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their practice is overseen by state medical boards. The
different levels of practice for physician extenders in oto-
laryngology are very nicely described and summarized
by Norris et al., and range from supportive to independ-
ent practice models. 3 The relatively small percentage of
patient care being provided for by APCs is consistent
with the fact that NPs in otolaryngology constitute only
0.2% of all active NPs, and PAs in otolaryngology consti-
tute only 0.9% of the total PA workforce as of 2008.
These percentages are better illustrated when compared
to the fact that approximately 1.2% of active physicians
in the United States are otolaryngologists.14
Interestingly, PAs, NPs, and RNs are most com-
monly involved in office visits that concern disorders of
the ear (Tables II and III). This is likely related to the
fact that ear complaints are among the most common
reasons for patients’ being seen in the outpatient otolar-
yngology setting, and ears are readily examined without
the need for a procedure such as endoscopy. Further-
more, there was significant overlap in the diagnoses
attributed to PA versus NP visits, which constituted
both acute and chronic conditions in otolaryngology.
Finally, with respect to type of patient distribution,
APCs were more commonly used in established patient
visits in contrast to new patient visits. This suggests
that APCs in otolaryngology are being employed in the
context of disease management and follow-up rather
than disease diagnosis. Again, given the contemporary
constraints of the healthcare system, further use of
APCs in diagnostic evaluations seems likely.
CONCLUSION
Although APCs are expected to expand in numbers
in otolaryngology, contemporary data indicate that
current penetration of APCs into ambulatory otolaryn-
gology care remains relatively limited. These data
provide an initial assessment for future modeling of
APCs in otolaryngologic care.
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