Analysis of the training pathway in sleep medicine: Training capacity versus demand in the United States

Previous studies have described an emerging deficiency of sleep medicine physicians in the United States (US). This study defines the training pipeline for sleep medicine physicians, including the annual number of applicants, training positions, and unfilled training positions. This was a cross-sectional analysis of all applicants for sleep medicine fellowship training in the US from 2012 to 2025. Annual match outcomes were calculated and trends analyzed with linear regression. From 2012 to 2025, growth in the annual number of applicants (103-249, 142% increase, P < 0.001) exceeded growth in the number of training positions (99-218, 120% increase, P < 0.001) for sleep medicine fellowship training. Accordingly, the annual applicant-to-training position ratio increased (1.04-1.14, P = 0.003) and the annual rate of unfilled training positions decreased (12.1% to 5.0%, P = 0.004) over the study period. The annual representation of US allopathic medical school graduates increased among incoming sleep medicine fellows (31.0% to 41.1%) while the annual representation of non-US allopathic medical school graduates decreased (69.0% to 58.9%), although this trend was not significant (P = 0.056). Match rates for US allopathic medical school graduates exceeded those for non-US allopathic medical school graduates (93.1% vs. 85.8%, P < 0.001). Growth in applicants for sleep medicine fellowship training has exceeded growth in training capacity, resulting in an increasing annual applicant-to-training position ratio. While interest appears to be increasing, surveillance of future match outcomes is warranted given anticipated deficiencies in the sleep medicine physician workforce.