Explore this issue:September 2013
—David W. Kennedy, MD
When Ronald B. Kuppersmith, MD, and his colleagues at Texas ENT and Allergy in College Station had the chance to hire a circulating room nurse who had previously worked with the practice as a nurse practitioner (NP), they didn’t waste any time bringing her onboard.
Since joining the practice earlier this year, Genna Lechler, MSN, RN, FNP-c, has been working full time, shadowing the physicians and learning the skillset involved with otolaryngology patient care, with the expectation that she’ll be seeing patients on her own, with physician supervision, in the future. Adding her to the practice means that the clinic is properly staffed to meet patient demand.
Increasingly, otolaryngologists are finding that NPs, physician assistants (PAs) and advanced practice clinicians (APCs) can be valuable assets to their practices, able to handle a variety of tasks related to patient care and address a wide range of patient needs, while also being a cost-effective alternative to bringing on another full-time otolaryngologist. But, knowing how and when to maximize the benefits a physician extender (PE) can offer depends on your specific needs.
A Matter of Supply and Demand
Otolaryngologists should look at the size of their practice, the demographics of their patients and their patient load and then evaluate which types of tasks are stealing their time from surgery and high-level services. Does removing earwax or managing chronic conditions for patients take up the bulk of your day, leaving you less time than you’d like for surgical cases? Does the number of hours you spend in the operating room prohibit you from devoting as much time as you’d like to seeing patients in clinic or examining new patients? After determining where another set of hands could best serve, otolaryngologists need to consider whether a full or part-time PE—who would demand a lower salary than a full-fledged otolaryngologist—could take over some of those responsibilities.
“The physician needs to look at what the primary needs are in that practice,” said David W. Kennedy, MD, professor of otolaryngology–head and neck surgery at the Perlman School of Medicine at the University of Pennsylvania in Philadelphia and co-author of the study, “Changing Practice Models in Otolaryngology–Head and Neck Surgery: The Role for Collaborative Practice (Otolaryngol Head Neck Surg. 2009;141:670-673). “If [a practice has] a significant sub-specialty population requiring ongoing care, then I think there is a great opportunity for a nurse practitioner,” he said. “If they’re spending a lot of time doing patient education that could easily be done by someone else, then that would be a very good time to consider bringing in a nurse practitioner. If they need someone to do additional surgery or additional night-call, then they’ll need an additional otolaryngologist.”