Sleep medicine

[cyanide12345678]

Asking for my spouse whose a pgy2 FM resident. The FM forums seem to have very few active users compared to us ER guys. So wondering what my ER community thinks.

What's the scope of sleep medicine in your opinion? Sounds like it's a good gig for family medicine docs, pay bump, great hours, no call, ability to become self employed with your own sleep lab, less association with those chronic patients who have 10+ items on their problem list.

If you were in FM, what would you do? Do a fellowship in something? Work at an urgent Care? Or just stick with out patient FM.

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[thegenius]

I have no idea.
Sleep medicine seems real boring to me.
Basically...lose weight and wear CPAP

 

[southerndoc]

My wife is a RPSGT (registered polysomnographic technologist), but she doesn't do sleep studies anymore. She's a photographer now.

It seems sleep labs are going away as there is a big push for more in-home testing. My wife doesn't think it's as reliable, but it's cheaper for Medicare and private insurers. If you have OSA, then you have to go to a sleep lab to get fitted for a mask and have your pressures titrated. However, insurance companies are at the beginning of pushing for auto-PAP (APAP) that will self-adjust your settings depending on your AHI's.

Having a wife that is an RPSGT, I am in a perfect position to start my own sleep lab and read studies. She could coordinate the RPSGT's to perform them. However, there is a reason I haven't gone into it. The majority of sleep labs are not as profitable as one would think, the majority of your referral base are hospital employed now, and a large number of health systems have gotten into the sleep medicine business by operating their own labs. It would be hard to get referrals except for the very few independent physicians out there.

 

[quiksilver87]

I graduated sleep medicine fellowship back in 2017 after doing IM residency. It is a dying field. It is a good retirement plan for people who chose to work for a hospital sleep lab. I briefly read some studies for an independent clinic but it was very unorganized so I quit. They got the majority of their referrals from the next door family medicine clinic.
As the above poster said, insurance companies are strongly pushing for home testing. They will flat out refuse in-lab testing prior to getting home testing (obviously there are exclusion criteria).

 

[VA Hopeful Dr]

What does she like to do?

 

[namethatsmell]

If I was FM I would do direct primary care in a heartbeat.

She should only do a fellowship if she’s truly interested in one of the options.

 

[AMEHigh]

Sleep medicine seems boring and like a not sustainable path.

I love FM. I work out patient and do a lot of procedures (endometrial biopsies, mva for miscarriage, colpo, skin stuff, injections, etc) on top of the rest of FM which includes peds and prenatal care. My colleagues also do OB deliveries and inpatient. I have no desire to do those. But no way would I give all that variety up to do sleep medicine.

 

[Preston Ganey Jr]

Is it necessary to do a fellowship in sleep medicine, or would a series of online courses suffice (looking at you, UPenn continuing Ed https://www.med.upenn.edu/sleepctr/cme.html)?

 

[Frazier]

Can make a huge impact on your pt's QoL. A number of interesting parasomnias. Good research potential if academic. Reimbursement addressed above.

I considered it as a good option back when I looked at IM --and, of course, if PalliMed wasn't a thing.