Sleep Medicine Fellowships—Accomplishments and More Issues

This year marks a relatively obscure event for most of us. It is the end of the initial accreditation cycle for those Sleep Medicine programs who were the vanguard of the ∼20 institutions that were the first to receive approval by the Accreditation Council for Graduate Medical Education (ACGME) for Sleep Medicine training. Obviously, for these institutions, it means considerable time spent by the program director and faculty in the preparation of the “PIF” (Program Information Form) and “dreaded” anticipation of the inevitable site visit. However, for the rest of us who fortunately will not have to complete a PIF, it is a marker of the gradual maturation of Sleep Medicine as a specialty of medicine. ACGME accreditation of our training programs means acceptance by the medical community that we have both a distinct base of scientific knowledge and a focused area of medical practice. The accreditation process also became the impetus for the development of an American Board of Medical Specialties (ABMS) certification examination in Sleep Medicine with the first examination to be given next month. These events are a result of hard work by colleagues who are too numerous to be recognized in this abbreviated message. Several years ago, I was fortunate to serve you as a member of the AASM (American Academy of Sleep Medicine) Board of Directors and was a participant in a discussion of what to include in our strategic plan. At that time, there were slightly over 25 AASM accredited fellowships, and there was considerable debate concerning whether a goal of 50 fellowship programs was achievable. Some of us, myself included, thought that this was unlikely to occur. Fortunately, I am not making my living as a psychic, and I am happy to report that I was quite wrong. At the current time, there are 57 ACGME accredited fellowship programs with 142 training positions1. However, our field's success in developing training programs raises an additional important issue. How many Sleep Medicine clinicians does this country require? If we conservatively count only those individuals who become ABMS certified and those who will be eligible for certification, there will be 142 people entering the field each year plus those who will become certified by taking the examination through practice/American Board of Sleep Medicine eligibility (over 1900 will be taking the first exam). Will this be sufficient to sustain our field? Do we need to encourage the development of more training programs? In comparison, there are 183 adult Pulmonary and/or Critical Care Medicine training programs with ∼550 first year positions and 91 Clinical Neurophysiology training programs with 282 positions in one year programs similar to Sleep Medicine training1. At a time when there is a debate in our field as to the role of the Sleep Medicine clinician in the delivery of patient care, these are critical questions, and ones that should be addressed in the near future. Another issue related to fellowship training is the content and length of training. In the next year, there will be a scheduled revision of the training requirements for Sleep Medicine. The Sleep Medicine community will be asked for input regarding the relevance of the current requirements for the practice of Sleep Medicine now and over the next several years. Should there be additions or deletions to the requirements? Is a one year training program appropriate? Should training be at least two years, similar that required by virtually all the Internal Medicine and Pediatric subspecialties? This latter question has significant cost and person power implications, but may be important in development of academic sleep clinicians. This two year anniversary of initial accreditation of Sleep Medicine training programs may not directly affect most of us. Nonetheless, it serves as a reminder that important issues related to person power and the practice of Sleep Medicine remain unresolved and should be addressed in the near future.