Who Is Taking the ABSM Sleep Medicine Board Exam?

BY DR. BARBARA PHILLIPS, FCCP
Sleep Institute Co-Chair
DR. NEIL FREEDMAN, FCCP
Sleep Institute Member
and John Stangel, CCMEP
ACCP Manager of Enduring Products

In late August, the ACCP offered the 4th Sleep Medicine Board Review Course in conjunction with its time-honored and popular critical care and sleep medicine board review courses. An astounding 800 individuals registered and attended the 4-day course in Phoenix, AZ. (This is not quite a record; Mr. Al Lever (personal communication; August 21, 2009) reported that more than 1,000 individuals took the ACCPs board review course for critical care when the first critical care certifying examination was offered.)

Both training (eg, fellowship and postgraduate training) and credentialing (board certification) in sleep medicine have evolved rapidly in the last several years.

The American Board of Sleep Medicine (ABSM) began as a rogue board, not recognized by the American Board of Medical Specialties (ABMS). Initially, the ABSM was managed by the American Academy of Sleep Medicine (AASM), which successfully sought ABMS recognition. The new ABMS-recognized Sleep Medicine Board is housed in the American Board of Internal Medicine (ABIM) and is conjointly administered by the ABIM, the American Board of Psychiatry and Neurology, The American Board of Otolaryngology, and the American Board of Pediatrics and the American Board of Family Medicine.

The first ABIM-sponsored sleep medicine board examination took place on November 13, 2007. A total of 1,880 people took the exam , and the overall pass rate was 73%. As one would predict, those with previous board certification by the ABSM had a high pass rate of 93%, while those who did not undergo any formal training and registered for the test via the self-attestation pathway, did not fare as well, with an overall pass rate of only 59%.

It is the ABMS's policy that ALL new board examinations under its umbrella must offer a 5-year grandfather period. Thus, clinicians who have been practicing in that field are eligible to take the new examination if they have a significant amount of experience in the medical practice of sleep medicine. In other words, people who have wanted to become board-certified in sleep medicine but have not yet been able to do so are eligible to take the new ABMS-recognized examination (which is only offered every other year) through the 2011 exam. This and the upcoming Centers for Medicare & Medicaid Services (CMS) changes regarding reimbursement for sleep study interpretation likely explain the popularity of the board review course just offered. The 2009 sleep medicine board exam is the next-to-the last time one will be able to grandfather into sleep board eligibility. After 2011, candidates will have to have taken an American Council on Graduate Medical Education (ACGME)-accredited fellowship in order to be eligible.

We collected demographic data via an audience response system from individuals who attended the ACCP Sleep Medicine Board Review Course. This information is of interest to those of us in the field of sleep medicine, because it gives some insight into who is taking the examination, the reasons why, as well as some other useful information concerning basic practice patterns. Of the 624 respondents, fully 87% plan to take the exam in November, with 10% planning to take it in 2011. Pulmonologists made up the largest group (74%) of individuals at the course, followed by neurologists at 10%, pediatricians at 5%, psychiatrists at 1%, and other (likely otolaryngologists, internists, and family medicine practitioners) making up 10% of participants. These data are somewhat different than the demographics of the 2007 ABMS test takers, in which 65% were from the ABIM (being predominantly pulmonologists), 25% were neurologists, 4% were pediatricians, and the remaining 6% were from various other fields. Given that the course was presented by the ACCP, the overwhelming predominance of pulmonologists attending the current course was not a surprise.

Most of the attendees preparing for the upcoming board exam are non-ABSM-boarded clinicians without formal fellowship training in sleep medicine. The majority (72%) of the respondents are in private practice, with the remaining 24% being in a clinical practice setting with some teaching responsibilities. Only 24% of the respondents have the old (ABSM) Sleep Board Credential and, as noted previously, the minority (18%) have completed a formal sleep medicine fellowship. Most (71%) spend 40% or less of their clinical time in the practice to sleep medicine, and 80% read 20 or fewer sleep studies a week. Despite recent changes in the acceptance of, and reimbursement for, portable sleep apnea testing by CMS, the overwhelming majority (81%) of the respondents never order or interpret portable sleep apnea studies. For those of us in clinical practice, this overwhelming lack of adoption of portable sleep apnea testing is not a surprise for many reasons, including the lack of identification of the ideal monitoring device, as well as difficulty with reimbursement by CMS and commercial payers.

Finally, with regard to accreditation by the AASM, 60% of the respondents work primarily in an accredited laboratory, and 21% are accredited by the Joint Commission or other accrediting body. For those who currently are associated with labs that are not accredited by the AASM, 47% plan to go for AASM accreditation in the next 12 months. This push for AASM accreditation may largely be driven by the changes in reimbursement proposed by CMS that are set to take effect in 2010.

Overall, the course was an overwhelming success. While the final evaluations from all of the course attendees are not yet available, the overwhelming majority (75%) of almost 600 of the participants who have completed their evaluations rated the course as excellent overall. One attendee described the course as "the best organized and most comprehensive course that I have ever taken. A home run." Similar comments have been echoed by many other attendees.

The astounding attendee turnout and overall outstanding evaluations are a testament to the group of professionals, including lecturers and ACCP support staff, who made presenting this course a pleasure and an honor. Good luck to everyone on the upcoming board exam in November!