Leveraging Advanced Practice Providers in an Otolaryngology Practice

Nita Sharma, David Upjohn, Carrlene Donald, Katie E. Zoske, Chelsea L. Aldridge, Devyani Lal

Research output: Contribution to journalArticlepeer-review


Objective: Advanced practice providers (APPs) may see patients independently or assist in “collaborative” clinics in otolaryngology practices. Our goal was to redesign the collaborative physician-APP clinic model to increase patient access, maintain financial sustainability, and optimize patient and staff experience. Methods: The study was performed in a tertiary care academic rhinology clinic seeing adult patients. The DMAIC framework (define, measure, analyze, improve, control) was used to develop the new model. The process shift between old and new models was analyzed by utilizing a statistical process control chart. Patient and staff surveys were tracked. Results: The collaborative physician-APP model was redesigned into 2 parallel and independently run (“concurrent”) physician and APP clinics. Patient access increased by 38.9% from a mean of 17.9 patients per collaborative clinic (n = 15 days, 269 patients) to 29.3 patients per concurrent clinic (n = 12 days, 352 patients). Medicare reimbursement rate modeling showed the collaborative clinic to operate at a loss of $1341.51 per day, while the concurrent clinic model operated at a $1309.88 gain (200% positive change). Patient and staff experience tracked positively. Discussion: Otolaryngology clinics can become overwhelmed by the volume of empaneled established patients. Traditional collaborative physician-APP clinics see the same panel of patients together. However, these can be successfully redesigned to a concurrent model. Concurrent clinics improve patient access and provider satisfaction while maintaining patient satisfaction and fiscal performance. Implications for Practice: Leveraging an experienced APP to run a parallel and independent clinic alongside the physician (concurrent clinic model) may improve patient access, financial metrics, and patient/staff experience.

Original languageEnglish (US)
Pages (from-to)959-963
Number of pages5
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number5
StatePublished - May 2021


  • advanced practice provider
  • advanced provider
  • health care delivery
  • patient safety/quality improvement (PS/QI)
  • patient satisfaction
  • physician assistant
  • practice redesign

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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