Reaching rural patients through otolaryngology visiting consultant clinics.

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.

Commentary on "Otolaryngology-head and neck surgery physician workforce issues an analysis for future specialty planning" by Kim, Cooper, and Kennedy.

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.

Otolaryngology-head and neck surgery physician work force issues: an analysis for future specialty planning.

OBJECTIVE: To predict future trends in the otolaryngology workforce and propose solutions to correct the identified discrepancies between supply and demand. STUDY DESIGN: Economic modeling and analysis. SETTING: Data sets at national medical and economic organizations. SUBJECTS AND METHODS: Based on current American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and National Residency Matching Program data sets, population census data, and historical physician growth demand curves, the future otolaryngology workforce supply and demand were modeled. Adjustments were made for projected increases in mid-level providers, increased insurance coverage, and the potential effects of lifestyle preferences. RESULTS: There are currently approximately 8600 otolaryngologists in the United States. Estimated demand by 2025 is 11,127 based on projected population growth and anticipated increase in insurance coverage. With an average retirement age of 65 years and no increase in PGY-1 positions for the specialty, the number of otolaryngologists in 2025 will be approximately 2500 short of projected demand. This shortfall will not be adequately compensated by mid-level providers performing less intensive services and may be increased by lifestyle preferences and changing demographics among medical students and residents. The current geographic maldistribution of otolaryngologists is likely to be exacerbated. CONCLUSION: The specialty needs to actively plan for the coming otolaryngologist shortage and train mid-level providers within the specialty. Failure to plan appropriately may result in a reduction in scope of practice of high-intensity services, which will likely remain a physician prerogative. Given the limited likelihood of a significant increase in residency slots, strong consideration should be given to shortening the base otolaryngology training program length.