According to Dr. Weaver, key ingredients for a hybrid program are an existing ACGME-accredited sleep medicine fellowship, an experienced sleep surgeon or team in the fellowship that practices the full range of sleep surgery (or at least the parts of sleep surgery of interest to trainees), and a collaborative sleep medicine team that works closely and well with the sleep surgery team.
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March 2015Hurdles Ahead
Dr. Weaver believes funding might be a challenge for some new programs. “ACGME-accredited fellows are not allowed to bill directly for their services or have attending hospital privileges, which limits the funding and programmatic flexibility,” he said. However, ACGME accreditation ensures an excellent, well-rounded training experience and provides eligibility for sleep medicine board sub-certification that would otherwise not be available.
José E. Barrera, MD, associate professor at Uniformed Services University of the Health Sciences in Bethesda, Md., and clinical associate professor at the University of Texas Health Sciences Center in San Antonio, also foresees funding as a primary challenge for fellowships.
“There is plenty of interest to teach, but less interest in funding; however, two large hospital systems are showing interest to meet this goal,” he said.
Another barrier to the development of fellowships has been a lack of awareness about which programs are available. Kanwar Kelley, MD, JD, resident at the University of California, Irvine and chair of the AAO-HNS Section for Residents and Fellows-in-Training, has compiled a list of fellowships in sleep medicine that have a surgical emphasis in sleep surgery.
Traditional Sleep Medicine Programs Give Support
Overall, sleep medicine programs increasingly support adding the surgical aspect and having otolaryngologists in the program. “If we work together in patients’ best interests, there will not be any resistance,” said Kathleen L. Yaremchuk, MD, MSA, chair of the department of otolaryngology–head and neck surgery at Henry Ford Health System in Detroit.
Dr. Weaver said sleep medicine colleagues have been supportive and enthusiastic about welcoming otolaryngologists to the fellowship. “I believe this successful training collaboration is related to our close working relationship and shared clinical and academic spaces,” he said. “Even before the hybrid sleep medicine/surgery fellowship program, the sleep medicine faculty always welcomed otolaryngology residents who sought extra sleep medicine training during their elective rotation.”
Dr. Barrera said that having a variety of training programs available is necessary to ensure the future of sleep surgery programs in the future. “Our training program incorporates reconstructive principles of soft tissue, maxillofacial, and facial plastic and reconstructive best practices and applies them to patients seeking sleep surgery to improve quality of life as well as functional airway parameters in the treatment of OSA in children and adults,” he said.