Dr Broker was asked to speak at the Board of Governors of the American Academy of Otolaryngology on the topic of sub-certification and its effect on the field of general otolaryngology. As a Board Certified Pediatric Otolaryngologist, Dr Broker has decades of experience caring for children. And yet, the American Society of Pediatric Otolaryngology (ASPO) is asking for a new certification that would change the credentials of the 10,000 or so active Pediatric Otolaryngologists like Dr Broker in the United States. ASPO would like to take the name "Pediatric Otolaryngologist" for themselves and thus eliminate the ability of general ENT doctors to use the term. But this would be inaccurate and detrimental to patient care.
What's In a Name?
The members of ASPO, who can be found at pediatric hospitals, have specialized training in very unusual pediatric ENT problems, such as congenital defects and pediatric head and neck cancer. General Otolaryngologists, like the ones found in your local community, have specialized training in common pediatric ENT problems such as chronic tonsil infections, ear disease, chronic cough, and allergy and are Board Certified Pediatric Otolaryngologists by the American Academy of Otolaryngology (AAO). Understanding the difference between the two groups is hard for pediatricians, let alone parents. So its clear that the AAO has a big public relations task cut out for itself. But limiting the use of the term "pediatric otolaryngologist" to one group would be dishonest.
The "father" of the ASPO group, Dr Charles Bluestone, defined their work as "caring for common problems in unusual children and uncommon problems in healthy children". Its a mouth-full. But its probably the best way to distinguish the ASPO doctors from the general ENT's.
In the end, there seemed to be general agreement from the Board of Governors that a more appropriate distinction would be "Pediatric Otolaryngologist for Common Problems" to refer to community ENT doctors who care for tonsils, throats, and ears. Thus the ENT doctors at pediatric hospitals would be called "Pediatric Otolaryngologists for Uncommon Problems" referring to their work with congenital defects and cancer.
On a separate but related note, the Board of Governors received Dr Broker's proposal favorably to promote the AAO's policy against "Itinerant Surgery". Itinerant surgery is the practice of surgeons going far away from their home base to operate and leaving the patients without adequate post-operative care. Sometimes this is done for disaster relief, like after the Haiti earthquake. But in those cases, every effort is made to get local doctors to agree to care for the post-operative patients and to give them training. This type of care is felt to be justified because the local doctors do not have the necessary surgical expertise.
But Itinerant Surgery has become a common practice of pediatric hospitals in the United States today as they look to make more money. They set up outpatient surgery centers far from their home base and are not available after-hours to provide emergence care locally, even for patients who have life-threatening bleeding after surgery. They make no attempt to arrange for local doctors to accept their post-operative patients in case of an emergency and simply tell the patients to "go to the local emergency room" if they have a problem. With local Board Certified Pediatric Otolaryngologists for Common Problems in abundance in these areas, the pediatric hospitals cannot argue that their surgery centers are providing care that is otherwise unavailable. And thus they are violating the AAO's policy against itinerant surgery. The policy is very clear, this practice is condemned by the AAO.
Hopefully, Dr Broker's lecture will spur an effort to stop the practice of itinerant surgery by pediatric hospitals. We'll keep you posted.
We are Board Certified Pediatric Otolaryngologists