Sleep and addiction?

[tenesmus-x]

Short version: is it in any realistic way to do both addiction and sleep fellowship despite their overall disconnect, and have a viable practice where you get to use skills from both.

Long version:
I have waffled between sleep, pain, and addiction all of residnecy, and had finally settled on doing an addiction fellowship. I love where pain And addiction cross and while I don’t think I will do a fellowship I would enjoy being the “pain whisperer/ addiction guy”.

That all being said I just recently was diagnosed with OSA (non obese) which has rekindled a strong Interest in sleep, I would love to sniff out the other people out there like me who arnt you classic OSA. I recognize I can just refer to sleep which I do on probably 50% of my patients.

If I was to do both sleep and addiction would there be anyway I could reasonably find a job doing both? I fully recognize it’s an odd pair for fellowship choices but I know that sleep is typically is never 100% of a docs time so I would have to be doing something else when not doing sleep anyway.

* to answer the comment before it comes: Yes I know you don’t HAVE to do an addictions fellowship, however I feel like it would make me way more confident in my decision making. I also hope to use the year to really “polish” my practice in an environment where I can still make mistakes and have tons of people to ask questions of.

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[whopper]

IMHO yes cause guess what?
Most people I've seen with addiction problems can't sleep. So you'd have plenty of patients where combined knowledge in these areas will be especially helpful.

 

[clausewitz2]

OP, do you want to be interpreting sleep studies or do you want to be treating people with sleep disorders?

You 100% need a fellowship for the first one.

You 100% do not need a fellowship for the second. The insomniacs shall ye always have with you.

In seriousness, if you got reasonable training in sleep during residency and know how to take a good sleep history/glean patterns from sleep diaries, you can do a pretty good job treating a lot of sleep problems. I do this all the time. For rare stuff or really treatment refractory things, sure, i will refer to sleep medicine, but as i have posted about before i have caught at least a handful of (MSLT-confirmed) cases of narcolepsy masquerading as a primary psychiatric problem and continue to treat them, all in the last couple of years. I am not going to be publishing case series of Kleine-Levin syndrome anytime soon but I still get to treat sleep disorders.

If, or course, you did not get a chance to do any sleep rotations or get appropriate training in residency, i understand your interest in a fellowship, but there are lots of good resources for learning CBT-I, AASM publishes practice guidelines, and between those two things you can do better by @ substantial majority of your patients with sleep problems than the average psychiatrist.

 

[singasongofjoy]

I'd think that anywhere that sees a lot of patients with either would love to have you on staff - that would be a huge asset.

 

[TexasPhysician]

You could get 1099 jobs for both a sleep center and an addictions center. It is highly unlikely that you will find one place that will pay you well to do both. These are typically different departments that will have their own incentives. From what I’ve seen in my area, sleep centers are seeing decreasing reimbursement and significant midlevel encroachment. It is easy to develop a relationship with a company that will provide all of the equipment for a fee and send reports to sleep medicine in the middle of nowhere. You bill insurance and train on the equipment. Any specialty can thus incorporate sleep now.

 

[singasongofjoy]

You could get 1099 jobs for both a sleep center and an addictions center. It is highly unlikely that you will find one place that will pay you well to do both. These are typically different departments that will have their own incentives. From what I’ve seen in my area, sleep centers are seeing decreasing reimbursement and significant midlevel encroachment. It is easy to develop a relationship with a company that will provide all of the equipment for a fee and send reports to sleep medicine in the middle of nowhere. You bill insurance and train on the equipment. Any specialty can thus incorporate sleep now.

^^sounds like a good approach- make connections with sleep clinics / specialists so they'll refer patients to you. Worked in a sleep clinic for a while and such a connection to refer folks to would have been super appreciated (did have a psychiatrist specializing in geriatrics that we referred to often)

 

[dl2dp2]

You won't find a job doing both. They have little in terms of overlap on a practical level, especially at a facility.

However, it is possible to set up a practice that has a dual focus, especially as a consultative service for people with refractory sleep issues of a psychiatric/substance use origin. I can see the market appeal if things are set up/marketed correctly. But this is not a facility driven job.

 

[tenesmus-x]

Good questions. One of the major reasons I have struggled with committing to addiction or sleep by way of fellowship is I know you can do a MASSIVE amount of either specialty without doing the fellowship/board cert. However if I want to be expert at something I fell like I really want the expertise that further training can provide.

To answer the questions.
1. Defiantly would like to be treating people with sleep disorders/everyone in the world could use better sleep so its a great skillset to have. Do I have a burning passion and my life wont be fulfilled if I don't read sleep studies? Probably not. Do I envision sleep studies to be an enjoyable way to still be do clinical practice without needing to sit across from a patient for X hours a week, and something I could probably do long into my aged "retirement years"? Yeah (it would kind of be my "radiologist life").

I have also only been able to rotate with sleep medicine, a handful of times during residency, so feel that I would defiantly have plenty to learn from fellowship (recognizing it would be possible to teach myself a lot of it).

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Overall what I am hearing is, it is possible to pull off doing both (probably overkill but possible).

 

[romanticscience]

On this topic, what are the opportunities for outpatient psychiatrists to get involved with home sleep-study testing and interpretation? I know PCPs do it.