General Neurologist + Sleep Medicine

[postbacpremed87]

Hello I am finishing up my first year of medical school and have an initial interest in neurology. By the time I get to practice how feasible will it be for a general neurologist to practice sleep medicine as well? It seems like most sleep is going the way of pulm. My ideal set up would be the following: 4 year neurology residency + 1 year sleep fellowship; practice as a general community neurologist with the ability to interpret sleep studies to augment income. Will this still be possible? Is a salary of 240-250 out of the realm of possibility? Thanks!

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[typhoonegator]

Neuro-sleep is a legit track to sleep medicine. You'll need to consider where you want to practice, though, as in many centers there are established sleep groups that will not be interested in letting you waltz in and start taking away studies from them. Also, you would need to consider whether it would be feasible or financially desirable for you to focus on sleep disorders in your clinic (rather than general neurology). It would be challenging in some places to justify reading sleep studies if you aren't referring those patients in the first place. $240-250 is a doable salary with or without the subspecialty training, particularly outside of academia or in underserved areas of the country.

There are some sleep specialists who are active in this forum that can likely tell you a lot more about how sleep practices are structured and how they bill for studies.

 

[neurolddoc]

In my region, it has become much more difficult to make a go of sleep. There has been a dramatic shift in insurance coverage for in lab studies. Many are requiring home studies instead and are even requiring that patients be placed on Auto-PAP instead of having an in lab titration. We had a lab in our practice for 5 years and while it was initially profitable, it got to the point where it barely broke even..

Maybe it is different in other areas of the country.

 

[michaelrack]

I know 3 sleep/neurologists and one sleep/neurologist/psychiatrist in the state of MS. I consider myself a sleep/psychiatrist, although my sleep certification is through the ABIM.
A career path in MS for a new sleep/neurologist would be to start a neurology solo practice or join a small neurology group that lets you do sleep on the side. Over a few years, the sleep/neurologist could gradually pick up contracts with small sleep labs (probably in a wide geographic area), do clinic at each a few days a month; read their sleep studies remotely.

 

[neurologist]

Your best bet would be to join a group/hospital practice that is looking for someone to do a mix of general neuro and sleep. Such positions are not unusual, although I suppose you may have to consider relocating. Generally you'd start out doing X% general neuro and Y% sleep, and adjust your mix accordingly as things change over time.

Doing general neuro and "interpreting sleep studies to augment income" is a bit trickier, if by that you mean working for one practice and reading studies from other practices. It's unlikely that some other group is going to just start giving you their studies to read, unless they are mind-blowingly over-worked, in which case they should just be hiring you full time as a sleep doc. Also, reading studies on a "piecework" basis for a practice to whom you refer, is, to my understanding, a bit legally dicey as it may be seen as a "kickback" arrangement ("send us patients and we'll give you a cut of the reading fees . . . ").

Finding a 100% sleep job is challenging, although not impossible, and yes, you are right that much of it is done by Pulmonary. The neuro/pulm division of sleep seems to vary somewhat regionally. Also, in general, private practice sleep seems to be strictly divided into "all pulmonologist" or "all neurologist" practices, whereas academic centers seem more inclined to mix the two into multispecialty sleep centers (which I personally think is the better approach).