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

“What the hospital gains is [that] patients are often seen ‘right now,’” he said. “The emergency room is very happy because the patients don’t sit around all day waiting for an ENT guy to finish their elective surgery, their whole day of patients and [then] come in and see the patients.”

Dr. Dudek said he typically sees patients within 12 hours of a consultation request from another physician. Many of the patients have abscesses that need draining, including peritonsillar and retropharyngeal cases. “So what happens is cases that would have gotten admitted out of the ER, I can get them drained and taken care of and they don’t have to get admitted and … some of my utility to the hospital is a cost savings that doesn’t show up on paper as income generated,” he said.

The hospital isn’t the only one benefiting. Dr. Dudek no longer worries about staffing issues, billing disputes and, perhaps most importantly, collection cases. “I’m still getting some collection stuff in from four years ago from my private practice,” he said. “That was always the most unattractive part of running a private practice, the bill collecting part.”

Dr. Dudek works about four hours a week in clinics where he sees only a few hand-picked cases, usually either long-time patients or hospital staff and their friends and family. But the bulk of his time is spent in different departments of the hospital, from the emergency department to cardiology to the neo-natal unit. He refers complex, major or time-consuming procedures to other physicians or other institutions when necessary.

He said it is important to emphasize to physicians who might be considering joining the wave of oto-hospitalists that the job lacks the financial rewards of private practice and the glamour of major procedures. Often, his job involves draining abscesses or performing straightforward tracheotomies. It does, however, require knowledge of a wide swath of procedures. He wonders if that makes the job suited to young physicians straight out of training, who have not yet been exposed to several years of the types of complex and novel cases a hospital generates.

“I would think it would be better not [to go into this job] straight out of residency, to get a certain amount of experience under your belt,” Dr. Dudek added. “When you’re young, you want to go out and apply all your skills. You want to gain that experience with patient care … To have as much as broad-based experience as possible is what somebody would need to do this job well.”