Once an NP or PA is hired, the credentialing process should be started early, following up with the hospitals, insurance companies, and Medicare to make sure they have received everything they need. Dr. McElveen also suggested getting NPs and PAs certified to use the Epic EMR system for use at hospitals, allowing remote access, utilizing the Academy’s instruction courses, familiarizing them with office equipment and the microscope, and using ear models and modeling clay for training on cerumen removal under a microscope. “Physician extenders not only facilitate patient care, but may be the key to maintaining the viability of traditional, independent private practice,” he said.
Explore this issue:March 2018
Physician Extenders in the Academic Setting
Melissa Pynnonen, MD, MS, professor of otolaryngology–head and neck surgery at the University of Michigan, said it’s important to understand the training backgrounds of PAs and NPs and to know how to make them a more valuable part of the practice. “An otolaryngologist spends four years in medical school and five or six years in surgical residency, and during that time they not only learn the science, but they learn how to function in a hierarchical team, and that cultural education and experience is what APPs [advanced practice providers] do not have,” she said. “As a result, they may not know how to escalate a medical concern.”
They also require clarity of their roles, she said. Nurse practitioners come from a nursing background and are used to taking orders, so they may have difficulty working independently at first, Dr. Pynnonen noted. “Not only is this an expensive waste of your investment, but this can create conflict with the nurses, because they’re not sure who’s supposed to be doing what,” she said.
NPs spend two years in school for their NP license, and this includes only 500 clinical hours, much of which might be introductory time and might not be true education or experience, she said. And PAs have only six to eight weeks of elective rotation, which may or may not include otolaryngology. “They need as much supervision as you would provide a young medical student,” she said. “Your support of them and your relationship with them needs to be positive and robust.”
This should include a willingness to supervise them in clinic, with a formal orientation plan and learning objectives. A good place to learn is in the OR, Dr. Pynnonen said. “We all developed our expertise with opportunities to do surgical procedures in the operating room,” she said. “And I think it’s really helpful for the APPs to develop basic skills in that more relaxed setting.”