Fellowship Strategy

[bGMx]

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I am a man with many varied interests, and a large debt burden. What I want to be is a man with a very particular set of skills; skills I have acquired over a very long career.

I'm interested in sleep medicine fellowship and addiction fellowship following a psychiatry residency which will give me the learning of psychotherapy of the east coast. I have two questions:

1) what do sleep medicine psychiatrists really do? I've done some reading and it seems like interpreting electronic EEGs? I take no issue with this but I'm not sure if I'm right on with this.

2) I'm aware fellowship has the opportunity cost of a year or two of invested physician salary. What I'm thinking is that those 2 years will allow me repayment of loans at a very low rate while I build up the years towards total public loan forgiveness; in my situation, this seems like a financially reasonable approach. Anyone have some thoughts on this? Looking for guidance as I make my way toward a fulfilling career and good life with friends + family.

 

[Ole_Toe]

RE: 2) %-wise PSLF is the same whether you are a fellow or attending, so there is the same financial opportunity cost of doing a fellowship imo. As long as you are working at a qualifying organization, you've got 6 years post-residency payments. If that's 10% off 250k or 80k there is still financial advantage to ending training asap (generally speaking). Are you in residency now? If not, I personally wouldn't worry about it too much. Read up on the different fellowship options and how they might help you in academics/PP/general training in an area of interest. Once you in residency, you'll start to get a feel for how much you want to stay in academics and how much that fellowship would really help you in PP based on your locale.

No idea re point 1 and also interested to hear what sleep medicine looks like for psychiatrists these days.

 

[bGMx]

Interesting. I'm in medical school right now. Trying to figure out a way to justify the financial nihilism that accompanies this loan burden + work toward my long term career goals.

Regarding insomnia, I do often wonder what happens to the patients I refer out from other services to address their sleep; CBTi being the most effective but for the amount of people I have report to me insomnia (granted, many have co-occuring substance use) I find it hard to believe there is anyone able to offer the CBTi. Instead they come back with a benzo from their primary care. Either someone who runs CBTi is highly booked, these people aren't getting the help they need, or I'm missing how the system provides proper insomnia care.

 

[Candidate2017]

Regarding insomnia, I do often wonder what happens to the patients I refer out from other services to address their sleep; CBTi being the most effective but for the amount of people I have report to me insomnia (granted, many have co-occuring substance use) I find it hard to believe there is anyone able to offer the CBTi. Instead they come back with a benzo from their primary care. Either someone who runs CBTi is highly booked, these people aren't getting the help they need, or I'm missing how the system provides proper insomnia care.

You want to know what happens?

Specialist to patient: [insert latest evidence-based non-pharm, behavioral recommendations].
Patient to specialist: ok, bye.
.
.
.
Patient to PCP: my specialist didn't listen, didn't do nothing. Can I have some [drug of choice]? It worked in the past.
PCP: ok, bye.

 

[FlowRate]

Most psychiatrists who specialize in / practice sleep med probably look more similar to other sleep med docs than to other psychiatrists. Lots of OSA treatment, small amount of the rest of sleep disorders. Although in my org it's the neuro and psych trained sleep docs who do more of the narcolepsy, sleep phase disorders, sleep behavior disorders, and truly complex/refractory insomnia. Pulm sleep docs handle more of the OSA and obviously OSA with other pulm comorbidities. Primary care and general psych take most of the basic insomnia.

I see no reason why you'd want to do a sleep med fellowship AND an addictions fellowship. The latter may be helpful but is probably not necessary if you structure your 4th year electives right and you're probably not going to be practicing both at the same time.

 

[bGMx]

I want to be is a man with a very particular set of skills; skills I have acquired over a very long career.

I was reading that sleep fellowship allows you to read EEGs and part of me would like to have a day or two a week where I just engage with insomnia, alongside a practice specializing in addictions. Part of me also wants to work locums tenems and supplement my income with remote work which isn't telemedicine. I'm mostly just entertaining my future as I'm trying to build my life into the kind I want to live, while also trying to play to the current financial scaffolding so that I can do the best I can with these loans.

They don't seem too disjointed to me; substance use begets insomnia and, maybe less often, vice versa.

 

[SmallBird]

I want to be is a man with a very particular set of skills; skills I have acquired over a very long career.

I was reading that sleep fellowship allows you to read EEGs and part of me would like to have a day or two a week where I just engage with insomnia, alongside a practice specializing in addictions. Part of me also wants to work locums tenems and supplement my income with remote work which isn't telemedicine. I'm mostly just entertaining my future as I'm trying to build my life into the kind I want to live, while also trying to play to the current financial scaffolding so that I can do the best I can with these loans.

They don't seem too disjointed to me; substance use begets insomnia and, maybe less often, vice versa.

There used to be a dance movement therapist who posted on this forum that would've liked your post and probably had some helpful feedback. I wish they would come back.

 

[FlowRate]

I want to be is a man with a very particular set of skills; skills I have acquired over a very long career.

I was reading that sleep fellowship allows you to read EEGs and part of me would like to have a day or two a week where I just engage with insomnia, alongside a practice specializing in addictions. Part of me also wants to work locums tenems and supplement my income with remote work which isn't telemedicine. I'm mostly just entertaining my future as I'm trying to build my life into the kind I want to live, while also trying to play to the current financial scaffolding so that I can do the best I can with these loans.

They don't seem too disjointed to me; substance use begets insomnia and, maybe less often, vice versa.

You could probably do addictions and insomnia treatment without needing either fellowship. Just build that specialty over the course of residency. Your profile says you're a med student/premed, is that actually the stage you're at?

 

[bGMx]

You could probably do addictions and insomnia treatment without needing either fellowship. Just build that specialty over the course of residency. Your profile says you're a med student/premed, is that actually the stage you're at?

Currently in clinical rotations of medical school.

 

[TexasPhysician]

I want to be is a man with a very particular set of skills; skills I have acquired over a very long career.

I was reading that sleep fellowship allows you to read EEGs and part of me would like to have a day or two a week where I just engage with insomnia, alongside a practice specializing in addictions. Part of me also wants to work locums tenems and supplement my income with remote work which isn't telemedicine. I'm mostly just entertaining my future as I'm trying to build my life into the kind I want to live, while also trying to play to the current financial scaffolding so that I can do the best I can with these loans.

They don't seem too disjointed to me; substance use begets insomnia and, maybe less often, vice versa.

Sleep is one of the specialties in which I’m seeing technology significantly alter practice. Im not sleep trained, so someone active in the field can chime in on how it effects them.

As a general psychiatrist, I can partner with many companies that help me provide home sleep studies (many have contacted me). I can send patients home with the equipment, and the company will read the results for me. I can then assist with CPAP acquisition. The devices are getting better every year it seems. Fewer adjustments are ever needed from what i can tell. This isn’t much different than what sleep trained people are doing around me. Since the start of Covid, many sleep practices shifted to home studies. No more sleep labs.

I can also do CBTi or get trained in it without a sleep fellowship. There is more need here.

Im open to being wrong on the above. It just seems like everyone around me is becoming a “sleep specialist”.

If this continues, I don’t see the draw on doing a fellowship just to read studies from a large corporation back to back to back.

 

[michaelrack]

There are still sleep labs. Sleep fellowship won't teach you to read an eeg

 

[mistafab]

I think you’re jumping the gun dude.

My advice is focus on specialty now, not fellowships.

You dont need to be a psychiatrist to do addiction, or sleep. Both can be done through IM/FM, which are shorter pathways. You also dont need an addiction fellowship to treat addiction. You want a particular set of skills, but you’re basically like those people that want multiple PhD‘s. What is the point of all the skills if you don’t contribute to anything meaningful.

Also, there’s really no point to do a sleep fellowship if you don’t wanna be doing sleep primarily. If EEGs really turn you on, do a neurology residency. Neurologist can also do sleep fellowship.