BackTable ENT BackTable

In this episode, Dr. Mihir Patel, Professor of Otolaryngology at Emory University and expert in Transoral Robotic Surgery (TORS), discusses HPV-positive head and neck cancer with host Dr. Ashley Agan.

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CHECK OUT OUR SPONSOR

Medtronic ENT
https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23

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SYNPOSIS

Dr. Patel opens by briefly sharing his journey to head & neck surgery, and, more specifically, expertise in TORS. After, Dr. Patel explains the epidemiology and pathophysiology of HPV-caused cancers, which frequently present as painless neck masses. Then, Dr. Patel describes workup and treatment of these cancers. He shares surgical strategies, paying special attention to cases of unknown primary lesions. He underscores the importance of collaboration with medical and radiation oncologists, particularly given the rapid pace of treatment innovation. Finally, Dr. Agan and Dr. Patel examine how increased HPV vaccine uptake could drastically lower the burden of this disease in the coming decades.

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TIMESTAMPS

00:00 - Introduction
05:26 - The Evolution of HPV-Related Oropharyngeal Cancer Treatment
17:26 - Contemporary Diagnostics for Head & Neck Cancer
24:39 - Surgical Strategies for Unknown Primary Lesions
38:15 - The Role of ctDNA in Cancer Management
46:10 - Advancements in HPV-Driven Cancer Treatment
53:30 - The Future of Cancer Screening and Vaccination
01:01:54 - Vaccination: A Tool for Cancer Prevention

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RESOURCES

Medtronic ENT:
https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Mihir Patel’s Emory University Profile:
https://winshipcancer.emory.edu/bios/faculty/patel-mihir-r.html

AVOID Trial:
https://pubmed.ncbi.nlm.nih.gov/31785337/

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the ENT workforce with Dr. Andrew (“AJ”) Tompkins, an Ohio-based comprehensive otolaryngologist and member of the American Academy of Otolaryngology-Head and Neck Surgery’s socioeconomic task force.

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SYNPOSIS

First, Dr. Tompkins provides an overview of the ENT workforce from trainee to retiree stages. He describes his work with the Academy’s socioeconomic task force, which provides important feedback on the number, location and work environments of practicing otolaryngologists. He emphasizes participation in the Academy’s workforce survey as the source of this data. Offering a sneak preview of 2023 survey results, Dr. Tompkins underscores the need to increase resident exposure to private practice settings and to plan for how treatment breakthroughs (such as the HPV vaccine) might affect future workforce needs. The surgeons finish by discussing necessary improvements in resident selection and continuing education.

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TIMESTAMPS

00:00 - Introduction
03:09 - Exploring the ENT Workforce: A Provocative Topic
08:09 - Unpacking the Challenges of ENT Workforce Data
22:16 - The Impact of Fellowship Training & Practice Shifts
31:59 - Previewing 2023 Data Insights
37:09 - Addressing Workforce Distribution and Access Issues
43:30 - How Technology & Training Influence the ENT Workforce
56:20 - Collaborations & Future Directions
01:01:24 - Concluding Thoughts on Workforce Dynamics

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RESOURCES

Dr. Andrew Tompkins’ Ohio ENT & Allergy Profile:
https://www.ohioentandallergy.com/physicians/andrew-tompkins-md-mba/

Triological Society Otolaryngology Workforce Analysis from 2016: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.26238

“The 2022 Otolaryngology Workforce” Report from AAO-HNS:
https://www.entnet.org/wp-content/uploads/2023/07/2022-Otolaryngology-Workforce.pdf

Tompkins AJ. The Otolaryngology Workforce, Part I: Supply. ENTtoday. May 2022.
https://www.enttoday.org/article/some-studies-predict-a-shortage-of-otolaryngologists-do-the-numbers-support-them/

Tompkins AJ. The Otolaryngology Workforce, Part II: Structure & Rethinking Supply. ENTtoday. June 2022.
https://www.enttoday.org/article/transparent-regular-data-vital-to-reworking-how-we-think-about-workforce-supply/

Tompkins AJ. The Otolaryngology Workforce, Part III: Competition & Future Design. ENTtoday. July 2022.
https://www.enttoday.org/article/tips-for-creating-a-dynamic-otolaryngology-workforce/

In this episode of the BackTable ENT podcast, Dr. Pete Manes, associate professor of rhinology at Yale, discusses political advocacy with host Dr. Ashley Agan.

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SYNPOSIS

Dr. Manes begins by explaining how a life-long interest in government underlies his work as a physician-advocate with the American Academy of Otolaryngology-Head & Neck Surgery. Currently, he serves as the Academy’s Coordinator of Health Policy, where he contributes to private payer advocacy and Academy position statements. Drawing on this experience, he explains political challenges associated with being a smaller specialty, roles played by of Action Committees (PACs), and steps in legislative advocacy. Then, he shifts focus to cover how the Academy works with private payers to ensure fair reimbursement. The podcast concludes with resources to connect otolaryngologists with advocacy work.

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TIMESTAMPS

00:00 - Introduction
01:02 - Dr. Pete Manes’s Advocacy Role
08:04 - The Importance of Advocacy in Medicine
20:24 - Scope of Practice and Physician Payment Reform
30:02 - Building Relationships for Healthcare Advocacy
37:12 - Navigating Insurance Companies for Patient Advocacy
42:33 - Utilizing Position Statements in Healthcare Advocacy
48:29 - Accessing Academy Resources for Healthcare Advocacy
50:43 - Exploring Opportunities for Engagement and Advocacy

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RESOURCES

Dr. Pete Manes’s Yale University Profile:
https://medicine.yale.edu/surgery/otolaryngology/profile/rpeter-manes/

American Academy of Head & Neck Surgery (AAO-HNS) Position Statements:
https://www.entnet.org/business-of-medicine/position-statements/

AAO-HNS Health Policy Contact:
healthpolicy@entnet.org

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/