Grandfathering question (for neurologists)

[Phantom Spike]

I have a question that I was hoping someone on this board could answer, that pertains mainly to neurologists interested in Sleep Medicine. My understanding is that as of 2007, the American Board of Psychiatry and Neurology (ABPN) is conducting the Sleep Medicine certification exam for board-certified neurologists.

The ABPN website states that, "sleep medicine fellowship training undertaken July 1, 2009 and after must be accredited by the Accreditation Council for Graduate Medical Education (ACGME)". At the same time, it mentions a grandfathering period until 2011, where candidates who have not adopted the ACGME-accredited Sleep medicine fellowship pathway could still take the exam under the "Practice Pathway", provided that the candidate could provide, "attestation of the equivalent of 12 months of full-time post residency or post fellowship experience providing clinical care to patients with sleep disorders accumulated over a maximum of five years prior to application for examination and involving minimum experience of evaluating 400 patients, as well as interpreting and reviewing raw data of 200 polysomnograms and 25 multiple sleep latency tests".

My question therefore is, if a board-certified neurologist were to do a non-ACGME accredited Sleep Medicine fellowship after July 1, 2009 during the grandfathering period (but one that was, say, accredited by the AASM and fulfills the grandfathering conditions described above), would they be eligible to take the ABPN certification exam offered by the ABPN prior to 2011 through the Practice Pathway?

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[Faebinder]

ACGME is like the black hand of the medical mafia. You can get your way but you might have to fight for it.

Technically can you get ACGME certified? Yes.

Will it happen? Hmm....

Can you fight it if it does not happen? Of course.

Will you win? Hmm....

I think the answer heavily depends on your background in sleep medicine and the reputation of the institution you are trained at. Expect resistance.

 

[michaelrack]

My question therefore is, if a board-certified neurologist were to do a non-ACGME accredited Sleep Medicine fellowship after July 1, 2009 during the grandfathering period (but one that was, say, accredited by the AASM and fulfills the grandfathering conditions described above), would they be eligible to take the ABPN certification exam offered by the ABPN prior to 2011 through the Practice Pathway?

No.
Time spent in an unaccredited fellowship will not satisfy the practice pathway. You have 2 options:
1) do an ACGME accredited fellowship.

or

2) satisfy the criteria of the pathway by seeing the 400 pts, reading the sleep studies, etc outside of a fellowship (you could do this by seeing sleep pts in your own private practice and perhaps get a private sleep lab to let you read some studies for them- you could pay one of the sleep docs at that lab to mentor you in this area). If you wanted to, you could also do an unaccredited fellowship to learn about sleep med (perhaps part-time, while you have an outside private practice), but anything you do in the unaccredited fellowship won't count towards the practice pathway #'s.

 

[michaelrack]

There are some sleep docs, including myself, who would allow someone interested in meeting the practice pathway requirements to work in their sleep lab. There are several possbile arrangements in which the person trying to meet the practice pathway requirements could meet those requirements, learn about sleep medicine, and make a decent income, all at the same time.

 

[WallyWalrus]

No.
Time spent in an unaccredited fellowship will not satisfy the practice pathway. You have 2 options:
1) do an ACGME accredited fellowship.

or

2) satisfy the criteria of the pathway by seeing the 400 pts, reading the sleep studies, etc outside of a fellowship (you could do this by seeing sleep pts in your own private practice and perhaps get a private sleep lab to let you read some studies for them- you could pay one of the sleep docs at that lab to mentor you in this area). If you wanted to, you could also do an unaccredited fellowship to learn about sleep med (perhaps part-time, while you have an outside private practice), but anything you do in the unaccredited fellowship won't count towards the practice pathway #'s.

Can somebody confirm this? My impression and understanding was that as long as during the non-accredited fellowship you see the 400 patients + 200 polysomnograms and 25 multiple sleep latency tests, you would technically meet the practice pathway requirements and thus be able to sit for the sleep boards in 2009 and 2011. Whether you fulfill the requirements in 'practice' or in a non-accredited 'fellowship,' it should not matter, so long as you have kept a verifiable log of your cases.

Am I missing something here?
comments/thoughts?

 

[Phantom Spike]

No.
Time spent in an unaccredited fellowship will not satisfy the practice pathway. You have 2 options:
1) do an ACGME accredited fellowship.

or

2) satisfy the criteria of the pathway by seeing the 400 pts, reading the sleep studies, etc outside of a fellowship (you could do this by seeing sleep pts in your own private practice and perhaps get a private sleep lab to let you read some studies for them- you could pay one of the sleep docs at that lab to mentor you in this area). If you wanted to, you could also do an unaccredited fellowship to learn about sleep med (perhaps part-time, while you have an outside private practice), but anything you do in the unaccredited fellowship won't count towards the practice pathway #'s.

What about sleep studies read, and patients with sleep disorders seen, during a non-sleep training program, such as a neurology residency or a clinical neurophysiology fellowship?

I guess I'm having some trouble understanding the logic of this rule. Why would studies and patients seen in private practice, which is less regulated and non-standard, be considered acceptable, whereas experience in training programs, even if they are not ACGME-approved, be discounted?

 

[michaelrack]

What about sleep studies read, and patients with sleep disorders seen, during a non-sleep training program, such as a neurology residency or a clinical neurophysiology fellowship?

I guess I'm having some trouble understanding the logic of this rule. Why would studies and patients seen in private practice, which is less regulated and non-standard, be considered acceptable, whereas experience in training programs, even if they are not ACGME-approved, be discounted?

sleep studies read/pts seen in a non-sleep training program don't count.

The logic of the rule is that the American Board of Med Specialities wants to promote ACGME-accredited sleep fellowships. The ABMS and ACGME would love to discount private practice experience, but due to past lawsuits, have to allow a grandfathering period in which private practice experience is accepted whenever a new specialty board exam is created.