2017 HSC Section 2 - Practice Management

To deduce future workforce numbers, this average number of 10,522 completely trained otolaryngologists in 2011 was extrapolated by using the Clinical Specialty Supply Model formula. Using this formula, Ct 5 C0 1 Ent 2 ( C0 3 A0 ), where Ct represents the projected cli- nician supply, C0 represents the current supply of clini- cians, Ent represents the number of new trainee entrants, and A0 represents the attrition rate, this extrapolation gives 11,088 trained otolaryngologists in 2015 and 12,084 trained otolaryngologists in 2025. The 2014 findings of the AAO-HNS PRC estimated practicing otolaryngologists in the United States at approximately 10,800, with an additional 1,318 residents and 769 fel- lows (AAO-HNS Physicians Resource Committee, Sep- tember 20, 2014, personal communication not subject to external validation). The difference in these numbers illustrates the complexity and difficulty of forecast meth- ods and highlights that multiple forecast methods with accurate baseline data are necessary to predict and pre- pare for future workforce needs. In 2015 otolaryngology matched 299 residents; if this remains stable, we would have 1,495 residents in training. Fellowships are also increasing. The 2014 attri- tion rate, based on available data, was estimated at 316 per year, an increase from 2011 estimates of 256 per year (September 20, 2014). There is debate as to what is a suf- ficient number of practicing US otolaryngologists. The current 10,800 otolaryngologists (1:27,000 population) is low compared to other countries and to current and future forecasted needs of the US population (AAO-HNS Physicians Resource Committee, May 20, 2015, personal commuication not subject to external validation). These numbers were essentially stabilized by the Congressional Budget Act of 1997, which froze graduate medical education (GME) funding. There is currently much debate on this subject, and changes to otolaryngol- ogy programs have occurred. According to the 2014– 2015 ACGME data book, there are 106 ACGME otolar- yngology training programs, with a total of 1,506 resi- dents in training. Additionally, they recognize 28 neurotology fellows and 34 pediatric otolaryngology fel- lows. The otolaryngology match matched 299 residents in 2015 and 302 residents in 2016. 4 Current Otolaryngology Demographics Current otolaryngology demographics databases were reviewed. The ACS Health Policy Research Insti- tute (HPRI) data were found to be the most comprehen- sive. According to the ACS HPRI reports, the number of otolaryngologists in active practice in the United States (excluding residents in training) increased 60% between 1981 and 2009. However, the ratio of otolaryngologists per 100,000 population increased from 1981 until 2001, was stable between 2001 and 2006, and then began to decline between 2006 and 2009. According to ACGME data, from 2001 to 2009, the number of otolaryngology residents in training increased by 23%, although the number of otolaryngology training programs remained at 103 during this period. 5 We do not find this increase in ABO and AAO-HNS data and are unclear as to the accuracy of these data.

However, even if this increase is considered, the data- bases agree that geographic distribution has become more challenging in that between 2004 and 2009, one in five US counties lost otolaryngologists relative to population. 6 The representative age and gender distribution of the otolaryngology workforce has also changed over time. In 2009, the average age of otolaryngologists in active practice was 51.4 years, with 15.1% older than 65 years. This represents a > 4% increase compared to 1981 (10.8%). Women have been increasingly entering the oto- laryngology workforce since 1981, with the number of female otolaryngologists increasing from 111 to 1,158. However, men continue to account for the majority of otolaryngologists (88.4%). 7 Otolaryngology practice demographics have also continued to change. The proportion of the otolaryngolo- gist workforce in group practice increased from 37.8% in 2001 to 53.4% in 2009. In 2001, slightly more than 30.1% of otolaryngologists were in solo practice com- pared with 25.1% in 2009. The percentage of otolaryng- ologists employed by health maintenance organizations, nonhospital government, and other entities also declined substantially between 2001 and 2009. Additionally, with- in this timeframe, otolaryngologists in solo practices were found to be 6.7 years older than otolaryngologists in group practice. 8 Current Otolaryngology Practice According to the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey, in 2010 there were an estimated 20 million visits to non- federal, employed, office-based otolaryngologists in the United States. Percentage distribution of office visits by patient age was 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 con- sisted of 59% private insurance, 19% Medicare, and 12% Medicaid/Children’s Health Insurance Program. The 2014 AAO-HNS PRC looked at socioeconomic data from a number of sources to illustrate current prac- tice. These findings suggest that the average practicing otolaryngologist in the United States is a 52-year-old man (84% male vs. 16% female), who works 51 hours per week for 48 weeks per year (2,448 hr/yr) and plans to retire at age 68 years. He works 30.0 hours in the office and 11.4 hours in the operating room or roughly 3.8 days in the clinic, 1.4 days in the operating room (AAO-HNS Physi- cians Resource Committee, May 20, 2015, personal com- munication not subject to external validation). Other statistics include: new patients/wk, 26.4 (median); established patients/wk, 49.5 (median); aver- age wait for new appointment, 2.0 weeks (median); 8.5% intend to retire within 3 years (up from 6.9% in 2011); 3% intend to close their practice to new patients; 23% intend to increase patient load; and there are twice as many female otolaryngologists who are < 45 years old (25%) than are > 45 years old (12%).

Hughes et al.: Otolaryngology Workforce Analysis

Laryngoscope 126: October 2016

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