2017 HSC Section 2 - Practice Management

INTRODUCTION To produce a health care workforce of sufficient size and skill to meet the US population’s health care needs requires accurate data on the current workforce and a thorough understanding of how changes in the popula- tion and health policy will affect future demand. Accu- rate projections of future health care supply and demand advise stakeholders and policymakers about the implications of expected changes in the health care envi- ronment and allow planned adjustments to be developed, discussed, and implemented. The number of trained oto- laryngologists available is believed to be insufficient to supply current and projected US health care needs. 1,2 Physician workforce planning is essential to ensure an adequate and appropriate supply of well-trained phy- sicians to meet the US population’s future health care needs. Additionally, the impact of an aging population and 47 million newly insured citizens under the Patient Protection and Affordable Care Act (ACA) are unprece- dented variables that will certainly exacerbate this shortage. The goal of this project is to access available data- bases and present accurate data on the current otolaryn- gology workforce, examine methods for prediction of future health care needs, and explore potential issues with forecasting methods and policy implementation based on these predictions. MATERIALS AND METHODS To accurately calculate the current practicing otolaryngolo- gy workforce, the total number of practicing otolaryngologists and current practices in the United States were tabulated using a number of research databases, public use files, and claims data. Research databases included the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), American Medical Association (AMA), American Board of Otolaryngology (ABO), American College of Surgeons (ACS), Association of American Medical Colleges (AAMC), National Center for Health Statistics (NCHS), and Department of Health and Human Serv- ices (HHS). Otolaryngologists were identified as surgeons and classi- fied into surgical groups using a combination of AMA primary and secondary self-reported specialties and American Board of Medical Specialties (ABMS) certifications. This analysis only included active, nonresident, nonfederal surgeons. Active sur- geons are defined as those younger than 80 years who report working in administration, direct patient care, medical research, medical teaching, or other nonpatient care activities, or who have an unclassified activity status. Active surgeons exclude those who are classified as retired, semiretired, tempo- rarily not in practice, or not active for other reasons. Once col- lected, results were cross-tabulated to remove any duplication. These data were obtained in close communication and coopera- tion with the Physicians Resource Committee of the AAO-HNS. These data represent raw numbers and do not reflect productiv- ity, type of practice, location, or age/gender-based analysis. To examine methods for prediction of future health care needs and to validate the best research tools to determine phy- sician workforce issues, demographics, current practices, and future projected public health needs, an extensive review of available literature was performed. Interviews were conducted with leaders from various specialties and disciplines to

understand available tools and their inherent strengths and weaknesses. A review of the available pertinent otolaryngology litera- ture was also performed, and interviews were conducted with leaders within otolaryngology to assess the current state of oto- laryngology. Public use files were utilized to quantify current otolaryngology practice demographics and to help form models for future needs.

RESULTS Current Otolaryngology Workforce

To accurately calculate the current practicing otolar- yngology workforce, the total number of practicing otolar- yngologists and current practices in the United States was tabulated using a number of research databases, pub- lic use files, and claims data. Otolaryngologists were iden- tified as surgeons and classified into surgical groups using a combination of AMA primary and secondary self- reported specialties and ABMS certifications. The results for actively practicing fully trained oto- laryngologists are: AAO-HNS, 10,102 (2010 data), 10,389 (2011 data), 10,800 (2014 data); ABO, 10,136 (2010 data), 10,654 (2014 data); NCHS, 9,989 (2010 data); HHS, 10,067 (2010 data); AMA, 9,882 (2010 data); ACS, 10,002 (2009 data), 10,008 (2011 data); AAMC, 9,232 (2009 data). In 2014, based on the work of the AAO-HNS Physi- cians Resource Committee (PRC), there were 1,318 resi- dents training in 103 Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in the United States, producing 271 trained otolaryngologists per year. In addition to these allopathic programs, 25 otolaryngology residents per year graduate from osteopathic programs, giving a total of 296 fully trained otolaryngologists per year entering the workforce. Based on the original Triological Society thesis, the 2011 AAO-HNS and ABO data appeared to be the most up to date and complete. The AAO-HNS data show 10,389 whereas the ABO data show 10,654 completely trained otolaryngologists in the workforce in 2011. If these two numbers are averaged, the approximate num- ber of trained otolaryngologists in the workforce in 2011 is 10,522. To these numbers one could add the 1,318 res- idents in training and the 769 individuals designated as fellows or others, giving a total of 12,609 active and training otolaryngologists in the workforce in 2011. These numbers do not, however, gauge physician produc- tivity or differences across category of employment (full- time equivalent, full time, or part time), number of patients seen, academic versus private, area distribution (urban vs. rural), and types of surgery done (general vs. fellowship-trained specialty care). The average attrition rate of otolaryngologists is not believed to differ from that of other medical special- ties. The overall annual attrition rate from clinical prac- tice, including estimated death rate, is approximately 1.7% based on the AMA’s Physician Masterfile, 3 which includes data on all physicians who have ever obtained a medical license in at least one US state.

Laryngoscope 126: October 2016

Hughes et al.: Otolaryngology Workforce Analysis

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