Dr. Sims has eloquently identified the value of diversity not only in otolaryngology, but also its contribution to the strength of the U.S. as a nation. Drs. Kuppersmith and Thomas have responded to his editorial indicating steps that the AAO-HNS has taken and is currently taking to increase diversity.
First, I would like to point out that this is not just an Academy issue. Yes, the Academy is the largest membership organization in the specialty, and is representative of all otolaryngologists. That said, we cannot lay correction of diversity issues only at the feet of the Academy. Diversity is an issue that all of us as individuals, as physicians, as members of a variety of organizations, and as Americans should address at all levels.
To me, the solution to this issue is multi-phased and begins early in life with caring parents who provide a nurturing home with an emphasis on education and achievement. We need to improve our elementary and secondary education systems so that those individuals (regardless of race, gender, religion, national origin or whatever label we apply to each other) who want to pursue a career in health care have the background so crucial to success.
Based on my observations, our universities are not so much a stumbling block to a career in health care, but there is always room for improvement in this segment of the educational system. The application to medical schools is where the real winnowing process begins, and the odds of successfully matriculating and completing medical school in large measure depend on the student’s educational background and ability, as well as increasingly his or her ability to pay for the education. Graduating from medical school with debts exceeding $200,000 (not an uncommon occurrence) has to be stressful to students, which means the financial aspect of education has to be examined and addressed. These are broad societal issues that are beyond the field of otolaryngology, although each of us should work to resolve them.
And then we come to the otolaryngology specific issue: residency. For better or worse, it is a fact of life that obtaining a position in an otolaryngology training program is a very competitive process. Each program’s faculty, program director and chairman decide who will enter training.It is these individuals who can make and have made a difference in the question of diversity in our specialty. The Academy can convene a meeting and encourage activities, but it is the individuals at the program level that control the composition of the otolaryngology workforce.
I know from personal experience that otolaryngology faculty members are interested in creating a diverse specialty, and I’ve never heard anyone speak publically or privately against the goal of diversity. Given that there are only about 275 first-year otolaryngology positions and the applicant pool contains an abundance of qualified candidates, flexibility in selecting residents is a challenge. Nevertheless, it is a challenge that needs to be met, and I encourage the Otolaryngology Program Directors Organization and the Association of Academic Departments of Otolaryngology to work with other groups, including the Academy, to address this important issue.
All of us need to work on this issue collectively because we benefit collectively from diversity in all its forms.
Robert H. Miller, MD, MBA
Physician Editor, ENT Today
Headlight vs. Head Mirror
Regarding the article “An Iconic Tool: Is there still a place for the head mirror?” (Sept. 2010), I’ve practiced ENT for 30 years, and during that time I’ve tried dozens of headlights. I do use a high-powered headlight for surgery, but nothing can replace the head mirror. It is light weight, allows binocular vision and most important for me avoids parallax error. I frequently see deeper into the nose with the mirror than I can see with the headlight, as I’m looking down the column of light. If some manufacturer could reproduce that effect, then I think the head mirror could be discarded. Until that time, I think residents of all specialities, especially ENT, should spend more time learning the benefits of the head mirror.
Carl W. Wulfestieg, MD