the current ABSM; (2) certification by one of the primary sponsoring boards and completion of training in a 1-year sleep medicine fellowship program, not overlapping with any other residency or fellowship; and (3) clinical practice experience. This clinical practice experience pathway may consist of a 5-year “grandfathering” period open to physicians who are board certified in one of the sponsoring specialty boards and who can attest that he or she has the equivalent of 1 year of clinical practice experience in sleep medicine during the prior 5 years. This experience could, for example, be gained by an individual practitioner who has devoted one-third of his or her practice to sleep medicine over 3 years. Physicians in the clinical practice pathway will also have to attest to a specified minimum number of patients seen and polysomnograms and Multiple Sleep Latency Tests read. At the end of this initial 5-year period, the only route to board eligibility will be through an ACGME accredited fellowship training program. This creates a one-time, unprecedented opportunity for pulmonologists, neurologists, otolaryngologists, psychiatrists, and other physicians already working in the field to sit for the board examination. However, not all sleep clinicians will be eligible for this accreditation. The ACGME only permits accreditation of doctors, thus nurses, dentists, and doctorally prepared sleep specialists (e.g. psychologists and behavioral health specialists) in other fields are no longer eligible to sit for the examination. As a consequence, there is the potential that in the future particular bodies of knowledge will not be represented in sleep medicine.

Representatives from all four boards are developing and setting standards for the new examination. The American Board of Internal Medicine has administrative responsibility for examination development, and the participating/sponsoring boards have responsibility for setting admission criteria for their own diplomates. These standards and criteria are expected to be announced in 2006.

Although this new structure is based on sleep medicine becoming recognized as an independent specialty, it is too early to tell how well this new approach will work in developing the needed workforce of practitioners for sleep medicine and the next generation of physician-scientists. The fellowship is somewhat unusual in that there is only the requirement for 1 year of training beyond completion of residency. It is unclear whether pulmonologists, who have until now formed the majority of the clinical workforce in sleep medicine (60 percent of diplomates in 2005), will continue to be attracted to the field (Figure 5-2). Clinical requirements for pulmonary medicine involve 18 months of training beyond residency. It appears that this will not count to training in sleep medicine even though there is now a defined curriculum for sleep medicine in pulmonary medicine (American Thoracic Society, 2005) and 10 to 15 percent of the board examination for pulmonary medicine is about sleep disorders. An additional clinical year of train-



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