From infectious illnesses in steep decline due to COVID-19 to a new subcertification category, leaders in pediatric otolaryngology discussed trends in the field during an American Society of Pediatric Otolaryngology (ASPO) session at the Combined Otolaryngology Spring Meetings in April. Panelists also delved into workforce issues, the choice between private and academic practice, the importance of involvement in medical societies, and working in rural settings.
Anna H. Messner, MD, chief of pediatric otolaryngology at Texas Children’s Hospital in Houston, ran through a series of slides that put into sharp relief the patterns in childhood illness that have been seen since the COVID-19 shutdown. Patterns for the first several weeks of 2020 mirrored those in 2019 for illnesses such as croup, sinusitis, and the common cold. But when the 10th week of 2020 came around and schools and other routines were shut down, the incidence of these illnesses significantly decreased, according to an analysis of insurance data for 375,000 children in Massachusetts. “They all of a sudden disappeared,” Dr. Messner said. “I mean, it has been truly remarkable, the effects on our practices.”
The question is, what will happen after COVID-19? For one thing, there will probably never be a truly “post-COVID” period, she said, because as COVID-19 becomes controlled in one part of the world, it’s likely to re-emerge in another.
But pediatric otolaryngology practices will likely see an increase in their volume of cases, said Dr. Messner. Many types of cases are mostly unaffected by the pandemic shutdown, such as hearing loss, head and neck congenital anomalies and cancer, cleft care, and sleep disorders. It’s also possible, she said, that incidence of disease will rise due to missed vaccinations. And, after a drop in the birth rate due to the stresses of COVID-19, an increase in births is also likely as the pandemic recedes, even if the pandemic itself doesn’t vanish, she said.
Pediatric otolaryngology practices are already seeing an increase in delayed diagnoses, she said, such as a 3-year-old who isn’t speaking, when previously that case might have presented when the child was 2.
The critical role of daycare, which also often gives rise to the spread of communicable illnesses, also means an increase in volume, said Dr. Messner, although an increased awareness of the importance of hand-washing and other infection-control measures might keep cases down somewhat. “Do I think this will come back? Yes,” she said. “Do I think it will be like pre-COVID? Probably not.”
Gaelyn Garrett, MD, president of the Triological Society and a director of the American Board of Otolaryngology–Head and Neck Surgery, discussed the establishment of subcertification for complex pediatric otolaryngology (CPO). The first written subcertification exam will be held on Nov. 2, 2021.
Certification in this area will be based on medical knowledge of and care for children with complex otolaryngologic disorders, or common otolaryngology disorders in children with a complex slate of comorbidities. A key aspect of CPO is that these children are often best suited for medical or surgical care in tertiary pediatric facilities with interdisciplinary teams, Dr. Garrett said.
Dr. Garrett noted that the subcertification, which will be achievable through either training or appropriate practice, was developed through a “very long but deliberate process. We feel like the end product is very appropriate for members of ASPO and even non-ASPO members,” she said. (For more on the development of CPO subcertification, see “Complex Pediatric Otolaryngology Subcertification” in the August 2020 issue of ENTtoday.)
Dr. Garrett also announced the launch of CertLink, a longitudinal assessment tool to be used in place of a 10-year high-stakes exam for certification and recertification. The program, which launched in February, received good reviews from those participating in the pilot program, she added.
Diego Preciado, MD, PhD, president of ASPO, said there’s a recent trend of pediatric otolaryngology fellowship positions going unfilled in the Match. In 2020, there were 14 unmatched positions, and the number of U.S. graduates applying to pediatric otolaryngology seems to have hit a plateau, while the number of training programs and slots has continued to increase. This was somewhat of a “disruptive event” in the field, he said.
In 2021, while matches weren’t finalized at the time of the presentation, there were only 24 U.S. applicants for 51 fellowship spots, he said. “This trend of unfilled spots may continue and potentially worsen,” Dr. Preciado said. “Whether these are blips or whether these are things that will be sustained into the future remains to be seen.”
The trend is taking shape as the pediatric population in the U.S. is in decline, raising the question of how many pediatric otolaryngologists are needed. “There is a concept of saturation of the workforce that’s pervasive and prevailing,” he said, but he added that predicting workforce needs is a tricky matter.
Mark Persky, MD, past president of the Triological Society and professor of otolaryngology–head and neck surgery at the New York University Grossman School of Medicine in New York City, examined the factors that go into deciding whether to pursue private or academic practice as a pediatric otolaryngologist.
The challenge for me is not to just focus on diseases of the ear in children who are in my office, but to turn and use my strength as a member of these societies to change our world for the better. —Blake Papsin, MD
An academic setting involves more teaching, mentoring, and research, which could be appealing to some physicians, as well as a more stable income source and fewer administrative concerns. Private practice offers greater flexibility and compensation based on work performance, but no guaranteed income, and it tends to involve a more limited internal career path.
“You really have to listen to your inner voice,” Dr. Persky said. “Exactly what do you want to accomplish in your professional lifetime? And you have to be very honest with yourself. Certain issues you have no control over—sometimes you just have to be at the right place at the right time and take advantage of those available opportunities.”
Sigsbee Duck, RPh, MD, the immediate past president of the Triological Society and a solo practitioner in Rock Springs, Wyo., said that rural practice involves remembering that you’re in a small community. When it’s done right, it’s a “unique and fulfilling” opportunity, he said.
He stressed the importance of focusing on local coverage, establishing good relationships for tertiary care, and being honest with yourself about your abilities. “You must realize you live in the same town with all your neighbors,” he said.
Blake Papsin, MD, past president of ASPO and chair of otolaryngology at The Hospital for Sick Children in Toronto, called on his colleagues to reach beyond the confines of their practice and use medical society involvement to make a bigger impact. He pointed to segments of the population who experience food insecurity and have low vaccination rates despite high rates of disease. “I’m challenging everybody to do better,” he said.
Being part of a “big tent” in a society such as the Triological Society can help tackle some of these problems, he said. “The bigger we are, the more shadow we can cast, the more change we can make,” said Dr. Papsin. “The challenge for me is not to just focus on diseases of the ear in children who are in my office, but to turn and use my strength as a member of these societies to change our world for the better.”
Thomas R. Collins is a freelance medical writer based in Florida.