Published: March 31, 2020

Incorporating Advanced Practice Providers Into Your Practice Part II: Why Work With an APP?

In 2020, AAO-HNS members find themselves challenged by our commitment to quality care for our patients, meeting regulatory and financial demands, and maintaining our own wellness.

Wendy B. Stern, MD

Wendy B. Stern, MDWendy B. Stern, MD

In 2020, AAO-HNS members find themselves challenged by our commitment to quality care for our patients, meeting regulatory and financial demands, and maintaining our own wellness. The 2017 AAO-HNS Socioeconomic Survey determined that 51 percent of members have unmet demand for access, and 40 percent of members have inadequate time with patients despite our reporting that 56 percent of us work more than 51 hours a week and 86 percent of us take no more than six weeks of vacation.1 And fewer of us are considering retirement than in 2014 or 2011. James C. Denneny III, MD, addressed physician wellness in his Bulletin article, “Speaking Up for Physician Well-being” (March 2017, vol. 36, no. 2),2 and AcademyU® has several offerings on physician wellness and how to prevent burnout.3

Ilana Feinerman, MDIlana Feinerman, MD

In Part II of our series examining the physician/advanced practice provider (APP) team approach, I have invited two of my colleagues to explain some of the benefits of working with APPs. First is Ilana Feinerman, MD, chief of the otolaryngology division at Southcoast Hospital Group in North Dartmouth, MA, who is also a former senior partner of a single specialty ENT group and now employed by a large multispecialty group. Second is Denis C. Lafreniere, MD, professor of surgery, chief of the Division of Otolaryngology, medical director of UConn Medical Group, and associate dean of clinical affairs at UConn Health.

How has the APP team approach improved access to care?

Dr. Feinerman: Our APPs write prescription renewals, perform H&Ps [history and physical evaluations], and hand out patient education materials in addition to handling phone calls from patients, pre-op counseling, and post-op care. They see selected new patients, initiate the work-ups, and facilitate our urgent visits. This has expanded access by freeing me to see more new patients.

Denis C. Lafreniere, MDDenis C. Lafreniere, MD

In what ways have you experienced improved patient satisfaction and quality outcomes?

Dr. Lafreniere: One of the biggest advantages to working with an APP in an academic program is the ability to maintain a responsive clinical presence even when academic duties may pull you off the floors and out of the clinic. Many practitioners in academia may not be in clinic more than a few days a week. An APP can easily fill those gaps and improve response time for patient care. This leads to improved satisfaction scores such as the CGCAHPS. In our pediatric hospital, the APPs cover daytime floor calls two days a week, allowing uninterrupted OR time for the residents, which improves their educational experience and wellness.

How did the team approach improve the practice’s financial profile?

Dr. Feinerman: The bottom line is that the team approach leads to higher volumes and codes with lower overhead, resulting in an improved financial profile.

Has the team approach allowed for an expansion of ENT services?

Dr. Lafreniere: Having an APP has allowed us to continue our Taste and Smell specialty clinic as the APP performs the smell test protocol on our patients. The APP also sees new nonsurgical patients, freeing the subspecialist to provide specialty care and surgery.

How has the team approach benefited your personal and professional lifestyles?

Dr. Feinerman: My quality of life is significantly better due to the help I have in the office. APPs truly extend me. We execute high-quality care in a timely fashion. I leave the office satisfied and ready to spend time with my family.

Dr. Lafreniere: The APP can reduce many of the small stressors that can invade any practitioner’s workday. In the academic setting where educational, research, and administrative duties can often demand a large part of your week, having an APP helps to ensure a consistent level of patient care. This improves wellness all around.


More from April 2020 – Vol. 39, No. 3