‘The Bad Old Days Are Gone’: Turf Battles Recede as Otolaryngologists and Allergy Leaders Communicate and Collaborate

Dr. Aaronson conceded that the general membership of the related societies may be a “few steps behind” the leadership when it comes to cooperating with related subspecialists. “When we talk to our cospecialists in our specific individual fields, we need to make them more aware of the level of cooperation that exists. The fact that we are cooperating does not mean that we each endorse each other’s practices with which we may not agree. It means that we respect each other. Then it becomes possible for everybody to work together.”

Stanley M. Fineman, MD, MBA

Sources point to the increased burden of allergic and respiratory disease, and to diminished numbers of internists who are doing residencies in allergy. “Each of our groups is small,” noted Dr. Krouse. “There are perhaps 4000 allergist/immunologists and about the same number of otolaryngologists doing allergy practice. If the prevalence of allergy is 25 percent to 30 percent, there are probably 75 million Americans with allergies, so this is a significant burden of disease.”

There may be plenty of patients to go around. “You don’t ‘own’ a condition,” Dr. Pillsbury maintained. “You see people because they come to you with related problems and you do the best you can to help them out. We’re not interested in doing anything that would inhibit the general allergists from treating nasal allergies as well as other parts of the body affected by allergy.”

Still, perceptions often die hard. There are multiple issues at the local level that create barriers between ENT allergists and general allergists, said Bob Lanier, MD, Past President of the American College of Allergy, Asthma, and Immunology (ACAAI), Clinical Professor of Pediatrics at the University of North Texas Health Science Center in Fort Worth, and an attending physician at Peking Medical College in Beijing. In some cities, he said, cooperation at the local level between the subspecialties has increased, depending on physician participation in insurance company panels. For instance, in the Fort Worth area, Dr. Lanier receives a fair number of referred patients from an otolaryngologist/allergist who is not covered on some plans. In turn, Dr. Lanier acts as a consultant with the otolaryngologist’s patients, and the two have a good working relationship.

However, communication between the subspecialists on the local level can be stymied by sensitive economic issues, said Dr. Lanier. Many of Dr. Lanier’s allergy colleagues object to what they perceive as “cherry-picking” techniques on the part of otolaryngologist/allergists. Dr. Lanier explains that medical allergists have cost-shifted their practices toward simple immunotherapy for allergic rhinitis. Billing for these treatments allows physicians to balance the other half of their practice loads, which often comprise patients with allergy-like complaints for whom the complaints do not result in immunotherapy. This shifting has become necessary to maintain billable levels of income for those practices. “The problem is that otolaryngologists have a unique ability, in many cases, to see easy allergy [cases] first and pick the ‘low-hanging fruit.’ That leaves the more difficult and revenue-negative patients—i.e., drug sensitivity, urticaria, and eczema—for the medical allergist,” said Dr. Lanier.