2017 HSC Section 2 - Practice Management

Reprinted by permission of Laryngoscope. 2012; 122(5):1010-1013.

The Laryngoscope V C 2012 The American Laryngological, Rhinological and Otological Society, Inc.

Involvement of Physician Extenders in Ambulatory Otolaryngology Practice

Neil Bhattacharyya, MD, FACS

Objectives/Hypothesis: Determine the penetration and point-of-care patterns for physician extenders in ambulatory otolaryngology practice. Study Design: Cross-sectional analysis of national database. Methods: The National Ambulatory Medical Care Survey was examined for 2008 and 2009, extracting all cases of ambu- latory visits to an otolaryngology outpatient setting. Visit types were then segregated according to providers seen including physician, advanced practice clinicians (APCs) (nurse practitioner and/or physician assistant) and nurses. Visit types were determined (physician alone, physician with APC, or APC alone) as well as type of patient seen (new vs. established patient). The top 10 diagnoses were compiled according to provider visit type. Results: An estimated 38.6 6 3.7 million outpatient office otolaryngology visits were studied. An APC was seen in 6.3 6 2.0% of visits (physician assistant, 4.6 6 1.9% visits; nurse practitioner, 1.7 6 0.9% of visits), and a nurse was involved in 25.1 6 7.6% of visits. Nurse practitioners were more likely see patients independently (47.7%) than were physician assis- tants (23.3%). APCs were more likely to be involved with established patient visits (7.2 6 2.3%) rather than new patient vis- its (4.3 6 1.8%, P ¼ .08). Disorders of the external and middle ears were the most common diagnoses seen by APCs. Conclusions: Although APCs are expected to expand numbers in otolaryngology, contemporary data indicate that cur- rent penetration of APCs into ambulatory otolaryngology care remains relatively limited. These data provide an initial assess- ment for future modeling of APCs and otolaryngologic care. Key Words: Physician extenders, ambulatory care, otolaryngology, advanced practice clinicians, nurse practitioner, physician assistant. Level of Evidence: 2b Laryngoscope, 122:1010–1013, 2012

INTRODUCTION The concept of a looming physician shortage linked to an expanding and aging population in the United States has been the subject of ongoing concern and debate. 1 One option to help offset a projected physician storage, including a projected shortage in otolaryngology, is the integration of midlevel and advanced practice per- sonnel into ambulatory and hospital-based care. 2,3 Recent commentaries have stressed the evolving role of advanced practice clinicians (APCs) and other providers in otolaryngologic practice. 3 However, although there is a perceived need for and a seeming progression toward the integration of APCs in otolaryngologic practices, almost no data are available indicating the actual penetration of APCs and other pro- viders into the point of care. Such data are essential as a foundation for understanding the epidemiology, eco- From the Division of Otolaryngology, Brigham and Women’s Hospital, Boston; and the Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A. Editor’s Note: This Manuscript was accepted for publication February 17, 2012. Dr. Bhattacharyya is a consultant for Intersect-ENT, Inc. and Entellus, Inc. The author has no funding, financial relationships, or con- flicts of interest to disclose. Send correspondence to Neil Bhattacharyya, MD, Division of Oto- laryngology, 45 Francis St., Boston, MA 02115. E-mail: neiloy@massmed.org

nomics, and patient experiences for care provided by APCs in otolaryngology. Data regarding the prevalence of care provided by APCs, interactions with physicians at the point of care, and the types of patients seen are also important components when projecting the role of APCs in future models of healthcare provision. We sought to examine current trends in APC care provided at the ambulatory otolaryngology level to help quantify these factors. MATERIALS AND METHODS The National Ambulatory Medical Care Survey (NAMCS) for the calendar years 2008 and 2009 formed the data source for this study. The NAMCS is a national survey conducted yearly by the Center for Healthcare Statistics, a branch of the Centers for Disease Control. It provides objective reliable infor- mation about the provision and use of ambulatory medical care services in the United States. Findings are based on a sample of visits to non-federally employed office-based physicians who are primarily engaged in direct patient care. The NAMCS uses a multistage probability design, first using primary sampling units (N ¼ 112, adjusting for variations national geography), followed by a second-stage sampling reflecting physicians, their specialties, and random sampling time periods during the calen- dar year. Specially trained interviewers visit the physicians prior to their participation in the survey to provide them with survey materials and instruct them on how to complete the forms. Data are collected from the physician, rather than from the patient. Each physician is randomly assigned to a 1-week

DOI: 10.1002/lary.23274

Laryngoscope 122: May 2012

Bhattacharyya: Physician Extenders in Otolaryngology

135