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Berg J, Tu A, Jones D, Geelan-Hansen K. Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments. EAR, NOSE & THROAT JOURNAL 2024; 103:430-434. [PMID: 34851159 DOI: 10.1177/01455613211058101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. METHODS Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. RESULTS There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. CONCLUSIONS Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates.
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Affiliation(s)
- Jenna Berg
- Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexander Tu
- University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Dwight Jones
- Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Katie Geelan-Hansen
- Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, USA
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2
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Falk GE, Okut H, Lightner JS, Farrokhian N, LaCrete F, Chiu A, Shnayder Y, Bond J, Sykes KJ. Forecasting Rural and Urban Otolaryngologists, Radiation Oncologists, and Oropharyngeal Carcinoma. Laryngoscope 2024; 134:136-142. [PMID: 37395265 DOI: 10.1002/lary.30809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/04/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. METHODS Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. RESULTS Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96). CONCLUSIONS Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. LEVEL OF EVIDENCE NA Laryngoscope, 134:136-142, 2024.
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Affiliation(s)
- Grace E Falk
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Hayrettin Okut
- Office of Research and Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Nathan Farrokhian
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Frantzlee LaCrete
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Alexander Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Justin Bond
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
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Tasoulas J, Schrank TP, Smith BD, Agala CB, Kim S, Sheth S, Shen C, Yarbrough WG, Hackman T, Sullivan CB. Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic. Oral Oncol 2023; 146:106535. [PMID: 37625360 DOI: 10.1016/j.oraloncology.2023.106535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020. MATERIALS AND METHODS Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020. RESULTS A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020. CONCLUSIONS TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.
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Affiliation(s)
- Jason Tasoulas
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Travis P Schrank
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Blaine D Smith
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sulgi Kim
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Davis RJ, Exilus S, Best S, Willink A, Akst LM. The Geographic Distribution of Videolaryngostroboscopy in the United States. J Voice 2023; 37:798.e7-798.e14. [PMID: 34158210 DOI: 10.1016/j.jvoice.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the geographic utilization of videolaryngostroboscopy (VLS) with the hypothesis that office-based voice care is unevenly distributed across the United States. MATERIALS AND METHODS This is a cross-sectional database analysis of Medicare beneficiaries. The Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Physician and Other Supplier Public Use File from 2012 to 2017 was analyzed to evaluate VLS utilization. VLS distribution was assessed by calculating the density of VLS in each of the 306 hospital referral regions (HRRs) nationally. Associations between VLS density and population demographics and health system factors were assessed using Pearson correlation and multivariate regression analyses. RESULTS In total, 957,648 outpatient VLS were billed to Medicare part B between 2012 and 2017. The annual VLS density per HRR ranged from 0 to 38.2 per 1,000 enrollees. Pearson correlation revealed positive correlations between VLS density and number of Medicare enrollees (r = 0.2584, P < 0.001), income (r = 0.1913, P = 0.0008), education (r = 0.2089, P = 0.0002), and density of otolaryngologists (r = 0.1589, P = 0.0053) and medical specialists (r = 0.2326, P < 0.0001). A negative Pearson correlation was observed between VLS density and percent male (r = -0.1338, P = 0.0192) and Medicare mortality rate (r = -0.1628, P = 0.0043). On multivariate regression positive associations between VLS and number of Medicare enrollees (P = 0.002) and otolaryngologists (P = 0.049), and negative association with Medicare mortality rates (P = 0.032) remained significant. CONCLUSIONS The distribution of office-based voice care varies widely across the country, even when analysis by HRR should have homogenized access to specialty care. Greater availability of VLS is seen in HRRs with more Medicare enrollees, greater density of otolaryngologists, and lower mortality rates.
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Affiliation(s)
- Ruth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Smirnov Exilus
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Simon Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amber Willink
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, Australia
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hong SA, Bergman JA, Walker RJ, Massa ST. Practice Patterns and Career Satisfaction in Recent Head and Neck Oncology Fellowship Graduates. OTO Open 2022; 6:2473974X221115660. [PMID: 36032986 PMCID: PMC9400404 DOI: 10.1177/2473974x221115660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Examine the characteristics of recent head and neck (H&N) oncology fellowship graduates and assess their current perceptions of career alignment and satisfaction. Methods H&N fellowship graduates from American Head and Neck Society–accredited programs between 2015 to 2020 were surveyed. Two-sample t tests and analysis of variance tests were used to determine the effect of respondents’ demographics, fellowship characteristics, career preferences, and current practice on their degree of career alignment with expectations and overall job satisfaction. Results Fifty-eight fellowship graduates completed the cross-sectional survey. Of all respondents, 52 (89.7%) primarily preferred an academic job, of whom 5 (9.6%) went into private practice. Respondents in private practice, those treating general otolaryngology patients, and those who do not work with residents demonstrated significantly poorer job alignment and career satisfaction as compared with those in academic medicine, those treating only H&N patients, and those working with residents, respectively. Discussion The majority of graduating H&N fellows prefer a job in academic medicine; however, there may be an insufficient number of desirable academic positions available each year to meet such demand. Implications for Practice By setting realistic career expectations, preparing for a mixed scope of practice, and integrating resident involvement into private practice groups, H&N providers may ultimately find more fulfillment in their work. These findings could also be valuable to the American Head and Neck Society and fellowship programs in designing training and in planning for the number of available fellowship positions each year.
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Affiliation(s)
- Scott A. Hong
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University Hospital, St Louis, Missouri, USA
| | | | - Ronald J. Walker
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University Hospital, St Louis, Missouri, USA
| | - Sean T. Massa
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University Hospital, St Louis, Missouri, USA
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Hall AE, Brandenburg C, Ward EC, Pokorny MA, Trafford K, Seabrook M, Whitfield BCS. Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study. Int J Audiol 2022:1-9. [DOI: 10.1080/14992027.2022.2073477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amber E. Hall
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Elizabeth C. Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michelle A. Pokorny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katye Trafford
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Bernard C. S. Whitfield
- Integrated Specialist ENT Service, Department of Otolaryngology Head and Neck Surgery, Logan Hospital, Meadowbrook, Australia
- School of Medicine, Griffith University, Southport, Australia
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7
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Miller RH, Gurgel RK, McCrary HC. Graduating Otolaryngology Residents' Ideal Practice Expectations: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2022; 167:472-478. [PMID: 34982583 DOI: 10.1177/01945998211069505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior literature has indicated that the number of trained otolaryngologists required to meet the need of our growing population may be insufficient. Therefore, identifying trends in the subspecialty composition of future otolaryngology practices will elucidate workforce needs. STUDY DESIGN One-page anonymous questionnaire. SETTING The survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS Data included age, gender, fellowship, practice type, and ideal future practice components. RESULTS A total of 2286 examinees were included: 58.1% were male and 57.2% completed a fellowship. Ideal practice specialties included general otolaryngology (19%), rhinology (15%), head and neck (13%), and pediatrics (11%). General and pediatric otolaryngology had a negative correlation over time (r = -0.81, P = .01, and r = -0.75, P = .03, respectively). An overall 45% of graduates reported 1 ideal practice area (r = 0.61, P = .10), with a statistically significant decline in the number of ideal practice areas over time (r = -0.79, P = .018). Men more commonly reported allergy, head and neck, otology, rhinology, and sleep medicine as part of their ideal practice (P < .05), while women more commonly reported pediatric otolaryngology (P < .05). There was a higher mean number of ideal practice areas among men than women (2.58 vs 2.1, P < .001). CONCLUSION There is a growing trend for more specialized otolaryngology practices. The data demonstrate a decline in considering general and pediatrics otolaryngology as part of practices, which portends a gap in access to comprehensive otolaryngology in the future.
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Affiliation(s)
- Robert H Miller
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hilary C McCrary
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
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8
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Liu DH, Ge M, Smith SS, Park C, Ference EH. Geographic Distribution of Otolaryngology Advance Practice Providers and Physicians. Otolaryngol Head Neck Surg 2021; 167:48-55. [PMID: 34428088 DOI: 10.1177/01945998211040408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Advanced practice providers (APPs), namely physician assistants (PAs) and nurse practitioners (NPs), play an increasing role in meeting growing demands for otolaryngologic services, particularly in rural communities. This study analyzes the geographic distribution of otolaryngology providers, which is essential to addressing future demands. STUDY DESIGN Cross-sectional study. SETTING Medicare Provider Utilization and Payment Data for 2017. METHODS Current Procedural Terminology codes were used to identify APPs providing 10 common otolaryngologic services. Geographic distribution was evaluated by calculating densities of APPs and otolaryngologists per 100,000 persons in urban versus rural counties as defined by the National Center for Health Statistics Urban-Rural Classification Scheme. RESULTS We identified cohorts of 8573 otolaryngologists, 1148 NPs, and 895 PAs. There were significantly higher population-controlled densities of otolaryngologists and APPs in urban counties as compared with rural counties. The majority of otolaryngologists (92.1%) and APPs (83.3%) were in urban counties. However, the proportion of APPs (16.7%) in rural counties was significantly higher than the proportion of otolaryngologists (7.9%) in rural counties (P < .01). A significant majority of rural counties (72.2%) had zero identified providers, and a greater proportion of rural counties (5.0%) were served exclusively by APPs as compared with urban counties (3.2%). CONCLUSIONS Although otolaryngologists and APPs mostly practiced in urban counties, a relatively higher proportion of APPs practiced in rural counties when compared with otolaryngology physicians. The majority of rural counties did not have any otolaryngologic providers. Given the expected shortages of otolaryngology physicians, APPs may play a critical role in addressing these gaps in access.
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Affiliation(s)
- Derek H Liu
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marshall Ge
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christine Park
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Oslock WM, Satiani B, Way DP, Tamer RM, Maurer J, Hawley JD, Sharp KL, Williams TE, Pawlik TM, Ellison EC, Santry HP. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. Am J Surg 2021; 223:28-35. [PMID: 34376275 DOI: 10.1016/j.amjsurg.2021.07.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. METHODS Twenty-one years of AMA Masterfile data (1997-2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) was used to determine wRVU demand and capacity based on projected and needed number of surgeons. RESULTS By 2030, surgeon shortages across nine specialties: Cardiothoracic, Otolaryngology, General Surgery, Obstetrics-Gynecology, Ophthalmology, Orthopedics, Plastics, Urology, and Vascular, are estimated to increase clinical workload by 10-50% additional wRVU. By 2050, shortages in eight specialties are estimated to increase clinical workload by 7-61% additional wRVU. CONCLUSIONS If historical trends continue, a majority of surgical specialties are estimated to experience workforce deficits, increasing clinical demands substantially.
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Affiliation(s)
- Wendelyn M Oslock
- The University of Alabama Birmingham Medical Center, Department of Surgery, Birmingham, AL, USA.
| | - Bhagwan Satiani
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - David P Way
- Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH, USA.
| | - Robert M Tamer
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, OH, USA.
| | - Julie Maurer
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA.
| | - Joshua D Hawley
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA.
| | - Kyle L Sharp
- Ohio State University Wexner Medical Center, Department of SCN Administration, Columbus, OH, USA.
| | - Thomas E Williams
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - Timothy M Pawlik
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - E Christopher Ellison
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - Heena P Santry
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, OH, USA.
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10
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Massa ST, Mazul AL, Puram SV, Pipkorn P, Zevallos JP, Piccirillo JF. Association of Demographic and Geospatial Factors With Treatment Selection for Laryngeal Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:590-598. [PMID: 33885716 DOI: 10.1001/jamaoto.2021.0453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Guidelines for many head and neck cancers, especially laryngeal cancers, allow for multiple treatment options. Currently, inequitable provision of surgery may contribute to outcome disparities. However, the role of geospatial factors remains understudied. Objective To assess the association between US geospatial factors and treatment selection for patients with laryngeal cancer. Design, Setting, and Participants In this retrospective cohort study, patients diagnosed with laryngeal squamous cell carcinoma between January 1, 2004, and December 31, 2014, were identified from the Surveillance, Epidemiology, and End Results database. Adjusted odds ratios (aORs) for surgical treatment were generated from multivariable, hierarchical models to assess associations with oncologic, demographic, and county variables. Outlier US counties with the highest and lowest aORs were described. Data analysis was performed from April 29 to September 11, 2020. Exposures County of residence. Main Outcomes and Measures The aORs for surgical treatment were generated from multivariable, hierarchical models. Outlier counties with the highest and lowest aORs are described. Results The cohort includes 21 289 patients (mean [SD] age, 63.6 [11.2] years; 17 214 [80.9%] male) in 598 counties. Most counties had no otolaryngologist (365 [61.0%]) or radiation oncologist (434 [72.6%]). Surgery rates varied from 7.1% to 85.7% among counties with at least 10 cases. After oncologic variables were controlled for, factors independently associated with surgical treatment included patient age (aOR [95% CI], 0.94; 0.91-0.98 per 10 years), marital status (single versus married: aOR [95% CI], 0.87 [0.79-0.97]), and county social deprivation index (aOR [95% CI], 0.98 [0.97-1.00 per 5 points]) but not physician number (≥2 otolaryngologists: aOR [95% CI], 0.91 [0.75-1.11] vs ≥1 radiation oncologist: aOR [95% CI], 0.91; 0.75-1.11). The 5% of counties most likely to provide surgery (aOR, >1.23) were nearly all large metropolitan areas (2593 patients [93.3%]) and treated a disproportionately large number of patients (2778 [13.1%]). The 5% of counties least likely to provide surgery (aOR, <0.79) were also mostly large metropolitan areas (1676 patients [91.2%]) and treated a disproportionately large number of patients (1838 [8.6%]). Patients in counties least likely to provide surgery had inferior survival compared with those most likely to provide surgery (adjusted hazard ratio, 1.16; 95% CI, 1.00-1.35). Conclusions and Relevance These findings suggest that sociodemographic factors contribute to the wide variety in surgical treatment practices by county. The largest metropolitan counties were often outliers regarding their adjusted odds of surgical treatment. This finding is concerning for the counties least likely to provide surgery where survival is inferior.
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Affiliation(s)
- Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University in St Louis, St Louis, Missouri
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,School of Population Health, Washington University in St Louis, St Louis, Missouri
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Department of Genetics, Washington University in St Louis, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Editor, JAMA Otolaryngology-Head and Neck Surgery
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11
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Lopes DF, Ramos AL, Castro EAD. The health workforce demand: a systematic literature review. CIENCIA & SAUDE COLETIVA 2021; 26:2431-2448. [PMID: 34133624 DOI: 10.1590/1413-81232021266.1.40842020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022] Open
Abstract
Understanding imbalances between the supply and demand of the human resour- ces for health (HRH) is essential for enhancing health outcomes. Addressing the HRH demand is particularly challenging, especially given the deficit of accurate data and surplus of unresolved methodological flaws. This study presents a systematic review of the literature surrounding HRH demand and answers the following key questions: How has HRH demand been addressed? What are the harms and barriers that accompany HRH demand modeling? This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Relevant keywords were used in a thorough search of the PubMed/MEDLINE, SCOPUS, and Web of Science databases. A total of 2,599 papers were retrieved and evaluated according to their title and abstract. Of these, the full-text of 400 papers was analyzed, 53 of which successfully met the inclusion criteria in our study. While the topic's relevance is widespread, it still lacks a validated approach to model HRH demand adequately. The main characteristics of the applied methods are presented, such as their application complexity by health policymakers. Opportunities and orientations for further research are also highlighted.
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Affiliation(s)
- Diana Fernandes Lopes
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal.
| | - Ana Luísa Ramos
- Departamento de Economia, Gestão, Engenharia Industrial e Turismo, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Abeiro Portugal
| | - Eduardo Anselmo de Castro
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal.
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Miller RH, McCrary HC, Gurgel RK. Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study. Otolaryngol Head Neck Surg 2021; 165:655-661. [PMID: 33618575 DOI: 10.1177/0194599821994477] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To summarize trends in otolaryngology fellowship applications, fellowships selected, and reasons for pursuing a fellowship. STUDY DESIGN One-page anonymous questionnaire. SETTING A survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS Data included age, gender, fellowship type, reasons for doing a fellowship, and type of practice that examinees will enter. Spearman correlation and Pearson chi-square tests were completed. RESULTS Over the 8-year study, 58% of the 2243 responding examinees did fellowships. The most frequently chosen fellowship was facial plastic surgery (25%), followed by pediatric otolaryngology (21%), head and neck surgery (19%), rhinology (13%), laryngology (9%), and neurotology (8%). The 2 most common reasons for doing a fellowship were desire for additional expertise beyond residency training (35%) and intellectual appeal (30%). Over the study period, the number of residents choosing to do a fellowship increased from 45.6% in 2011 to 61.5% in 2019, with a positive correlation between year and number of residents (r = 0.73, P = .036). When the data were stratified by gender, there were statistically significant differences in fellowship selection (P < .001), notably with women selecting pediatric otolaryngology at a higher frequency than men (30.9% vs 15.8%). CONCLUSION There is a statistically significant increasing trend of otolaryngology residents who choose to undergo further training in fellowship. These data from a large, long-term study will be valuable in planning for training and workforce needs in the future.
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Affiliation(s)
- Robert H Miller
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Hilary Caitlyn McCrary
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
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Shih YCT, Kim B, Halpern MT. State of Physician and Pharmacist Oncology Workforce in the United States in 2019. JCO Oncol Pract 2021; 17:e1-e10. [PMID: 33270520 PMCID: PMC8189614 DOI: 10.1200/op.20.00600] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the geographic distribution of physician and pharmacist workforce specialized in oncology in the United States. METHODS Using the National Provider Identifier data, we identified two types of oncology workforce via the healthcare provider taxonomy codes. Oncologists were physicians self-identified as providing oncologic care to patients. Oncology pharmacists were pharmacists with an oncology subspecialty. We calculated the geographic density of physician and pharmacist oncology workforce and used county-level cancer crude rates to quantify the demand for oncology workforce. We used spatial data to plot the density of oncology workforces relative to county-level cancer rates and compared the county-level density of oncologists and oncology pharmacists. RESULTS Of the 30,553 members of the oncology workforce in 2019, 28,681 were oncologists and 1,090 were oncology pharmacists. The mean county-level density of oncologists was 2.94 (SD = 7.32) per 100,000 persons. Sixty-four percent of counties had no oncologists with primary practice location in that county and 12% had no oncologists in the local and adjacent counties. Counties in the top quartile of cancer rates had the highest percentage without any oncologists with primary practice location in the county (75%) and with no oncologists in the local as well as adjacent counties (16%). CONCLUSION Geographically mismatched demand and supply characterized the current oncology workforce. Wide discrepancies in the supply of oncologists across geographic regions highlight the importance of developing core competencies for health professions not specialized in oncology to deliver quality cancer care in areas with unmet need for oncology care.
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Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bumyang Kim
- Section of Cancer Economics and Policy, Department of Health Services Research, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael T. Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Ge M, Kim JH, Smith SS, Paul J, Park C, Su P, Ference EH. Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population. Otolaryngol Head Neck Surg 2020; 165:69-75. [DOI: 10.1177/0194599820971186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology. Study Design Cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use Files, 2012-2017. Methods The Medicare database was searched for 13 commonly used otolaryngology-specific Current Procedural Terminology ( CPT) codes, and 10 evaluation and management (E/M) codes were evaluated by provider type. Changes in code utilization were compared between physicians and APPs over time. Results From 2012 to 2017, there was a 51% increase in the number of otolaryngology APPs, compared to a 2.2% increase in physician providers. APPs increased their share of new and established patient visits from 4% to 7%d 11% to 15%, respectively. There was not a significant difference over time in number of patient visits performed annually per provider according to provider type. The increase in number of APP vs physician providers was significantly greater for every procedure except for balloon sinus dilation and tympanostomy tube placement. Conclusion Due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.
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Affiliation(s)
- Marshall Ge
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jee-hong Kim
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Stephanie Shintani Smith
- Department of Otolaryngology–Head and Neck Surgery, McGaw School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Julianna Paul
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Christine Park
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Peiyi Su
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Elisabeth H. Ference
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Barinsky GL, Wassef DW, Povolotskiy R, Grube JG, Hsueh WD, Baredes S, Eloy JA. Time is Money: Relative Value Units and Operative Time in Otolaryngology. Laryngoscope 2020; 131:E395-E400. [PMID: 33270239 DOI: 10.1002/lary.28988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time. STUDY DESIGN Retrospective analysis of a surgical database. METHODS NSQIP was queried from 2015-2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates. RESULTS Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017). CONCLUSION This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E395-E400, 2021.
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Affiliation(s)
- Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - David W Wassef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Roman Povolotskiy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jordon G Grube
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, U.S.A
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Geelan-Hansen K, Were V, Granger K, Jones D. Assessing the Practice Characteristics of Otolaryngology Same-Day Appointments in an Academic Center. Otolaryngol Head Neck Surg 2020; 164:918-922. [PMID: 32718239 DOI: 10.1177/0194599820942497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES to Examine the practice characteristics of same-day clinic appointments and the use of same-day appointment scheduling to provide access to care in an otolaryngology-head and neck surgery clinic. METHODS Retrospective chart review of same-day clinic appointments from January 1, 2016, to December 31, 2018, in patients aged >19 years at a single academic center. Demographic data, diagnoses, procedures completed, and operations completed were analyzed. RESULTS There were 2696 visits by 2324 patients during the 3-year study period. More men than women (57% vs 43%) made same-day appointments. The mean age was 50.7 years (range, 19-99 years). Sinonasal and otologic diagnoses were the most frequently coded. A total of 1452 procedures were completed on the day of the visit, and 239 operations were completed as a result of the visit. Overall, a broad spectrum of otolaryngology care was delivered within the organizational new patient access goals. DISCUSSION Access to otolaryngology-head and neck surgery care can be challenging. Many patients will seek care when they feel they need it, and patient conditions can change unexpectedly. Offering same-day scheduling can allow patients timely health care and appropriate care. IMPLICATIONS FOR PRACTICE Same-day appointment scheduling can provide access to care and urgent care for patients. The department of otolaryngology-head and neck surgery has been able to maintain a high rate of providing new patient appointments within 10 days with this method. Further considerations for the impact of same-day scheduling on no-show rates and patient satisfaction can be evaluated.
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Affiliation(s)
- Katie Geelan-Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vega Were
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kleve Granger
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dwight Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Abstract
A shortage of otolaryngologists is predicted for the coming decades, primarily because of an aging population and aging workforce. However, many factors affect the agility of the workforce to expand or contract. This article discusses what is known about factors of the current otolaryngology workforce, including trends in residency and fellowship training, diversity of the specialty, its geographic distribution, and the challenges of caring for an aging population. Predicting the shortage and possible solutions through modeling is complex and prone to errors caused by incomplete data and assumptions about otolaryngology's similarity to other specialties of medicine at large.
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Affiliation(s)
- Lauren M Cass
- Department of Otolaryngology Head and Neck Surgery, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66106, USA.
| | - Joshua B Smith
- Department of Otolaryngology Head and Neck Surgery, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66106, USA. https://twitter.com/JBSmithMD
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Hur K, Gibbons J, Finch BK. Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits. Otolaryngol Head Neck Surg 2020; 162:860-866. [DOI: 10.1177/0194599820913495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists. Study Design Retrospective cross-sectional analysis. Setting United States. Subject and Methods Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics. Results There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county’s disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space. Conclusions There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.
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Affiliation(s)
- Kevin Hur
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, California, USA
| | - Brian Karl Finch
- Center for Economic and Social Research, Department of Sociology and Spatial Sciences, University of Southern California, Los Angeles, California, USA
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Factors influencing the choice of practice location among Canadian otolaryngologists. The Journal of Laryngology & Otology 2019; 133:339-343. [PMID: 30924439 DOI: 10.1017/s0022215119000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Little is known about what shapes the choice of employment location in a competitive surgical specialty like otolaryngology - head and neck surgery. This study aimed to identify factors important in determining practice location among Canadian otolaryngologists METHODS: An online survey was distributed nationally to active members of the Canadian Society of Otolaryngology - Head and Neck Surgery. The survey collected data on general demographics, current practice description, training location, factors deemed important in practice location decisions, and job satisfaction. RESULTS A total of 122 survey responses were collected, with a similar proportion of participants in academic versus community practice. The majority of respondents (73 per cent) practised in the same province as their residency training. Participants identified job vacancy, colleague interaction, spouse opinion and hospital services as important in the decision of practice location. CONCLUSION Key determinants of practice location among Canadian otolaryngologists include job vacancies, spouse opinion, and colleague interactions. Overall, Canadian otolaryngologists report high satisfaction with current employment.
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The workforce trends of physician assistants in Iowa (1995-2015). PLoS One 2018; 13:e0204813. [PMID: 30296294 PMCID: PMC6175273 DOI: 10.1371/journal.pone.0204813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Physician assistants are expected to have an important role in providing both primary and specialty care. Iowa has a large rural (and aging) population and faces challenges to provide equitable access to care. This study examined changes in the Iowa physician assistant workforce (1995-2015) focusing on practice setting (primary v. subspecialty care) and geographic location (rural/urban, Health Professional Shortage Area). Documenting their current locations and service in HPSAs for primary care will help health planners track future changes. METHODS Data from 1995-2015 from the Iowa Health Professions Inventory (Office of Statewide Clinical Education Programs, Carver College of Medicine, University of Iowa) were combined with US census data on rural location and HPSA status. SPSS was used to compare Iowa and national data. Growth trends were analyzed using joinpoint regression. RESULTS The overall Iowa physician assistant workforce increased 161% between 1995 and 2015. In 2015, more than two-thirds (71%) were female and more than 30% practiced in rural counties. The average annual growth rate of primary care PAs (per 100,000 population) was significantly higher in the periods from 1995-1997 and 1997-2001 (22.4% and 7.4% respectively) than in period from 2001-2015 (3.8%). By 2015, 56% of Iowa's physician assistants practiced in primary care (versus 29.6% nationally). Of these, 44% of primary care physician assistants in Iowa practiced in counties, geographic locations or worksites designated as Health Professional Shortage Areas for primary care. CONCLUSIONS A high proportion of Iowa's physician assistant workforce practiced in primary care and many served patients in Health Professional Shortage Areas. The number of physician assistants in Iowa will continue to grow and serve an important role in providing access to health care, particularly to rural Iowans.
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Riley CA, Soneru CP, Husain Q, Gray ST, Senior BA, Tabaee A. Faculty Attitudes Toward Rhinology Fellowship Training: A Survey of Rhinology Fellowship Programs. Am J Rhinol Allergy 2018; 33:8-16. [DOI: 10.1177/1945892418801403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The number of rhinology fellowship programs has grown rapidly over the past decade. To date, no standardization or accreditation process exists, raising the potential for disparate programs. The attitudes of faculty regarding training are important to elucidate the educational experience of rhinology fellowship. Methods An anonymous, web-based survey of rhinology faculty assessed the subjective attitudes toward various domains of fellowship training including surgery, office-based procedures, research, and career development. A 5-point Likert-type scale assessing importance was used (1—not at all important, 5—extremely important). Results A total of 34 faculty (response rate 35.8%) completed the survey. The surgical procedures that received the highest mean importance scores were endoscopic surgery for advanced inflammatory disease (median = 5), cerebrospinal fluid leak closure (5), and extended endoscopic sinus surgery (5). The procedures with the lowest scores were nasal valve repair (2), inferior turbinate surgery (3), and open approaches to the sinuses (4). A wide range of responses was noted for the minimum target number of fellow cases for the surveyed procedures. Higher importance scores were noted for direct attending supervision (5) when compared to fellow autonomy (4, P < .001) or shadowing (3.5, P < .001) in the operating room. Higher scores were noted for career preparation in academic (4) versus private practice (3, P < .001) and providing opportunities for clinical (4) versus basic science research (2, P < .001). The majority of faculty felt that there were too many fellowship positions with respect to the market place for private practice (58.8%), academic jobs (85.3%), and overall societal need (61.8%). Conclusion A range of faculty attitudes with respect to fellowship training was noted in this study. Continued assessment and refinement of the educational experience in rhinology fellowships is necessary.
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Affiliation(s)
- Charles A. Riley
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Christian P. Soneru
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Qasim Husain
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Stacey T. Gray
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Brent A. Senior
- Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abtin Tabaee
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
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Eskander A, Campisi P, Witterick IJ, Pothier DD. Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology - head & neck surgery in Ontario, Canada. J Otolaryngol Head Neck Surg 2018; 47:47. [PMID: 30029682 PMCID: PMC6053828 DOI: 10.1186/s40463-018-0293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022] Open
Abstract
Background An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates. Methods Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded. Results There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon. Conclusion This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of ‘otology’, ‘general’ and ‘rhinology’ based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. .,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, Michael Garron Hospital, Endocrine Surgery, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada.
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - David D Pothier
- Department of Otolaryngology - Head & Neck Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Harrill WC, Melon DE, Seshul MJ, Katz MS, Zanation AM. Contemporary analysis of practicing otolaryngologists. Laryngoscope 2018; 128:2490-2499. [DOI: 10.1002/lary.27196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Willard C. Harrill
- Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA; Hickory North Carolina
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - David E. Melon
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - Merritt J. Seshul
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - Marc S. Katz
- Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA; Hickory North Carolina
| | - Adam M. Zanation
- Department of Otolaryngology/Head and Neck Surgery and Neurosurgery; University of North Carolina at Chapel Hill; Chapel Hill North Carolina U.S.A
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Zuniga SA, Lango MN. Effect of rural and urban geography on larynx cancer incidence and survival. Laryngoscope 2017; 128:1874-1880. [PMID: 29238975 DOI: 10.1002/lary.27042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Investigate the impact of rural geography on larynx cancer incidence and survival. STUDY DESIGN Surveillance, Epidemiology, and End Results (SEER) database study. METHODS Incidence and survival rates by Rural-Urban Continuum codes for larynx squamous cell carcinoma patients diagnosed from 2004 to 2012 were evaluated using SEER statistical software and Cox proportional hazards survival analysis. RESULTS The lowest age-adjusted incidence rates for larynx cancer were seen in densely populated urban regions, with mean rates of 2.8 per 100,000 person years (95% confidence interval [CI]: 2.7-2.8); the highest were in the most rural areas, with mean rates of 5.3 per 100,000 person years (95% CI: 4.7-5.9). Nevertheless, of 23,659 larynx cancer patients diagnosed over this period, 19,556 (82.7%) arose in urban residents, compared with 1,428 or 6% from rural areas. Urban larynx cancer patients more likely lived in counties with an American College of Surgeons-approved cancer center and/or a fourfold greater otolaryngology physician supply. Nevertheless, frequency of advanced stage at initial presentation was similar. Cause-specific and overall survival were no different, both on univariable and multivariable analyses. CONCLUSIONS Compared with urban populations, Rural populations are at greater risk of developing larynx cancer, but initial stage and survival after diagnosis are comparable. Priority should be given to prevention strategies to decrease incidence rates. LEVEL OF EVIDENCE 4 Laryngoscope, 1874-1880, 2018.
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Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
| | - Miriam N Lango
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
- Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, U.S.A
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Anne S, Chandrasekhar SS. In reference to Otolaryngology workforce analysis. Laryngoscope 2017; 127:E291-E292. [DOI: 10.1002/lary.26502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Samantha Anne
- The Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio; and the New York Head and Neck Institute; New York New York U.S.A
| | - Sujana S. Chandrasekhar
- The Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio; and the New York Head and Neck Institute; New York New York U.S.A
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Lango MN, Handorf E, Arjmand E. The geographic distribution of the otolaryngology workforce in the United States. Laryngoscope 2016; 127:95-101. [PMID: 27774588 DOI: 10.1002/lary.26188] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States. STUDY DESIGN Cross-sectional study. METHODS The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files. Multiple linear regression tested the association of population, physician, and hospital factors on the supply of Medicare-enrolled otolaryngologists/HRR. RESULTS Two methods of measuring the otolaryngology workforce were moderately correlated across hospital referral regions (Pearson coefficient 0.513, P = .0001); regardless, the supply of otolaryngology providers varies greatly over different geographic regions. Otolaryngologists concentrate in regions with many other physicians, particularly specialist physicians. The otolaryngology supply also increases with regional population income and education levels. Using AMA-derived data, there was no association between the supply of otolaryngologists and staffed acute-care hospital beds and the presence of an otolaryngology residency-training program. In contrast, the supply of otolaryngology providers enrolled in Medicare independently increases for each HRR by 0.8 per 100,000 for each unit increase in supply of hospital beds (P < .0001) and by 0.49 per 100,000 in regions with an otolaryngology residency-training program (P = .006), accounting for all other factors. CONCLUSION Irrespective of methodology, the supply of otolaryngologists varies widely across geographic regions in the United States. For Medicare beneficiaries, regional hospital factors-including the presence of an otolaryngology residency program-may improve access to otolaryngology services. LEVEL OF EVIDENCE NA Laryngoscope, 127:95-101, 2017.
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Affiliation(s)
- Miriam N Lango
- Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, and the Department of Otolaryngology, Temple University School of Medicine, Temple University Health System, Philadelphia, Pennsylvania, U.S.A
| | - Elizabeth Handorf
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, U.S.A
| | - Ellis Arjmand
- Department of Surgery (Otolaryngology), Texas Children's Hospital, and the Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Hughes CA, McMenamin P, Mehta V, Pillsbury H, Kennedy D. Otolaryngology workforce analysis. Laryngoscope 2016; 126 Suppl 9:S5-S11. [PMID: 27576957 DOI: 10.1002/lary.26238] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/07/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The number of trained otolaryngologists available is insufficient to supply current and projected US health care needs. The goal of this study was to assess available databases and present accurate data on the current otolaryngology workforce, examine methods for prediction of future health care needs, and explore potential issues with forecasting methods and policy implementation based on these predictions. STUDY DESIGN Retrospective analysis of research databases, public use files, and claims data. METHODS The total number of otolaryngologists and current practices in the United States was tabulated using the databases of the American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Board of Otolaryngology, American College of Surgeons, Association of American Medical Colleges, National Center for Health Statistics, and Department of Health and Human Services. Otolaryngologists were identified as surgeons and classified into surgical groups using a combination of AMA primary and secondary self-reported specialties and American Board of Medical Specialties certifications. Data gathered were cross-referenced to rule out duplications to assess total practicing otolaryngologists. Data analyzed included type of practice: 1) academic versus private and 2) general versus specialty; and demographics: 1) urban versus rural, 2) patient age, 3) reason for visit (referral, new, established, surgical follow-up), 4) reason for visit (diagnosis), and 5) payer type. RESULTS Analysis from the above resources estimates the total number of otolaryngologists practicing in the United States in 2011 to be 12,609, with approximately 10,522 fully trained practicing physicians (9,232-10,654) and 2,087 in training (1,318 residents and 769 fellows/others). Based on 2011 data, workforce projections would place the fully trained and practicing otolaryngology workforce at 11,088 in 2015 and 12,084 in 2025 unless changes in training occur. The AAO-HNS Physicians Resource Committee performed an extensive analysis of collated data from multiple sources in 2014 and identified 10,800 practicing otolaryngologists and 2,087 in training. It is estimated that the current attrition rate is approximately 306 otolaryngologists per year. Percentage distribution of office visits by patient age was found to be 20% <15 years old, 7% 15 to 24 years old, 21% 25 to 44 years old, 32% 45 to 64 years old, 11% 65 to 74 years old, and 10% ≥75 years old. Reason for visit was 34% new, 29% chronic, 17% chronic with exacerbation, and 15% pre- or postsurgical follow-up. The top diagnoses consisted of otitis media, chronic sinusitis, and impacted cerumen. Payer mix consisted of 59% private insurance, 19% Medicare, and 12% Medicaid/Children's Health Insurance Program. CONCLUSIONS Despite past findings and predictions of 8,000 to 8,500 otolaryngologists practicing in the United States, collated data from above resources places the total at 12,887, with 10,800 fully trained and practicing in 2014. This 30% to 50% underestimation of the otolaryngology workforce has an impact on future predictions and resource utilization analysis. Even when this correction is considered, the available trained otolaryngologists required to serve the otolaryngologic health care needs of the US population are still insufficient and understaffed. The impact of an aging population and the estimated 30 to 47 million newly insured citizens under the 2010 Patient Protection and Affordable Care Act are also unprecedented variables that must be considered. Further analysis of differences in physician productivity and geographic population density, and model formation of current otolaryngology workforce utilization, are needed to predict future public health needs. LEVEL OF EVIDENCE NA Laryngoscope, 126:5-11, 2016.
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Affiliation(s)
- Charles Anthony Hughes
- Departments of Otolaryngology of the Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | | | - Vikas Mehta
- Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, U.S.A
| | - Harold Pillsbury
- University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - David Kennedy
- University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Paydarfar JA, Gosselin BJ, Tietz AM. Improving Access to Head and Neck Cancer Surgical Services through the Incorporation of Associate Providers. Otolaryngol Head Neck Surg 2016; 155:723-728. [DOI: 10.1177/0194599816647945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/13/2016] [Indexed: 11/17/2022]
Abstract
Objective The urgent nature of head and neck cancer referrals often results in overbooked schedules, access delays, and patient, physician, and staff dissatisfaction. The goal of this study is to examine how incorporation of associate providers (APs) into a head and neck tumor clinic (HNTC) can improve access. Methods Scheduling data for the Dartmouth-Hitchcock HNTC 2 years prior (January 2011 to December 2012) and 2 years subsequent (January 2013 to December 2014) to program initiation were abstracted, including number of new patients seen per month, third available for new and established patients, overbooked hours, surgeon productivity, and patient satisfaction scores. Results New patients seen per month increased from 44 ± 4 to 60 ± 5 ( P < .001). Third available for new patients decreased from 56 ± 4 to 27 ± 2 days and from 43 ± 3 to 35 ± 2 days for follow-ups ( P < .001). Overbooked hours decreased from 14.7 ± 3.1 to 8.6 ± 1.7 hours ( P < .001). Surgeon productivity remained stable (109% ± 11% vs 113% ± 6%, P = .56). Patient satisfaction in seeing APs versus surgeons was comparable (94 ± 2 vs 94 ± 3, P = .79). Discussion Incorporation of APs into the HNTC increases the number of new patients seen by the surgeon, decreases wait times for all appointments, and decreases overbooking while maintaining patient satisfaction and surgeon productivity. Implications for Practice AP incorporation significantly improves access to head and neck surgical services. With improved access, new cancer patients could start treatment sooner, potentially affecting outcome.
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Affiliation(s)
- Joseph A. Paydarfar
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Benoit J. Gosselin
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Annette M. Tietz
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Vickery TW, Weterings R, Cabrera-Muffly C. Geographic Distribution of Otolaryngologists in the United States. EAR, NOSE & THROAT JOURNAL 2016. [DOI: 10.1177/014556131609500607] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a study to determine the demographic traits, training characteristics, and geographic distribution of otolaryngologists in the United States using publicly available data. We then correlated our findings with U.S. census data. Univariate analysis was performed to analyze results, with a p value of < 0.05 determined as significant. We used data from the American Board of Otolaryngology's list of 18,587 board-certified allopathic otolaryngologists through 2013 and the American Osteopathic Colleges of Ophthalmology & Otolaryngology–Head & Neck Surgery's list of 428 osteopathic otolaryngologists. From these two databases, 9,642 otolaryngologists met inclusion criteria, which included an active practice in the United States and an age of 70 years and younger. This group was made up of 8,185 men (84.9%) and 1,449 women (15.0%); we were not able to identify the sex of 8 otolaryngologists (0.1%). The median age of the women was significantly lower than that of the men (54 vs. 48 yr; p < 0.001). A total of 8,510 otolaryngologists (88.3%) graduated from a U.S. allopathic medical school, and 8,520 (88.4%) graduated from a U.S. allopathic residency program. We determined that 25.9% of otolaryngologists established their practice in the same metropolitan statistical area where they completed their residency training. Older practitioners (p < 0.001) and women (p < 0.001) were significantly more likely to stay in the same area than younger physicians and men. In terms of population, 61.8% of the otolaryngologists practiced in metropolitan areas with more than 1 million residents; by comparison, these areas represent only 55.3% of the total U.S. population, indicating that otolaryngologists are over-represented in larger U.S. cities.
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Affiliation(s)
- Thad W. Vickery
- Department of Otolaryngology, University of Colorado
School of Medicine, Aurora
| | - Robbie Weterings
- Department of Natural Resources and Environment,
Naresuan University, Phitsanulok, Thailand
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Lin J, Kacker A, Trujillo O, Stewart MG. Status and trends of general otolaryngology in academia. Laryngoscope 2015; 126:1995-8. [DOI: 10.1002/lary.25825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Jiahui Lin
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Columbia University Medical Center; New York New York U.S.A
| | - Ashutosh Kacker
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
| | - Oscar Trujillo
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Columbia University Medical Center; New York New York U.S.A
| | - Michael G. Stewart
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
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Okera N, Escabasse V, Coste A, Albers AE. ORL residency in France: Satisfaction and training quality in 2013. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:327-32. [PMID: 26403653 DOI: 10.1016/j.anorl.2015.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the quality of ORL training in France and hierarchical relationships, working conditions and quality of life, based on a questionnaire answered by ORL residents and fellows. MATERIAL AND METHODS The anonymous questionnaire covered the following topics (106 questions): structure of training, supervision by superiors, involvement in teaching medical students, work for publication, working conditions, quality of life and practical and surgical skills. RESULTS One hundred and seventeen questionnaires were included, with 56% female respondents and 78% resident respondents. A total of 80% of respondents would choose the same training again, with overall satisfaction of 70%. In total, 71% felt appreciated, with responsibilities matching their level of training (85%). Supervisors were supportive (85%) and showed good teaching ability (92%). Residents were mainly guided by fellows (70%), or consultants (60%). Providing good training was an important aim for the training structures (78%). Respondents worked 11 hours per day, with a median of 4 duties per month; the post-duty rest-day was fully respected in the case of 38% of respondents. Surgical procedures were taught and delegated step by step, shared fairly between residents, in a large majority of cases. Training progression was in line with seniority. CONCLUSIONS Overall satisfaction, quality and supervision of ORL training were good in France. There remain geographical differences in terms of theoretical and surgical training.
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Affiliation(s)
- N Okera
- Département d'otorhinolaryngologie, chirurgie cervico-faciale, maxillo-faciale et plastique, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris Diderot, UFR de médecine Paris VII - Denis Diderot, France
| | - V Escabasse
- Service d'otorhinolaryngologie, stomatologie et chirurgie cervico-faciale, Hôpital intercommunal de Créteil, 40, rue Verdun, 94000 Créteil, France; Université Paris Est Créteil Val-de-Marne, Unité Inserm 955, France
| | - A Coste
- Service d'otorhinolaryngologie, stomatologie et chirurgie cervico-faciale, Hôpital intercommunal de Créteil, 40, rue Verdun, 94000 Créteil, France; Université Paris Est Créteil Val-de-Marne, Unité Inserm 955, France
| | - A E Albers
- Klinik für Hals- Nasen-, Ohrheilkunde, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
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Smith KA, Sommer DD, Grondin S, Rotenberg B, Tewfik MA, Kilty S, Wright E, Janjua A, Lee J, Diamond C, Rudmik L. Assessment of the current Canadian rhinology workforce. J Otolaryngol Head Neck Surg 2015; 44:15. [PMID: 25956996 PMCID: PMC4432821 DOI: 10.1186/s40463-015-0070-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/29/2015] [Indexed: 11/16/2022] Open
Abstract
Background The Canadian Rhinologic workforce and future needs are not well defined. The objective of this study was to define the current demographics and practice patterns of the Canadian Rhinologic workforce. Outcomes from this study can be used to perform rhinologic workforce needs assessments. Methods A national survey was administered to all Canadian otolaryngologists who were identified to have a clinical practice composed of >50% rhinology. Results 42 surgeons participated in the survey (65% response rate). The mean age was 46 (SD 10.1) years and the average age of planned retirement was 66 (SD 4.0). Eighty three percent of respondents had completed a rhinology fellowship and 17% practiced exclusively rhinology. Thirty three percent hold advanced degrees. Forty two percent of surgeons felt their access to operative time was insufficient. Six percent of surgeons reported not having access to image guided surgery. Fourteen percent felt that there were too many practicing rhinologists in Canada while 17% believed there were too few practicing rhinologists. Seventeen percent have advised their residents to pursue other fields due to a perceived lack of future jobs. Overall, 66% of respondents were satisfied with their income, and 83% were satisfied with their careers. Conclusions This study has demonstrated that there is a perceived mismatch between the current supply of Rhinology labor and the capacity to treat patients in a timely manner. Outcomes from this study will begin to improve Rhinologic workforce planning in Canada and reduce the gap between patient demand and access to high quality care.
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Affiliation(s)
- Kristine A Smith
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, Alberta, Canada.
| | - Doron D Sommer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Sean Grondin
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
| | - Brian Rotenberg
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
| | - Marc A Tewfik
- Department of Otolaryngology, Head and Neck Surgery; McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Shaun Kilty
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Erin Wright
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Arif Janjua
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - John Lee
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Chris Diamond
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Luke Rudmik
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, Alberta, Canada.
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Gruca TS, Nam I, Tracy R. Reaching rural patients through otolaryngology visiting consultant clinics. Otolaryngol Head Neck Surg 2014; 151:895-8. [PMID: 25281751 DOI: 10.1177/0194599814553398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Providing otolaryngology care to rural populations is a major challenge. In this study, we focus on rural outreach by the otolaryngology workforce in Iowa, a state with a high proportion of rural residents. Using data from 2013, we find that almost half (46%) of Iowa-based otolaryngologists participate in outreach. Along with colleagues from adjoining states, Iowa otolaryngologists staffed more than 2100 in-person clinic days in 76 mainly rural sites. This system of rural outreach has expanded access from 20 to 85 of the 99 counties in Iowa. These efforts improve access for more than 1 million residents out of a total population of 3 million. However, this improved level of access comes at a cost as visiting otolaryngologists drove an estimated 17,000 miles per month. This established approach to serving rural patients may be negatively impacted by changes under the Affordable Care Act.
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Affiliation(s)
- Thomas S Gruca
- Tippie College of Business, University of Iowa, Iowa City, Iowa, USA
| | - Inwoo Nam
- College of Business and Economics, Chung-Ang University, Seoul, South Korea
| | - Roger Tracy
- Office of Statewide Clinical Education Programs, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Gooi Z, Gourin CG, Boahene KDO, Byrne PJ, Richmon JD. Temporal trends in head and neck cancer surgery reconstruction. Head Neck 2014; 37:1509-17. [DOI: 10.1002/hed.23786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/14/2014] [Accepted: 05/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
- Armstrong Institute for Patient Safety and Quality; Johns Hopkins University; Baltimore Maryland
| | - Kofi D. O. Boahene
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Patrick J. Byrne
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Jeremy D. Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
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Van Buren NC, Groen RS, Kushner AL, Samai M, Kamara TB, Ying J, Meier JD. Untreated Head and Neck Surgical Disease in Sierra Leone. Otolaryngol Head Neck Surg 2014; 151:638-45. [DOI: 10.1177/0194599814542587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Demonstrate how the Surgeons OverSeas Assessment of Surgical Need (SOSAS) can be used to determine the burden of head and neck (H&N) surgical disease in developing countries and identify reasons for untreated disease. Study Design Cluster randomized, cross-sectional, countrywide survey. Setting Sierra Leone. Subjects and Methods The survey was administered to 75 of 9671 enumeration areas in Sierra Leone between January 9 and February 3, 2012, with 25 households in each cluster randomly selected for the survey. A household representative and 2 randomly selected household members were interviewed. Need for surgical care was based on participants’ responses to whether they had an H&N condition that they believed needed surgical care. Results Of 1875 households, data were analyzed for 1843 (98%), with 3645 total respondents. Seven hundred and one H&N surgical conditions were reported as occurring during the lifetime of the 3645 respondents (19.2%).The current prevalence of H&N conditions in need of a surgical consultation was 11.8%. No money (60.1%) was the most common reason respondents reported for not receiving medical care. A bivariate analysis demonstrated that age, village type, education, and type of condition may be predictors for seeking health care and/or receiving surgical care. Conclusions These results show limited access for patients to be evaluated for a potential H&N surgical condition in Sierra Leone. The true incidence of untreated surgical disease is unknown as most respondents were not evaluated by a surgeon. This survey could be used in other countries as health care professionals assess surgical needs throughout the world.
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Affiliation(s)
- Nicholas C. Van Buren
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reinou S. Groen
- Surgeon OverSeas, New York, New York, USA
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Adam L. Kushner
- Surgeon OverSeas, New York, New York, USA
- Department of Surgery, Columbia University, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohamed Samai
- College of Medicine and Allied Health Science, Freetown, Sierra Leone
| | - Thaim B. Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Jian Ying
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Pryor SP, Brodsky L, Chandrasekhar SS, Zaretsky L, Taylor DJ, Yaremchuk KL, Pillsbury HC. Commentary on "Otolaryngology-head and neck surgery physician workforce issues an analysis for future specialty planning" by Kim, Cooper, and Kennedy. Otolaryngol Head Neck Surg 2014; 146:203-5. [PMID: 24436482 DOI: 10.1177/0194599811433979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An impending physician shortage has been projected. The article by Kim, Cooper, and Kennedy, titled "Otolaryngology-Head and Neck Surgery Physician Workforce Issues: An Analysis for Future Specialty Planning," is an attempt to evaluate and address this potential shortage as it applies to otolaryngology. The authors of this comment have concerns about the article's assumptions, design, and recommendations. Kim et al attempt to extrapolate data from other specialties and other countries to the US otolaryngology workforce, use that data in modeling methods without demonstrated validity, and based on their analysis, they recommend drastic changes to otolaryngologic training and practice in the United States. Particularly troublesome are (1) the emphasis placed on gender and part-time work and (2) the measurement of productivity defined as hours worked per week. Before redefining our specialty, more thorough and systematic data acquisition and review are necessary to meet the needs of our patients now and in the future.
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Abstract
Objectives: We describe the incidence of chronic laryngitis (CL) and identify the most common presenting symptoms and initial treatments used. Methods: We retrospectively identified patients with a diagnosis of CL who were seen among a primary care cohort at an urban academic medical center from 2009 to 2010. The incidence of CL was calculated. Symptoms, first-visit treatment, smoking, and demographics were recorded. Results: Of a population of 40,317 people, 280 received a new diagnosis of CL over a 2-year period, representing a yearly incidence of 3.47 cases per 1,000 people. The subjects consisted of 160 women and 120 men. Race was recorded as black (126), Hispanic (47), white (68), or other (39). The mean age was 52.9 years (range, 20 to 90 years). The initial therapies included proton pump inhibitors (79%), voice therapy (17%), nasal steroid (13%), antihistamine (4%), amitriptyline (4%), other (17%), and none (11%). The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases. Conclusions: The yearly CL incidence was 3.47 per 1,000 people. Up to 21% of the population may develop CL in their lifetime. Most of the patients in this cohort were referred to otolaryngologists, and the majority were treated with proton pump inhibitors. Dysphonia, globus sensation, and pain were the most common symptoms. Population surveys could be used to define undiagnosed disease and the overall prevalence of CL.
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Rosenberg TL, Kelley K, Dowdall JR, Replogle WH, Liu JC, Raol NP, Zafereo ME. Section for residents and fellows-in-training survey results. Otolaryngol Head Neck Surg 2013; 148:582-8. [PMID: 23396591 DOI: 10.1177/0194599813477353] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To present data from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Section for Residents and Fellows-in-Training (SRF) annual survey from 2002 to 2011. (2) To compare and analyze trends in resident demographics, residency experiences, and post-training career choices. STUDY DESIGN Review of cross-sectional survey data. SETTING Residents and Fellows registered as Members-in-Training through AAO-HNS. METHODS A review of data from surveys distributed between 2002 and 2011 was conducted. Respondent demographic data including age, postgraduate year, gender, and geographic distribution were analyzed. Responses about training experiences, fellowship selection, debt burden, and post-training practice choice were studied in order to elicit trends. RESULTS Respondents have consistently rated otolaryngology, anesthesia, and trauma/critical care as the most important intern rotations for otolaryngology residents. Each year, approximately 70% of respondents have reported interest in pursuing a fellowship. Pediatric otolaryngology fellowship is now the most popular fellowship among respondents. There has been a recent increase in the percentage of respondents who are interested in pursuing a career in academics. Location, family, and lifestyle have consistently been the most important factors in determining choice of practice. Respondents have reported increasing levels of educational debt. CONCLUSION The AAO-HNS SRF survey collects important data regarding resident/fellow training. Several factors limit the generalizability of these results. Despite its limitations, these unique data provide valuable information for continual evaluation and improvement of physician training in the specialty.
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Affiliation(s)
- Tara L Rosenberg
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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Kennedy DW. Otolaryngology workforce planning: why we cannot wait for perfect data. Otolaryngol Head Neck Surg 2012; 147:399. [PMID: 22851281 DOI: 10.1177/0194599812449115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bhattacharyya N. Characteristics and Trends in Ambulatory Otolaryngology Visits and Practices. Otolaryngol Head Neck Surg 2012; 147:1060-4. [DOI: 10.1177/0194599812456956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To determine characteristics and trends for outpatient otolaryngology visits and practices in the United States. Study Design Cross-sectional analysis of national survey database. Setting Ambulatory care settings in the United States. Methods Outpatient otolaryngology records from 2005 to 2009 were extracted from the National Ambulatory Medical Care Survey. Visit characteristics were assessed for patient type (established versus new), expected source of payment, and average time spent with the physician. Provider characteristic variables were assessed for practice type (solo versus group), employment status of the physician, electronic claims submission, and the use of electronic medical records in the practice. Trends were analyzed for the above and the average number of outpatient visits per otolaryngologist per year. Results A total of 98.8 ± 7.0 million outpatient otolaryngology office visits, consisting of 27.9 ± 2.1 million new patient visits and 70.9 ± 5.3 million established patient visits, were studied. Expected sources of payment consisted of private insurance (65.1%), Medicare (21.1%), Medicaid (9.2%), and self-pay (2.0%). These sources did not change over the 5 calendar years ( P = .301). Practitioners consisted of solo (30.7%) and group (69.3%) practices. Electronic medical records were in use in 40.2%. Electronic medical record penetration did significantly increase over the 5 years to 57.7% in 2009 ( P = .002). The number of outpatient visits per otolaryngologist per year remained remarkably consistent over the years at about a mean of 3325 ± 299 visits seen per year ( P = .580). Conclusion Characteristics of otolaryngology outpatient visits have remained largely consistent over the past 5 years. Electronic medical record penetration has noticeably increased. These results help validate prior Academy socioeconomic surveys.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women’s Hospital, and the Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Pryor SP, Yaremchuk KL, Brodsky L, Chandrasekhar SS, Zaretsky L, Pillsbury HC, Taylor DJ. Response to “A Call for Future Adequacy of the Otolaryngology–Head and Neck Surgery Workforce” from Richard A. Cooper. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812448163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Kathleen L. Yaremchuk
- Chair, Department of Otolaryngology, Sleep Medicine and Vice President, Clinical Practice Performance, Henry Ford Health System, Detroit, Michigan, USA
| | - Linda Brodsky
- ENT Associates PLLC and Expediting the Inevitable, Amherst, New York, USA
| | - Sujana S. Chandrasekhar
- New York Otology, New York, New York, USA Mount Sinai School of Medicine, New York, New York, USA
| | - Lauren Zaretsky
- Otolaryngology Associates of Long Island, Port Jefferson, New York; Stony Brook University, School of Medicine, Department of Surgery, Division of Otolaryngology, Stony Brook, New York, USA
| | - Harold C. Pillsbury
- Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery and Professor and Chair, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill–School of Medicine, Chapel Hill, North Carolina, USA
| | - Duane J. Taylor
- Le Visage ENT & Facial Plastic Surgery, Bethesda, Maryland, USA
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