Has Otolaryngology Subspecialization Gone Too Far?

by Tom Collins •

He began his talk with a quote from Byron Bailey, MD, chair emeritus for the department of otolaryngology at the University of Texas Medical Branch in Galveston, who said, “Specialization is a powerful engine for change—our real task is to manage the changes that are occurring in a manner that will lead to safer and more effective patient care.”

“From my perspective, subspecialization in otolaryngology is great for the field,” Dr. Hoffman said. “It advances research and technology, concentrates experience, [and is] great for the patient exposure to focused attention.” One suggestion, he said, would be to keep subspecialties under the otolaryngology umbrella but shorten the length of broad education to allow entry into further specialization earlier.

The Need for Generalists

Gerry Funk, MD, an otolaryngologist who recently joined Grande Ronde Hospital in a small town in Oregon after years with the University of Iowa, noted that, in many parts of the country, good general otolaryngologists are hard to find. “Subspecialization will further increase the divide between initial healthcare encounter and a competent specialist”—meaning a good general otolaryngologist.

Richard Waguespack, MD, clinical professor of otolaryngology at the University of Alabama in Birmingham (UAB) and immediate past president of the American Academy of Otolaryngology-Head and Neck Surgery, who spent 35 years in private practice before returning to the academic world, said that three years ago, approximately 60% of otolaryngologists self-reported as generalists. That number is now at 52%, indicating a trend away from general practice.

From the audience

Otolaryngology clearly was the strongest interest of mine because of the breadth. I think that is one of the major assets of our specialty, and it really draws some of the brightest minds of medical school. A person who wants to be a jack-of-all-trades and is skilled enough to be a jack-of-all-trades is really going to be drawn to otolaryngology.

—Alan Johnson, MD general otolaryngologist, North Dakota

“There is an absolute need for subspecialization,” he said, particularly in the academic community. But the need for generalists cannot be ignored, he said. Patients will often self-refer to a specialist and, in otolaryngology, the physician they seek is a general otolaryngologist. Additionally, he said, “There are going to be communities that just simply, based on population … cannot support subspecialists in the way that we’ve been defining them.” Even in residency training, he said, it’s important to have some exposure to general otolaryngologists as role models.