Changing Practice Models in Otolaryngology–Head and Neck Surgery: The Role for Collaborative Practice

Abstract

The increased complexity of medicine, the imperative of reducing health care costs, and the goals of improving quality and patient satisfaction require that we rethink current models of practice. Such reevaluation will receive additional impetus from workforce changes within medicine and the specialty. Furthermore, as chronic disorder care becomes more complex, it may increasingly be provided within a specialty setting. Our goal is to stimulate discussion regarding the potential for alternative health care delivery models within the specialty in the face of predicted workforce shortages and the impetus toward health care reform. A collaborative practice model utilizing midlevel health care providers increases productivity and patient satisfaction and provides the potential to deliver an exceptionally high level of care for chronic disorders when such care is sufficiently complex to require specialty management.

Subspecialty emergency room as alternative model for otolaryngologic care: Implications for emergency health care delivery

“…2 With the passage of the Patient Protection and Affordable Care Act, the number of insured Americans is expected to rise, resulting in a projected shortage of otolaryngologists. 3 As a result, the burden of acute otolaryngologic care in both outpatient and standard emergency room practice settings will increase in the near future. 3,4 …”

“…3 As a result, the burden of acute otolaryngologic care in both outpatient and standard emergency room practice settings will increase in the near future. 3,4 …”

Effective use of physician extenders in an outpatient otolaryngology setting

“…Based on data from 2007, there are approximately 120,000 active nurse practitioners (NPs) and physician assistants (PAs) in the United States, and the use of midlevel providers is increasing in specialty and subspecialty aspects of medicine 1. Despite the increase, the field of otolaryngology is currently underrepresented 2. According to the 2008 American Academy of Physician Assistant's Census Report there were 251 PAs working in otolaryngology practices, representing 0.9% of the total workforce 3.…”

“…NPs are governed by the state boards of nursing and may have greater autonomy than PAs 6. In addition, the requirements for education, prescribing practices, and credentialing vary between state for NPs 2. For example, as of 2008, only 30 states required NPs to collaborate with a physician for diagnosis and treatment 2.…”

“…In addition, the requirements for education, prescribing practices, and credentialing vary between state for NPs 2. For example, as of 2008, only 30 states required NPs to collaborate with a physician for diagnosis and treatment 2. PA's training and education are centered around physician collaboration and are governed by state medical boards 6.…”