Why Otolaryngologists Have an Advantage When Dual Boarding in Sleep Medicine

The State of Sleep

Otolaryngology residents and clinicians who are thinking about dual boarding in sleep medicine have several factors to consider. As noted earlier, getting certified isn’t as simple as it used to be. Moreover, the number of ACGME-accredited fellowship programs is limited. “There are currently only 180 certified fellowship positions in sleep medicine at 84 centers in the U.S.,” said Dr. Wardrop. “Also, most sleep surgery programs for otolaryngologists aren’t accredited for the purpose of board certification, and most sleep medicine fellowships provide no surgical training.”

Still, there are some compelling reasons to consider taking the leap. First, there’s no shortage of patients, as sleep disorder cases are on the rise, and it’s estimated by the American Sleep Apnea Association that a large majority of sleep-disordered breathing cases have yet to be diagnosed.

Second, it’s becoming increasingly clear that CPAP isn’t a panacea treatment for patients with OSA. “The era of the single-modality treatment for sleep-disordered breathing is changing,” said Dr. Woodson. “Even in medical fields, [physicians] are becoming much more aware of multiple therapies, and even multimodality therapies, as well as a number of surgical procedures.” He cited a recent randomized trial conducted in Australia indicating that multilevel soft-tissue surgeries can be successful in patients who have failed CPAP (JAMA. 2020;324:1168-1179). “So I think there’s more of a role for the subspecialist surgeon to be involved in this disease.” 

Looking forward, Dr. Wardrop sees a “looming shortage” of trained sleep medicine practitioners, as many of those who were certified years ago reach retirement age. “I think we’re about to run into a crunch because there aren’t a lot of doctors coming through the pipeline,” she said. Although dual boarding isn’t right for everyone, this scenario just might represent an opportunity too good to pass up.

Linda Kossoff is a freelance medical writer based in Woodland Hills.