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Involvement of physician extenders in ambulatory otolaryngology practice


  • Neil Bhattacharyya MD, FACS

    Corresponding author
    1. Division of Otolaryngology, Brigham and Women's Hospital, Boston
    2. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    • Division of Otolaryngology, 45 Francis St., Boston, MA 02115
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  • Dr. Bhattacharyya is a consultant for Intersect-ENT, Inc. and Entellus, Inc. The author has no funding, financial relationships, or conflicts of interest to disclose.



Determine the penetration and point-of-care patterns for physician extenders in ambulatory otolaryngology practice.

Study Design:

Cross-sectional analysis of national database.


The National Ambulatory Medical Care Survey was examined for 2008 and 2009, extracting all cases of ambulatory 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.


An estimated 38.6 ± 3.7 million outpatient office otolaryngology visits were studied. An APC was seen in 6.3 ± 2.0% of visits (physician assistant, 4.6 ± 1.9% visits; nurse practitioner, 1.7 ± 0.9% of visits), and a nurse was involved in 25.1 ± 7.6% of visits. Nurse practitioners were more likely see patients independently (47.7%) than were physician assistants (23.3%). APCs were more likely to be involved with established patient visits (7.2 ± 2.3%) rather than new patient visits (4.3 ± 1.8%, P = .08). Disorders of the external and middle ears were the most common diagnoses seen by APCs.


Although APCs are expected to expand numbers in otolaryngology, contemporary data indicate that current penetration of APCs into ambulatory otolaryngology care remains relatively limited. These data provide an initial assessment for future modeling of APCs and otolaryngologic care.