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

“It allows the attending physician to see more patients in clinic, so then you have increased numbers of surgeries scheduled, which relates to increased revenue,” Dr. Norris said. “There’s less time needing to be spent in clinic, so there’s more time for administration and research, which provides for happier attending physicians and then also leads to easier recruitment and also stability. Everybody’s happy here because … you’re not leaving with 20 charts to dictate at the end of a busy clinic day. You’re leaving with a need to review the notes dictated by someone else, so faculty retention is at an all-time high in part because of this setup. So it’s a domino effect.”

Dr. Norris sees that “domino” as a good outcome, because it can potentially increase a physician’s volume and revenue with less expense than adding a second physician. It could also help patients if it leads to decreased wait times.

The collaborative model, brought to the University of Mississippi Medical Center in 2003 by department chair Scott Stringer, MD, MS, does require managerial oversight. New team members must undergo orientation and training that can last more than a year before being able to handle patient encounters on their own, a particularly key ingredient if the model is to be applied to private practices.

Dr. Norris recommends that otolaryngologists allow midlevel providers to see patients autonomously, which will decrease overhead and increase revenue. “In the private world or in another group practice, it would be beneficial if the mid-level providers are used in the spectrum of the methods that we’ve outlined,” he said.

Dr. Norris wishes there were more evidence-based data on the viability of collaborative practice models but has found little research outside of that related to primary care practices. Still, anecdotally, he believes it’s clear that the team approach to otolaryngology is effective, particularly in chronic conditions that require time-intensive encounters.

“Patients appreciate the additional time that is spent; even though it’s probably a shorter time with the physician itself, it’s a greater time with a physician plus an assistant,” he said, noting that a physician extender can reinforce plans outlined by the physician. “The assistants are there after the encounter is over with the attendings to answer questions, go over any details. I think it’s a more relaxed process, leading to greater patient satisfaction.”

Paging a Hospitalist

Stanley Dudek, MD, has been an otolaryngologist at Sparrow Health System in Lansing, Mich., for 32 years. He’s been an “oto-hospitalist” for the last four. The nascent job title—Dr. Dudek is one of only two known “otos”—describes a new breed of otolaryngologists whose job duties are tied to hospitalized patients. In Dr. Dudek’s case, he is a salaried employee on call for the hospital from 7 a.m. to 5 p.m. Although his compensation exceeds his billings, not only was his institution willing to accept him as a “loss leader,” it welcomed the setup.