Practice Alternatives: Three otolaryngologists discuss what it’s like to work under evolving care models

Certain well-established care delivery models for otolaryngologists have long defined the specialty. But, like pharmacology, surgical techniques and treatment therapies, practice models evolve. And while traditional models continue to dominate the scope of most otolaryngology practices, the field is seeing a gradual shift to new constructs. Among them:

• The growing market share of the largest health plans, in particular, the Mayo Clinic of Rochester, Minn., Kaiser Permanente of Oakland, Calif. and the Cleveland Clinic. Each of the three is a fully integrated system whose physicians often say that working in a model of such breadth with access to so many resources can allow providers to focus more on clinical duties, without the practice management issues faced by solo providers.
• The use of physician extenders in outpatient otolaryngology practices. The model’s proponents argue that using physician assistants and nurse practitioners can increase a practice’s cost efficiency, improve patient satisfaction and promote physician productivity.
• At least two otolaryngologists nationwide generate their entire patient load and surgical pipeline from admissions to an academic or community hospital.
• ENT Today spoke to otolaryngologists working under each of the three models to illustrate how they work.

The Biggest of the Big

Daniel Alam, MD, head of the Section of Facial Aesthetic and Reconstructive Surgery in the Head and Neck Institute at the Cleveland Clinic in Ohio, joined the health plan in 2002, straight out of training. So he’s the first to admit he’s a bit biased on the benefits of working for one of the country’s largest health delivery models.

The advantages—Dr. Alam calls them “creature comforts”—start with not having to deal with the billing and coding issues that solo practitioners must manage. Those business-side skills are instead overseen by the infrastructure of the Cleveland Clinic, which operates nine regional hospitals and 16 family health centers across the U.S. and Canada.

“The day-to-day interaction of you with a patient is identical,” Dr. Alam said. “You’re not limited in what you can do surgically, who you can operate on … but the actual financial modeling of what you do is very, very different. Who’s handling my billing, my this, my that? I don’t have to worry about that.”

Another advantage, Dr. Alam said, is that the clinic is self-insured, which means that the malpractice costs decried by many physicians are far from the minds of clinic employees. Dr. Alam said he has never been sued but is comforted knowing that he is backed by the legal and financial might of a large organization. The insurance issue is one reason physicians accept lower salaries and lower potential earning power to work for the clinic, he added.