Commentary
The Uncertain Fate of Otolaryngology in Sleep Medicine Raj C. Dedhia, MS, MD1,2, and Kathleen L. Yaremchuk, MD3
Otolaryngology– Head and Neck Surgery 2015, Vol. 152(3) 381–382 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814562721 http://otojournal.org
No sponsorships or competing interests have been disclosed for this article.
Abstract Since 2011, otolaryngologists have been required to complete a 1-year fellowship in sleep medicine in order to be eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). Resultantly, the number of sleep medicine boardcertified otolaryngologists has plunged since that time. This push toward extinction comes at a time when otolaryngologists have been cast into the spotlight for the diagnosis and treatment of obstructive sleep apnea, the prevailing disorder in sleep medicine. To reverse the trajectory of this subspecialty, 2 changes need to occur: increase the exposure to sleep medicine/surgery during residency and improve access to sleep medicine fellowships featuring a strong otolaryngology presence. Keywords sleep medicine, fellowship, sleep surgery
Figure 1. The number of sleep medicine board-certified otolaryngologists by year. The examination is offered every other year in odd-numbered years (eg, 2007, 2009, etc), and board certification occurs the year following the examination year. Those persons failing the examination are eligible to reappear in successive examination offerings. For example, 35 persons who previously failed the examination will be eligible to appear for the 2015 examination. (Data courtesy of the American Board of Otolaryngology)
Received October 29, 2014; accepted November 14, 2014.
I
n 2004, the Residency Review Committees (RRC) for internal medicine, neurology, pediatrics, psychiatry, and otolaryngology assembled guidelines for a 1-year sleep medicine fellowship, which subsequently were accepted by the American Board of Medical Specialties. The Accreditation Council for Graduate Medical Education (ACGME) granted ‘‘equal opportunity’’ status for otolaryngology with colleagues in the 4 other specialties.1 The American Board of Otolaryngology (ABOto) developed a ‘‘practice/alternate pathway’’ as a means for otolaryngologists to become eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). The pathway allowed otolaryngologists with adequate documentation of requisite sleep medicine experience to be eligible for the ASMCE. In 2007, the first otolaryngologists took the ASCME and became certified in January 2008. In 2011, the opportunity to use the practice/alternate pathway closed and a 1-year ACGME sleep fellowship became the sole option for board eligibility. It is estimated that fewer than 5 otolaryngologists have completed a sleep fellowship since 2011. Accordingly, the number of sleep medicine board-certified otolaryngologists has dropped precipitously since 2011 (Figure 1).
This dramatic decline represents a serious threat to the viability of sleep medicine as a subspecialty in otolaryngology even while otolaryngology is now uniquely positioned to play an instrumental role in the multidisciplinary arena of sleep medicine. Obstructive sleep apnea (OSA) is the most common sleep disorder, affecting between 5% and 10% of the American population.2 All aspects of OSA are increasingly recognized by the public, including health risks, diagnostic tools, and potential therapies. Promising innovations such as drug-induced sleep endoscopy and the hypoglossal nerve stimulator place the otolaryngologist at the center of patient care.
1 Department of Otolaryngology, University of Washington School of Medicine, Seattle, Washington 2 Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington 3 Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
Corresponding Author: Raj C. Dedhia, MS, MD, University of Washington, Otolaryngology, 325 Ninth Ave, Box 359803, Seattle, WA 98103, USA. Email: [email protected]
Downloaded from oto.sagepub.com at RUTGERS UNIV on August 10, 2015
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Otolaryngology–Head and Neck Surgery 152(3)
Nationally, the constituency of sleep medicine physicians has been reported to be endangered. In 2013, 25% of the 129 sleep fellowship positions remained unfilled.3 Possible reasons include reimbursement decline for polysomnography and lower intellectual challenge associated with treating sleep-disordered breathing. Interestingly, these reasons are not applicable to otolaryngologists. Most sleep otolaryngologists derive their income from clinic visits and operative procedures, not sleep study interpretations, and most otolaryngologists enter the field of sleep medicine in order to treat sleep-disordered breathing. The future for diagnostic and therapeutic applications for treatment of OSA offers academic opportunities for advancement in patient care. However, 2 major hurdles in training sleep otolaryngologists must be addressed: exposure during residency and access to sleep medicine fellowships with exposure to otolaryngologists. A limited number of otolaryngology training programs include faculty providing tertiary care for patients with OSA. Otolaryngology residents, as a result, often do not graduate with appropriate training in the surgical management of OSA or an interest in making sleep medicine an area of specialization.4 The current state of sleep otolaryngology harkens back to other subspecialties within our field (eg, laryngology, pediatrics) that have only recently attained their academic cachet. For example, the American Society of Pediatric Otolaryngology (ASPO) instituted a mini-mentorship program several years ago to ‘‘increase the number of residents who are exposed to an active, tertiary care pediatric otolaryngology practice.’’ The program provides funding for interested residents to visit another institution with pediatric otolaryngology expertise over a 3-day period.5 Those otolaryngologists interested in sleep medicine seek to emulate such strategies to achieve a critical mass. In addition to suboptimal residency exposure, only a handful of the 64 sleep medicine fellowship programs afford trainees exposure to hands-on-training from otolaryngologists specializing in sleep medicine. Most commonly, the fellowship faculty does not contain such an otolaryngologist. Even in the rare cases in which sleep otolaryngology faculty exist, the sleep medicine fellowship curriculum does
not offer flexibility for dedicated time (both clinical and operative) with a sleep surgeon. We issue this ‘‘call to arms’’ for otolaryngology residency training programs to facilitate careers in sleep medicine and for sleep fellowship programs to encourage more otolaryngology faculty and fellow representation. The field of otolaryngology is presented with a rare opportunity for inquisitive minds to advance and distinctly shape the future of sleep medicine. Let us seize the moment. Author Contributions Raj C. Dedhia, substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that; Kathleen Yaremchuk, substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; and final approval of the version to be published.
Disclosures Competing interests: None. Sponsorships: None. Funding source: None.
References 1. Osguthorpe JD. Otolaryngology and sleep medicine fellowships. Ear Nose Throat J. 2004;83:731. 2. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleepdisordered breathing. JAMA. 2003;289:2230-2237. 3. Quan SF. Graduate medical education in sleep medicine: did the canary just die? J Clin Sleep Med. 2013;9:101. 4. Sim MW, Stanley JJ. Trends in otolaryngology residency training in the surgical treatment of obstructive sleep apnea. Laryngoscope. 2014;124:579-582. 5. ASPO Mini Mentorship Program.Retrieved from http://www. aspo.us/aspo-mini-mentor-program/. Accessed October 15, 2014.
Downloaded from oto.sagepub.com at RUTGERS UNIV on August 10, 2015
The Uncertain Fate of Otolaryngology in Sleep Medicine Raj C. Dedhia, MS, MD1,2, and Kathleen L. Yaremchuk, MD3
Otolaryngology– Head and Neck Surgery 2015, Vol. 152(3) 381–382 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814562721 http://otojournal.org
No sponsorships or competing interests have been disclosed for this article.
Abstract Since 2011, otolaryngologists have been required to complete a 1-year fellowship in sleep medicine in order to be eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). Resultantly, the number of sleep medicine boardcertified otolaryngologists has plunged since that time. This push toward extinction comes at a time when otolaryngologists have been cast into the spotlight for the diagnosis and treatment of obstructive sleep apnea, the prevailing disorder in sleep medicine. To reverse the trajectory of this subspecialty, 2 changes need to occur: increase the exposure to sleep medicine/surgery during residency and improve access to sleep medicine fellowships featuring a strong otolaryngology presence. Keywords sleep medicine, fellowship, sleep surgery
Figure 1. The number of sleep medicine board-certified otolaryngologists by year. The examination is offered every other year in odd-numbered years (eg, 2007, 2009, etc), and board certification occurs the year following the examination year. Those persons failing the examination are eligible to reappear in successive examination offerings. For example, 35 persons who previously failed the examination will be eligible to appear for the 2015 examination. (Data courtesy of the American Board of Otolaryngology)
Received October 29, 2014; accepted November 14, 2014.
I
n 2004, the Residency Review Committees (RRC) for internal medicine, neurology, pediatrics, psychiatry, and otolaryngology assembled guidelines for a 1-year sleep medicine fellowship, which subsequently were accepted by the American Board of Medical Specialties. The Accreditation Council for Graduate Medical Education (ACGME) granted ‘‘equal opportunity’’ status for otolaryngology with colleagues in the 4 other specialties.1 The American Board of Otolaryngology (ABOto) developed a ‘‘practice/alternate pathway’’ as a means for otolaryngologists to become eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). The pathway allowed otolaryngologists with adequate documentation of requisite sleep medicine experience to be eligible for the ASMCE. In 2007, the first otolaryngologists took the ASCME and became certified in January 2008. In 2011, the opportunity to use the practice/alternate pathway closed and a 1-year ACGME sleep fellowship became the sole option for board eligibility. It is estimated that fewer than 5 otolaryngologists have completed a sleep fellowship since 2011. Accordingly, the number of sleep medicine board-certified otolaryngologists has dropped precipitously since 2011 (Figure 1).
This dramatic decline represents a serious threat to the viability of sleep medicine as a subspecialty in otolaryngology even while otolaryngology is now uniquely positioned to play an instrumental role in the multidisciplinary arena of sleep medicine. Obstructive sleep apnea (OSA) is the most common sleep disorder, affecting between 5% and 10% of the American population.2 All aspects of OSA are increasingly recognized by the public, including health risks, diagnostic tools, and potential therapies. Promising innovations such as drug-induced sleep endoscopy and the hypoglossal nerve stimulator place the otolaryngologist at the center of patient care.
1 Department of Otolaryngology, University of Washington School of Medicine, Seattle, Washington 2 Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington 3 Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
Corresponding Author: Raj C. Dedhia, MS, MD, University of Washington, Otolaryngology, 325 Ninth Ave, Box 359803, Seattle, WA 98103, USA. Email: [email protected]
Downloaded from oto.sagepub.com at RUTGERS UNIV on August 10, 2015
382
Otolaryngology–Head and Neck Surgery 152(3)
Nationally, the constituency of sleep medicine physicians has been reported to be endangered. In 2013, 25% of the 129 sleep fellowship positions remained unfilled.3 Possible reasons include reimbursement decline for polysomnography and lower intellectual challenge associated with treating sleep-disordered breathing. Interestingly, these reasons are not applicable to otolaryngologists. Most sleep otolaryngologists derive their income from clinic visits and operative procedures, not sleep study interpretations, and most otolaryngologists enter the field of sleep medicine in order to treat sleep-disordered breathing. The future for diagnostic and therapeutic applications for treatment of OSA offers academic opportunities for advancement in patient care. However, 2 major hurdles in training sleep otolaryngologists must be addressed: exposure during residency and access to sleep medicine fellowships with exposure to otolaryngologists. A limited number of otolaryngology training programs include faculty providing tertiary care for patients with OSA. Otolaryngology residents, as a result, often do not graduate with appropriate training in the surgical management of OSA or an interest in making sleep medicine an area of specialization.4 The current state of sleep otolaryngology harkens back to other subspecialties within our field (eg, laryngology, pediatrics) that have only recently attained their academic cachet. For example, the American Society of Pediatric Otolaryngology (ASPO) instituted a mini-mentorship program several years ago to ‘‘increase the number of residents who are exposed to an active, tertiary care pediatric otolaryngology practice.’’ The program provides funding for interested residents to visit another institution with pediatric otolaryngology expertise over a 3-day period.5 Those otolaryngologists interested in sleep medicine seek to emulate such strategies to achieve a critical mass. In addition to suboptimal residency exposure, only a handful of the 64 sleep medicine fellowship programs afford trainees exposure to hands-on-training from otolaryngologists specializing in sleep medicine. Most commonly, the fellowship faculty does not contain such an otolaryngologist. Even in the rare cases in which sleep otolaryngology faculty exist, the sleep medicine fellowship curriculum does
not offer flexibility for dedicated time (both clinical and operative) with a sleep surgeon. We issue this ‘‘call to arms’’ for otolaryngology residency training programs to facilitate careers in sleep medicine and for sleep fellowship programs to encourage more otolaryngology faculty and fellow representation. The field of otolaryngology is presented with a rare opportunity for inquisitive minds to advance and distinctly shape the future of sleep medicine. Let us seize the moment. Author Contributions Raj C. Dedhia, substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that; Kathleen Yaremchuk, substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; and final approval of the version to be published.
Disclosures Competing interests: None. Sponsorships: None. Funding source: None.
References 1. Osguthorpe JD. Otolaryngology and sleep medicine fellowships. Ear Nose Throat J. 2004;83:731. 2. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleepdisordered breathing. JAMA. 2003;289:2230-2237. 3. Quan SF. Graduate medical education in sleep medicine: did the canary just die? J Clin Sleep Med. 2013;9:101. 4. Sim MW, Stanley JJ. Trends in otolaryngology residency training in the surgical treatment of obstructive sleep apnea. Laryngoscope. 2014;124:579-582. 5. ASPO Mini Mentorship Program.Retrieved from http://www. aspo.us/aspo-mini-mentor-program/. Accessed October 15, 2014.
Downloaded from oto.sagepub.com at RUTGERS UNIV on August 10, 2015
