BackTable ENT BackTable

In this episode, Dr. Hamdy El-Hakim, pediatric airway surgeon and Associate Professor at the University of Alberta, joins host Dr. Gopi Shah to review laryngeal clefts in children.

First, Dr. El-Hakim describes the presentation of laryngeal clefts. Affected children have coughing fits bad enough to cause watery eyes and “blue spells.” These fits are sometimes misattributed to other airway abnormalities or GERD. Then, discussion shifts to the workup of laryngeal clefts. All patients with a suspected laryngeal cleft need a comprehensive physical exam, a risk factor assessment and a swallow assessment, most commonly a FEES. Many patients will also require a diagnostic laryngoscopy with bronchoscopy (DLB). Dr. El-Hakim advises listeners on performing this test in children. Treatment of laryngeal clefts include thickened feeds, injection laryngoplasty, or surgical repair. Finally, Dr. El-Hakim advises listeners on compassionate care for families living with this condition.

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SHOW NOTES

00:00 - Introduction
03:39 - Laryngeal Clefts in Children: Diagnosis & Classification
06:36 - Presentation of Laryngeal Cleft
12:07 - Risk Factors & Associated Conditions
21:38 - Physical Examination Insights and Diagnostic Approaches
30:15 - The Role of FEES and Modified Barium Swallow in Diagnosis
37:37 - Navigating Pediatric Swallowing Disorders: Strategies and Challenges
41:12 - The Complexities of Diagnosing & Treating Laryngeal Cleft
45:28 - Surgical Techniques & Postoperative Care
01:03:13 - Evaluating Success Post-Surgery
01:09:20 - Final Thoughts: The Impact of Pediatric Dysphagia on Families

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RESOURCES

Dr. Hamdy El-Hakim’s University of Alberta Profile:
https://www.ualberta.ca/airway-research/iarc-team/hamdy-el-hakim.html

Article demonstrating superiority of cold steel relative to laser in type I laryngeal cleft repair:
https://pubmed.ncbi.nlm.nih.gov/34184769/

In this episode, Dr. Mark Royer, private practice otolaryngologist and medical director of ENTLocums.com, joins BackTable to discuss salary negotiation for physicians.

Dr. Royer begins by using his personal career journey to highlight the importance of negotiation skills. Then, he describes how to develop these skills. Throughout the episode, Dr. Royer emphasizes the importance of knowing one’s value as a surgical subspecialist and tailoring your strategy to best suit your employer’s perspective and your needs. Relevant topics covered include selecting a practice, starting salaries, RVUs, locums, and non-compete agreements. Dr. Royer concludes by encouraging otolaryngologists to reflect on what they truly want out of their careers as they approach the negotiation table.

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SHOW NOTES

00:00 - Introduction
01:22 - Salary Negotiation
05:24 - Dr. Royer’s Journey from Residency to Entrepreneurship
10:16 - Negotiating Your Salary: Essential Tips and Strategies
26:27 - Different Approaches to Negotiation: Hospital vs. Private Practice
28:40 - Exploring the World of Locum Tenens
31:59 - Mid-Career Physician Negotiations and Raises
41:26 - Mastering Negotiation Tactics and Strategies: Tips from “Never Split the Difference”
47:38 - Navigating Non-Compete Clauses & Final Thoughts

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RESOURCES

ENT Surgery Solutions, LLC:
https://www.entlocums.com/

BackTable ENT Episode 57, “Locums Opportunities in ENT with Dr. Allison Royer:”
https://www.backtable.com/shows/ent/podcasts/57/locums-opportunities-in-ent

BackTable ENT Episode 107, “How Do I Negotiate My Physician Contract? Part I with Michael Johnson Jr., Esq:”
https://www.backtable.com/shows/ent/podcasts/107/how-do-i-negotiate-my-physician-contract-part-i

BackTable ENT Episode 108, “How Do I Negotiate My Physician Contract? Part II with Michael Johnson Jr., Esq:”
https://www.backtable.com/shows/ent/podcasts/108/how-do-i-negotiate-my-physician-contract-part-ii

“Never Split the Difference” by Chris Voss:
https://www.amazon.com/Never-Split-Difference-Negotiating-Depended/dp/0062407805

In this episode, Dr. Gavin Setzen of Albany ENT & Allergy Services addresses the current landscape of insurance reimbursement with host Dr. Ashley Agan.

The episode opens by reviewing the current state of healthcare financing, where climbing costs, declining reimbursement, and continued consolidation of medical groups confront physician-owned private practices. Mindful of this context, Dr. Setzen describes his experiences tackling reimbursement challenges. Recounting his successes, Dr. Setzen encourages physicians to base their claims in evidence-based medicine, enlist allies (such as patient unions), and develop relationships with insurers. He then provides strategies to efficiently manage Prior Authorizations, including Peer-to-Peer conversations. Finally, Dr. Setzen shares how coordinating one’s reimbursement strategy with colleagues and advocacy groups helps increase odds of success.

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CHECK OUT OUR SPONSOR

Stryker ENT
https://ent.stryker.com

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SHOW NOTES

00:00 - Introduction
01:55 - Dr. Gavin Setzen’s Journey and Practice Insights
05:30 - The Challenges of Healthcare Landscape and Insurance
10:06 - Innovations in ENT: Navigating New Technologies & Reimbursement Challenges
20:23 - Strategies for Overcoming Insurance Denials
52:30 - The Importance of Data and Collaboration in Patient Advocacy
55:19 - Closing Thoughts

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RESOURCES

Dr. Setzen’s Albany ENT & Allergy Services Profile:
https://albanyentandallergy.com/bio/gavin-setzen/

In this episode, pediatric otolaryngologist Dr. Julie Wei (Akron Children’s Hospital) and psychologist Dr. Herdley Paolini discuss surgeon burnout with guest host, pediatric otolaryngologist Dr. Anthony Sheyn (Le Bonheur Children’s Hospital).

First, Dr. Paolini reviews causes of surgeon burnout, drawing on three decades of experience working in physician wellness. Then, Dr. Sheyn and Dr. Wei discuss steps they’ve taken to combat burnout. Dr. Wei illuminates challenges unique to female surgeons, including higher levels of emotional exhaustion, fertility struggles, and ‘mom guilt.’ Then, the discussion shifts to address the roles that healthcare administration and medical education play in surgeon burnout. The podcast concludes with Dr. Wei’s experience advocating for needed changes in her hospital’s call policies.

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SHOW NOTES

00:00 - Introduction
03:18 - Operating Through Challenges: Dr. Wei’s Experience with Burnout
06:02 - Exploring Causes of Surgeon Burnout with Dr. Paolini
16:03 - Squashing the Stigma: Embracing Vulnerability in Surgery
25:37 - The Power of Advocacy and Building a Case for Wellness Programs
31:06 - Early Interventions and Transforming Medical Education
34:10 - Balancing Professional & Personal Life As A Surgeon
42:47 - Initiating System Changes for Physician Well-being

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RESOURCES

Dr. Anthony Sheyn’s Le Bonheur Children’s Hospital Profile:
https://www.lebonheur.org/doctors/anthony-sheyn

Dr. Julie Wei’s Akron Children’s Hospital Profile:
https://akronchildrens.org/people/Julie-Wei.html

About Dr. Herdley Paolini:
https://www.physicianintegration.org/about

“Safeguarding Physician Wellbeing” by Dr. Julie Wei:
https://www.routledge.com/Safeguarding-Physician-Wellbeing-Using-Checklists-for-Personal-Professional-and-Psychological-Safety/Wei/p/book/9781032589893

“Inside the Mind of a Physician: Illuminating the Mystery of How Doctors Think, What they Feel, and Why they Do the Things They Do” by Dr. Herdley Paolini:
https://www.amazon.com/Inside-Mind-Physician-Illuminating-Publishing/dp/0982040903

In this episode, Pediatric Speech Language Pathologist (SLP) Olivia Brooks (University of Florida Shands Hospital) shares her experience performing inpatient fiberoptic endoscopic evaluation of swallowing (FEES) with host Dr. Gopi Shah.

First, Olivia reviews the presentation of swallowing disorders in infants. She explains differences between the two most common swallowing tests: videofluoroscopic swallow study (VFSS) and (FEES). Then, she reviews how she uses patient comorbidities and the physical exam to select the appropriate test for each infant. Underscoring the importance of collaboration across care teams, she describes her role performing swallow studies in the NICU and pediatric CVICU. She then shares tips on equipment, ergonomics, and teamwork while performing bedside FEES. The podcast wraps with her advice about working on an interprofessional team to care for children with swallowing disorders.

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CHECK OUT OUR SPONSOR

Karl Storz Tele Pack
https://www.karlstorz.com/

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SHOW NOTES

00:00 - Introduction
06:26 - The Importance of a Comprehensive Evaluation
13:00 - Choosing Between VFSS & FEES
22:44 - The Evolution of Inpatient Bedside FEES
31:27 - The Role of Speech Pathologists in Swallow Assessment
33:23 - Collaboration between Speech Pathologists & Otolaryngologists
35:31 - Developing Safety Protocols for Bedside FEES
41:21 - Equipment for Bedside FEES
53:20 - Differences between the NICU and the CVICU
01:00:03 - Final Thoughts and Advice Regarding Swallow Studies

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RESOURCES

KARL STORZ ENT Products:
https://www.karlstorznetwork1.com/ent

Olivia Brooks CCC-SLP’s UF Profile
https://ufhealth.org/doctors/olivia-a-brooks/bio

In this episode, Dr. Ashleigh Halderman, Rhinologist and Associate Professor at the University of Texas Southwestern Medical Center, discusses chronic invasive fungal sinusitis with hosts Dr. Gopi Shah and Dr. Ashley Agan,

First, Dr. Halderman outlines her advocacy work as President of the Texas Association of Otolaryngology. Then, the discussion transitions to chronic invasive fungal sinusitis. Dr. Halderman defines the disease, describes typical patient presentation, and reviews concerning imaging findings. Until biopsy can clinch the diagnosis, she maintains a high index of suspicion in cases of bizarre clinical presentation or facial paresthesia. The surgeons then shift their attention to management, which consists of culture-directed antifungals and judicious surgical intervention. Dr. Halderman wraps up the episode by sharing her pearls for operative management and long-term surveillance.

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SHOW NOTES

00:00 - Introduction
02:10 - Exploring the Texas Association of Otolaryngology
05:58 - Understanding Chronic Invasive Fungal Sinusitis: Types & Treatments
20:25 - Diagnostic Challenges and Imaging Insights
27:07 - Navigating Diagnostic Challenges and Treatment Options
29:40 - The Role of Biopsy in Confirming Fungal Infections
30:52 - Surgical Considerations and Pre-Operative Strategies
40:29 - Surveillance Strategies: Managing Chronic Invasive Fungal Sinusitis
46:34 - The Future of Surgical & Antifungal Therapies for Chronic Invasive Fungal Sinusitis

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RESOURCES

Dr. Ashleigh Halderman’s UT Southwestern Profile:
https://utswmed.org/doctors/ashleigh-halderman/

BackTable ENT Episode 30, “Revision Endoscopic Sinus Surgery"
https://www.backtable.com/shows/ent/podcasts/30/revision-endoscopic-sinus-surgery

Texas Association of Otolarynogology:
https://www.taohns.org/