So how do we all coexist and thrive in what feels like a fish bowl with limited resources and surgical patients? To compete with the academic groups in town, many super groups are actively hiring their own subspecialists, keeping many of the tertiary cases that the academic groups rely on to train their residents and fellows. Academic groups, needing the clinical revenue to fund research and educational activities that don’t fund themselves, end up hiring generalists to compete with the private practitioners for primary care referrals. Instead of working together, in many regions the academic and super groups are in direct competition with each other, further fragmenting the otolaryngology community.
Otolaryngologists and their departments are leaders in many of the academic medical centers across the country. The faculty serve as role models for the best and brightest of students, and those same people are becoming driven residents and practitioners who are changing our specialty. But many of these high-achieving students end up becoming attending otolaryngologists who choose to stay in urban environments or go on to fellowship and eventually join a super group or academic practice.
As a result, rural and small group practices have a hard time recruiting and, because of their size, often get the squeeze from insurers. Many of these practices are vital to the communities they serve, and they enjoy the autonomy of running their own practice. Now, they’re at risk. Where do they best fit in this fish bowl?
I’m optimistic that the academy’s focus on the business of medicine will help all of us out—decreasing the need for pre-authorizations and fighting for greater reimbursement will benefit all practitioners. But we haven’t yet addressed the workforce issue. Is private equity good for our specialty? Are academic and super groups getting too big? Why aren’t we focusing on rural practices and encouraging some residencies to have rural health tracks? And when the future points to us being a less surgical-heavy specialty—biologics for sinus inflammatory disease are on the rise, immunotherapy is gaining traction in head and neck cancer, there are improvements in hearing aid technology, and the scope of audiologists is increasing—are we selecting the right medical students who will adapt comfortably to this new future? Will they have the research acumen and drive to improve our specialty but possess the same passion for a specialty that may be less surgical and more medical?
These are tough questions, and I’m not sure who has the answers. But when I think of the future of otolaryngology, this is what weighs heavily on my mind. Thanks for reading, and stay safe.