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

“Just look at the tort issues and rising malpractice burdens,” Dr. Alam said. “If that becomes 25% of your burden … you can take a 10% pay cut and still come out ahead.”

Still, Dr. Alam understands that working for a conglomerate is not ideal for all otolaryngologists. Clinic employees come to work, provide care for patients and collect a paycheck. They have less control over their schedules and their patient loads than a solo practitioner does. They can’t choose to work added hours to reach higher financial thresholds.

“It has to do with the personality of the individual and the type of practice they’re interested in developing,” Dr. Alam said. “The advantage of a Cleveland Clinic model is it gives you all the advantages of a tertiary-care hospital, but we don’t have any of the [business-side] burden.”

Even with the potential downsides of schedule control and the earnings ceiling, Dr. Alam expects the largest health plans to get larger. As the government reforms payment systems to reward efficiency, it only makes sense that the most efficient organizations will thrive.

“Everything from buying gauze to buying warfarin … we can do cheaper because we have the contracting power and capacity,” he added. “And we can subdivide out our process to make them more efficient. It’s about an efficient system. And society and the world demands more efficiency out of its healthcare because of the spiraling costs.”

“Who’s handling my billing, my this, my that? I don’t have to worry about that.”

—Daniel Alam, MD

Working Well with Others

Byron Norris, MD, is a fourth-year resident in the department of otolaryngology and communicative sciences at the University of Mississippi Medical Center in Jackson, Miss., but his brief career experience has already taught him one thing: Physician extenders can be a very good idea for an outpatient otolaryngology practice.

Dr. Norris presented a paper at the 2010 American Academy of Otolaryngology-Head and Neck Surgery annual meeting, “Effective Use of Physician Extenders in an Outpatient Otolaryngology Setting,” that highlighted the ways in which nurse practitioners, physician assistants and residents can be used in high-volume settings to improve efficiency and patient satisfaction. In short, the model uses physician extenders to free up attending physicians or, in private practice, an independent practitioner, to perform the highest-acuity, highest priority tasks. In a typical patient encounter, an extender enters a room first to take a patient’s history, perform an introductory physical exam and collate medical images or test results, streamlining a physician’s first encounter.