Clete A. Kushida, MD, PhD, RPSGT, on accreditation, young investigators, collaboration with the respiratory care community, and crafting his legacy as president of the American Academy of Sleep Medicine.
Clete A. Kushida, MD, PhD, RPSGT, AASM president, isn’t underestimating the challenges that he will face during his tenure as president of the American Academy of Sleep Medicine. Spurring the growth of young investigators, maintaining the integrity of accreditation, and balancing the AASM’s relationship with the American Association for Respiratory Care (AARC) fall under the scope of his authority. Kushida spoke with Sleep Review about his plans for handling the above responsibilities while supporting his vision that sleep medicine must embrace comprehensive care and chronic disease management models to defend the profession against arbitrary and unnecessary cuts to reimbursement.
Sleep Review: There has been a lot of concern about the lack of young investigators in sleep medicine. Can you put this problem into perspective? What initiatives is the AASM taking to foster growth of young investigators?
Clete A. Kushida, MD, PhD, RPSGT, AASM president, associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University Medical Center, acting medical director of the Stanford Sleep Disorders Clinic, and director of the Stanford University Center for Human Sleep Research: Young investigators in sleep medicine, like their colleagues in other medical disciplines, face numerous obstacles such as limited faculty positions, noncompetitive salaries, and an economic downturn that has deleteriously affected academia. Still there is hope—the American Recovery and Reinvestment Act has created more opportunities for academic institutions. Additionally, the AASM, through its American Sleep Medicine Foundation (ASMF), has provided more than $3 million to investigators, mainly to those at the start of their careers with grants such as the Physician Scientist Training Awards, Junior Faculty Research Awards, and Strategic Research Awards. The AASM also launched its first Young Investigators Conference at the National Institutes of Health (NIH) in April 15-16, 2009. The plan is to continue this conference on an annual basis; it covers the basics for new investigators such as grant application development, presentation skills, planning controlled trials, and writing and reviewing manuscripts. In addition, I’ve asked several experienced investigators of the AASM and Sleep Research Society (SRS) to contribute to “A Guide for Developing, Writing, and Implementing Research Grant Proposals.” The purpose of this soon-to-be-published guide is to provide a valuable resource for young investigators in sleep and other fields as they launch their careers.
SR: With the trend to tie reimbursement to sleep lab accreditation in both independent diagnostic testing facility and hospital-based labs, accreditation is becoming a business. How will the new trend in sleep lab accreditation by other bodies impact the AASM? Will the AASM relax its standards?
Kushida: In our view, accreditation is not a business, but the gold standard for patient care. Central to the AASM’s mission is ensuring that optimal sleep health care is delivered to patients, and accreditation is our assurance of this duty to our patients.
The AASM has a recognized and respected accreditation process that is time-tested. The Standards for Accreditation are comprehensive and fair, and are developed specifically for sleep disorders centers. The AASM won’t compromise or relax its standards based on how other accrediting bodies are conducting themselves; instead, our accreditation standards are developed and updated to reflect the best practice of sleep medicine.
SR: As part of the ongoing discussions with the AARC, the AASM Board of Directors ruled that AASM Standards for Accreditation will not require enrollment in or completion of A-STEP Online Self Study Modules and/or a CAAHEP-accredited sleep technology training program for respiratory therapists. Why are RTs exempt? Can AASM members expect additional changes as the AASM continues its dialogue with the AARC? What changes would the AASM like to see the AARC make?
Kushida: The AASM leadership recently met for the first time in recent years with the leadership of the AARC and American Association of Sleep Technologists (AAST) to discuss shared interests and goals; the plan is to continue to meet at regular intervals in order to maintain an open dialogue. The organizations collectively agree that we need to ensure that the personnel in sleep laboratories are adequately educated and trained in all aspects of sleep technology.
With this in mind, these organizations are attempting to reach a consensus regarding the scopes of practice for sleep technologists and respiratory therapists as well as mutual areas of practice. During this process, the AASM Board of Directors has decided to temporarily suspend the standard requiring enrollment in or completion of A-STEP Online Self Study Modules and/or a CAAHEP-accredited sleep technology training program for respiratory therapists. I believe that addressing the scopes of practice for sleep technologists and respiratory therapists will resolve the legislative issues that have been ongoing in several states.
On a related note, the AASM leadership is encouraged by a new initiative that fosters the careers of technologists and promotes sleep technology as a profession. Following discussions with the leadership of the Board of Registered Polysomnographic Technologists (BRPT) and the AAST, which commenced this June, the BRPT has recently developed a new Certified Polysomnographic Technician (CPSGT) Certificate for Sleep Professionals. The CPSGT exam will be offered for the first time in March 2010; this entry-level certificate is designed to provide competency-based testing from the start of a technologist’s career and to enhance professionalism in the sleep technology field.
SR: With the introduction of portable monitoring, do you see the sleep medicine profession moving more toward a chronic disease management and outcomes-based profession and departing from the heavy emphasis on diagnosis? What is your vision for the field?
Kushida: My belief is that the sleep medicine profession must work toward comprehensive care and chronic disease management models, irrespective of the future status of portable monitoring. These models may include programs such as dispensing durable medical equipment (DME) to our patients in sleep centers where this service is allowed by federal and state laws; offering specialized care for sleep-disordered patients with complex medical conditions; providing comprehensive care of sleep disorders including cognitive behavioral therapy for those with insomnia; and employing the best evidence-based patient diagnostic and treatment strategies. In light of impending health care reform, we must maintain our efficiency in diagnosing and treating our patients yet at the same time defend our profession against arbitrary and unnecessary cuts.
In order to predict how our field will evolve, a Presidential Task Force on the Future of Sleep Medicine has been organized with the first meeting on December 7, 2009. The principal aim of this task force is to forecast where sleep medicine will be in the future with respect to technology, staffing, research, economics, and health care delivery, and these predictions will be used by the AASM Board of Directors to plan, prepare, and successfully guide our field through the uncharted territory that lies ahead.
SR: In your AASM presidential acceptance speech, you said, “We realize that residency and fellowship training are longer and more complex, and we must seek solutions that enable our trainees to be able to complete their postgraduate training in a reasonable time period and yet not compromise the comprehensiveness of their education in sleep medicine.” What solutions are in the works?
Kushida: In my address to members at SLEEP 2009, I touched briefly on the increase in the number of sleep medicine physicians entering our field through internal medicine and the noted decrease in the number entering sleep medicine through a fellowship in pulmonary medicine. The AASM leadership is in the process of working with our sleep-pulmonary colleagues in the American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP) to address the issue with the length of fellowships for physicians with an interest in pursuing a career in pulmonary and sleep medicine. It is the core belief of our leadership that postgraduate trainees in sleep medicine and pulmonary fellowships should not “double-dip” (ie, double-counting hours of sleep-pulmonary training), but we are collectively exploring ways of restructuring the fellowship programs so that the sleep and pulmonary training can still coexist and not be individually compromised.
SR: At the end of your term as AASM president, what do you hope to leave as your legacy?
Kushida: Any legacy I leave is primarily the result of the tireless, unselfish efforts of the AASM Board of Directors, an extremely experienced executive director, and a dedicated staff. I would like to believe that during my tenure as president, the Board of Directors will have made contributions to the sleep field in the areas of education, research, and clinical care.
We must strive to capture the imaginations of our youth at an early age so that they can someday become sleep clinicians and scientists. The AASM is in the process of launching several exciting new initiatives, such as a national high school essay contest on sleep-related topics, in the hopes of enticing more young minds into the sleep field.
Initial support by the ASMF was instrumental in launching the two largest clinical trials in sleep funded by the NIH: the Apnea Positive Pressure Long-term Efficacy Study (APPLES) and the CPAP Apnea Trial North American Program (CATNAP). The AASM leadership recognizes that availability of continued ASMF funding and the previously discussed new educational and training opportunities for sleep researchers are crucial to the continued success of our field, and, in conjunction with the Research Committee, is currently exploring various mechanisms to increase the availability of funding to sleep specialists.
Safeguarding our field has not only been a major concern of mine but of our Board of Directors as well. In addition to initiating the formal process of examining where our field will be years from now by the establishment of the Presidential Task Force on the Future of Sleep Medicine, a Presidential Coding and Compliance Committee has been formed to ensure that our sleep medicine codes accurately reflect the testing conducted by sleep centers. Given the unprecedented economic challenges that lie before us, it is critical that the AASM ensures that the steady growth of our field is supported and maintained.
Lastly, even though our organization is called the American Academy of Sleep Medicine, one-tenth of our members are from outside the United States. It has been one of my top priorities to work with our international colleagues in developing sleep medicine board certification programs within their countries, and we have recently initiated a pilot initiative to develop these programs with sleep specialists in Taiwan, Thailand, China, Hong Kong, Korea, India, and Turkey. We are also in discussions to develop training and certification programs for technologists in countries lacking such programs. As a member of the international sleep community, the AASM needs to share ideas and programs with our colleagues in other countries, increase availability of our educational resources, and help foster sleep technology throughout the world.