Sunday, June 21, 2009

Preparing for a Sleep Fellowship

A reader asks:

I'm a current first year (almost second year) internal medicine resident and I'm currently looking into the possibility of sleep medicine as a fellowship choice. Everything I learn about sleep medicine sounds great and I find myself very interested in the subject of sleep and sleep disorders, so I think it would be a great choice for me. I was wondering if you could give me any pointers about the process of applying to sleep fellowships, doing rotations, building my application and so forth. Also, what sort of career options are there for internists who do a fellowship in sleep med? Any good textbooks that you would recommend me starting with?

I previously posted a little about sleep fellowships here.
As an internal medicine resident, elective rotations that would be helpful include pulmonary, psychiatry, neurology, ENT, and sleep medicine (if available). The ENT rotation should include a large outpatient component in which you learn the head and neck exam as well as gain expertise in evaluating and treating sinus problems.
Sleep medicine fellowships are becoming very competitive, especially for those who have only completed a general Internal Medicine residency. Research, especially something related to sleep, would be helpful in getting accepted to a sleep fellowship.

Join the American Academy of Sleep Medicine

Books that I recommend include Sleep Medicine Pearls by Richard Berry, MD. Unfortunately, the current (2002) edition obviously doesn't include the new AASM sleep scoring/staging guidelines.
I also recommend getting The AASM Manual for the Scoring of Sleep and Associated Events.

Principles and Practice of Sleep Medicine is the standard textbook. I would recommend waiting until the new (5th) edition comes out in several months.

Journals you should be reading include Sleep and The Journal of Clinical Sleep Medicine, which are availabe with membership in the American Academy of Sleep Medicine. Non-members can read older articles free on-line.

I have posted regarding career options previously in this blog, and will do so again later this month.

Monday, June 08, 2009

The Future of Sleep Technicians

I'm in Seattle at the annual Sleep meeting. I'm about to go to the opening session and hear a talk by Dr. Howard Roffwarg on REM sleep.

I have a few minutes before the session starts and will take the time to answer a question from a few weeks ago:

A reader (TimRPSGT) asks:
I have a couple of questions about the future of sleep medicine. First, how do you see the role of the sleep technologist changing over the coming years? I'm also curious bout the new approval for home studies with type 2 and 3 devices. Is there a possible business opportunity here for RPSGT's to do home studies as independent contractors for doctors?

I don't see the role of sleep technologists changing much in sleep centers over the coming years. One trend that has been developing over the last several years is the movement towards certification of sleep technicians. Within several years all new sleep technicians will be required to complete commnunity/vocational college training program to work at an accredited sleep center. I am not totally up to date on RPSGT/AASM sleep tech requirements, but I believe that A-STEP was designed as a transitional program and will be phased out in several years in favor of community/vocational college-based programs (see this page for further details: On the job training of technicians is on the way out.

I don't see the role of sleep technicians changing much; they will still perform in-lab sleep studies as well as frequently perform administrative duties within the sleep lab.

Type 2 studies (full sleep study done at a patient's home)- I don't think many of this type of study will be done.

Type 3 studies (4-6 channel portable)- Reimbursement for these portable studies remain low.
The 2 ways to make a profit from type 3 studies is 1) use it as a loss leader for a sleep center or 2) do the study very cheaply. As margins at sleep centers are continually squeezed, I don't think it will be possible to portable studies as a loss leader much longer. As far as doing type 3 studies cheaply, the way to do this is to give the patient very little support. The patient picks up the device or has it shipped to them, and is given little instruction from a live person (and if there is any, it is from a secretary rather than a technician).
Neither of the 2 ways is appealing to me; I generally don't do home studies. There are business opportunities out there for entrepeneurial RPSGT's to work with doctors and provide home sleep studies., but I wouldn't recommend it.