APPs can see new patients, perform re-checks, order work-ups, run clinics, take pre-operative histories and conduct physicals, handle post-operative visits, and act as first assistants during surgical procedures. The practice can bill for those things. Procedures APPs can be involved in run the gamut from cerumen disimpactions to tympanostomy, said Gilbert. “It depends on what the PA’s and NP’s experience and training are up to and what the physician delegation will allow,” she added. “Some physicians don’t want their APPs doing any procedures at all.”
Explore This IssueDecember 2015
To show the financial effects an APP can have, Gilbert described a PA who is paid $106,000 a year. Using a conservative estimate of $150 of income for every physician visit that’s made available for every post-operative visit that the PA conducts instead, a practice can net an additional $400,000 a year or more, she said. That factors in the extra office visits the PA handles, as well a CME allowance, additional insurance costs for the PA, and other considerations.
Smart Hiring Is Key
Jerry Schreibstein, MD, an otolaryngologist at a Springfield, Mass.-based private practice with 6.5 full-time-equivalent otolaryngologists and between 1.5 and three PAs depending on the current staffing level, said their training includes a variety of techniques.
The physicians shadow the PAs, and the PAs use online tools available through the AAO-HNS, observe in the operating room, and observe the speech pathologist and the audiologist, and, along the way, they have to learn the idiosyncrasies of the half-dozen physicians in the practice.
At Dr. Schreibstein’s practice, there is always a physician on site and all new patients are seen and evaluated by a physician, while the PAs handle common problems such as epistaxis, sinusitis, cerumen, and hearing loss. “If you don’t let them synthesize the information and you solve the problem for them, they will never learn,” he said. “I always challenge them: What are you going to do?”
When it is hiring, the practice has to decide whether to hire a new graduate or someone with experience, while taking into consideration why the APP wants to work in otolaryngology, whether this is a first or second career, and what their expectations are for their schedule. “Hiring an advanced practice provider is like hiring any other employee or physician,” he said. “They’re people, and there are going to be good and bad experiences. The important thing is going to be the interview process and shadowing.”