2017 HSC Section 2 - Practice Management

Reprinted by permission of Laryngoscope. 2011; 121(11):2317-2321.

The Laryngoscope V C 2011 The American Laryngological, Rhinological and Otological Society, Inc.

Contemporary Review

Effective Use of Physician Extenders in an Outpatient Otolaryngology Setting

Byron Norris, MD; Tristen Harris, MPAS, PA-C; Scott Stringer, MD, MS

Physician extenders may be a valuable asset to an outpatient otolaryngology practice. The adjunctive care pro- vided by physician extenders appears to be cost effective and has the advantages of increasing patient education, promoting physician productivity, and improving management of chronic conditions. Practice types that may benefit from advanced practice providers include group or solo practices with high demand or who need improved efficiency. We discuss five different practice models for incorporation of advanced practice providers in an outpatient otolaryn- gology practice. These models include scribe, collaborative, limited independent, partial independent, and near com- plete independent practice and are based primarily on the autonomy level of the physician extender. In additon, we examine available literature discussing the cost effectiveness of physician extenders used in an outpatient setting. Key Words: Physician extender, midlevel providers, practice management, cost–benefit. Level of Evidence: 5. Laryngoscope, 121:2317–2321, 2011

INTRODUCTION Physician extenders have an increasing presence in the healthcare workforce. Based on data from 2007, there are approximately 120,000 active nurse practi- tioners (NPs) and physician assistants (PAs) in the United States, and the use of midlevel providers is increasing in specialty and subspecialty aspects of medi- cine. 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 The percentage of NPs in otolaryngology is even fewer, being reported as less than 0.2% of all active NPs. 4 The increase in advanced practice providers is needed in part to offset the relative decline in practicing otolaryng- ologists. According to the American Association of Medical Colleges 2006 data, there are only 9,077 active otolaryngologists in the United States, with 42% of these physicians aged 55 years or older. 5 From the Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson, Mississippi, U.S.A. Editor’s Note: This Manuscript was accepted for publication June 27, 2011. This research was presented at the Annual Meeting of the Acad- emy of Otolaryngology September 29, 2010. The authors have no financial disclosures for this article. The authors have no conflicts of interest to disclose. Send correspondence to Scott K. Stringer, MD, MS, Department of Otolaryngology and Communicative Sciences, University of Mississippi, 2500 North State Street, Jackson, MS 39216. E-mail: sstringer@umc.edu

Physician extenders, including NPs and PAs, refer to health professionals who are trained and licensed to practice medicine under the supervision of or in collabo- ration with a physician. The background, education, and level of autonomy differ between NPs and PAs. 6 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 PA’s training and education are centered around physician collaboration and are governed by state medical boards. 6 Although the training, scope of practice, and background education may differ between NPs and PAs, this manu- script groups the two subsets together to focus on similar roles in relation to an outpatient otolaryngology practice. This manuscript is intended to highlight the chang- ing face of healthcare with respect to the increasing presence of advanced practice providers, specifically regarding specialty practices such as otolaryngology. Pertinent literature is reviewed and five models are dis- cussed relating to the incorporation of advanced practice providers into the outpatient otolaryngology sector. Cost analysis, impact on patient care, and future healthcare directions are reviewed. Although there are many appli- cations of advanced practice providers for inpatient management and assisting with surgical procedures, this manuscript focuses solely on the application in the outpatient clinic setting.

DOI: 10.1002/lary.22192

Laryngoscope 121: November 2011

Norris et al.: Physician Extenders in Otolaryngology

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