LoudBark

5+ Year Member
Nov 14, 2011
300
65
Status
Resident [Any Field]
If I have read correctly, to do sleep + pulm/CC, then you do 3 years of pulm/cc then an additional year of sleep.

If you do a year of sleep, right after pulm/cc, do you ever feel you may lose your skills in pulm/cc? You go a year without bronchs or putting lines in or doing any procedures or seeing sick as heck patients in the ICU. Would taking that year off to do sleep make you a bit rusty the first time you walk into an ICU full of intubated patients with muli-organ failure after you just spent the last year reading sleep studies?

So are most pulm/cc people who plan to practice in the community now doing sleep as it makes them more marketable, not to mention the sleep part can be profitable part of the practice?
 
Last edited:

jdh71

epiphany at nine thousand six hundred feet
10+ Year Member
Dec 14, 2006
67,897
47,017
FEMA Camp, USA
Status
Attending Physician
If I have read correctly, to do sleep + pulm/CC, then you do 3 years of pulm/cc then an additional year of sleep.

If you do a year of sleep, right after pulm/cc, do you ever feel you may lose your skills in pulm/cc? You go a year without bronchs or putting lines in or doing any procedures or seeing sick as heck patients in the ICU. Would taking that year off to do sleep make you a bit rusty the first time you walk into an ICU full of intubated patients with muli-organ failure after you just spent the last year reading sleep studies?

So are most pulm/cc people who plan to practice in the community now doing sleep as it makes them more marketable, not to mention the sleep part can be profitable part of the practice?
Of course you will be rusty, and the extra year does not make you more marketable. Sleep can be done with or without pulmonary and critical care, and you find general IM, neurology, Psychiatry, and even ENT and anesthesia doing fellowships.

Being pulmonary and critical care trained makes you VERY marketable for pulmonary and critical care, employers give ****-all if you do sleep. In fact, most of the old guys who are leaving the unit would prefer it if you didn't show up and try to get your greedy hands into what looks like it will be a shrinking pie going forward.

Only do sleep if you really, really, really like and/or are very interested in the medicine of sleep. And I'd suggest doing the sleep fellowship before pulmonary and critical care.
 

gout

5+ Year Member
Sep 30, 2009
35
0
Status
Resident [Any Field]
Another option is to moonlight in the ICU while doing sleep. This what I will be doing.
 

Bobblehead

Senior Member
15+ Year Member
Nov 30, 2003
693
90
Status
Attending Physician
It's not correct to state that sleep is unimportant. It does make you more marketable to certain practices that are looking for another sleep trained physician to split the load. Some practices may not care as suggested by one of the prior posters. It'll be up to you to decide whether or not to pursue those types of practices.
 

jdh71

epiphany at nine thousand six hundred feet
10+ Year Member
Dec 14, 2006
67,897
47,017
FEMA Camp, USA
Status
Attending Physician
If you are coming out of pulmonary and critical care fellowship right now. SLEEP IS NOT IMPORTANT.

That's the bottom line, I would know, I was job hunting. No one cares about sleep. What is being looked for is people to staff the ICU and the pulmonary clinic.
 
OP
L

LoudBark

5+ Year Member
Nov 14, 2011
300
65
Status
Resident [Any Field]
In fact, most of the old guys who are leaving the unit would prefer it if you didn't show up and try to get your greedy hands into what looks like it will be a shrinking pie going forward.

Why is it a "shrinking pie"? I thought that the guys and gals who do sleep can rake in the big bucks as it is a cash cow that is all outpatient and can have a high volume of patients.
Aren't 99% of what sleep docs deal with is the run of the mill OSA?
 

jdh71

epiphany at nine thousand six hundred feet
10+ Year Member
Dec 14, 2006
67,897
47,017
FEMA Camp, USA
Status
Attending Physician
Why is it a "shrinking pie"? I thought that the guys and gals who do sleep can rake in the big bucks as it is a cash cow that is all outpatient and can have a high volume of patients.
Aren't 99% of what sleep docs deal with is the run of the mill OSA?
Most patients don't need in sleep lab studies and like most things that so many people have what payers will pay will be cut back.

If you think you're going to make a gazillion dollars just reading slept studies, you're going to be disappointed.

Do sleep if you like it not because you're lazy and want to make gads of cash from suckers.
 

d1ony5u5

10+ Year Member
5+ Year Member
Feb 11, 2009
303
1
somewhere
Status
Medical Student
jdh, regarding your comment of a "shrinking pie" did you mean pulmonary medicine? If you did, I'd love to hear your thoughts about that issue.
(I'm serious, not being facetious)
 

jdh71

epiphany at nine thousand six hundred feet
10+ Year Member
Dec 14, 2006
67,897
47,017
FEMA Camp, USA
Status
Attending Physician
jdh, regarding your comment of a "shrinking pie" did you mean pulmonary medicine? If you did, I'd love to hear your thoughts about that issue.
(I'm serious, not being facetious)
No. I meant sleep. It used to be a free-for-all-no-man's-land of money without any of the pesky responsibilities of call, consults, and people so sick that if you don't intervene, and at 3AM on Christmas morning, they will die. Don't get me wrong, no one is going to starve doing sleep, but the field is largely saturated in most markets and the reimbursements will be going down and a good part of that will be because most patients will not need nor qualify for a formal overnight in the sleep lab sleep study.