Collegial Relationships: Extending Otolaryngology Practice with Other Professional Providers

The salient issue for a PA or NP entering an otolaryngology practice, then, is to acquire “a sense of the complexity of the problems so that you know when to appropriately do extra testing.” Because audiograms, CT scans, and ENGs, for example, are expensive, providers must be astute historians, said Dr. Pillsbury, and capable of performing an excellent physical exam so that they will know when to appropriately order ancillary tests.

Physician Assistants

The American Academy of Physician Assistants (AAPP) estimates that there are currently about 575 PAs practicing in otolaryngology. Physician assistants graduate from a competency-based medical program that is accredited by organizations including the American Medical Association and the Academy of Physician Assistants; are certified with the National Commission on Certification of Physician Assistants, and are licensed providers (see sidebars). But “one PA will not necessarily fit in the same slot covered by another PA,” said Mel D. Brown, MPAS, PA-C, SA, of the Otolaryngology, Head and Neck Surgery Division at University of New Mexico Health Sciences Center in Albuquerque, N.M. “Individuals have different levels of expertise and we do fit into a certain niche.”

Mr. Brown earned a master’s degree in otolaryngology at the University of Nebraska and then did a postgraduate fellowship through the US Air Force, from which he retired in 2003. He believes his postgraduate training in education makes him more marketable in otolaryngology. He is also exceedingly knowledgeable about what it takes to succeed as a PA in this specialty: he was at one time the surgeon general’s consultant for otolaryngology PAs and addressed the surgeon general, other physicians, and various CEOs of the Air Force hospitals on the topic of using and training PAs as providers in otolaryngology.

Based on the many questions prospective employers have asked him over the years, Mr. Brown has two key pieces of advice: First, PAs do provide the standard of care; second, they are very cost-effective. “Our salaries are not what a physician’s salary is,” he said, but he emphasized that you get what you pay for. “If you want someone right out of school who has little experience and training, of course you can pay them less; but with more experience, we also do quite a few more procedures, manage more complex patients, and generate more surgeries and revenue for the practice as well—all while giving peace of mind for the physicians, that their patients are well cared for.” The lines of communication between a PA and physician must be open. “I have colleagues who are not doing the same thing I am; some are doing more, some are doing less, and that’s the way it is with any profession—you progress according to your own speed and motivation.”