don't agree with them but that's the view at this time. They mentioned that it's possible for a psych applicant to acquire a sleep fellowship but they will likely have to take a 1-2 years off to do research. For many psych residents, this is just not an option so you don't see it discussed much on this forum. Freudianslip was at Mayo and had access to a great sleep lab that had 5 psychiatrists so he was in a unique situation. I think the other residents and attendings on this forum at great programs will have a great chance but the remaining residents from average programs will struggle.

I know a FP who did not complete a sleep fellowship and is doing sleep studies. As Dienekes mentioned above, this FP hired RPSGT's and set up a lab near his clinic. He doesn't have difficulty acquiring patients. He simply recruits from his own patient base. I was suprised how willing these patients were to undergo sleep studies. In family practice, many of your patients have psych related issues and difficulty sleeping so it's fairly easy to build a patient base. These patients didn't care about the fact this FP was not boarded in sleep. I'm assuming a psychiatrist could do the same. The biggest challenge seems to acquiring the capital or enduring the debt required to establish a sleep lab. Many physicians let alone psychiatrists are risk adverse and are not comfortable establishing their own practice let alone doing that and adding an entire sleep lab.
 
freudianslip said:
Non- sleep docs running sleep labs will change because rules for reimbursement will soon include require board certified Sleep Physicians to interpret the studies.

I expect many sleep centers to close or clamour for Board certified sleep docs to become Directors of their centers to comply with these rules.

As far as the earlier post, it is true that Pulmonologists play a huge and important role in Sleep, but the field is varied now and different sleep disorders thta stress psychiatric comorbidity and neurological disease is gaining more attention. You can get into a sleep fellowship if you are a psychiatrist. I did.
Click to expand...

I agree the rules for reimbursement will require board certified sleep physicians to interpret studies, but I disagree with the idea that this will cause current non-sleep physician labs to close. Also, there are many who will disagree with you about the requirement for board certified sleep physiians interpreting studies. There are several primary care physicians performing colonoscopies despite the rumor that plans would only reimburse a colonoscopy performed by a GI. These non-sleep docs will simply outsource those studies to a sleep specialist for a fee. This is no different than primary care physicians outsourcing x-ray and ultrasound images to radiologists for a fee. Many FP have their own lab, ultrasound and X-ray at their clinic. They simply pay another specialist to interpret the data. And there will always be a few sleep specialists that will be more than happy to interpret someone else's studies for a fee even if they are not located in the same city. Cardiologists routinely read EKG's that are referred to them from primary care physicians. The primary care physicians still code and receive reimbursement for performing the EKG.

What will likely happen is that more sleep studies will be ordered in general as more sleep labs come into existence. As more studies are ordered, medicare will significantly reduce reimbursement for the procedure which will cause insurance companies to follow. And as the reimbursement falls, physicians will start ordering more studies to compensate for the reduced reimbursement. This is what has occurred in medicine for the past 15 years.
 
slope and freudianslip: Thank you both for your replies 🙂
 
Sophie,

I think that if you have a strong sleep interest, you will want to be near a well established sleep center (academic preferably). Watto made a point that you can have mentorship early on.
 
Well, I just started my 2nd year of medical school, and haven't totally decided on going into Psych yet, although I'm strongly leaning that way. I've found the few lectures we've had that discussed sleep or topics related to sleep fascinating, and started thinking how cool it would be to specialize in that (I actually didn't think there was such a specialty at that time). I'm hesitant to go find a sleep medicine mentor this early, however, since it's totally possible my interests will change once I've started rotations, and I would feel bad if I took up someone's time and then switched tracks a year later. There is apparently a sleep center pretty close to where I live, though, so I was thinking about contacting them regarding shadowing, just to see what it's like.
 
I say Psychiatry in general should be the leaders in sleep medicine. Freudianslip,

YOU TAKE BACK THE NIGHT!!!!
 
Puffle,

You rock! But really, having colleagues from diverse fields who take the effort to train can be so rewarding. Sleep is getting so interesting.
 
"Who looks outside, dreams; who looks inside, awakes."
— Carl G. Jung

I've since abandoned it, but I had this fantasy in med school of having my very own multi-discipline sleep clinic, with the walls painted like a sunset, the ceiling lit with tiny stars in their true constellations. I'd have a post-prandial nap break for all. Ah, the dreams of youth....

But I digress...when you think about how many sleep disorders are psych-related, and how few pulmonologists out there are doing proper psychoeducation and referring to us for co-morbidities, it's good know we'll have a few more in our corner. Good luck to you in your pursuit, and I'll do my part by drilling sleep hygiene into each and every patient. 🙂
 
I just finished a sleep disorders medicine elective and loved it.

There are electives out there for interested students.
😴​
 
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