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

The historical relationships between medical allergists and otolaryngic allergists have sometimes been characterized by distrust and socioeconomic turf battles. As recently as 10 years ago, said John H. Krouse, MD, PhD, Professor and Vice-Chair, Department of Otolaryngology at Wayne State University, and current president of the American Academy of Otolaryngic Allergy (AAOA), ENT allergists and general allergists “probably couldn’t have sat in an airport lounge and had a civil discussion.”

But in the past five to seven years, there has been a significant change in these professional relationships. Especially at the leadership level, allergists and otolaryngologists who practice allergy are cooperating and collaborating in numerous ways. Interdisciplinary initiatives focused on CPT coding and carrier advocacy issues, evidence-based practice guidelines, and plans for collaborative scientific projects are now yielding appropriate returns—as well as mutual respect—between these subspecialties. Leaders in the otolaryngology and allergy communities believe that these initiatives will, in time, also improve collegial relations at the community and private practice levels.

Why the Change?

Harold C. Pillsbury, MD

Experts interviewed for this report point to multiple factors that have changed the tenor of interprofessional dialogue between otolaryngic allergists and general allergists. The first is that the incidence of allergy, asthma, and related conditions continues to trend upward. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), more than 50 million Americans are affected by allergies; allergic rhinitis precipitates 16.7 million physician office visits a year; and the association between sinusitis and asthma has now been validated in scientific studies. In addition, the concept of the unified airway model, as outlined in the editorial in this issue by Bradley F. Marple, MD, Professor and Vice-Chair of the Department of Otolaryngology at the University of Texas Southwestern Medical Center, lends weight to the efficacy of interdisciplinary management of upper and lower airway disease. Recognition of this reality at the leadership level has triggered other seminal events, such as the invitation by the AAAAI for otolaryngologists to contribute review and editorial input into the Academy’s Allergy Report in 2000.

“If you look at the impact of allergic disease on the diseases that we treat, both in allergy and immunology as well as in otolaryngology, the overlap is amazing,” said Dr. Marple. The number of otolaryngologists who are practicing allergy is significant (approximately 4000, according to conservative estimates of the AAOA), said Harold C. Pillsbury, MD, President of the Triological Society, Chairman of the Department of Otolaryngology at the University of North Carolina Medical Center in Chapel Hill, and Chair of the AAOA’s Socioeconomic Committee. “At some point, when two people are doing similar things and it’s clear that they’re both going to be in this market for a while, it makes more sense to collaborate than to butt heads with each other.”