Why won't urban/suburban ENT/pulm siphon off patients from allergy?
Some do, mostly ENT. Primary care in both adult and peds occasionally offer skin testing and sometimes shots. My understanding is that these practices are typically approached by larger corporations who sort of sell it as a service where the larger company sort of sets things up for them and the practice gets a piece of the revenue. It seems to be less common than it used to be. I've seen a few sort of get out of the game recently. There's a few reasons not to do it.
-Economy of scale. Skin testing and shots are margin dependent like anything else. If you're only dabbling, your return may not be worth the headache. Staffing is rough for everyone these days, so running lean and staying in your lane may be more profitable than biting off more than you can chew.
-Liability. Shots and drops carry risk. Testing, not so much. But then you have to interpret it correctly and are liable if you do it wrong. Wouldn't want to be the non-allergist who had a bad outcome from something outside their scope.
-Playing nice in the sandbox. Allergy, pulm, ENT, derm, and primary care all refer to each other. Allergy in a nice metro has a large portion of patients with PPO plans that self refer. Lots of patients that are on the younger side end up asking me for a PCP recommendation. You think we are sending patients to those folks who are poaching our specialty? I think both ENT and allergy do better when they work well together. I send you plenty of surgical cases and you send me allergy stuff. I'm also happy to deal with starting and maintaining patients on biologics for derm/ent/pulm. I have the built-in infrastructure to store biologics, administer them, and process the auths. There's not much money in this space either unless you're large enough to buy and bill.
Also, non-allergist providing immunotherapy tend to use much less potent serum than allergists. Probably because they don't want to be dealing with shot reactions and anaphylaxis like we do. You're simply not going to get efficacy out of it if you don't use high enough doses. I think patients catch on to this. In a metro/suburb area, patients have choices. Also, in the age of the internet, I think educated patients might pick up on the whole stepping out of their lane practice. I mean if you were gonna put you or your kid on shots, would you go to the allergist who specializes in it or to the PCP? If your pcp does testing, are they going to be able to have an in depth conversation on what the results actually mean for the patient? Probably similar to how we hear about family med doing colonoscopies and delivering babies in rural areas. Patients with choices would probably prefer GI and OB to be doing these things and they are readily accessible.