Managing the Increasing Primary Care Burden in Otolaryngology

“Even if expanding opportunities for clinical otolaryngology one-year fellowships for primary care physicians cannot be done, encouraging the senior trainees in your area in family practice or internal medicine, or the new graduates, to shadow you in the office for a significant but small amount of time, will really help cross-pollinate knowledge,” added Dr. Chandrasekhar. She noted that practices that are comfortable using physician extenders should continue to do so, with the caveat that patients understand “when they are being seen by a physician and when they are being seen by someone who isn’t a physician but who has the skillset needed.”

Dr. Hawley agreed that otolaryngology is a specialty that could support a nonsurgical/medical fellowship. “Residents could graduate from pediatrics, internal medicine, family medicine, or emergency medicine and enter a ‘medical otolaryngology’ fellowship, perhaps for one to two years, to learn to better manage medical conditions of the head and neck and then refer to an otolaryngologist for surgery if needed. These fellows could learn to scope patients—nasal endoscopy and flexible laryngoscopy are examples of simple procedures that offer an immensely more detailed exam and often are the sole purpose of an otolaryngology consult. They could also learn simple procedures like [performing] peritonsillar abscess drainage, packing epistaxis, or using a microscope in clinic to remove a foreign body or cerumen. They could also offer specialized services in a rural community, whether it be primary care or in the emergency room. They could also work within an otolaryngology department and help offload clinic patient load. This would help reduce the referral to the surgically focused otolaryngologists (as most of us are) and improve patient access to much of their needs. “

A fellowship-trained medical otolaryngologist would have no shortage of work,” Dr. Hawley added. “These MDs would have a much better foundation and regimented fellowship training than what our advanced practice providers are currently providing.”

Citing Katy Milkman, PhD, the James G. Dinan Professor at The Wharton School of the University of Pennsylvania, Dr. Bowe said, “Landmark events, such as the coronavirus pandemic, that demarcate the passage of time, can initiate a ‘fresh start effect,’ motivating aspirational behaviors and spurring improvement efforts. I think that now is a great time to explore different methods of training. Some of these altered training paradigms have already been started, such as with pilot studies looking at competency-based training in plastic surgery. Perhaps there are different alternatives that could be explored with otolaryngology as well.”