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MD on MD Violence: Turf War in Sleep Medicine

Sleep specialists are ticked off that, looking for new revenue streams, an increasing number of primary care physicians and other non-Sleep certified MDs are hopping on the Sleep Medicine bandwagon. As patients, the question is whether we should care. The answer I think is yes.

The complaint of the Sleep specialists is that interpreting sleep studies and diagnosing sleep disorders takes a fair amount of skill and training. Now, if you've ever taken a gander at your raw sleep study data and tried to make sense of all those squiggly lines and chicken scratch, you'd appreciate that they probably have a point. The general practice MDs, they claim, don't know how to interpret the raw data, but rather simply rubber stamp whatever the sleep lab tech concluded about the sleep study in question. And sleep lab techs didn't go to medical school. The result, the specialists claim, is that unqualified doctors are being paid for doing nothing, and while the sleep lab and the unqualified physician win, the patient ultimately loses out. Now, I'm not close enough to any of this to know for sure whether this is just sour grapes on the part of sleep specialists facing increased competition, or if they truly have a point. But my hunch is that the sleep specialists are in the right on this one. Perhaps our industry insiders will be able to shed further light on the answer to this question.

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Comment by Judy on February 4, 2009 at 7:18pm
In the US sleep medicine is a sub-specialty and to get accredited in that sub-specialty there is some training a doctor must go thru. AND, in theory, these sleep doctors are SUPPOSED to go over the raw data and score that data themselves. Some just go over the scoring of the data that the RPSGTs do and do a comparison to see if they or the RPSGT missed something. Too many just rubber stamp the RPSGT's scoring rather than bothering to double-check it. Some sleep doctors consult w/the patient before and after their sleep evaluation and the titration. At the other end of the spectrum are those "prima donnas" who never bother to see or consult w/the patient but rather just FAX their dictated report to the referring doctor w/their recommendations and wash their hands of the affair unless the REFERRING DOCTOR requests a consult, but not w/the patient. Currently, unfortunately, sleep medicine is a "cash cow" attracting those doctors who want a financially rewarding but not time consuming, sub-specialty. Fortunately, there are a few GOOD ones out there who really went into sleep medicine because the CARE about the patient, OSA and CPAP and other sleep therapies. Also unfortunately, accredidation does NOT mean the quality that it should. Not of sleep labs and not of sleep doctors.

Do I have any sympathy for the sleep profession? Uh uh. A big fat no. Its their profession, they are the ones who have to clean up the profession w/meaningful training, continuing education and accredidation. Or face the consequence of the "audit" (which I don't have a whole lotta faith in either).
Comment by Henning on February 4, 2009 at 3:01pm
Here in Denmark, sleep medicine has not yet recognized as a separate specialty. So we have no formal training for the "sleep specialists."

So in reality, this is the "wild west".

But nonetheless, a large part of the MD's is dealing with this area because of great interest. So some are trained abroad, others have taken courses and finally this is people with the right attitude.

But of course, you can also find "money makers" among our "sleep specialists".

Henning
Comment by Mike on February 4, 2009 at 2:06pm
as a factual matter, i'm not sure it's the case that a sleep specialist needs to be in charge of a sleep lab. i think any MD can be in charge of a sleep lab. as long as an MD has a license to practice medicine, that MD can practice in any sub-specialty of medicine. Now I'm not saying it's ethical to do so. I think doctors owe their patients a duty of competence. That said, it might be one of those things that slips through the cracks. I'm not a doctor, though, so perhaps I'm missing something...
Comment by sleepycarol on February 4, 2009 at 8:02am
If that truly is the case that the sleep specialist are not interpreting the data if a general practioner does the referal then our sleep specialist ripped off my insurance big time!!

I was referred by my primary care physician to our sleep lab. I had both sleep studies done and insurance paid for both studies (the diagnostic and titration study) to be read by our sleep specialist. I never saw this sleep specialist but my insurance coughed up big bucks for "his" part.

Am I missing something here? I would think that a sleep specialist would have to be in charge of the sleep lab and why would they let their lab be allowed to be on the receiving end of a lawsuit? I know when you go to a lab -- example blood work -- you have someone read and interpret the results and send them to the doctor.

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