Dr. Pensak, immediate past president of the Triological Society, foresees a “financial loggerhead” for academic departments, which increasingly shoulder responsibility for their own financial well-being. His concern: With decreasing reimbursements and increasing workloads, faculty may have less time to devote to scholarly endeavors and non-reimbursable activities such as education and training.
Explore This IssueJanuary 2010
GME funding is not likely to increase any time soon. Even if it does, the current health care reform debate has introduced pressures against training more specialists. Researchers at the Dartmouth Institute for Health Policy in Lebanon, N.H., after studying geographic variation in health care spending, have concluded that more specialists lead to higher health care costs and lower quality, a determination Dr. Cooper said is “fundamentally incorrect.” A 2008 white paper released by the group urged Congress to resist removing limits on GME because training fewer specialists will help hold down future healthcare costs. The phenomenon Dr. Cooper has called “antipathy toward specialists” will likely result in the funding of more primary care residencies than specialist residencies.
All these trends will alter the scope of otolaryngology practice, Dr. Pillsbury said. Physicians may gravitate toward more lucrative procedures, while using physician extenders to deliver more general otolaryngologic care. Otolaryngologists may expand further into areas like allergic disease, where there is also an undersupply of providers. Incorporating treatment of thyroid and parathyroid disease, performing more skull base surgery, and treating head and neck cancer are all well within the realm of the trained otolaryngologist. Dr. Pillsbury advised his colleagues to remember that “your value is not because you’re the great surgeon. It’s because you’re the great diagnostician. We have a specialty that’s well defined because of one thing—that is, the capacity to do a competent head and neck exam. Our specialty will continue to evolve, as it has for the past 112 years.”