AAO-HNS and AOA, time to nationalize an ENT assistant curriculum

Coordination within AAO-HNS and AOA in standardizing a workforce

The Association of Otolaryngology Administrators is an organization, which I have only recently become aware of and will be joining. I have been a member of the American Academy of Otolaryngology- Head and Neck Surgery since starting residency. I have attended almost every annual meeting since then and have walked thru the OTO-Expo every year. But it was only in the past year that I paid attention to the AOA booth.

My interest took off after my struggles in developing Physicians Angels. At last year’s AAO-HNS meeting, Karen Zupko had a course that touched on managing employees and theft. She spoke in earnest about how ENTs and physicians in general need to take more care in hiring and training. She shared cases on employees with criminal records that somehow get hired over and over again in physician offices. I found the talk fascinating considering how the vast majority of the people we hire get a very superficial review.

Physicians often believe that they are the central figures in their practice. The hierarchy is doctor, practice administrator, audiologist, nurse and then all others. So in terms of focus on hiring and training, doctors reduce their efforts in determining the quality of their applicants as they go down the chain. After all, as the organization gets bigger it gets harder and harder to pay attention to the “little people”. That is until one of the “little people” creates a big problem.
The AOA is relatively new compared to the AAO-HNS. The AAO-HNS is relatively new compared to the AMA. Medical school education did not develop nationalized standards till 1919. ENT residency training did not become standardized until the late 1970’s and is continually being updated. The trend has been to specialize the workforce from a general practitioner to a specialist to a specialist’s office administrator and now to nurse practitioners or physician’s assistants. But that still excludes the vast number of employees in a practice. The typical specialist will have 4 support staff often excluding the administrator/manager. The only resource that is available for the general office staff is Primary Care Otolaryngology produced by the Education Faculty of the AAO-HNSF.

When developing the Angels concept of creating a workforce for the ENT and other medical specialty markets, what struck me was that most communities did not have a training program for specialists. Check out the community colleges and trade schools around the country and they mostly produce assistants for primary care. The burden and expense falls on the specialists to take these low skilled employees and raise them to the level of functionality. The time frame from personal experience ranges from 6 months to 2 years to get a generic medical assistant to a high level of performance. The hidden cost is not obvious to most doctors. The other thing that is often forgotten is the turn over in medical assistants. The average assistant stays for 3 years at a practice. In many cases they end up taking time off to raise children or pursue additional degrees or worse…take that precious training and hop to the next employer who pays a dime more per hour.

So why don’t schools teach a specialized curriculum? Consider than in many markets there are just a handful of ENT practices within reasonable driving distance. Even large markets like New York or Chicago ultimately have very few new job postings within a specialty every year. A school and student would think twice about a curriculum that graduates people into an environment where the job market is ultimately very teeny weenie. Yet on a national level, there are jobs to be had but most of these potentially skilled workers are not going to move/travel more than 45 minutes daily for a job that pays less than $15/hr. This leaves ENTs and other specialists with 3 options: 1) accept the status quo 2) enter into a wage war 3) embrace a virtual staff model.

The virtualization of staff creates new flexibilities for both workers and the office. Physicians Angels has proven over the last two years at multiple practices around the country that employees from anywhere can work anywhere with minimal impact on daily routines at an office. This of course means that the office has to have an electronic medical record and adequate broadband.

We have undertaken an ambitious effort to translate Otolaryngology into teaching modules for the average high school graduate. This teaches them enough to understand a conversation and the activity of a busy ENT office. We have formulated a curriculum with Terra Community College. This curriculum will be placed online and students from anywhere can take the course. This will provide ENT practices around the country with a curriculum for new hires.
Physicians Angels plugs the graduates of these courses into offices around the country. Angels can take graduates working in a data center in Montana and have them work in Miami. Telecommuting, telemedicine, and telepresence has been present in every industry. The cost of doing this is now cheaper than driving to work every day. Yet we are stuck in the past when it comes to our daily routines. Once you take a manila paper patient chart and digitize it, the extra space in the office where the files used to be disappears. But guess what? Do you still need all your physical staff sitting at desks taking up real estate that is usually more expensive? They had to be there when the chart was physically a few feet away. Now the chart is anywhere they are with a computer.

Wages for a skilled virtual ENT assistant cost a minimum of $12/hr. The same person in Manhattan, San Francisco, and similar cities earns wages reported up to $17/hr. Doctors and administrators often forget that the cost of their employees include the physical space they take up ($ per sq ft), parking, utilities, taxes, and miscellaneous expenses. Then take into consideration of having to train, inservice, and retain these workers, wouldn’t it be easier to have this done in collaboration with other ENT’s around the country? I will be pushing this at the AOA and AAO-HNS in San Diego.

I invite your comments and questions.