“The goal is not to be exclusionary,” he said. “We’re really bending over backward to emphasize that our purpose is not to steal tonsillectomies” and other procedures commonly performed in children by general otolaryngologists. He added, however, that the increasing number of accredited fellowships for pediatric otolaryngology makes this a logical time to move forward.
Explore this issue:August 2010
Lessons from the Past
Robert Miller, MD, executive director of the ABOto, noted that the neurotology subcertification process had its share of controversy. When subcertification in otology/neurotology was explored, otolaryngologists who practice otology as part of their overall practice expressed concern that the name of the subspecialty would negatively affect them. Based on these comments, the term “otology” was dropped. After the subcertification process was officially announced and after discussions for many years with the leadership of the affected societies, some doctors were still not happy, he said.
“There was a very small but vocal opposition that fought it a bit,” said Dr. Miller, who is also editor of ENT Today. “The leadership was very genuine in their interest, but I don’t know to what extent their membership knew what was going on,” he said. “Part of the opposition had to do with some physicians just not wanting to take the exam.”
Based on this experience, the ABOto learned the importance of communicating directly with everyone affected, not just the society leaders, he added.
The ABOto went about the process for subcertification in sleep medicine differently, Dr. Miller said. “…We did e-mails, we did editorials, we did questionnaires, basically saying, ‘Here’s what we’re thinking about doing. What are the pros and cons?’” he said. “It’s just true with anything in life, communication is just critical.”
Dr. Miller said pediatric otolaryngology is “a logical subcertification. It is clearly an identified subspecialty with ACGME-accredited fellowships.”
Defining “the Dura”
The main hurdle, Dr. Miller said, is defining the subspecialty of pediatric otolaryngology. For neurotology, the line was drawn fairly simply: For the most part, procedures inside the dura belong to neurotology, and those that don’t belong to otology.
“How do you define the dura for pediatric otolaryngology?” Dr. Miller said. “That is the challenge for otolaryngology.”
Dr. Miller said it’s important to protect the value of the primary otolaryngology certificate. “The otolaryngology world is somewhat sensitized, because some people have gone out and advertised that they’re a pediatric otolaryngologist and marketed themselves as … the only ones who can operate on children,” he said.