Multispecialty Collaboration: Learning from Our Past to Shape Our Future

Sleep apnea treatment is an area which seems especially conducive to multispecialty collaboration, which would benefit many patients. Collaboration in this area was recently enhanced by the creation of the new conjoint American Board of Sleep Medicine (the American Board of Otolaryngology is a co-sponsor), and otolaryngologists are eligible for board certification (see ENToday, inaugural issue, page 18 for more information).

Surgical Collaboration and Beyond

Skull base surgery is another area where head and neck surgeons, rhinologists, neurotologists, neurosurgeons, and others are working together to advance the frontiers of surgical resection as well as to decrease the morbidity of surgical approaches. From neurotologic approaches to the lateral skull base, to craniofacial approaches, and now to endoscopic-guided trans-nasal and -sinus approaches, otolaryngologist-head and neck surgeons have a proud history of surgical teamwork.

There are many more examples of opportunities for collaboration, consultation, and mutual benefit, and not all involve surgery. We work with ophthalmologists in orbital decompression, orbital trauma and reconstruction, and dacryocystorhinostomy. In the management of laryngopharyngeal reflux, dysphagia, and other esophageal disorders, we work with gastroenterologists and speech language pathologists. Increasingly, otolaryngologists are leaders in the multidisciplinary design of clinical trials and creation of treatment guidelines for sinusitis, working with allergists, primary care physicians, and pulmonary physicians. Collaborative care also benefits patients with combined sinonasal and lower respiratory disease. In addition, we share the airway with anesthesiologists and pulmonary specialists, and our expertise and innovation in endoscopic techniques and lasers is called on frequently by both groups.

Clearly, our patients are the major beneficiaries of these advances. Further advances and collaborations will only enhance the care we provide, which will benefit our patients and our specialty.

Decisions for Our Future: Training Our Residents

Although several factors have contributed to the steady growth in the scope and influence of our specialty, we should be mindful of the benefits of otolaryngology-head and neck surgery residents spending one or two years of training in general surgery, integrated alongside other surgical residents. Having our resident trainees working alongside the general surgeons, neurosurgeons, and other surgical specialists clearly enhanced our stature and helped pave the way toward our status as definitive head and neck surgeons.

‘While consultation is an everyday part of contemporary medicine, otolaryngologists-head and neck surgeons might be unique in the number of specialties and territories that we overlap with-or bump into.’

However, the landscape of residency training is changing. This year, otolaryngology-head and neck surgery training programs have the option of taking control of the PGY-1 year of surgical training, with some designated time for surgery and electives. This is not unique; other surgical subspecialties have also moved control of the PGY-1 year to their own residency programs. While this change was initiated for good reasons, I am concerned that the importance of a full year of surgical training, as well as the surgical integration that occurs during that year, could be lost in the future. In addition, there could be other potential unintended consequences. For example, too much emphasis on non-surgical electives could result in residents starting the PGY-2 year with poor surgical skills.