Has Otolaryngology Subspecialization Gone Too Far?

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CORONADO, CALIF.—As otolaryngology trends toward ever more specialization, a group of veterans in the field discussed the benefits and drawbacks of subspecialties in a panel session at the 2015 Triological Society Combined Sections Meeting held here Jan. 22-24.

One of the panelists, Jeffrey Harris, MD, PhD, chief of otolaryngology-head and neck surgery at the University of California, San Diego, set out to determine whether subspecialization in otolaryngology has led to more and higher quality research. He looked at the number of publications in the field to see whether the amount of research increased in a certain subspecialty area at the time when the subspecialty emerged. He found that, as an overall trend, the number of publications has grown over time but that there wasn’t a specific link between an increase in quantity and the beginning of a subspecialty area.

He looked at publications in the field of physical medicine and rehabilitation, an area of practice in which subspecialization is less predominant, and found a growing number of publications in that field. “Even though there’s much less interest in subspecialization in physical medicine and rehabilitation, they still showed that same graph,” Dr. Harris said. “It’s increasing over time, just like the other ones.”

He also looked at H-index—a measurement of the productivity and citation impact of an individual’s published body of work—and found a paper concluding that fellowship-trained neurosurgeons had a higher H-index than nonfellowship-trained neurosurgeons. So, he said, “there’s a little bit of suggestion through this paper that subspecialization and fellowship training will ultimately result in a higher impact of your papers.”

Also, he said, fellowship training increases the chances that you’ll end up working in a research-rich environment, giving rise to more research with greater influence. Subspecialization has also led to more interest in partnerships from industry, which sees a targeted audience.

Nonetheless, he wasn’t able to draw any definitive conclusions in his research. “I have not been able to determine, without a focused study, that subspecialization can with great certainty increase research productivity [or] the quality or quantity of our research,” he said.

The “Powerful Engine” of Subspecialization

Henry Hoffman, MD, professor of otolaryngology-head and neck surgery at the University of Iowa in Iowa City, who spent two years in private practice before entering academia, culled his own observations and those of others to give an assessment of subspecialization.