2017 HSC Section 2 - Practice Management

Reprinted by permission of Laryngoscope. 2016; 126 Suppl 9:S5-S11.

The Laryngoscope V C 2016 The American Laryngological, Rhinological and Otological Society, Inc.

TRIOLOGICAL SOCIETY CANDIDATE THESIS

Otolaryngology Workforce Analysis

Charles Anthony Hughes, MD, MBA, MPH; Patrick McMenamin, MD; Vikas Mehta, MD; Harold Pillsbury, MD; David Kennedy, MD

Objectives/Hypothesis: The number of trained otolaryngologists available is insufficient to supply current and pro- jected 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 fore- casting 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 Otolaryngol- ogy, 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 resi- dents and 769 fellows/others). Based on 2011 data, workforce projections would place the fully trained and practicing otolaryn- gology 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 otolar- yngologists 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 sinus- itis, 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. Key Words: Public heath, otolaryngology workforce, physician shortage, resident training, specialty planning, physician supply, health care reform. Level of Evidence: NA Laryngoscope , 126:S5–S11, 2016 From the Departments of Otolaryngology of the Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas ( C . A . H .); Aiken ENT, Aiken, South Carolina ( P . M .); Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana ( V . M .); University of North Carolina, Chapel Hill, North Carolina ( H . P .); and University of Pennsylvania, Philadelphia, Pennsylvania ( D . K .), U.S.A. Editor’s Note: This Manuscript was accepted for publication June 28, 2016. This article was accepted as a Triological Society Thesis under the sponsorship of Stil Kountakis, MD, PhD and David Terris, MD. This article is a synthesis of years of work and the efforts of many people. The subject of workforce analysis is a complex issue. The task of defining a point in time for a moving target and of digesting both objective data and subjective opinions on what is most relevant and important is difficult at best. In 2014, the American Academy of Otolaryngology–Head and Neck Surgery Physicians Resource Committee led by David Kennedy, MD completed an analysis of practicing US otolaryngologists. The findings of this committee as well as the findings of “Triological Society Thesis: Otolaryngology Workforce 2015, Public Health Resource Requirements” by C . A . H . are presented in this article. We hope this document accomplishes the desired goal of establishing an accurate and meaningful baseline and a tool for future discussion and analysis. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Charles Anthony Hughes, Texas Children’s Hospital, Suite D.620, 6701 Fannin Street, Houston, TX 77030. E-mail: cahughes@bcm.edu

DOI: 10.1002/lary.26238

Hughes et al.: Otolaryngology Workforce Analysis

Laryngoscope 126: October 2016

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