Graduating Otolaryngology Residents’ Ideal Practice Expectations: A Longitudinal Analysis

Abstract

Objective Prior literature has indicated that the number of trained otolaryngologists required to meet the need of our growing population may be insufficient. Therefore, identifying trends in the subspecialty composition of future otolaryngology practices will elucidate workforce needs. Study Design One-page anonymous questionnaire. Setting The survey was completed by examinees at the conclusion of their American Board of Otolaryngology–Head and Neck Surgery oral examination from 2011 to 2019. Methods Data included age, gender, fellowship, practice type, and ideal future practice components. Results A total of 2286 examinees were included: 58.1% were male and 57.2% completed a fellowship. Ideal practice specialties included general otolaryngology (19%), rhinology (15%), head and neck (13%), and pediatrics (11%). General and pediatric otolaryngology had a negative correlation over time ( r = −0.81, P = .01, and r = −0.75, P = .03, respectively). An overall 45% of graduates reported 1 ideal practice area ( r = 0.61, P = .10), with a statistically significant decline in the number of ideal practice areas over time ( r = −0.79, P = .018). Men more commonly reported allergy, head and neck, otology, rhinology, and sleep medicine as part of their ideal practice ( P < .05), while women more commonly reported pediatric otolaryngology ( P < .05). There was a higher mean number of ideal practice areas among men than women (2.58 vs 2.1, P < .001). Conclusion There is a growing trend for more specialized otolaryngology practices. The data demonstrate a decline in considering general and pediatrics otolaryngology as part of practices, which portends a gap in access to comprehensive otolaryngology in the future.

Practice Patterns and Career Satisfaction in Recent Head and Neck Oncology Fellowship Graduates

“…H&N physicians whose scope of practice includes a substantial amount of general otolaryngology and those who do not work with residents reported significantly lower agreement scores with job alignment and job satisfaction. Miller et al 3 found that only 19% of all newly fellowship-trained otolaryngologists, including H&N oncologists, planned to include general otolaryngology as part of their practice. However, because of the need to build up a patient base early on and the relatively low reimbursement rates in providing H&N oncologic care, 8 treating general otolaryngology patients may be necessary for young H&N physicians despite the desire to care exclusively for patients with H&N cancer.…”

“…About 58% to 64% of fifth-year otolaryngology residents anticipate advanced training following graduation, and about 13% to 18% of fifth-year residents expect to complete a fellowship in H&N and/or microvascular surgery. 3 , 4 However, for the newly graduated H&N oncology fellow in the current economic climate, there are uncertainties regarding the job application process and career expectations. While most H&N fellowship graduates tend to prefer a career in the academic setting over private practice, 4 this may not be an entirely realistic outcome if there is a limited number of academic positions available.…”

“…Fellowship pursuance in general has also increased since the 1990s, whether out of desire or perceived necessity prior to entering a competitive job market. About 58% to 64% of fifth‐year otolaryngology residents anticipate advanced training following graduation, and about 13% to 18% of fifth‐year residents expect to complete a fellowship in H&N and/or microvascular surgery 3,4 . However, for the newly graduated H&N oncology fellow in the current economic climate, there are uncertainties regarding the job application process and career expectations.…”