CHICAGO–Kristi Gidley, PA-C, a physician assistant, administrative director, and supervisor of advanced-practice providers (APPs) in the department of otolaryngology at the University of Alabama in Birmingham, introduced a session on APPs at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Society. She began with a basic description of certified nurse practitioners (NPs) and physician assistants (PAs), both of whom can be APPs.
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November 2017NPs often choose a specialty area and complete 500 didactic hours, plus 700 to 800 clinical hours, before they become certified in that specialty (otolaryngology nurses are, certified by the National Certifying Board of Otorhinolaryngology and Head–Neck Nurses). PAs also take board exams, but they are certified by the National Commission on Certification of Physician Assistants. In addition, they are licensed through the state medical boards and must earn continuing medical education credits as well as take an exam to recertify every six to ten years, requirements that mirror those expected of medical doctors.
Healthcare has seen an overall increase in demand for APPs, partly due to expanded coverage under the Affordable Care Act and the increasing numbers of aging baby boomers. This upsurge in patient demand is coupled with an under-supplied healthcare system, and experts estimate that by 2025, the demand for physicians will dramatically exceed supply. While the otolaryngology workforce increased in number through 2001, it remained stable from 2001 to 2006 and began a decline in 2006. The result is that one in five counties has seen a decline in the ratio of otolaryngologists to population. Despite the reduced number of physicians, consumers continue to expect and demand high quality and timely care. APPs can help fill this gap.
NPs often choose a specialty area and complete 500 didactic hours, plus 700 to 800 clinical hours, before they become certified in that specialty.
Role of APPs
APPs can provide more face time for the patient, decrease wait time, and improve the efficiency of clinic flow.
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The APP scope of practice varies across states but includes prescriptive authority as well as the ability to perform many routine procedures. With training, APPs may also be able to perform more advanced procedures. APPs can thus bill for any code and can perform whatever procedures their training, experience, and the physician allow. Marie Gilbert, PA-C, works at Northeast ENT and Allergy in Dover, N.H. She explained that while the supervision requirements for APPs can vary from state to state, the physician is generally not required to be on site with the PA, as long as they are reachable by phone. In addition, PAs must have their own National Provider Identifier number to bill for services. PA services are not always billed under the physician.