More from August 2012 - Vol. 31 No. 08
On April 25, 2012, AAO-HNS representatives, including physician and audiology volunteers and staff, conducted a conference call with UnitedHealthcare (UHC) and hi HealthInnovations (HHI) executives as a follow-up to our January in-person meeting and February 21 letter regarding the direct-to-consumer hearing aid program (see the Private Payer website for more: www.entnet.org/Practice/News-and-Updates-from-Private-Payers.cfm. A day earlier, the Academy’s government affairs team spoke with HHI’s legal counsel regarding potential regulatory and statutory issues with the program. The AAO-HNS and numerous other hearing health organizations have expressed serious concerns regarding the company’s online hearing test. During the call, HHI confirmed it had removed the self-rendered online hearing test from the company’s website. However, HHI continues to distribute air conduction tests to providers. HHI has not made any changes to its program based on our feedback, so the Academy believes it is unlikely anything will change quickly. As a result, we made our position clear in our discussion with UHC and HHI that while we are supportive of providing patients access to affordable hearing aids, we do not believe the program represents safe and high quality care for patients. AAO-HNS staff also had a conference call on April 26 with counterparts at the American Academy of Audiology (AAA), the American Speech-Language Hearing Association (ASHA), the Academy of Doctors of Audiology (ADA), and the International Hearing Society (IHS) during which each organization discussed its recent interactions with UHC on this issue.
On May 15, the Academy signed on to a letter urging state health departments to advise consumers experiencing hearing loss to seek a comprehensive hearing evaluation by a licensed hearing professional prior to purchasing hearing aids over-the-counter or through the Internet. The letter additionally urges each department of health to notify consumers of the importance of seeing a physician for hearing loss and that failure to do so skirts state and federal regulations and could potentially be harmful. The letter, which was signed by numerous other organizations, including the ADA, AAA, ASHA, and IHS, was sent to the departments of health in all 50 states and six unincorporated U.S. territories. The goal of the effort was for all states to issue a statement similar to the Minnesota Department of Health’s as part of May’s Better Hearing and Speech month. The statements were to stress the importance of seeing a hearing healthcare professional for hearing loss. To view the Minnesota Department of Health’s news release, view its website at www.health.state.mn.us/news/pressrel/2011/hearing102611.html.
In addition, on June 25, the Academy communicated our concerns in a letter to the U.S. Food and Drug Administration (FDA), in an attempt to warn consumers at the federal level of risks associated with direct-to-consumer hearing aid programs. Stay tuned to the Academy website for further updates.
If you or any of your patients are experiencing issues with UHC’s hearing aids or air conduction hearing kits, email the Academy’s Health Policy team at healthpolicy@entnet.org.
Advocacy-Effort TimelineOctober 3, 2011—Academy is alerted of hi HealthInnovations’ new hearing aid program.
October 24, 2011—Academy comments about the program in American Medical News.
November 2, 2011—Comment letter sent to UHC followed by an immediate response from UHC to arrange a conference call.
November 28, 2011—Several members from the Academy’s physician payment policy group (3P), Board of Governors chair, and staff conduct a brief conference call with UHC. All parties agree a face-to-face meeting is necessary.
December 5, 2011—Academy follows up with UHC, sending a summary of the conference call and suggesting potential dates for a meeting.
January 30, 2012—Academy leadership, physician and audiologist volunteers, and staff meet with UHC.
February 9, 2012—Academy signs on to a joint statement emphasizing patient safety with four other associations.
February 21, 2012—Academy follows up with a letter to UHC reaffirming Academy requests made during the January 30 meeting.
April 24, 2012—Government Affairs staff speak with UHC counsel to discuss regulatory and statutory issues.
April 25, 2012—Academy leadership, physician and audiologist volunteers, and staff participate in a conference call with UHC as a follow-up to the February 21 letter.
April 26, 2012—Academy staff participates in conference call with four other organizations concerned with UHC’s hearing aid program.
May 15, 2012—Academy signs on to letter urging state health departments in all 50 states and six unincorporated U.S. territories to warn consumers about potential health risks of UHC hearing aid [36.1] programs.
June 25, 2012—Academy sends a letter to the FDA communicating concerns about consumer safety of DTC hearing aid programs. Rahul K. Shah, MD
Co-chair, AAO-HNSF PSQI Committee
George Washington University School of Medicine
For the past two years, the Academy, under the direction of Jean Brereton, senior director of Research, Quality, and Health Policy, and with Peter Robertson, senior manager of Research and Quality Improvement, has been exploring the feasibility of having our membership anonymously report patient safety-related issues, such as errors, adverse events, and near misses. The concept behind this is similar to what the Federal Aviation Administration (FAA) does to keep track of near misses and similar events. The nonpunitive reporting system the FAA has is so robust that many consider it one of the reasons for that agency’s exemplary safety record.
The federal designation as a patient safety organization as authorized by the Patient Safety and Quality Act of 2005 denotes certain protections to organizations in collecting such data and using this information in a nonpunitive manner. Our hope was that becoming a patient safety organization would be in the best interest of our members and their patients. However, after many months and extensive research into a number of options, including potentially partnering with an existing Patient Safety Organization, we have decided this is not the route to pursue.
We need information on patient safety events to be able to take a macro-level view of the zones of risk in our practices and help aggregate our one-off occurrences into meaningful actionable data. The difficulty is that a problem experienced by one otolaryngologist in a specific region of the country may not even be known to another practitioner in a different practice region. The need to have information on these rare, but significant, events reach the broadest possible targeted audience is imperative.
As such, the Academy, in conjunction with the Patient Safety Quality Improvement Committee, is piloting a patient safety portal where Academy members can securely, confidentially, and anonymously report an event. The reported error does not necessarily have to have resulted in an adverse event; reports can essentially reflect any safety concern that the Academy member has noted, including a near miss or other such error. Academy staff has gone to great lengths to ensure and corroborate the two most important aspects of a nonpunitive report system: confidentiality and anonymity.
The initial step is to ensure users of the portal are Academy members. Once your membership is confirmed and you access the patient safety portal, your report immediately becomes anonymous. Indeed, we have run checks to ensure that no data are recorded, not even the IP address of the computer from which the report is submitted. As a final security check, as reports come in, they will be reviewed by a nonphysician Academy staff member to ensure that any report containing any type of identifying information is purged.
Our hope is to create a place where Academy members can and should be able to report near misses, adverse events, and errors. The hope is that as our membership starts using this reporting tool, we will be able to rapidly identify macro trends that are becoming an issue. For example, if there are infrequent, but significant, issues associated with a particular device, the reporting system may be able to catch this. To be clear, the patient safety portal is not to be duplicative of existing reporting systems such as the U.S. Food & Drug Administration’s mandatory reporting system for device issues. Rather, it is to be complementary and immediately available and accessible for our Academy membership, with the ability to improve our practices and the safety for our patients and our specialty.
We are currently piloting this with the Patient Safety and Quality Improvement Committee to discern if the portal asks the right questions that can lead to collection of actionable data. We hope to refine this portal soon and then begin opening this up to all members, so that we can identify opportunities for improvement of our systems of practice based on the aggregate data.
We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
Evidence-Based Guidelines Affecting Policy, Practice, and Stakeholders (E-GAPPS) Conference
The 2012 E-GAPPS Conference is a two-day meeting co-sponsored by the Guidelines International Network North America (G-I-N NA) and the Section on Evidence-Based Health Care (SEBHC) of the New York Academy of Medicine. It will take place Monday, December 10, through Tuesday, December 11, in New York, NY. The E-GAPPS mission focuses on constructive dialogue and collaboration; best practices in guideline development, dissemination, and implementation; and perspectives, processes, values, and principles that influence healthcare policy.
To register to attend, or to learn more about the confirmed plenary speakers, conference themes, or breakout sessions, visit http://www.nyam.org/events/2012/evidence-based-guidelines-conference.html. By Jane T. Dillion, MD, with Jenna W. Minton, Esq., AAO-HNS Staff, Health Policy
As an Academy member, you’ve probably seen frequent requests distributed in the e-News asking for volunteers for upcoming AMA Relative Value Update Committee (RUC) surveys of physician services. Many of you may have asked yourself what the RUC is and why the surveys are important. By providing the membership with some general background on this important process, we hope to encourage you to become an active participant in the annual RUC survey process.
The AMA RUC was developed in response to the transition to a physician payment system based on the Resource-Based Relative Value Scale (RBRVS). The RUC is a multispecialty committee that provides clinical expertise and input on the resources required to provide physician services. The RUC submits recommendations to the Centers for Medicare and Medicaid Services (CMS) on an annual basis, which are used by CMS to develop relative values for physician services provided to Medicare beneficiaries. The RUC, in conjunction with the Current Procedural Terminology (CPT) Editorial Panel, has created a process where specialty societies can develop relative value recommendations for new and revised codes, and the RUC carefully reviews survey data presented by specialty societies to develop recommendations for consideration by CMS. CMS then issues final payment policies and values in the final Medicare Physician Fee Schedule rule, which is typically released in early November each year.
The RUC is intended to represent the entire medical profession. Of its 31 members, 21 are appointed by major national medical specialty societies, including those recognized by the American Board of Medical Specialties; those with a large percentage of physicians in patient care; and those that account for high percentages of Medicare expenditures. Four seats rotate on a two-year basis, with two reserved for an internal medicine subspecialty, one for a primary care representative, and one for any other specialty. The RUC chair, the co-chair of the RUC Health Care Professionals Advisory Committee Review Board, and representatives of the AMA, American Osteopathic Association, the chair of the Practice Expense Review Committee, and chair CPT Editorial Panel hold the remaining six seats. The AMA Board of Trustees selects the RUC chair and the AMA representative to the RUC. The individual RUC members are nominated by the specialty societies and are approved by the AMA.
The RUC currently includes the seats mentioned above and a representative and alternates for the following medical specialties: anesthesiology, cardiology, dermatology, emergency medicine, family medicine, general surgery, geriatrics, internal medicine, neurology, neurosurgery, obstetrics/gynecology, ophthalmology, orthopaedic surgery, otolaryngology, pathology, pediatrics, plastic surgery, primary care (rotating seat), pulmonary medicine (rotating seat), psychiatry, radiology, rheumatology (rotating seat), thoracic surgery, urology, and vascular surgery (rotating seat).
The Academy actively participates in the RUC process and surveys codes for nearly every RUC meeting. Meetings take place three times a year during the winter, spring, and fall. The Academy’s current RUC representatives include RUC panel member Charles F. Koopmann, MD, and panel member alternate, Jane T. Dillon, MD. It is important to recognize that the RUC representatives for each specialty are not advocates for their specialty; rather they participate in an individual capacity and represent their own views and independent judgment while serving on the panel. The Academy also has RUC Advisors who are responsible for working with the Physician Payment Policy Workgroup (3P) and Academy staff to develop relative value recommendations and practice expense direct inputs for otolaryngology services that are presented to the RUC. The Academy RUC advisors are Wayne M. Koch, MD, and advisor alternate John T. Lanza, MD.
As part of the Academy’s participation in the RUC, we often ask members to participate in surveys to help value CPT codes. The RUC team, outlined above, uses those survey responses to develop the recommendations for values and practice expenses that are presented to the RUC. The RUC hears presentations from all specialties interested in the service being reviewed and determines whether they agree with the proposed values, or whether the code needs further review. In the event the RUC does not agree with the value presented by the society, the code is sent to a facilitation committee to try to reach agreement on the most appropriate value for the service. Familiarity with the survey instrument and methodology is essential for accurate completion of a survey, which has important implications for Medicare reimbursement. Survey instruments are standardized across all specialties and random member samples are used to derive data for presentation to the RUC. In order to participate, respondents must be American physicians who are familiar with the service under review. Respondents must have supervised or performed the code being surveyed at least once during the past 12 months to complete a survey.
For more background on the RUC Survey Process, members can access the following PowerPoint presentation on the AcademyU® website, located under Practice Management: www.entnet.org/educationandresearch/academyu.cfm. Members can also email any questions to healthpolicy@entnet.org. We hope this background is useful to members in better understanding the composition of the RUC as well as the importance of the survey process and its role in the valuation of medical services. The Physician Payment Policy Workgroup (3P), co-chaired by Richard W. Waguespack, MD, and Michael Setzen, MD, is the senior advisory body to Academy leadership and staff on issues related to socioeconomic advocacy, regulatory activity, coding or reimbursement, and practice services or management. The Health Policy staff and 3P have been busy during the first half of 2012 with a continued high level of activity, constant emails and monthly calls, working diligently and tirelessly on behalf of all members. 3P has focused on the development of future payment mechanisms and two programs the Centers for Medicare and Medicaid Services (CMS) are working on, the distribution of Quality Resource Use Reports (QRURs), and the installation of the value-based payment modifier program.
By way of background, the Medicare Improvements for Patients and Providers Act of 2008 created the Physician Resource Use Measurement and Reporting Program. In 2010, the Affordable Care Act extended and enhanced the program and named it the Physician Feedback Program. The program authorizes CMS to produce annual physician QRURs. The Affordable Care Act also authorized the creation of the value-based payment modifier program, which requires the use of differential payments to physicians or groups based upon the quality of care furnished compared with cost.
QRURs
In early March 2012, CMS sent the first QRURs to nearly 24,000 physicians in Iowa, Kansas, Missouri, and Nebraska. Data contained in QRURs compared the cost and clinical care provided to Medicare beneficiaries in 2010 by a physician to the average costs and clinical care of other physicians in these four states. These reports contained the number of Medicare beneficiaries a physician saw during the reporting period, compared the quality of care for Medicare beneficiaries seen by a physician to other physicians based upon 28 quality measures (27 of which are National Quality Forum endorsed), and showed cost data for patients whose care the physician directed, influenced, or contributed to. This was measured by outpatient evaluation and management (E&M) office visits or total professional costs.
Wisconsin Physician Services (WPS), the Medicare contractor that processes claims in the four states, emailed QRURs to one physician or employee who has been designated as the primary contact for communications from WPS. The reports were available until the first week of June. These reports, according to CMS, are intended to be informational and allow physicians to compare the quality and cost of Medicare patients’ care to physicians in their specialty and by all physicians within those states. Although they are currently informational in nature only, the reports also provided quality of care and cost information that will be used by CMS in the development of the value-based payment modifier program, which will begin to be phased in starting in 2015.
Value-Based Payment Modifier Program
The Affordable Care Act created the value-based payment modifier program and required the use of differential payments to physicians or groups based upon the quality of care furnished compared with cost and will apply to services physicians’ bill under the Medicare Physician Fee Schedule. Through the program, CMS will make adjustments in cost for difference in geographic rates (payment standardization) and the underlying health status of individual beneficiaries seen by a provider (risk adjustment).
Although the Value-Based Modifier will not take effect until 2015, the 2015 modifier will be based upon services provided during 2013. For 2015 and 2016, the U.S. Secretary of Health and Human Services has discretion to apply the modifier to specific physicians and/ or groups of physicians they deem appropriate. In 2017, the modifier will apply to most or all physicians who submit claims through the Medicare Physician Fee Schedule. Few specifics are currently known about the program, but CMS plans on proposing methodology for the value-based modifier program during the 2013 Physician Fee Schedule rulemaking process.
CMS is soliciting input from associations, including the Academy, in the development of the methodology for the modifier, and the Academy will provide input to CMS through comments and coalitions as necessary. The Academy is asking members who received and downloaded QRURs to notify the health policy unit and provide input so we can forward concerns from members to CMS officials. For example, are the performance highlights important or are there others that may be more useful? Please email feedback to healthpolicy@entnet.org.
At this year’s annual meeting in Washington, DC, 3P will conduct a miniseminar on Academy Advocacy for Physician Payment: 2012 on Sunday, September 9, 2012, from 10:30 am to 11:50 am. One of the future payment strategies that will be discussed during the miniseminar is the value-based payment modifier program that will likely incorporate aspects from the initial QRURs. In the meantime, please monitor our Medicare Updates page, which can be accessed at http://www.entnet.org/Practice/Medicareupdates.cfm, for updates on these programs. Advocacy Opportunities during the Meeting
It is a legislative and political affairs homecoming during the AAO-HNSF 2012 Annual Meeting & OTO EXPO! With this year’s meeting in Washington, DC, AAO-HNS members are provided the perfect opportunity to become more involved in advocacy-related events scheduled during the meeting.
As in past years, the ENT PAC Booth will serve as the Government Affairs “hub” for the meeting. AAO-HNS members are encouraged to stop by the booth to learn more about easy ways to support the Academy’s various legislative, political, and grassroots advocacy programs. The booth will be located in the convention center on the L Street Bridge.
Visit the booth to:
Obtain information on becoming a 2012 ENT PAC Investor;
Sign our petition to Congress on a key AAO-HNS legislative issue;
View the renowned ENT PAC 2012 “Wall of Investors;”
Receive copies of the latest edition of the ENT PAC “Investors Report;”
Join the ENT Advocacy Network to receive timely updates on political and legislative issues affecting the specialty and a free subscription to a biweekly e-Newsletter, The ENT Advocate;
Receive the latest updates on federal and state legislation affecting your practices and your patients;
Learn ways to effectively advocate on behalf of the specialty when you return home.
Exclusive Events for ENT PAC Investors during Annual Meeting
ENT PAC, the political action committee of the AAO-HNS, financially supports incumbent Members of Congress and viable candidates regardless of their party affiliation who champion the specialty’s legislative priorities. To that end, it is important to achieve diverse and widespread support from AAO-HNS members across the country. In order to better educate ENT PAC Investors and eligible supporters about the importance of the PAC, the ENT PAC Board of Advisors and staff have scheduled various events during the annual meeting to share critical information with PAC Investors. The events scheduled for 2012 include:
The annual ENT PAC Investors “thank-you” reception. This popular event will take place on Monday, September 10. U.S. AAO-HNS members who make donations to ENT PAC prior to or during the annual meeting are invited to the event.
An inaugural “Residents Briefing,” on Tuesday, September 11. As the future of the specialty, now is the time for residents to learn about the Academy’s various political and legislative programs. Residents will receive an “insider’s” update on current federal legislative activities, upcoming elections, and new PAC programs. Residents can expect an exciting, yet casual, discussion outlining the politics and policy fueling efforts on Capitol Hill.
A special “thank-you” luncheon for members of the ENT PAC Chairman’s Club ($1,000+ donors). The luncheon, hosted by members of the ENT PAC Board of Advisors, is a unique opportunity to learn about the Academy’s political strategy and decision-making process. The luncheon will take place on Tuesday, September 11.
Mark your calendars today to attend these special events! For more information on becoming an ENT PAC Investor, visit www.entnet.org/entpac (U.S. AAO-HNS member log-in required) or email ENT PAC staff at entpac@entnet.org.
*Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology—Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. By Dale Tylor, MD, for the Media and Public Relations Committee
As summer winds down, families complete preparations for the transition of returning to school. While it can be easy to focus on purchasing the necessary back-to-school supplies and clothing for the child, families should be educated about a number of otolaryngologic health considerations that can help ensure a successful and safe year ahead.
Hearing Loss and Hearing Screening
Fortunately, most newborns undergo hearing screening evaluations, but this does not guarantee that hearing will remain within normal limits as they age.1 Hearing loss in children may be associated with issues of speech, even if the loss is unilateral.2 Clues to hearing impairment include complaints from the family or teacher that they have to repeat themselves to be understood by the child, or the child preferring to watch television at volumes that are excessively loud. Parents should ask their pediatrician or otolaryngologist about hearing testing if they have any concerns about the child’s hearing, language development, or ability to concentrate at school or home. These children may require a formal audiogram with an audiologist. Ultimately, issues of conductive or sensorineural hearing loss or central auditory processing disorder and a variety of medical and surgical managements can help to address the spectrum of diagnosed hearing disorders.
Speech Delay
The ability to communicate effectively is vital to scholastic and occupational success.3 Children with delayed speech development are at a severe disadvantage in school. If parents are concerned about the child’s language development or articulation, they should ask their doctor if the child might benefit from a formal evaluation with a speech-language pathologist and subsequent speech therapy. An otolaryngologist can also help assess medical causes of speech impairment, including ankyloglossia, palatal anomalies, or tonsil hypertrophy.
Sleep Disordered Breathing
Children who snore or have witnessed apneic pauses, gasping, or choking can be paradoxically hyperactive during the day with impaired behavioral and neurocognitive function.4 The poor quality sleep experienced by children with obstructive sleep-disordered breathing can lead to short-term consequences, such as diminished attention spans, headaches, hypersomnolence or hyperactivity, and enuresis, and longer-term health effects on the heart, lungs, brain, and other body systems. Parents who notice their child snoring or not getting restful sleep should discuss this with their physician, as the child may require a sleep study or other evaluation. Children with suspected attention deficit hyperactivity disorder and concomitant symptoms of sleep-disordered breathing might be evaluated by an otolaryngologist to rule out sleep apnea before commencing prescription medication for the ADHD. Often medical or surgical management of sleep apnea can significantly improve the child’s quality of life.
Facial Trauma/Sports
Facial fractures are fairly common in active children, and care should be taken during higher risk activities to minimize the risk of trauma to the craniofacial skeleton. Protective sports gear (helmets, facial visors, mouth guards) should be worn when appropriate. Children with suspected nasal or facial fractures, auricular hematomas, or concussions should be evaluated expeditiously after an injury, as some of these conditions are best addressed in an immediate fashion.
Recurrent Upper Respiratory Infections
During the cooler months at school, children are more likely to be indoors and in fairly close quarters. This leads to increased risk of acquiring upper respiratory infections like the common cold, and other subsequent infections of the upper aerodigestive tract, including otitis media, sinusitis, and tonsillitis. Parents should be reminded that the average child suffers with 20 viral upper respiratory infections by the age of 12,5 the vast majority of which do not benefit from the administration of antibiotics or treatment other than conservative care. Children should be taught to wash their hands frequently, to cough into their sleeve, and how to use nasal saline irrigations. If the child has repeated episodes of acute otitis media, tonsillitis, or sinusitis that are affecting quality of life, or has chronic symptoms of these infections, it is reasonable for the parents to request evaluation with an otolaryngologist–head and neck surgeon.
References:
Lü J, Huang Z, Yang T, Li Y, et al. Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening. Int J Pediatr Otorhinolaryngol 2011; 75(8):1045-9.
Lieu JE, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics 2010; 125(6):e1348-55.
Muir C, O’Callaghan MJ, Bor W, Najman JM et al. Speech concerns at 5 years and adult educational and mental health outcomes. J Paediatr Child Health 2011; 47(7):423-8.
Landau YE, Bar-Yishay O, Greenberg-Dotan S, Goldbart AD, et al. Impaired behavioral and neurocognitive function in preschool children with obstructive sleep apnea. Pediatr Pulmonol 2012; 47(2):180-8.
Grüber C, Keil T, Kulig M, Rolls S, et al. History of respiratory infections in the first 12 years among children from a birth cohort. Pediatr Allergy Immunol 2008; 19(6):505-12. 
By Kathleen Yaremchuk, MD, for the Women in Otolaryngology Section
The term “empty nest syndrome” refers to a sense of sadness and loneliness that may occur after a grown child leaves home. Although women and men may parent equally, the primary caregiver is most likely to experience that feeling. The transition affects many tasks considered a major focus of the nurturing parent role, such as organizing or overseeing the typical school activities of athletics, social commitments, and parent-teacher conferences. As a physician and a parent, one makes compromises and decisions on whether to attend soccer games, after-school activities, and parent-teacher conferences or to pursue professional advancement by engaging in research, journal club, specialty medical societies, and departmental meetings.
With limited hours in the day, the opportunity to serve on institutional committees or attend meetings that require travel and time away from home often means missing out on a family dinner or children’s activities. The decision to favor parenting activities instead of professional pursuits isn’t meant to be intentionally detrimental to a career, but is based on priorities at the time. Children aren’t always going to be young and want their parents at a special event. Nevertheless, these commitments can be problematic when the operating room is running late or the on-call emergency beckons. Usually, there are times in every parent’s experience that induce a feeling of guilt because of missed opportunities.
Much of family life revolves around the children’s schedule. When the last child heads off to college or work, parents and the rest of the family often experience a void in social activities. For some, this leads to depression and a loss of purpose. There is often an underlying concern that the child is unprepared for life on his/her own. How will the child survive without the parents?
The challenge is to be emotionally prepared for the change in relationship with the children and to learn to maintain communication without the daily face-to-face at home. Texting, email, and cell phone chats allow frequent contact and communication. Online chats can provide the visual contact that many have come to depend on. The newfound free time can be problematic for some parents while others breathe a sigh of relief. It is a time to reconnect with a spouse and share mutual interests. Travel, hobbies, and professional growth are areas that can be cultivated in a way that was not possible previously. Without the pressure of rushing home to make dinner and sit with the family, there is time to meet with friends and reconnect anew. Similarly, professional contacts that have been made during the years can be leveraged to do research and advance professionally.
The AAO-HNSF Annual Meeting & OTO EXPO, Combined Section Meeting, and Combined Otolaryngology Spring Meetings (COSM) are all opportunities to travel, learn, and spend time with colleagues. The many committees of the AAO-HNS and specialty societies are always looking for members to volunteer time and knowledge to further the aims of otolaryngology. A common misconception is that to become an active participant in our specialty it is necessary to do so right after residency. In fact, the “right time” is whenever you are ready to raise your hand and volunteer for an assignment. There is no dearth of work for the willing participant. All AAO-HNS committees welcome members to attend meetings, even if they are not formal members of the committee. The multitude of committees are listed on the Academy’s website, so make plans to attend a committee meeting that interests you this September in Washington, DC.
Many individuals in academics may have been limited in their activities because of constraints from home. With the freedom of the “empty nest” and newfound time, an interest in research or leadership can become a reality. Develop a game plan that includes sharing your goals with the chair of the department, dean, or chief medical officer. Sign up for courses offered internally or through affiliated institutions that will help you grow. Similarly, mentors within the department or in other departments can give advice and help in reinventing yourself. Professional volunteerism will help in many ways, too.
It is never too late to learn and challenge yourself personally or professionally. While much of this discussion has centered on professional development, the spirit of volunteerism can be given to the community or spiritual institutions. It’s important to recognize what gives you happiness and fulfillment at the end of the day.
Keep in mind, just when you are recovering from the empty nest and bursting with energy, the kids may come home. This new phenomenon has been described by social psychologists as the “boomerang kids.” They are adult children between the ages of 25 and 34 who live with their parents after college because they “want the limited responsibility of childhood and the privileges of adults.”
So take advantage of your empty nest freedom and look over your shoulder for the “boomerang” effect. 
