Prime Time for Pediatric Otolaryngology: ASPO seeks subcertification

Ron Kuppersmith, MD, president of the American Academy of Otolaryngology-Head and Neck Surgery, said pediatric otolaryngology subcertification could be a good thing if done correctly.

The range of pediatric cases varies widely among otolaryngologists, but for many, a third to half of their cases, or even more, could be pediatric, Dr. Kuppersmith estimated.

“I think the important thing is to continue the conversation and to hopefully come up with something everybody can agree to,” Dr. Kuppersmith said. “I commend ASPO and Rich Rosenfeld and others who have tried to engage the entire specialty on what is the right way to do this.”

Gerald Healy, MD, professor of otology and laryngology at Harvard Medical School and former president of the American College of Surgeons, said he is in favor of subcertification, as long as it is narrowly defined. As an example, he pointed out that Charles Bluestone, MD, came up with a good general definition of pediatric otolaryngology more than 30 years ago when he said it should be training individuals to care for “common things in unusual children and uncommon things in healthy children.”

Dr. Healy wondered about the motivation for the interest in subcertification at this point in time. “It’s resurfaced that people want this designation—the question is why?” he said. “Is it truly that a group of people want to improve care and make sure that physicians who claim to be pediatric specialists have the credentials and knowledge to do this, or is there another economic agenda?”

Dr. Healy said subcertification should be reserved for those “who have a very specific type of practice that the board would carefully outline and define. That way,” he said, “you avoid giving a specific designation to fellowship-trained physicians who then go to a community and do routine pediatric care.”

“As with any process, there may be some who seek certification for personal gain or a competitive advantage, but I am sure the vast majority will not.”
—Richard Rosenfeld, MD, MPH

The Business of Subcertification

Harold Pillsbury, MD, chair of the otolaryngology-head and neck surgery department at the University of North Carolina Medical School and former president of the American Board of Otolaryngology, said a board-recognized subcertification in pediatric otolaryngology would be a reasonable step.

He dismissed concerns about those with more expertise in pediatrics siphoning business from other otolaryngologists, because it’s happening already. “That horse already left the barn,” he said.