Salary?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
ussdfiant

ussdfiant

Full Member
Moderator Emeritus
Verified Member
Physician
15+ Year Member
20+ Year Member
Joined
Jul 31, 2001
Messages
1,633
Reaction score
38
I can imagine that the lifestyle of a Sleep doc is relatively relaxed, but how does it pay (in comparison to a general internist for example, as I am an IM R2)?
Members don't see this ad.
 
ussdfiant said:
I can imagine that the lifestyle of a Sleep doc is relatively relaxed, but how does it pay (in comparison to a general internist for example, as I am an IM R2)?
Click to expand...

This is a complicated question, but I'll try.

#1. You will make more as a "sleep doc" than as a general internist, for no better reason than you will be involved in what has been (so far, but likely soon to change) a "cash cow," i.e., sleep studies, whereas a general internist is not.

#2. That being said, you will also probably also be a fellowship trained subspecialist in something else (neurology, pulm/crit care, ENT, etc), all of whom at baseline make more than a general internist anyway, whether they do sleep or not.

#3. The above fellowship trained specialists rarely do 100% sleep med; they usually split sleep with some of their other work (general neuro, pulmonology, ENT surgery, etc), so it's hard to say what percentage of sleep work really makes you a "sleep doc."

#4. Because of all the above factors, there is precious little data out there on what "sleep docs" actually make. The "gold standard" for physician salary data is the the MGMA report, and it has only scant data for sleep physicians (yes, I've looked at it myself . . . :D). The numbers mentioned in the web link above are probably not too far off, though. A pulm/crit care or neurologist in private practice doing about 50% sleep should easily clear 200K, possibly up to $300 if they're busy and in a group with a well-insured patient base. ENTs in surgical groups would make more but that's more because of all the other non-sleep related procedures they do. Expect less $ in academia.

Hope this was helpful.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
Thanks guys. I wonder how big the discrepancy really is between IM vs Pulm/CC vs Neuro trained sleep docs in terms of jobs/salary. Many of the jobs I have seen listed want Pulm/Neuro trained sleep docs for their group practices. I wonder how marketable an IM trained sleep doc would be. Also, do you think one could practice both general IM and sleep?
 
I agree, it's really hard to say how much you will make as a sleep medicine physician. Likewise the same problem with Pain medicine physicians and Intensive Care Physicians... those subspecialties are all multi disciplined and it seems that you carry your weight with you from other specialties.
 
ussdfiant said:
Thanks guys. I wonder how big the discrepancy really is between IM vs Pulm/CC vs Neuro trained sleep docs in terms of jobs/salary. Many of the jobs I have seen listed want Pulm/Neuro trained sleep docs for their group practices. I wonder how marketable an IM trained sleep doc would be. Also, do you think one could practice both general IM and sleep?
Click to expand...

The few IM sleep fellows and IM candidates I talked to during my interview trail for sleep fellowship were planning to do pulm/cc after finishing sleep fellowship.

Most sleep docs don't do 100% sleep. You will still need to see patients from your respective field.

The graduating sleep fellows I talked to mostly from neuro and Pulm/cc told me they were getting offers in the $250 and $275 range. One guy had already signed up a $250K contract.

Hope this helps.
 
PCCM grads usually get 250K without a Sleep fellowship. Ive heard anecdotally, that sleep can make you a lot of money. Im also curious about how much. I think it would be fascinating to work in a Sleep group with people from different disciplines.
 
Now with the ABA stating that sleep medicine is an accredited fellowship option for those coming out of anesthesiology for residency, how competitive would one need to be to land a sleep spot. What would be the pecking order now in terms of those pursuing this fellowship? I was always genuinely interested in sleep, but decided I didn't like Pulm/Crit Care, neurology to make the jump just for sleep (and give up something I did enjoy, anesthesiology). However, now I can have my cake and eat it too. Feels good for once.
 
Doctor4Life1769 said:
Now with the ABA stating that sleep medicine is an accredited fellowship option for those coming out of anesthesiology for residency, how competitive would one need to be to land a sleep spot. What would be the pecking order now in terms of those pursuing this fellowship? I was always genuinely interested in sleep, but decided I didn't like Pulm/Crit Care, neurology to make the jump just for sleep (and give up something I did enjoy, anesthesiology). However, now I can have my cake and eat it too. Feels good for once.
Click to expand...


You would think that Gas and Sleep are a logical fit -- after all, anesthesiologists spend their time putting people to sleep, right?

Nevertheless, I don't think the fellowship "pecking order" (i.e., pulm = neuro > psych >>> everyone else) will change too fast, mostly for the reason that there aren't a lot of anesthesia people in sleep to begin who can advocate for other anesthesia-trained fellows.

That being said, sleep apnea, at least, is getting more and more attention from anesthesiologists due to the increased risk of peri- and post-op respiritory and cardiac complications among OSA patients. It's increasingly screened for in anesthesia pre-ops, so the specialty does have some stake in sleep medicine.

However . . . there is a big difference between recognizing a sleep disorder in a screening setting and taking on responsibility for long term care of chronic sleep patients, many of whom have things other than sleep apnea. I'm not sure that people initially attracted to the primary modus operandi of anesthesia would find sleep practice to be very appealing, but that's just my take on things.

Based on the above, with regard to your "how competitive would one need to be" question, I would think that at least in the next couple years you'd 1) have to be pretty competitive and 2) have to have a pretty good explanation of why you wanted to go into sleep in order to land a spot.
 
neurologist said:
You would think that Gas and Sleep are a logical fit -- after all, anesthesiologists spend their time putting people to sleep, right?

Nevertheless, I don't think the fellowship "pecking order" (i.e., pulm = neuro > psych >>> everyone else) will change too fast, mostly for the reason that there aren't a lot of anesthesia people in sleep to begin who can advocate for other anesthesia-trained fellows.

That being said, sleep apnea, at least, is getting more and more attention from anesthesiologists due to the increased risk of peri- and post-op respiritory and cardiac complications among OSA patients. It's increasingly screened for in anesthesia pre-ops, so the specialty does have some stake in sleep medicine.

However . . . there is a big difference between recognizing a sleep disorder in a screening setting and taking on responsibility for long term care of chronic sleep patients, many of whom have things other than sleep apnea. I'm not sure that people initially attracted to the primary modus operandi of anesthesia would find sleep practice to be very appealing, but that's just my take on things.

Based on the above, with regard to your "how competitive would one need to be" question, I would think that at least in the next couple years you'd 1) have to be pretty competitive and 2) have to have a pretty good explanation of why you wanted to go into sleep in order to land a spot.
Click to expand...

Thanks. Sleep would provide a change of pace when not in the OR, and I'd get to (hopefully) see positive results when helping those with sleep apnea (unlike with pain, where most seem to bounce back after X number of months for more procedures). Plus, I get to work with a wide variety of patients, as there's a lot more than just obese people having sleep apnea, tack on central sleep vs. obstructive sleep. Tack on narcolepsy (friend has it), and other sleep-related disorders. I find it to be a very interesting, and still developing, field.
 
You guys should not be complaining for the pay...come to my country and you will not get paid more than 1300$...and that is for medium doctors...I don't even want to mention the beinning pay
 
Coming from a RRT/RPSGT, almost every doctor that I've worked for has been either a Nuero, Pulm, or Cardio. One lab had a phycologist that worked at the lab, and would frequently stay night with us techs. The majority of them were pulm though. All of them had patients outside of sleep.
 
rrt said:
Coming from a RRT/RPSGT, almost every doctor that I've worked for has been either a Nuero, Pulm, or Cardio. One lab had a phycologist that worked at the lab, and would frequently stay night with us techs. The majority of them were pulm though. All of them had patients outside of sleep.
Click to expand...

A phycologist? Damn! I had no idea algae were involved in sleep medicine!
:laugh:
 
rrt said:
Coming from a RRT/RPSGT, almost every doctor that I've worked for has been either a Nuero, Pulm, or Cardio. One lab had a phycologist that worked at the lab, and would frequently stay night with us techs. The majority of them were pulm though. All of them had patients outside of sleep.
Click to expand...

A sleep-certified doc with a pulm background doing a combination of pulm/sleep is the predominant model in sleep medicine today. There are exceptions, though. My background is IM/PSYCH, and I don't have patients outside of sleep. I personally don't know any cardiologists who practice sleep medicine.
 
  • Like
Reactions: 1 users
I think anyone that was comfortable in the ICU was doing sleep because they were used to CPAP machines. However these are often sleep apnea mills and not sleep medicine clinics.

This will slowly change after this year as this is the final year of grandfathering into sleep medicine. I think eventually sleep will be mostly neurology and psychiatry along with primary care. Sleep will not continue to be reimbursed like it is right now and also there will be a transition to home studies with improved equipment. This is already happening and this will significantly decrease the motivation for subpsecialties like pulm, ENT, cardiology and anesthesia to enter the field.
 
Last edited:
Manicsleep said:
I think anyone that was comfortable in the ICU was doing sleep because they were used to CPAP machines. However these are often sleep apnea mills and not sleep medicine clinics.

This will slowly change after this year as this is the final year of grandfathering into sleep medicine. I think eventually sleep will be mostly neurology and psychiatry along with primary care. Sleep will not continue to be reimbursed like it is right now and also there will be a transition to home studies with improved equipment. This is already happening and this will significantly decrease the motivation for subpsecialties like pulm, ENT, cardiology and anesthesia to enter the field.
Click to expand...

Please elaborate. Thanks
 
Doctor4Life1769 said:
Please elaborate. Thanks
Click to expand...

I'm not the one who originally posted but as a recently "retired" RPSGT, I can try to elaborate.

Home sleep tests (HSTs) are increasingly preferred by patients and insurance companies. They are cheaper to run and can be done in the comfort of your own home. However, the quality and reliability is lacking right now. It is improving, however.

In my lab, anyone referred with a (+) HST was fit for CPAP and then run as a split, to confirm the diagnosis and initiate treatment. Most of the time, it was pretty close (i.e. HST shows RDI = 20, lab PSG shows RDI = 24 -- close enough, but not perfect). Occasionally, HST would show rampant apnea that just wasn't present in the lab.

From a business standpoint, many PCPs are set up with a ton of HST equipment. They send their patients home with them, then bill for reading the output. It's a pretty good bump to your income for not a lot of work.
 
  • Like
Reactions: 1 users
Doctor4Life1769 said:
Please elaborate. Thanks
Click to expand...

Sleep reimbursement is going down like many subspecialties. A lot of times the price will go down until the market will not bear it anymore. This is happening with PCPs right now. PCP salaries will be rising (already have been rising in some areas) because nobody wants to become a primary care doctor anymore.

Sleep is getting reimbursed well for now because a lot of studies are being done in house. However, many systems are transitioning to HST including VA and Kaiser for a huge percentage of their studies. In the open market the salary per hour is usually like this (at least where I work) ENTs>Med subspecialties like pulm and cardio> Psychiatry> Neurology > PCP. Add to this the extra time it will now take for ENTs and med subspecialists to be boarded in sleep and it becomes an expensive proposition long term. For primary care, it makes a lot of sense and you will probably see a lot of primary care docs doing sleep in the future.
 
  • Like
Reactions: 1 users
A sleep doctor's salary is primarily determined by the type and place of practice he/she chooses. Physicians who are specialists earn an annual median -- meaning half earn more, half less,salary of $339,738.
 
dcbrvo said:
A sleep doctor's salary is primarily determined by the type and place of practice he/she chooses. Physicians who are specialists earn an annual median -- meaning half earn more, half less,salary of $339,738.
Click to expand...

I agree - location will have great influence on salary potential.
 
I believe that the MGMA is publishing (or has published) Sleep Medicine as a separate and distinct entity from Neuro/Sleep, Pulm/Sleep, or Psych/Sleep as had apparently been done in the past. This information should be helpful to those of you considering a 100% sleep practice.

To answer one of the original questions above, a 100% sleep practice (though rarer than others) should basically reimburse the same across for board for anyone - regardless of background residency. Billing for sleep patients and sleep studies wouldn't change, ergo the money you make for yourself or someone else doesn't change.
 
danielmd06 said:
I believe that the MGMA is publishing (or has published) Sleep Medicine as a separate and distinct entity from Neuro/Sleep, Pulm/Sleep, or Psych/Sleep as had apparently been done in the past.
Click to expand...

They do, but as of the last time I looked (about 3 yrs ago) the sample size was small and data was pretty scant
 
Anyone have access to MGMA data for the FT Sleep Medicine practice and also the split specialty practices PCCM/Sleep, Neuro/Sleep, Psych/Sleep, IM or FP/Sleep?

I've tried hard to look for this current data, but has been impossible to date for me to find.
 
  • Like
Reactions: 1 user
I recently posted this in my blog:

An experienced sleep technician recently asked me about compensation for sleep physician services at a sleep disorders center (IDTF) he is starting. Below is what I told him (disclaimer: this is based on my experiences over the last several years talking to numerous sleep professionals, and not on my own salary/compensation) -

1. There are 2 basic options for compensating the sleep physician for interpreting sleep studies. One is for the physician to bill for the professional component (-26) of the study, and the IDTF for the technical component (-TC). The other option is for the IDTF to bill for the studies on a global basis and pay the physician a fee for each interpretation. This fee typically ranges from $75 to $175 ($100-125 is average).
Although I am unsure if you can legally take it into account, the physician is going to probably expect to receive somewhere in the higher range if he is generating many of the referrals to the sleep center or providing outpt follow up to the patients. In this case, I would recommend letting the physician just bill for the professional component.

2. Medical director fees: Although some sleep centers try to bundle this in with interpretations, it is best from a legal standpoint to pay a separate fee for medical director duties (such as supervision of technicians, developing policies and procedures, administration, etc). There are 2 basic options. First, the medical director can keep a log of his administrative hours and be compensated on an hourly basis (typically $100-$150 per hour). The other option is to pay the medical director a fixed monthly fee- this is usually based on number of beds. $500-1000 for a 4 bed lab and $750-$1500 for a 6 bed lab are typical salaries.

One of the reasons that I don't recommend bundling sleep study interpretation fees with medical director fees is that it makes things "messy" if a 2nd sleep physician (other than the medical director) starts interpreting studies.

There are a lot of legal pitfalls in setting physician compensation, and I recommend consulting with an experienced healthcare attorney familiar with both federal regulations and the laws of your state.

I welcome reader comments regarding this subject
 
Dr. Rack,

How would you design a contract for a split practice? Specialty A with Sleep Med, directorship and PSG reading?

I'm thinking of an employed model as private practice would be a little more self-evident with the model you have proposed. And would there be much of a difference in said employed model between hospital vs group?

Thanks!
 
Shikima said:
Dr. Rack,

How would you design a contract for a split practice? Specialty A with Sleep Med, directorship and PSG reading?

I'm thinking of an employed model as private practice would be a little more self-evident with the model you have proposed. And would there be much of a difference in said employed model between hospital vs group?

Thanks!
Click to expand...

It's hard to answer your question. The majority non-hospital sleep labs are IDTF's, which typically don't employ physicians directly. If you are looking for an employed model, I guess you would need to be an employee of a physician group. That physician group would then negotiate contracts with sleep labs. I think, however, that the med director contract would be an individual contract, but I am not 100% sure.

There are some physician groups which own a sleep lab as part of their practice. You could look for such a group.

The model I proposed was specific to a sleep lab (IDTF) that was trying to contract with an indivdual doctor for services that did NOT include seeing patients

edit: IDTF= Independent diagnostic and testing facility
 
Necro'd this bad boy because I was curious about one thing: Do non-surgeons who complete sleep fellowships commonly perform sleep surgery themselves or do they refer out the surgeries (to ENT for instance) as is common practice in other medical specialties? Thanks.
 
capnamerica said:
Necro'd this bad boy because I was curious about one thing: Do non-surgeons who complete sleep fellowships commonly perform sleep surgery themselves or do they refer out the surgeries (to ENT for instance) as is common practice in other medical specialties? Thanks.
Click to expand...

Would you really trust a pulmonologist to do a T&A?
 
braineddetermined said:
Are these numbers reasonable for sleep medicine?
View attachment 292756
Click to expand...
1579195144885.png
 
  • Like
  • Haha
Reactions: 2 users
braineddetermined said:
Are these numbers reasonable for sleep medicine?
View attachment 292756
Click to expand...
I live in what would be the “Eastern” region and I can tell you that, yes, that’s about right for these parts.
I’m a little puzzled by the salary difference between Eastern and Western regions though. $100k difference seems kinda wacky.
 
  • Like
Reactions: 1 user
neurologist said:
I live in what would be the “Eastern” region and I can tell you that, yes, that’s about right for these parts.
I’m a little puzzled by the salary difference between Eastern and Western regions though. $100k difference seems kinda wacky.
Click to expand...

I suppose those earning >400k are partners?
 
Anyone have access to the AASM compensation survey and wouldn't mind sharing some details?
 
  • Like
Reactions: 1 user
TorusTubarius said:
Anyone have access to the AASM compensation survey and wouldn't mind sharing some details?
Click to expand...

There is a ton of data in that report.

The most important thing to note is that they invited about 8,000 physicians to participate and only 11% responded. So, kind of self-selecting sample and who knows how really generalizable? I'll let the stats mavens sort that out,

Mean salary: 300 K
Median salary: 280 K
90th %-ile: 460 K


BTW, that $100 K salary difference between East and West shown in the other data table in this thread (which I thought was kind of fishy) is not supported by the AASM report, which shows only a $15 K difference.
 
mcolumbmd said:
That would be with a pure sleep training or people with Neuro/Sleep or PCC/Sleep?
Click to expand...
Sleep from any back ground. The E&M reimbursement is the same regardless of anyone's base specialties. A 99204 will pay the same for doing a sleep consult. Insurance doesn't care if you are IM/FM/Psych/Neuro/PCC/ENT etc
 
You must log in or register to reply here.
Next unread thread

Similar threads

T
Perennial question updates: salary/competitiveness
Replies
10
Views
5K
The kitchen sink
The kitchen sink
Top