How Underfunded Graduate Medical Education Programs May Affect Otolaryngology

A paper published in 2012 in Otolaryngology-Head and Neck Surgery (146;196-202) reported an estimated demand of 11,127 otolaryngologists in 2025 based on projected population growth and anticipated increases in insurance coverage and noted that this demand would be met with a supply, based on an average retirement age of 65 and no increase in PGY-1 positions, of only 8,627 otolaryngologists. The authors used American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and National Resident Matching Program datasets, population census data, and historical physician growth demand curves to model their estimates.

Study co-author David W. Kennedy, MD, a rhinology professor at the University of Pennsylvania School of Medicine in Philadelphia, said that since the article was published, a subcommittee of the AAO-HNS Workforce Committee reevaluated data from the AAO-HNS, the AMA, and the American College of Surgeons and found that the number of practicing U.S.-based otolaryngologists is slightly larger than the 8,600 reported in the analysis he and his co-authors conducted in 2011. Taking into consideration population growth, as well as an aging population, however, the total number of otolaryngologists needed by 2025 will likely be greater than anticipated, he said.

“It is likely that even if there is some continued growth in residency training programs, if otolaryngologists delay their average retirement age until the age of 70, and we have success in recruiting mid-level providers into the specialty, we will still have a shortage of otolaryngologists, if the current ratio of otolaryngologists/population is correct,” Dr. Kennedy said. “This prediction is based on the U.S. census estimates of population growth, the anticipated demands of an aging population, and some increase in the insured population. Accordingly, it is unlikely that the specialty will be able to provide the breadth of services that it currently provides moving forward.”

According to data from the Accreditation Council for Graduate Medical Education (ACGME), 65 otolaryngology residency positions have been added in the past five academic years. These increases aren’t enough to expand the number of specialists to meet demand, said Terry T. Tsue, MD, FACS, physician-in-chief of the University of Kansas Cancer Center; Douglas A. Girod, MD, Endowed Professor of Head and Neck Surgical Oncology; and vice chairman of the department of otolaryngology-head and neck surgery, University of Kansas School of Medicine in Kansas City.

Dr. Tsue, who led the ACGME/ABOto committee that developed the Otolaryngology Milestone Project, explained that each residency position is estimated to cost teaching hospitals over $100,000 a year. This includes the cost of paying a resident’s salary coupled with the institutional and program-specific costs of running a training program but doesn’t include faculty salaries. With the federal government providing the bulk of GME funding since Medicare was established in 1965, other mechanisms to fund current and future training in a significant way aren’t adequately in place, he said.