ing above and beyond that for pulmonary medicine may represent a barrier to pulmonologists entering this discipline. It is hoped that this issue is addressed, as pulmonologists encompass a significant percentage of the clinical workforce of practitioners in sleep medicine.
Another area of uncertainty is funding for these new sleep fellowships. Previously, when the fellowship was not ACGME-approved, fellows could obtain reimbursements for their clinical activities, including sleep study interpretation. In some other programs, sleep medicine training was incorporated into multiyear research training supported by training grants from the National Institutes of Health (NIH). Neither of these options is available in the new format.
Unfortunately, the rules introduced by the ACGME are not flexible and require 1 complete year of clinical training even in programs that are multi-year and committed to research training. This may have a negative impact on the already fragile pipeline of physician-scientists in this new discipline as outlined elsewhere in this report (see Chapter 7). As described in detail in Chapter 8, the committee encourages the proposed Type II comprehensive academic sleep centers to incorporate research training into their sleep medicine fellowships, while for Type III centers this is considered an essential component.
A final potential limitation of this new examination structure is that it is open exclusively to physicians. Other clinician scientists in fields such as psychology, neuroscience, and nursing will not be eligible to sit for the examination as was the case in prior years. Currently, there are 154 ABSM