Onboarding and Working with APPs

Advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs), play an essential role in delivering timely, high-quality otolaryngology care. Yet the onboarding process for APPs and the scope of their responsibilities can look very different across subspecialties and between academic and private practice settings.

“APPs are an essential part of providing high-quality care and meeting growing demands for outpatient and inpatient timely care,” said Ron B. Mitchell, MD, professor of otolaryngology and pediatrics and chief of pediatric otolaryngology in the department of otolaryngology–head and neck surgery at UT Southwestern Medical Center in Dallas. Dr. Mitchell, who has been working with APPs since 2000, added that “we currently have more APPs than physicians.”

“APPs independently see new and follow-up patients in clinic, including multidisciplinary clinics, and manage inpatient consultations. They perform procedures in clinic and in the inpatient setting. They take day and night calls for urgent/emergency cases,” Dr. Mitchell said. APPs “promote efficiency and patient access, they participate and lead policies, and are leaders in writing and improving educational material for patients.”

Cecelia E. Schmalbach, MD, MSc, David Myers MD professor and chair in the department of otolaryngology– head and neck surgery and director of the Temple Head and Neck Institute at Lewis Katz School of Medicine at Temple University, and chief of the head and neck division at Fox Chase Cancer Center, both in Philadelphia, has worked with PAs and NPs throughout her entire otolaryngology career. The impactful partnership “helps to ensure timely and quality care,” she said. “It has been an incredibly rewarding working relationship that allows me to do more for my patients and their families.”

“In my current cancer practice, our APPs participate in patient care in both the outpatient and inpatient settings. In the outpatient setting, they assist attending physicians during clinic sessions by seeing patients. In addition, they hold their own independent clinics, which include a ‘survivorship clinic’ when patients are more than five years out from cancer care, wound checks, and add-ons. On the inpatient side, they participate in daily multidisciplinary rounds to assist with timely discharge. This inpatient rounding provides a great opportunity for the APP and patient/ family to get to know one another; in doing so, there is meaningful continuity of care, which facilitates seamless transition in the outpatient setting,” Dr. Schmalbach said. “The APPs assist in returning patient phone calls (managing the electronic health record patient portal), sharing non-urgent test results, and following up on orders/ recommendations from our weekly tumor board.”