In reference to Effective Use of Physician Extenders in an Outpatient Otolaryngology Setting

We recently reviewed the article ‘‘Effective Use of Physician Extenders in an Outpatient Otolaryngology Setting.’’ This article was of particular interest as we currently employ five highly skilled, fellowship-trained, otolaryngology/head and neck surgery physician assistants (PAs) in our practice. PAs have, as a profession, rejected calls to seek independent licensing, believing in a collaborative physician-led model of care. This decision, from the inception of the profession, places the care of the patient as the foremost goal of a skilled team. In our multispecialty, academic, tertiary care setting, PAs have proven to be an extremely valuable asset. They function, as noted in the article, from a collaborative to a near independent role. Like the article, we believe that the role of ‘‘scribe’’ should be limited to a medical assistant or trainee. PA responsibilities embody the three-shield model at Mayo Clinic: patient care, education, and research. PAs are first assistants in surgery, as well as responsible for both inpatient and outpatient care. They maintain an independent clinic appointment list, seeking consultation when necessary, and billing under their own Medicare number. This allows improved access into our department from in-house referral, as well as delegation of select postsurgical care. They are preceptors for PAs in training as well as residents in our institution. PAs are also deeply involved in many clinical research projects within our department and institution. Under the section Future Directions in the abovementioned article, there is reference to postgraduate training programs for PAs. The authors state that there are no such training programs in otolaryngology. Although this may be correct for nurse practitioners, this is not accurate for the PA professional. Mayo Clinic Arizona is currently in the sixth year of our postgraduate fellowship for PAs in otolaryngology/head and neck surgery. This 12-month fellowship includes subspecialty rotations in head and neck surgery; laryngology; rhinology; facial plastic surgery; endoscopic skull base surgery; oral and maxillofacial surgery; neurotology; pediatric ear, nose, and throat (ENT); medical ENT; audiology, radiation oncology, and the intensive care unit. Our fellows graduate with extensive surgical experience as well as inpatient and outpatient training. Our fellowship is under review for national accreditation through the Accreditation Review Commission on Education for the Physician Assistant, and beginning in 2012 will expand to two fellows per year. Past fellows are currently employed in both academic and communitybased practices. Further information may be obtained through contacting Carrlene Donald, MMS, PA-C, Program Director, at donald.carrlene@mayo.edu. Thank you for your time.