Managing the Increasing Primary Care Burden in Otolaryngology

The Future

While some of the short-term challenges created by COVID-19 (backlog of services and deferred care, for example) will likely become less acute as the pandemic recedes, other changes represent secular shifts, Dr. Brenner said. Expansion of the workforce is needed and could include primary care physicians or APPs.

“Whereas the number of otolaryngologists has been essentially flat for many years, the number of advanced practice providers has steadily risen over the past decade,” he explained. “Several studies have documented the tendency of physicians, particularly specialists, to concentrate in urban areas. So, the long-term solution will require expanding the workforce so that patients who most need a specialist can receive timely, appropriate care.”

“Advanced practice providers will be vital to creating greater access into our practices,” said Dr. Brown. “These are bright, well-trained professionals who flourish under our guidance, with our tutelage, and under our supervision. They can see many of our return patients, especially for cerumen impactions, and many of our acute care patients, creating revenue for our challenged practices and allowing surgeons to practice at the top of our licensure.” He added that, “with mounting economic pressures, I don’t predict that the higher-cost physician model will achieve as much traction. The advanced practice provider model is successful, and their employment is growing logarithmically within otolaryngology practices today.

“Rural specialty practice is a challenge for not just otolaryngology but for the ‘house of medicine’ overall,” Dr. Brown continued. “Rural ENT doctors tend to be older, and most describe recruitment of next generation otolaryngologists as ‘impossible.’ Our footprint in rural settings will continue to contract. This subspecialty vacuum will challenge small, rural hospitals and medical communities. Ultimately, I think that this will create opportunities for successful practices to serve this population with telehealth, weekly/monthly clinics, and advance care provision.”

Otolaryngology Fellowships

According to Dr. Chandrasekhar, if otolaryngology organizations, such as the American Academy of Otolaryngology– Head and Neck Surgery and the Triological Society, provide education for primary care counterparts in terms of clinical practice guidelines and clinical consensus statements, especially for common otolaryngological issues that often present to primary care, it will help improve patient care.

“There are a handful of medical otolaryngology fellowships for primary care physicians interested in joining otolaryngology practices or departments,” she said. “I think that this is an excellent opportunity to build upon the knowledge base and skillset of well-trained family physicians or internists to provide comprehensive otolaryngologic office care, with referrals to otolaryngologists within the practice when needed. This is still in its infancy, however.