2017 HSC Section 2 - Practice Management

health care workforce projections have been unreliable because they are often based upon idealized future deliv- ery systems rather than current identifiable utilization trends. The shortage of physicians is expected to grow as the US population expands and advances in care are realized. This growing population lives longer, suffers from multiple illnesses, and uses more than double the health care services at age 65 years as younger adults. “With looming changes in health care treatments, tech- nology, finance, and delivery, researchers and policy makers must understand that an adequate supply of physicians will have to be achieved both through more efficient health care delivery models and through an increased number of GME training positions . . . . Current attempts at payment and delivery system reform must be complemented with an adequate supply of physicians and other health professionals in primary care and in medical and surgical specialties.” 24 Complex changes such as improving efficiency, reconfiguring the way services are delivered, and mak- ing more effective use of physicians will certainly be required, but an increase in the number of well-trained physicians is also essential. It is estimated that if cur- rent proposals before Congress to lift the cap on the number of residency positions that Medicare partially supports are accepted, an additional 4,000 physicians per year could be trained, an expansion of approximately 15% over current training levels. However, this would only meet 30% of expected shortages. 25,26 If our specialty does not take an aggressive lead in this process, other policy makers may determine our future pathway. If physician supply and use patterns stay the same, the United States is expected to experience a shortage of 124,000 full-time physicians by 2025. 26 To address the predicted shortage, the AAMC recommended an increase in medical school enrollment, although a corresponding number of residency slots for these graduates have yet to be assessed or developed. According to the AMA Wire in 2015, a “record-breaking 20,630 students enrolled in medical school for the first time, contributing to a 25 percent increase in medical school enrollment since 2002. Medical student enrollment in U.S. osteopathic medical schools also increased by 3.5 percent over 2014 enrollment, with 7,025 students enrolling this year, according to the American Association of Colleges of Osteopathic Medicine.” 27 AAMC President and Chief Executive Officer Darrell Kirch, MD stated “these num- bers underscore a dire need for Congress to increase funding for graduate medical education, so students can continue to succeed in training and meet demands . . . . To ensure that we have enough physicians to care for our growing, aging population in the face of a real and sig- nificant doctor shortage in the coming decade, Congress also must increase federal support for residency train- ing . . . . Unless lawmakers act without delay, patients may not have access to the care they need in the future.” 26 Although this increase is necessary, it will not be sufficient to meet predicted patient needs and demand. Simply educating and training more physicians will not

be enough to address these shortages. To be successful, complex changes such as improving efficiency, reconfi- guring the way services are delivered, and making bet- ter use of our physicians will be required. CONCLUSION Despite past findings and predictions of 8,000 to 8,500 otolaryngologists practicing in the United States, this study places the total at 12,609, with 10,522 fully trained and practicing in 2011. The 2014 findings of the AAO-HNS Physicians Resource Committee, September 20, 2014, personal communication not subject to external validation, placed practicing otolaryngologists in the United States at approximately 10,800, with an addi- tional 1,318 residents and 769 fellows. Even when this correction is considered, the avail- able trained otolaryngologists required to serve the oto- laryngologic health care needs of the US population are still insufficient. All current forecast models predict a continued shortage of otolaryngologists to 2025. Policy changes, if instituted, will take a decade to be even par- tially realized. A comprehensive, systematic analysis to assess the current strength of the otolaryngology work- force, the current patient need for otolaryngology serv- ices, and the current infrastructure of health care delivery and patient access is required to make accurate future predictions. To guarantee our ability to deliver quality otolaryngology health care to the US population, we must guarantee an adequate, well-trained workforce supply. This requires we plan appropriately and form the necessary policies to educate our future otolaryngolo- gists. The impact of an aging population and 47 million newly insured citizens under the ACA are unprecedent- ed variables that must be considered. Further analysis of differences in physician productivity and geographic population density are needed to predict future public health needs. Additional model formation of current workforce utilization is also needed to predict the effects of our aging population and the influx of 47 million new- ly insured US citizens. It is imperative that we as a specialty address these issues, because our members and leaders have the best grasp of the pertinent issues and possible solutions. It is our obligation to provide access and serve our patients’ health care needs. We must accept this responsibility for the future of our specialty. Acknowledgment The authors thank the staffs of the AAO-HNS, AMA, ABO, ACS, AAMC, NCHS, HHS, and ACGME for their time and support; the AAO-HNS PRC for its work and support; and Drs. Michael Maves, Paul Rocky, Harold Pillsbury, and David Kennedy for their insights. BIBLIOGRAPHY 1. Cooper RA. There’s a shortage of specialists: is anyone listening? Acad Med 2002;77:761–766. 2. Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2013 to 2025. 2015. Available at: https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_ mmc 5 AAMC-_-ScientificAffairs-_-PDF-_-ihsreport. Accessed on 6 Feb- ruary 2016.

Laryngoscope 126: October 2016

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