This week’s “spotlight” interview shines on the Houston Neurology and Sleep Diagnostic Center’s Ching-Chiang Allen Chu, MD, PhD, a 1998 graduate of our residency program. Chu talks to us about the challenges he experienced building up an outpatient private practice specialized in neuromuscular medicine and sleep medicine, the combination of intellectual and emotional rewards in his work, and how centralization in hospitals and advances in technology will affect sleep medicine over the next decade. He also offers advice for residents and young faculty, and shares his memories of Rick Bedlack, MD, PhD, Vani Chilukuri, MD, and other former colleagues.
Where did you go after completing your training at Duke, and how and why did that lead to your current career?
In the 20 years since my residency and sleep training at Duke, I first did a clinical fellowship in neuromuscular diseases and EMG at Massachusetts General Hospital and then founded a private practice, Houston Neurology and Sleep Diagnostic Center, which included a 4-bed AASM accredited sleep center and an electrodiagnostic laboratory accredited by AANEM with exemplary status.
Like many Duke residents and fellows, I had some research background - in my case, a PhD in neuroscience. In the past, I was considering PhD programs at Johns Hopkins University and the University of Iowa. Although I knew Iowa winter weather could be harsh, I chose to study cognitive neuroscience and behavioral neurology with Dr. Antonio Damasio at Iowa because I was fascinated with his research. Later, the decision whether to go into academia or private practice was difficult. I asked myself, “What is a meaningful career that fits my values?” Even though I anticipated that the path would be uncertain and full of challenges, I decided to establish a private practice in the fields I enjoy most, with the desire to achieve autonomy and life balance.
What are your current medical responsibilities as a neurologist? What does a typical workday look like for you?
The combination of neuroscience, behavioral neurology, sleep medicine, general neurology, and neuromuscular medicine has given me a broader knowledge foundation to help my patients. I am currently an active staff of hospitals affiliated with Baylor College of Medicine and the University of Texas. Training at Duke and MGH has helped me develop quality specialty care and gain the confidence of referring physicians. It has become the practice I desired, with autonomy and accredited diagnostic centers, in the fields I enjoy - neuromuscular medicine and sleep medicine. The typical workday involves primarily EMG studies as well as neuromuscular and sleep consultations.
What do you enjoy most about your work? What’s the most difficult part of your job?
I enjoy the intellectual work of diagnostic EMG and sleep studies and the rewarding feedback from treating patients with neuromuscular diseases and sleep disorders. I have also enjoyed listening to patients’ stories while performing many EMG studies - over 30,000 of them.
The difficult part of my job in private practice was to establish the practice. As I recall, in the first three years of solo private practice, a typical workday was like this: clinic 8am to 5pm, dinner break, hospital round (including ICU consultation) without a resident or fellow till 10-11pm, then on-call at night. On the weekends, I had dictation, paperwork, and studying for board certifications. It was crucial to learn referral patterns, insurance contracts, office management, personnel, EHR/IT, marketing, and finance while balancing family, health, and sleep. After the difficult parts passed, I transformed the practice into outpatient clinic only, electrodiagnostic laboratory, and sleep center. With essentially no more emergency or night calls, I had improved autonomy at work and balance in private life. Recently, in order to prioritize higher quality time with patients, family, and myself, I have gradually decreased clinic work to three days per week and spend the rest of time pursuing other interests. For me, private practice fits well.
You completed both your neurology residency and six months of additional training in sleep medicine at Duke Neurology. What are some memories from that time that were especially useful or memorable?
Here are some great memories.
- Junior resident Dr. Richard S. Bedlack Jr. was such a smart guy and always had a funny joke to tell or thoughts about cars and politics while reading EEG.
- I was finally able to tell a joke during my resident graduation speech and make everyone laugh in the yearly neurology department party.
- Fellow resident Lynn - first met her husband during a CPR scene
- Chief resident Dr. Vani Chilukuri had such a calming, understanding smile even when the residents messed up
- Sleep fellow Dr. Aatif Husain - His suits were so well-cut and amazing
- Resident Director Dr. Joel C. Morgenlander - He coached mock board exams after dark
- Beloved Dr. Marvin Rozear’s comment on pediatric EEGs: “They are not human.”
What’s the biggest change that you’ve seen in sleep medicine since you completed your fellowship? What changes do you see coming over the next decade?
One sleep practice trend is centralization in hospitals. Private sleep facilities may have to compete in cost and accessibility. Technology will advance in home diagnostic devices, wireless data monitoring, big data, and telemedicine. The science of sleep medicine and neuroscience will progress quickly, with the emergence of newer drugs and devices that improve sleep quality and efficiency. The private sleep practice may evolve into entrepreneurial corporations that provide portable home sleep study, CPAP supplies, and telemedicine for clinics and hospitals.
What’s one piece of wisdom or advice that you’d offer to the current crop of neurology residents and fellows?
The healthcare system is changing. If possible, decide what you really want, even it is against the tide. Just follow it through and see. What you experience is yours. What you missed, you never knew anyway.
Humor is the best friend for patients and you.
What passions or hobbies do you have outside of work?
Outside of work I enjoy travel to national parks and playing table tennis.
I spend time with family - my wife Leeann and children Veronica and Aaron. We like to travel to countries in East Asia, particularly Japan, and care for 20 beautiful koi fish in our Japanese garden at home.