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Curious as to what it takes to become a certified sleep doc?
#41
This forum inspires me to do things.

When I looked for a sleep doc, I used ZocDoc, which gave me who's closest in a particular specialty, in my insurance. That's about all its good for, but I was able to find someone close with a fellowship in sleep medicine. Didn't really know what that meant, but the diplomas he hangs look impressive. He is also a neurologist, and operates a 2-room sleep clinic at his offices.

But after this thread, I started to dig. Apparently the place to go is the ABMS, or American Board of Medical Specialties (in the US). Turns out he is certified.

But Mosquitobait's point is well-taken. He seems to have little interest (after the sleep study) to do anything other than collect a copay every 90 days and look for compliance. I tell him how my charts are, and he stares through me like he's thinking about tonight's FIFA game. I did get a few answers, after pressing him a bit. So I may shop around.

I know nothing about why, but I think my preference would be in this order: neuro, pulmo, ENT. And this is because most ENTs make sleep med a smaller part of their practice. I want the guy who sees 15 sleep patients a week, not 15 sleep patients a year. Of course if you have neuro, pulmo, or ENT issues, the order of pref might be different for you.
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#42
(07-07-2015, 05:40 PM)surferdude2 Wrote: I think the typical doctor, in any field, suffers from a lack of allowable billable time to explain all of his diagnosis in detail.

How very true - I don't know if it is the same in the US at the moment, but we are run on a very tight schedule, even the specialists, and frankly if we spend more than a few minutes with a patient, matron starts knocking on our door. Insurance rules forces us to see so may patients a day (I am allowed a maximum of 15 minutes unless there is a good reason, which has to show up in the tax points (our billing system) so sometimes patients get short changed on the clear, careful explanations, something I hate, and is something I love about this forum, I can take time to explain sometimes better than I can with my own patients), as do the miserably difficult patient to physician ratio in almost all fields, even though in Switzerland he have one the of the best ratios in Europe, it still means a massive patient load. I have a mate practising in Ontario who says I am positively spoilt here, what with him having to see one patient every five minutes or justify why he needs longer with one, and I heartily sympathise (OHIP is a bitch, I understand) but most places suffer from the same problem problem - we are run off our feet. Oh, to be a country doctor in a lazy one horse town, but us city types don't get much rest or time.

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#43
Personally, I don't think does matter at all, whether my doc is certified or not
Because, I don't have complex problems, just garden-variety type and my machine is an AutoSet
My AutoSet is my certified doctor

Compliance rate is below 50%, what the so called certified doctors doing about it

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#44
(07-07-2015, 05:46 PM)zonk Wrote: What Does It Mean to Be a Board-Certified Sleep Specialist?
http://www.huffingtonpost.com/stanford-c...16318.html


To be honest, I think PAs also ought to take the Fellowship training in the US and sit the exam (they will be allowed to in certain states, I think)(our rules and system is different, as is our training, although not so much that a medical professional anywhere in the world would not recognise it) , and frankly, I think most follow up visits at sleep centres should be taken by PAs, turfing only the tough ones up to the MD at their discretion. PAs came into existence in order to take some of the work load off the MDs by dealing with common cases and scut-work, and I see no problem with them doing the same in speciality areas. In a good 70% of the cases in sleep medicine, it would be enough, they would be able to take time for the patient's questions and the MD could have more time for the complex cases and all patients would be given more attention. Win-win.

BTW, you have no idea how tough any Board Certification is. US Boards are just as tough as the FMH here (really tough, crying and screaming tough), and we live in fear of taking them or letting our certs lapse. Hence, btw, the reason your doc is always away taking courses - the terror of letting the license and board certs lapse is just too high to skip on the continuing education requirements. It has the advantage of winnowing out the non-committed. But it is a pain, personally speaking. I took my US surgical boards before I took my FMH, and I remember both being near nightmares. But I was the better doctor for it. Of the two, I think I still get nightmares about the FMH more, but then, my career hung more on it than the US boards, the opportunity to taking of which was extended to me as courtesy to a visiting surgical resident specialist.
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#45
OK. It is good that the boards are tough, and I am a little less cynical now knowing that the system that places us on a Lucy-Ricardo conveyor belt is more due to the insurance and nature of medicine today than it might be to uncaring docs. My apologies to all docs that I perceived as uncaring when it might really have been the system that is uncaring. They probably feel they are on the conveyor belt as well.

My dad was an orthopedic surgeon with his own practice in a farm town of 25,000 people. He saw maybe 30 patients a week, and I hardly ever saw him, because he was always at the hospital or seeing patients in his office. I have been to docs that see over 200 patients a week, and the care is minimal. I recall that he had a 10-inch acetate recording of Ronald Reagan in 1960 railing about socialized medicine. He discouraged me from going into medicine, and the way things are today is probably the exact reason why.

But my ophthalmologist spends a good 30-40 minutes with me, on a routine checkup, after her PA has spent a good 20. Maybe their requirements are different somehow.
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#46
(07-07-2015, 05:40 PM)surferdude2 Wrote: DocWils, Like you, we also use the term "cowboys" in the U.S. to describe people in any occupation that tend to operate ostentatiously beyond their abilities and bring disgrace to those who are more able and well trained in the particular field. Pretty common term, not meant to refer to the true western cowboy, of which few are left to take exception.

I think the typical doctor, in any field, suffers from a lack of allowable billable time to explain all of his diagnosis in detail. As a result, you just have to find someone you can trust and place your well being in his/her hands. That's sad, but that's how it has evolved and won't likely change until ______________ (fill your own term in there).

While I agree it is a commonly used term it is still disrespectful and inaccurate IMO. Yahoo or jack leg is what ought to be used depending upon the context. My extended family is very large (huge by todays standards) and includes a lot of different occupations. When I became a hard hat I learned about the chameleon effect as I came from a very different place in life.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#47
For any of my fellow hose heads here who may be concerned please be aware Doc Wils knows I have a passionate, almost unquenchable desire, to learn and understand. I am a philosopher in the literal definition of the word. While I will dig in and defend myself and question authority positions please be assured Doc knows I mean him no disrespect and I am able to apologize if I find I have transgressed. Though I may disagree with him or anyone else I rarely seek to be disagreeable.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#48
(07-07-2015, 06:04 PM)DocWils Wrote: Oh, to be a country doctor in a lazy one horse town, but us city types don't get much rest or time.

Doc, I lived for a time in a small village of approximately 3500 people. It was a one horse errrr one doctor town and it was a good thing that the doctor was a relatively young man. His patient load was 5000 people. He built a 2 wing office and clinic to house another doctor and spent a lot of time trying to recruit someone to use the other wing. Never happened.

One could go in for an appointment and still wait 1-2 hours to be seen. Needless to say that doctor aged quite quickly. I think that it is just a case of the grass looking greener.

Best Regards,

PaytonA
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#49
(07-07-2015, 06:40 PM)TyroneShoes Wrote: OK. It is good that the boards are tough, and I am a little less cynical now knowing that the system that places us on a Lucy-Ricardo conveyor belt is more due to the insurance and nature of medicine today than it might be to uncaring docs. My apologies to all docs that I perceived as uncaring when it might really have been the system that is uncaring. They probably feel they are on the conveyor belt as well.

My dad was an orthopedic surgeon with his own practice in a farm town of 25,000 people. He saw maybe 30 patients a week, and I hardly ever saw him, because he was always at the hospital or seeing patients in his office. I have been to docs that see over 200 patients a week, and the care is minimal. I recall that he had a 10-inch acetate recording of Ronald Reagan in 1960 railing about socialized medicine. He discouraged me from going into medicine, and the way things are today is probably the exact reason why.

But my ophthalmologist spends a good 30-40 minutes with me, on a routine checkup, after her PA has spent a good 20. Maybe their requirements are different somehow.

30 patients a week? Paradise!

Yes, each individual discipline has different time requirements - you can't knock out an eye patient very quickly - the testing takes a specific amount of time, and some bright guy years and years back timed what each procedure in each discipline took and applied it to the insurance billing and to some hospital appointment schedules, forcing all of us to take on more patients per hour than ever before. it was done to save money, but I think it makes things more expensive and hinders quality of care. And yes, we feel we are on a treadmill. I don't know many physicians who don't end their day feeling exhausted and ready to collapse.
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#50
(07-07-2015, 10:38 PM)PaytonA Wrote:
(07-07-2015, 06:04 PM)DocWils Wrote: Oh, to be a country doctor in a lazy one horse town, but us city types don't get much rest or time.

Doc, I lived for a time in a small village of approximately 3500 people. It was a one horse errrr one doctor town and it was a good thing that the doctor was a relatively young man. His patient load was 5000 people. He built a 2 wing office and clinic to house another doctor and spent a lot of time trying to recruit someone to use the other wing. Never happened.

One could go in for an appointment and still wait 1-2 hours to be seen. Needless to say that doctor aged quite quickly. I think that it is just a case of the grass looking greener.

Best Regards,

PaytonA

I think my fantasy was always to be something like Seth Hazlit (played by one of my favourite actors, William Windom, R.I.P.) on Murder She Wrote (I am certainly beginning to resemble him, and sure as hell am as "crusty" as he was), down to getting in the fishing he always seemed to be off getting and sitting in Jessica's kitchen eating pie, but you are right - small town doc is only great if there are at least two of them. I had a cousin who answered an ad to be a doctor in the outports of Newfoundland, which, given the small population seemed like the ideal life - but she ended up having to work twice as hard as she had in her previous posting in La Chaux-de-Fonds. It was a great life in many ways, and she loved the Newfoundland people and the island life, but she quickly understood why they had a hard time keeping doctors there. She now lives on a farm and practices in the nearby village in the Zermatt region and raises, with her husband, Newfoundland Dogs on the side. She still pulls thirteen hour days on average, and that is excluding her surgical duties at the local hospital.
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