2017 HSC Section 2 - Practice Management
their practice is overseen by state medical boards. The different levels of practice for physician extenders in oto- laryngology are very nicely described and summarized by Norris et al., and range from supportive to independ- ent practice models. 3 The relatively small percentage of patient care being provided for by APCs is consistent with the fact that NPs in otolaryngology constitute only 0.2% of all active NPs, and PAs in otolaryngology consti- tute only 0.9% of the total PA workforce as of 2008. These percentages are better illustrated when compared to the fact that approximately 1.2% of active physicians in the United States are otolaryngologists. 14 Interestingly, PAs, NPs, and RNs are most com- monly involved in office visits that concern disorders of the ear (Tables II and III). This is likely related to the fact that ear complaints are among the most common reasons for patients’ being seen in the outpatient otolar- yngology setting, and ears are readily examined without the need for a procedure such as endoscopy. Further- more, there was significant overlap in the diagnoses attributed to PA versus NP visits, which constituted both acute and chronic conditions in otolaryngology. Finally, with respect to type of patient distribution, APCs were more commonly used in established patient visits in contrast to new patient visits. This suggests that APCs in otolaryngology are being employed in the context of disease management and follow-up rather than disease diagnosis. Again, given the contemporary constraints of the healthcare system, further use of APCs in diagnostic evaluations seems likely.
current penetration of APCs into ambulatory otolaryn- gology care remains relatively limited. These data provide an initial assessment for future modeling of APCs in otolaryngologic care. BIBLIOGRAPHY 1. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg 2003;238:170–177. 2. Reger C, Kennedy DW. Changing practice models in otolaryngology-head and neck surgery: the role for collaborative practice. Otolaryngol Head Neck Surg 2009;141:670–673. 3. Norris B, Harris T, Stringer S. Effective use of physician extenders in an outpatient otolaryngology setting. Laryngoscope 2011;121:2317–2321. 4. Gilchrist VJ, Stange KC, Flocke SA, McCord G, Bourguet CC. A compari- son of the National Ambulatory Medical Care Survey (NAMCS) mea- surement approach with direct observation of outpatient visits. Med Care 2004;42:276–280. 5. Lee LN, Bhattacharyya N. Regional and specialty variations in the treat- ment of chronic rhinosinusitis. Laryngoscope 2011;121:1092–1097. 6. Bhattacharyya N, Kepnes LJ. Initial impact of the acute otitis externa clinical practice guideline on clinical care. Otolaryngol Head Neck Surg 2011;145:414–417. 7. Lin HW, Bhattacharyya N. Otologic diagnoses in the elderly: current utiliza- tion and predicted workload increase. Laryngoscope 2011;121:1504–1507. 8. Mattos JL, Woodard CR, Payne SC. Trends in common rhinologic illnesses: analysis of U.S. healthcare surveys 1995–2007. Int Forum Allergy Rhi- nol 2011;1:3–12. 9. Bhattacharyya N. The increasing workload in head and neck surgery: an epidemiologic analysis. Laryngoscope 2011;121:111–115. 10. Henkel G. A partner in the business: practices see mid-level providers as valuable additions. ENT Today May 2010. Available at: http://www. enttoday.org/details/article/690067/A_Partner_in_the_Business_Practices_ see_mid-level_providers_as_valuable_addition.html2010. Accessed Janu- ary 4, 2012. 11. Reddy VM, Sargent H, Prior MJ. Benign paroxysmal positional vertigo nurse-led follow-up clinic. Eur Arch Otorhinolaryngol 2011;268:829–832. 12. Robertson S, Maxwell C, McGarry GW, MacKenzie K. A nurse-led snoring clinic: how we do it. Clin Otolaryngol 2009;34:158–161. 13. Palmquist DS. The Role, Productivity, and Patient Satisfaction of Surgical Nurse Practitioners Compared to Medical Surgeons in VHA Outpatient Surgery Clinics [dissertation] . Cypress, CA: Trident University Interna- tional, 2010. 14. Association American Medical Colleges. Center for Workforce Studies. 2008 physician specialty data. 2008; Washington, DC. Available at: https://www.aamc.org/download/47352/data/specialtydata.pdf. Accessed January 4, 2012.
CONCLUSION Although APCs are expected to expand in numbers in otolaryngology, contemporary data indicate that
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