Looking Through the Right Scope: Safeguarding Excellence in Patient Care

Rahul K. Shah, MD, MBA
AAO-HNS/F Executive Vice President and CEOThe start of a new academic year reminds me of beginning medical school. It was an honor to learn from the legendary Dr. Charlie Vaughn at Boston University School of Medicine, who taught us the head and neck ENT examination. To this day, I still remember him teaching us how to properly hold an otoscope and what to look for during examination.

I asked him how we could ensure we don't miss anything—subtle or obvious—as I was determined to become an excellent diagnostician. Dr. Vaughn's response was elegantly simple: "Just always look. If you use a scope to help you look, you will never miss anything." I have carried that advice throughout my career, and now as I've transitioned from predominantly practicing clinical medicine to leading your Academy, I often think about scope—though now scope means something entirely different.

The Scope of Our Expertise

We have perhaps the most comprehensive scope of practice in medicine. As otolaryngologist-head and neck surgeons, we are experts of the head and neck. We understand that a significant proportion of primary care, preventative care, and pediatric medicine stems from diseases directly pertinent to our specialty.

This broad expertise didn't develop by accident. It represents decades of rigorous training—medical school, internship, residency, sometimes fellowships—creating a depth of knowledge that encompasses complex anatomical relationships, intricate surgical techniques, and nuanced medical management across multiple subspecialties.

The Challenge of Expanding Boundaries

As healthcare evolves, we're witnessing unprecedented expansion of practice boundaries across various disciplines. While innovation in healthcare delivery can benefit patients, we, as a society, must remain vigilant about maintaining appropriate standards of care and those supported by such credentialing organizations. The fundamental question isn't about access or convenience—it's about ensuring patients receive the highest quality of care from practitioners with the comprehensive training necessary for optimal outcomes.

Some argue that expanding scope of practice increases access to care. However, multiple studies demonstrate this assumption is often flawed. Alternative care models frequently develop alongside, rather than instead of, traditional specialty care—sometimes even within the same practice settings where otolaryngologist-head and neck surgeons provide oversight and leadership. It has been shown repeatedly that expansion of scope for any stakeholder does not expand access for patients.

Protecting Patient Safety Through Appropriate Training

What concerns me most is when legislative routes are pursued to expand prescribing authority, ordering privileges, and medical practice boundaries without corresponding educational nor certification requirements. There are established pathways to become a physician—whether doctor of medicine or doctor of osteopathic medicine—that ensure comprehensive medical training. Legislation should not substitute for education.

This isn't about economic protectionism; it's about patient safety. When I think of my own family members needing otolaryngologic care, I want them treated by someone with the comprehensive training our specialty requires. If it's not appropriate for my family, it shouldn't be appropriate for anyone else's family.

Our Strategic Response

As outlined in our Strategic Plan, one of our fundamental goals is ensuring, "Otolaryngology-head and neck surgery is a unified specialty dedicated to high quality, equitable care." This includes being the authoritative voice of our specialty and decreasing fragmentation in care delivery, which is ultimately deleterious to patient care.

The Academy continues to advocate for physician-led care delivery teams where otolaryngologist-head and neck surgeons provide clinical leadership while working collaboratively with appropriately trained allied health professionals. This model leverages everyone's expertise within appropriate scope boundaries.

Our advocacy efforts, building on the modernization initiatives I've previously discussed, include comprehensive resources to support members facing scope-of-practice challenges in their communities.

The Path Forward

We're not facing isolated incidents but rather systematic challenges to our specialty's scope of practice. This requires a coordinated response at community, county, state, and federal levels. Your Academy provides advocacy resources and support—we encourage you to reach out and let us know how we can help address specific challenges in your geographic practice areas.

The solution isn't to restrict innovation in healthcare delivery, but to ensure that complex medical and surgical care is provided by practitioners with appropriate training. Otolaryngology-head and neck surgery represents one of the longest training pathways in medicine, creating expertise that directly correlates with patient safety and outcomes.

Always Look

Returning to Dr. Vaughn's advice about examination technique: "If you use the scope to look, you will never miss anything." For this different kind of scope—the scope of our practice—I implore us all to remain vigilant. We must continue looking out for our patients' best interests by preserving appropriate practice boundaries that ensure they receive the highest quality care.

This vigilance isn't about protecting territory—it's about protecting patients. Every time we advocate for appropriate scope of practice, we're ensuring that complex head and neck conditions receive the comprehensive evaluation and management that our extensive training provides.

As we continue building our unified voice through the Strategic Plan, remember that preserving our scope of practice serves a higher purpose: ensuring that patients receive care from practitioners with the depth of knowledge and breadth of training that otolaryngologic conditions demand.

Your Academy stands ready to continue to support these efforts, because putting patients first means ensuring they have access to the expertise that only comprehensive otolaryngologic training can provide.

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