BackTable ENT & Allergy

We talk with Dr. Allison Royer about locums opportunities for otolaryngologists, why locums is becoming more popular amongst ENTs, and how to get started as a locums physician.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/MMVvXV

---

CHECK OUT OUR SPONSORS

DI4MDs

https://www.di4mds.com

Laurel Road for Doctors

https://www.laurelroad.com/healthcare-banking/

---

SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan interview Dr. Allison Royer, a private practice ENT who co-founded ENT Surgery Solutions, a staffing company that organizes ENT locums.

First, Dr. Royer shares her transition from being a hospital-employed ENT to becoming a locum physician with her husband. Once they met other locum physicians and heard about their experiences, they decided to start their own locum staffing company. Dr. Royer believes ENT Surgery Solutions is unique because it is managed directly by ENT physicians; Dr. Royer and her husband directly work with the doctors they employ to find work opportunities that will fit their unique needs. Although ENT Surgery Solutions is primarily Midwest-based, it is quickly expanding in the West and South.

Next, Dr. Royer transitions to discussing why many doctors are moving toward locums work. She explains that because many small private practice groups and community hospitals have been bought by hospital systems, there are now significant call burdens needing to be covered by small ENT groups. For this reason, many ENTs decide to do locums in order to balance work and life. Additionally, with locums, doctors don’t have to renegotiate their salaries or their call schedules. Finally, Dr. Royer highlights that locums are fun for her because she likes to work in different hospitals and ORs and see different patient populations and pathology.

---

RESOURCES

ENT Surgery Solutions

​​https://www.entlocums.com/

We talk Naso Sano Associazione founder Puya Dehgani Mobaraki about the importance of connecting with Otolaryngologists around the world for education, how social media has made this possible, and the impact of listening to the needs of the future generation.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/vP06PS

---

SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Puya Dehgani-Mobaraki, founder and president of Associazione Naso Sano, a global non-profit organization that provides free education for otorhinolaryngology and head and neck cancer physicians and trainees.

Naso Sano supports international trainees by providing them with grants for instrument kits, dissection courses, and textbooks. Dr. Dehgani-Mobaraki emphasizes the importance of surveying trainees to determine which resources and educational opportunities will best help them achieve their future goals. Another important aspect of Naso Sano is the virtual grand rounds. Although organization of these sessions can be challenging due to differing time zones, Naso Sano grand rounds sessions have reached attendance levels of up to 1000 participants. These sessions are available on a variety of platforms, including Facebook, Youtube, and Twitch. Dr. Dehgani-Mobaraki lets the medical and public community decide the topics they would like to learn about, which has included cystic fibrosis, anatomy and dissection courses, and many more diverse subjects.

Finally, the doctors discuss the duty of physicians to use their credibility and knowledge to address human rights violations and gender inequality in healthcare. Both doctors agree that marginalized populations still do not receive adequate healthcare and that small conversations with colleagues and trainees can have a great impact in resolving these matters.

---

RESOURCES

Dr. Dehgani-Mobaraki Twitter:

https://twitter.com/puyadehganimd

Naso Sano Twitter:

https://twitter.com/nasosano

Naso Sano Website:

https://www.nasosano.it/

In this episode Dr. Eric Gantwerker talks with Dr. Steve Goudy about the importance of finding and thoroughly researching pain points for patients and their families, to then drive innovative solutions.

Reflect on how this Podcast applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ via point-of-care learning activities here: https://earnc.me/Jhj06n

We talk with Dr. Ashley Sikand and Dr. Brian Weeks about performing In-Office Sinus procedures, including differences in technique, and keeping up with the latest technologies.

---

CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

---

SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Ashley Sikand (Nevada Sinus Relief in Las Vegas, NV) and Dr. Brian Weeks (SENTA Clinic in San Diego, CA) about tips for starting in-office procedures and forming effective industry partnerships.

First, Dr. Sikand and Dr. Weeks outline their motivations for entering the medical device industry space and serving as consultants for Acclarent, an otolaryngology medical device company. Next, they summarize the types of nasal conditions they can treat with an office-based procedure. These conditions include: deviated nasal septum, nasal valve disorders, turbinate obstructions, nasal polyps, and chronic rhinitis. They note that these procedures have only been made possible due to advances in anesthesia and blocking techniques. Although anesthesia varies based on the type of procedure, anesthesia for sinus work in general consists of three steps: anxiolysis (lorazepam or benzodiazepine), topical anesthesia (lidocaine and tetracaine), and infiltrative anesthesia (sphenopalatine block).

Patient selection criteria is also very important when considering good candidates for office-based procedures. The doctors note that younger patients may have more apprehension towards in office procedures. Additionally, if a patient presents with a complex condition that requires multiple procedures, operating in the OR may be a better option. With experience, surgeons will be able to discern whether an in-office procedure is possible for different types of patients.

Finally, the doctors emphasize how important good in-office resources are. The starting toolbox for an otolaryngologist should contain: a good endoscopic system, a camera, an instrument tray, effective suction, and an image guidance system. Knowing the room set up is a crucial requirement as well. Although the doctors admit that young otolaryngologists may not have the capital to purchase all the essentials, they encourage them to leverage their industry connections by inviting representatives to bring different equipment for demonstrations first. Finally, they end by advocating for doctors to critically evaluate medical technology using their medical education and training before adopting a device into their standard practice.

Special guest The White Coat Investor James M. Dahle talks with Christopher Beck about where physicians can start when it comes to financial literacy, including common financial mistakes docs make when start practicing, a primer on mortgage rates, and tips on insurance.

---

CHECK OUT OUR SPONSOR

DI4MDs

Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDS. Contact them today at www.Di4MDS.com or call 888-934-4637

---

SHOW NOTES

In this episode, White Coat Investor founder Dr. James Dahle and our host Dr. Chris Beck discuss strategies for physicians seeking to manage their personal finances and gain financial freedom.

First, Dr. Dahle explains the reasoning behind the famous quote, “live like a resident.” He explains that for an early career physician, their greatest wealth-building tool is their income. The income jump from residency to attending years can be extremely useful for quickly paying off student loans. Then, he moves on to discuss another way to resolve student debt, the Public Service Loan Forgiveness (PSLF) program. This option is ideal for physicians who have spent a significant amount of time working for a nonprofit institution (for example, during training and in academic medicine).

Dr. Dahle advises all physicians to reflect on their priorities when deciding where to allocate their assets. Possible categories could include retirement funds, 529 college savings funds, payment of high-interest debt, and emergency funds. We talk about the power of having a written plan to stay on track with financial goals and prevent ourselves from making rash decisions.

Next, we discuss different financial vehicles that can provide benefits for physicians. The “back door Roth IRA” strategy allows for yearly contributions to a tax-free retirement fund, even when a physician’s income exceeds the maximum limit for the conventional Roth IRA. Additionally, the funds in a Health Savings Account (HSA) can be used for investment, and then withdrawn at a later date, penalty-free. Dr. Dahle explains the difference between fixed rate and variable rate mortgages, noting that the latter is better for short-term loans because interest rates are unlikely to dramatically increase from year to year. Finally, Dr. Dahle covers the advantages of buying disability insurance as a way to protect physician income, especially for those working in procedural specialties.

---

RESOURCES

White Coat Investor: https://www.whitecoatinvestor.com/

White Coat Investor Podcast: https://www.whitecoatinvestor.com/wci-podcast/

White Coat Investor Email: [email protected]

Passive Income MD: https://passiveincomemd.com/

Physician on FIRE: https://www.physicianonfire.com/

In this episode of BackTable ENT, Dr. Gopi Shah talks with Miami-based otolaryngologist Dr. Carlos Torre (Sleep, Snoring & Sinus Clinic of Florida) about his journey to building an adult sleep practice and management of sleep disorders, such as sleep apnea and insomnia.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/5lScN4

---

SHOW NOTES

First, Dr. Torre shares his personal experience in the field of sleep medicine. He explains his path to becoming board-certified in otolaryngology, sleep study, and sleep medicine, and obesity medicine. During his sleep surgery fellowship, he was fortunate to train with good mentors who showed him a diversity of techniques and procedures to treat sleep disorders. Driven by his entrepreneurial mindset, he eventually transitioned to his own solo private practice in August 2021.

Next, the doctors discuss how to work up an adult patient initially presenting with snoring. Dr. Torre first evaluates the presence and severity of the patient’s symptoms as well as other comorbidities. Next, he orders a home sleep study to confirm the diagnosis of sleep apnea and interprets the sleep studies himself. Many cases of sleep apnea can be resolved nonsurgically through nasal breathing training if the patients are chronic mouth breathers. Nasal breathing training is a type of myofunctional therapy that incorporates exercises such as correct tongue positioning, strengthening of facial muscles, and palatal coupling. Besides nasal breathing training, he recommends CPAP for every patient with obstructive sleep apnea. He prefers to perform surgery conservatively. Thus, he will only consider surgery (tonsil removal, septum deviation surgery) if the patient has failed CPAP therapy for a prolonged period of time and he will use surgery as a tool to optimize CPAP instead of aggressively trying to cure the patient’s sleep apnea. Dr. Torre mentions that nightly dental appliances are also a treatment option.

Finally, Dr. Torre acknowledges that general wellness plays an integral role in sleep hygiene. The most common comorbidity associated with sleep apnea is obesity. He recommends fasting and eating early dinners to patients presenting with obesity-related sleep disorders. He also explains how meditation can help relieve anxiety and depression in patients suffering from insomnia. Dr. Torre ends the episode by emphasizing the benefits of multidisciplinary care for patients with sleep disorders.

In this episode we talk with Dr. Matthew Hensler about Hypoglossal Nerve Stimulation for treating Adult Obstructive Sleep Apnea (OSA), including how he learned the procedure, patient selection, procedure tips, and advice on building a successful program.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Jw85Cq

---

SHOW NOTES

First, Dr. Hensler explains the initial workup for a snoring patient. In this history, he addresses the impact snoring has on the patient’s quality of life and also assesses the environmental factors that may be responsible for the snoring, such as lack of sleep and alcohol consumption. Then, during the physical exam, he checks for anatomical reasons for snoring, such as large tonsils and a deviated septum. From the history and physical exam, he is able to classify patients into two categories: primary snorers (without sleep apnea) and snorers with sleep apnea. He recommends that all patients complaining of snoring obtain a sleep study.

Dr. Hensler then explains his criteria for choosing good hypoglossal nerve stimulator candidates. He recommends choosing patients with an Apnea Hypopnea Index (AHI) score between 15-65, a BMI of less than 31, and patients who have less than 25% of apnea attributed to mixed and central apnea. Because the CPAP machine is still the gold standard treatment for treatment of OSA, he usually only recommends this surgery to patients who have failed CPAP treatment already.

Next, Dr. Hensler explains the mechanics behind the hypoglossal nerve stimulator, which only treats obstructive sleep apnea. During the implantation surgery, the first incision is made in the right chest for placement of the processor. The processor is attached to a sensor lead that feeds into the rib cage space between the external and internal intercostal muscles. A second submandibular incision is made below the submandibular gland to place the stimulator lead. When the sensor lead in the rib cage senses the patient breathing, it relays a message to the stimulatory lead, which stimulates the protrusive branches of the hypoglossal nerve to fire and push the tongue outwards. The surgery can be performed in an outpatient setting andlasts less than 2 hours. Patients can start turning on the device before they sleep 3-5 weeks after implantation. Finally, Dr. Hensler obtains a 3 month follow up sleep study in order to monitor improvement in AHI scores.

Post-operative complications like infection and pain are possible. Dr. Hensler prescribes his patients with a short duration of narcotics for submandibular pain and a 7-day course of antibiotics to prevent infection. Because of chest involvement during surgery, a pneumothorax is another post-operative complication. A chest X-ray should always be ordered after surgery to rule out this possibility. Finally, it is important to note that patients with a hypoglossal nerve stimulator are unable to undergo MRI scans involving their right chests because of the battery in the processor.

In this episode Dr. Kumar and Dr. Bennett discuss various levels of racism found in healthcare, and share allegories of racism as outlined by Dr. Camara P. Jones, including the gardeners tale.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Y1eaX6

---

SHOW NOTES

In this episode, guest host Dr. Vishal Kumar interviews Dr. Ayanna Bennett about how to train ourselves to recognize perpetuated health disparities within the medical system and how we can actively work to dismantle them.

The doctors first talk about understanding racism on an institutional level, which results in a “machine” that selectively delivers better and worse aspects of healthcare to different populations. Dr. Bennett emphasizes that every disease process shows race disparities not because of inherent biological differences in racial groups, but because of unequal frequencies and quality of contact with healthcare systems.

Throughout the episode, they reference the allegories of Dr. Camara Jones, a physician-epidemiologist and civil rights activist. These allegories provide a framework for discussing nature vs. nurture for health outcomes and also privilege defined as the lack of barriers to entry.

In terms of actionable steps that providers can take toward reducing health inequity, Dr. Bennett encourages us to learn and engage with the communities that they serve. She advises us to be “counter-stereotypical” and show interest in patients’ lives outside of the healthcare setting. Finally, she calls us to analyze the impact that our institutions have on maintaining the health of the community as a whole, rather than solely focusing on individual patients.

---

RESOURCES

The Gardener’s Tale Allegory by Dr. Camara Jones:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/

Tedx Talk by Dr. Camara Jones:

https://www.youtube.com/watch?v=GNhcY6fTyBM

In this episode we talk with Dr. Reena Mehta about her experiences building a solo Allergy practice from scratch, including finding a space, staffing, essential equipment, and a successful marketing strategy.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/qiQz8G

---

SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan talk with Dr. Reena Mehta about her path to starting her own allergy private practice, including tips on successful budgeting, hiring practices, advertising, and maintaining a work-life balance as a solo physician.

FIrst, Dr. Mehta reflects on her personal journey to starting her own private practice. Although she started her post-graduate career in academic medicine, she transitioned to a group private practice. She then decided to open a solo private practice in order to practice medicine in the location and way she had always wanted to. In order to assess the feasibility of this idea, she consulted her network of private practice physicians. Then, she did market research to understand the location and demographics of the area in which she was planning to open her practice. Finally, she was able to find a space to rent, formulate a budget, apply for a loan, and start staffing her practice.

Dr. Mehta acknowledges that cost projections and staffing were the two most difficult aspects of starting her solo private practice. There were many costs associated with private practice that she had to account for, such as rent, staff salaries, equipment, website and marketing, electronic health records, and insurance credentialing. Fortunately, she received help from advice forums for private practice doctors as well as American Academy of Allergy, Asthma, & Immunology (AAAI) resources. Next, Dr. Mehta recounts the difficulties of staffing her practice, including unpredictability and high turnover during the peak of the COVID-19 pandemic. She notes that learning to not take staffing issues personally, hiring younger and motivated employees, and using a hiring service such as Zip Recruiter and Indeed really helped her be successful in hiring the right candidates.

Finally, Dr. Mehta discusses how she maintains a healthy work-life balance. As a solo private practitioner, she is able to close her clinic when she wants to but is still available via telehealth visits and remote consulting with her staff. One method she has found to be helpful is to hire second year fellows to manage emergency allergy events and give allergy shots to patients when she is on leave.

All-star panel Daniel Chelius, Jeff C. Rastatter, and Anthony Sheyn discuss the challenges and importance of building centers of excellence for pediatric head and neck cancer.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/SXwP9d

---

SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah leads a panel discussion about building centers of excellence for pediatric head and neck tumors. She invites Dr. Daniel Chelius (Baylor College of Medicine/Texas Children’s Hospital), Dr. Jeff C. Rastatter (Feinberg School of Medicine, Lurie Children’s Hospital), and Dr. Anthony Sheyn (University of Tennessee Medical School, St. Jude Children’s Hospital) to speak about their experiences and advice for establishing these centers of excellence.

First, the three panelists discuss their career paths to becoming pediatric head and neck cancer surgeons. Then, they share their motivations for building these centers of excellence at their own institutions. All of them realized the importance of routing complex and rare pediatric cancer cases to centralized hospitals and experienced surgeons who saw high volumes of the same cases. Additionally, they saw the need for multidisciplinary collaboration with surgeons in the fields of plastic surgery and oncology. Finally, these centers of excellence facilitate the formation of multidisciplinary tumor boards for pediatric cancer cases.

Additionally, they discuss the important elements they needed to form their centers of excellence of pediatric head and neck tumors. First, they needed support within their own otolaryngology division for a shared vision of division specialization and focused expertise. They also needed to form strong relationships with different specialties, namely pediatric plastic surgery and pediatric general surgery. Another important aspect was the institutional commitment of the affiliated children’s hospitals, which were tasked with patient outreach referrals. Finally, each center of excellence needed to be an open environment in which asking for advice and thinking outside of the box was encouraged.