Frequently Asked Questions 

What is a physician assistant or PA?

The Physician Assistant or PA is a skilled person, qualified by rigorous academic and extensive clinical training , to provide services to patients with the supervision of a licensed physician. A PA is graduate of a competency based medical program accredited by an independent organization supported by the American Medical Association , the American Academy of Physician Assistants, and other national organizations. PAs are part of the "Physician-PA Team" and together, they are dedicated to your health and well-being.

Click here to view an article about Physician Assistants in Otolaryngology.

How will physicians be reimbursed for PA services?

PAs are providers with Medicare and Medicaid, and are reimbursed at 85% of the supervising physician's contracted charges. Many third party carriers also reimburse supervising physicians for PA services. Consult individual health plans and state regulations for details. For more information, visit AAPA's Reimbursement webpage.

What can a PA do?

The tasks Physician Assistants perform depends on their practice setting, education, experience, and state laws and regulations. In general, PAs:

• Perform physical examinations
• Elicit medical histories
• Diagnose & treat illnesses and injuries
• Order & interpret laboratory & radiographic studies
• Educate & counsel patients
• Perform minor surgical procedures
• First Assist in surgery
• Assist with call
• Render emergency care
• Facilitate patient referral to the appropriate physician or agency
• Conduct research & drug studies
• In all states PAs prescribe medication

Are there a number of cases that are required for certification of the physician assistant for solo performance of different procedures in ENT, e.g., flexible fiberoptic laryngoscopy and peritonsillar abscess drainage?

There are no state laws or regulations that require a set number of cases. Generally, the number of required cases is determined by each institution, based on accepted standards of medical practice and recommendations from the supervising physician(s). Those physicians are in the best position to directly observe the PA and evaluate the PA’s competence. Sometimes, specialty societies provide guidance as well but in this case, there doesn't appear to be any from either the American Academy of Otolaryngology–Head and Neck Surgery or the Society of Physician Assistants in Otolaryngology.

How can a physician utilize a PA?

Many physicians have asked about the utilization of PAs. Physician assistants practice in every aspect of otorhinolaryngology/ head & neck surgery. Below are two excellent articles published in ENT Today as well as two briefs published by AAPA.

A Partner in the Business: Practices see mid-level providers as valuable additions
Collegial Relationships: Extending Otolaryngology Practice with Other Professional Providers
The Physician-PA Team
Hiring a PA - The Benefits for Physicians and Practices

What about hiring a PA?

For more information on hiring PA, click here.

What types of patients and patient visits are most appropriate for an APP?

Post ops? Allergy? New Visits? APPs see all varieties of ENT patients including new, established, post-op, cancer surveillance, allergy, etc. APP patient panels will vary depending on the needs of the practice and access concerns.

What licensure type does each type of APP need to have?

PAs are certified by the National Commission on the Certification of Physician Assistants (NCCPA). Most are then licensed through state Board of Medical Examiners (BME) like MDs. NPs may also be dually boarded by BME and Board of Nursing (BON). If controlled substance prescribing is needed and anticipated (and state allows) DEA license is also needed.

As of April 4th, 2024, there is a PA Licensure Compact that has been enacted in 7 states. This PA Compact is an interstate occupational licensure compact for PAs. Interstate compacts are a constitutionally authorized, legally binding, legislatively enacted contract among participating states that allows PAs a privilege to practice in various states. https://www.pacompact.org/

How do you train an APP? Is there a standardized training program that the academy or anyone else offers? Should there be?

Majority of training is on-the-job. There is variability in training based on the needs of each practice. There are also postgraduate programs that provide clinical/surgical training (i.e. Mayo Arizona, Dartmouth, etc.). Resources such as Academy U, Clinical Practice Guidelines, annual CME courses (ENT for the PA-C Conference) and/or specialty specific training/meetings (sleep, survivorship, facial plastics, etc.) and online resources are all used. There is a competency-based workplace curriculum that will be available through SPAO-HNS soon.

What are the malpractice liabilities when you’re working with an APP? What are you required to do when supervising? How can you obtain this information?

Liability is no different than having any other MD in your practice. Supervising requirements vary by state and can be found on AAPA and/or state PA society, BME websites. A quick literature review will pull up articles that state that having an APP does not increase malpractice risk and may actually help because of the time and care APPs provide.

Are there differences in CPT codes that an APP can use? How should they bill?

Billing for APPs vs. MDs should not differ as long as the procedure(s) being performed is within the scope of practice of the APP.

How do you ‘explain’ to your referring doctors that their patients might see an APP?

Introduce them as part of your care team. Promote them to colleagues. This is often a concern, initially, that is quickly debunked once patients/MDs interact with APPs in practice. Make sure clinic staff treat them as providers.

What are the differences between an NP or PA as it pertains to otolaryngology?

At the practice level they are essentially the same, but training varies and NPs are often tied to specific patient populations based on their certification – important if serving pediatric population for instance or if needing assistance in the OR. This often requires NPs to also be certified RNFAs.

Are there differences in how an APP can be used in an employed or academic position versus a private practice?

No

How to best utilize APP in the OR setting vs the clinic? How to define the scope of practice in your practice?

Dependent on each individual practice – solo practices may want APPs seeing patients when the surgeon is in the OR, in larger settings APPs assisting in OR or with floor work/consults may capture untapped revenue and/or free up MDs or meet institutional needs (early discharge/decreased readmission, etc.). To best utilize APPs, you first need to understand the needs of the practice – ambulatory access vs OR backlog, consult demands, etc.

How to integrate APP care into your own patients' care (e.g. postop visits, debridement?)

There should be an initial period of observation/learning, then shared/split visits where APP/MD see all patients together (start to build trust and familiarity with patients/practice), start telling return/post op patients they will see APP during the next visit, consider alternating visits depending on the patient needs and then set up scheduling algorithms to assign patients to APP and MDs based on those needs. Consider patient acuity, referral source (In a sub-specialty practice an ENT referred patient may go to the MD while self-referred/primary care referred may see APP first for triage) APPs work great for same day/urgent care type access as well as common procedures such as cerumen impaction, post op debridement etc.)

How can you determine an appropriate salary for an APP in your practice setting?

There are several benchmarking sources – AAPA has state level data, Sullivan Cotter is considered the best market comparative for APP benchmarking for salary and productivity. SPAO-HNS provides an annual survey of members (available under Members-Only). Ask around and see what going rates are in your area – consider start-up costs and benefit offerings (sign-on, moving/relocation, CME, PTO, etc)

How does an APP market to practices compared to a physician?

Must be transparent about who APPs are and who APPs aren’t but otherwise, marketing should not differ.