In this episode of Voices of Otolaryngology, host Dr. Rahul Shah sits down with Nora W. Perkins, MD, a private practice otolaryngologist with Albany ENT & Allergy Services, in New York, and liaison for advanced practice providers (APPs) in her group. Dr. Perkins shares how her practice grew from a single APP in the early 2000s to more than 20 today, creating a thriving model for expanding patient access, reducing physician burden, and maintaining high-quality care. Dr. Perkins walks listeners through her group's 24-week onboarding and training program, including eight to ten weeks of shadowing, structured educational resources, and gradual ramp-up to independent practice. She explains how her team balances APP autonomy with strong physician collaboration and fosters a culture where both physicians and APPs thrive without competing for patients. The discussion also highlights strategies for building a collegial culture, retaining providers, and ensuring quality through oversight, education, and procedural training. Whether you're a practice leader, a physician exploring APP integration, or an APP considering otolaryngology, this episode provides a practical, experience-driven roadmap for success.