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The Laryngoscope
V
C
2012 The American Laryngological,
Rhinological and Otological Society, Inc.
Involvement of Physician Extenders in Ambulatory Otolaryngology
Practice
Neil Bhattacharyya, MD, FACS
Objectives/Hypothesis:
Determine the penetration and point-of-care patterns for physician extenders in ambulatory
otolaryngology practice.
Study Design:
Cross-sectional analysis of national database.
Methods:
The National Ambulatory Medical Care Survey was examined for 2008 and 2009, extracting all cases of ambu-
latory visits to an otolaryngology outpatient setting. Visit types were then segregated according to providers seen including
physician, advanced practice clinicians (APCs) (nurse practitioner and/or physician assistant) and nurses. Visit types were
determined (physician alone, physician with APC, or APC alone) as well as type of patient seen (new vs. established patient).
The top 10 diagnoses were compiled according to provider visit type.
Results:
An estimated 38.6
6
3.7 million outpatient office otolaryngology visits were studied. An APC was seen in 6.3
6
2.0% of visits (physician assistant, 4.6
6
1.9% visits; nurse practitioner, 1.7
6
0.9% of visits), and a nurse was involved in
25.1
6
7.6% of visits. Nurse practitioners were more likely see patients independently (47.7%) than were physician assis-
tants (23.3%). APCs were more likely to be involved with established patient visits (7.2
6
2.3%) rather than new patient vis-
its (4.3
6
1.8%,
P
¼
.08). Disorders of the external and middle ears were the most common diagnoses seen by APCs.
Conclusions:
Although APCs are expected to expand numbers in otolaryngology, contemporary data indicate that cur-
rent penetration of APCs into ambulatory otolaryngology care remains relatively limited. These data provide an initial assess-
ment for future modeling of APCs and otolaryngologic care.
Key Words:
Physician extenders, ambulatory care, otolaryngology, advanced practice clinicians, nurse practitioner,
physician assistant.
Level of Evidence:
2b
Laryngoscope,
122:1010–1013, 2012
INTRODUCTION
The concept of a looming physician shortage linked
to an expanding and aging population in the United
States has been the subject of ongoing concern and
debate.
1
One option to help offset a projected physician
storage, including a projected shortage in otolaryngology,
is the integration of midlevel and advanced practice per-
sonnel into ambulatory and hospital-based care.
2,3
Recent commentaries have stressed the evolving role of
advanced practice clinicians (APCs) and other providers
in otolaryngologic practice.
3
However, although there is a perceived need for and
a seeming progression toward the integration of APCs in
otolaryngologic practices, almost no data are available
indicating the actual penetration of APCs and other pro-
viders into the point of care. Such data are essential as
a foundation for understanding the epidemiology, eco-
nomics, and patient experiences for care provided by
APCs in otolaryngology. Data regarding the prevalence
of care provided by APCs, interactions with physicians
at the point of care, and the types of patients seen are
also important components when projecting the role of
APCs in future models of healthcare provision. We
sought to examine current trends in APC care provided
at the ambulatory otolaryngology level to help quantify
these factors.
MATERIALS AND METHODS
The National Ambulatory Medical Care Survey (NAMCS)
for the calendar years 2008 and 2009 formed the data source
for this study. The NAMCS is a national survey conducted
yearly by the Center for Healthcare Statistics, a branch of the
Centers for Disease Control. It provides objective reliable infor-
mation about the provision and use of ambulatory medical care
services in the United States. Findings are based on a sample
of visits to non-federally employed office-based physicians who
are primarily engaged in direct patient care. The NAMCS uses
a multistage probability design, first using primary sampling
units (N
¼
112, adjusting for variations national geography),
followed by a second-stage sampling reflecting physicians, their
specialties, and random sampling time periods during the calen-
dar year. Specially trained interviewers visit the physicians
prior to their participation in the survey to provide them with
survey materials and instruct them on how to complete the
forms. Data are collected from the physician, rather than from
the patient. Each physician is randomly assigned to a 1-week
From the Division of Otolaryngology, Brigham and Women’s
Hospital, Boston; and the Department of Otology and Laryngology,
Harvard Medical School, Boston, Massachusetts, U.S.A.
Editor’s Note: This Manuscript was accepted for publication
February 17, 2012.
Dr. Bhattacharyya is a consultant for Intersect-ENT, Inc. and
Entellus, Inc. The author has no funding, financial relationships, or con-
flicts of interest to disclose.
Send correspondence to Neil Bhattacharyya, MD, Division of Oto-
laryngology, 45 Francis St., Boston, MA 02115. E-mail:
neiloy@massmed.orgDOI: 10.1002/lary.23274
Laryngoscope 122: May 2012
Bhattacharyya: Physician Extenders in Otolaryngology
Reprinted by permission of Laryngoscope. 2012; 122(5):1010-1013.
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