Surgical techniques

The Business of American Medicine

This session underscores the importance of business-of-medicine skills within today’s medical climate. These skills are largely absent from rigorous modern medical education curricula, yet they are essential to physicians remaining autonomous and preventing the commoditization of what we offer society within a patient-centered health care ecosystem around the world.

This session examines the structural forces reshaping otolaryngology practice ownership in the United States and what they mean for surgeons worldwide. Drawing on national physician-consolidation data alongside a 30-year case study of Charleston ENT & Allergy — one of the largest independent, physician-owned ENT groups in the U.S. — the talk traces how private equity acquisition, hospital employment, and administrative burden have accelerated market consolidation, and contrasts these forces with a proven alternative: growth through independent physician alliances rather than sale to private equity or a hospital system. A “flywheel” framework illustrates how scale, integrated services (allergy, audiology, surgery centers, pharmacy, radiology, and clinical research), and physician governance reinforce one another to sustain independence. The session closes with practical lessons that international colleagues can apply as they confront increasing economic pressure on health care worldwide.

By the end of this session, participants will be able to:

1.     Describe the major national trends driving consolidation in otolaryngology and specialty medicine, using current physician employment and ownership data.

2.     Explain the flywheel model of practice growth — how service-line integration, scale, and physician governance compound over time.

3.     Compare acquisition-based growth with the independent physician alliance model as a path to preserving practice autonomy.

4.     Identify at least two strategies transferable to their own national or regional practice environments to strengthen physician practices amid increasing economic pressure.

The presenter is CEO of Charleston ENT & Allergy, the largest otolaryngology and allergy practice in South Carolina, which he has built over more than 25 years into a multi-site, physician-owned enterprise spanning ENT, allergy, audiology, ambulatory surgery, and urgent care. He also serves as President of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) and its Foundation. This dual vantage point — hands-on practice builder and specialty-wide advocate — grounds the talk in operational reality rather than theory, offering an evidence-based, practitioner’s perspective on how independent practice can still thrive.

Better endoscopic, CT and MR diagnostics of laryngeal cancer significantly improved the local assessment of the spread of cancer, especially the volume and intensity of the affected structures of the larynx. This is the basis for a better selection of patients for a certain method of treatment, especially in advanced cancers, which represent a heterogeneous group, where some respond better to surgery and others to organ preservation therapy. In the previous period, the very popular non-selective organ preservation with induction/competitive chemoradiotherapy did not give the expected results with a decrease in overall survival, worse functional results and worse quality of life. In the light of modern knowledge, the indication for chemoradiotherapy is reserved for patients with a small volume of cancer, preserved airway, good swallowing function without the need for a tracheostomy or gastrostomy or tube, limited cartilage destruction and patients who can tolerate the toxicity of chemoradiotherapy related to radiotherapy.   for open surgery, it is very important to assess the degree of involvement of the paraglottic, preepiglottic space, cartilage infiltration, and spread to extralaryngeal tissues. The paraglottic space is divided into anterior and posterior compartments, so advanced carcinomas involving the anterior compartment can be treated with open laryngeal reconstructive surgery, while advanced posterior compartment carcinomas are better controlled by total laryngectomy. Reconstructive surgery involves the application of one of the horizontal laryngectomies, supraglottic, supracricoid or supratracheal. Reconstructive surgery is indicated in patients younger than ≤70 years, who are neurologically healthy and can master the procedure of postoperative swallowing rehabilitation, with good cardiopulmonary function, a tumor that does not spread too far posteriorly and/or massive involvement and ankylosis of the cricoarytenoid joint.  n status affects the choice of therapy, so a low n status favors the application of surgical therapy, and a high one favors the application of organ preservation. 

good patient selection and individual application of an adequate treatment modality is the key to achieving good oncological disease control, good functional results and good quality of life.