Otolaryngology–Head and Neck Surgery Physician Work Force Issues

2012 ◽  
Vol 146 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Jin Suk C. Kim ◽  
Richard A. Cooper ◽  
David W. Kennedy
Keyword(s):  
Head And Neck ◽  
Census Data ◽  
Supply And Demand ◽  
Insurance Coverage ◽  
Neck Surgery ◽  
The United States ◽  
Economic Modeling ◽  
Head And Neck Surgery ◽  
Population Census ◽  
Data Sets

Objective. To predict future trends in the otolaryngology workforce and propose solutions to correct the identified discrepancies between supply and demand. Study Design. Economic modeling and analysis. Setting. Data sets at national medical and economic organizations. Subjects and Methods. Based on current American Academy of Otolaryngology–Head and Neck Surgery, American Medical Association, and National Residency Matching Program data sets, population census data, and historical physician growth demand curves, the future otolaryngology workforce supply and demand were modeled. Adjustments were made for projected increases in mid-level providers, increased insurance coverage, and the potential effects of lifestyle preferences. Results. There are currently approximately 8600 otolaryngologists in the United States. Estimated demand by 2025 is 11,127 based on projected population growth and anticipated increase in insurance coverage. With an average retirement age of 65 years and no increase in PGY-1 positions for the specialty, the number of otolaryngologists in 2025 will be approximately 2500 short of projected demand. This shortfall will not be adequately compensated by mid-level providers performing less intensive services and may be increased by lifestyle preferences and changing demographics among medical students and residents. The current geographic maldistribution of otolaryngologists is likely to be exacerbated. Conclusion. The specialty needs to actively plan for the coming otolaryngologist shortage and train mid-level providers within the specialty. Failure to plan appropriately may result in a reduction in scope of practice of high-intensity services, which will likely remain a physician prerogative. Given the limited likelihood of a significant increase in residency slots, strong consideration should be given to shortening the base otolaryngology training program length.

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

2021 ◽  
pp. 000348942199696
Author(s):  
Hilary C. McCrary ◽  
Sierra R. McLean ◽  
Abigail Luman ◽  
Patricia O’Sullivan ◽  
Brigitte Smith ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
National Survey ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Residency Programs ◽  
Surgery Training ◽  
Robotic Surgery Training ◽  
Operative Experience

Objective: The aim of this study is to describe the current state of robotic surgery training among Otolaryngology—Head and Neck Surgery (OHNS) residency programs in the United States. Methods: This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. Results: A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. Conclusion: This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. Level of Evidence: IV

Implementation of duty hour standards in otolaryngology-head and neck surgery residency training

2005 ◽  
Vol 132 (6) ◽  
pp. 819-822 ◽  
Author(s):  
Todd A. Kupferman ◽  
Tim S. Lian
Keyword(s):  
Head And Neck ◽  
Residency Training ◽  
Training Programs ◽  
Neck Surgery ◽  
Program Directors ◽  
The United States ◽  
Head And Neck Surgery ◽  
Training Experience ◽  
Duty Hours ◽  
Resident Duty

OBJECTIVE: To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States. STUDY DESIGN AND SETTING: Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States. RESULTS: Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions. CONCLUSIONS: According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents. SIGNIFICANCE: This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.

Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence

2017 ◽  
Vol 156 (6) ◽  
pp. 1142-1149 ◽  
Author(s):  
Garrett D. Locketz ◽  
Justin T. Lui ◽  
Sonny Chan ◽  
Kenneth Salisbury ◽  
Joseph C. Dort ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Head And Neck ◽  
Temporal Bone ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Data Sets ◽  
Perceived Utility ◽  
Cortical Mastoidectomy ◽  
Surgeon Experience ◽  
Subjective Confidence

Objective To evaluate the effect of anatomy-specific virtual reality (VR) surgical rehearsal on surgeon confidence and temporal bone dissection performance. Study Design Prospective pre- and poststudy of a novel virtual surgical rehearsal platform. Setting Academic otolaryngology–head and neck surgery residency training programs. Subjects and Methods Sixteen otolaryngology–head and neck surgery residents from 2 North American training institutions were recruited. Surveys were administered to assess subjects' baseline confidence in performing 12 subtasks of cortical mastoidectomy with facial recess. A cadaver temporal bone was randomly assigned to each subject. Cadaver specimens were scanned with a clinical computed tomography protocol, allowing the creation of anatomy-specific models for use in a VR surgical rehearsal platform. Subjects then rehearsed a virtual mastoidectomy on data sets derived from their specimens. Surgical confidence surveys were administered again. Subjects then dissected assigned cadaver specimens, which were blindly graded with a modified Welling scale. A final survey assessed the perceived utility of rehearsal on dissection performance. Results Of 16 subjects, 14 (87.5%) reported a significant increase in overall confidence after conducting an anatomy-specific VR rehearsal. A significant correlation existed between perceived utility of rehearsal and confidence improvement. The effect of rehearsal on confidence was dependent on trainee experience and the inherent difficulty of the surgical subtask. Postrehearsal confidence correlated strongly with graded dissection performance. Subjects rated anatomy-specific rehearsal as having a moderate to high contribution to their dissection performance. Conclusion Anatomy-specific virtual rehearsal improves surgeon confidence in performing mastoid dissection, dependent on surgeon experience and task difficulty. The subjective confidence gained through rehearsal correlates positively with subsequent objective dissection performance.

Commentary on “Otolaryngology–Head and Neck Surgery Physician Workforce Issues An Analysis for Future Specialty Planning” by Kim, Cooper, and Kennedy

2012 ◽  
Vol 146 (2) ◽  
pp. 203-205 ◽  
Author(s):  
Shannon P. Pryor ◽  
Linda Brodsky ◽  
Sujana S. Chandrasekhar ◽  
Lauren Zaretsky ◽  
Duane J. Taylor ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Physician Workforce ◽  
Modeling Methods ◽  
The Us ◽  
Workforce Issues ◽  
Time Work ◽  
Part Time

An impending physician shortage has been projected. The article by Kim, Cooper, and Kennedy, titled “Otolaryngology–Head and Neck Surgery Physician Workforce Issues: An Analysis for Future Specialty Planning,” is an attempt to evaluate and address this potential shortage as it applies to otolaryngology. The authors of this comment have concerns about the article’s assumptions, design, and recommendations. Kim et al attempt to extrapolate data from other specialties and other countries to the US otolaryngology workforce, use that data in modeling methods without demonstrated validity, and based on their analysis, they recommend drastic changes to otolaryngologic training and practice in the United States. Particularly troublesome are (1) the emphasis placed on gender and part-time work and (2) the measurement of productivity defined as hours worked per week. Before redefining our specialty, more thorough and systematic data acquisition and review are necessary to meet the needs of our patients now and in the future.

Proliferation and Contributions of National Database Studies in Otolaryngology Literature Published in the United States: 2005-2016

2018 ◽  
Vol 127 (9) ◽  
pp. 643-648 ◽  
Author(s):  
Rahul S Subbarayan ◽  
Lindsey Koester ◽  
Mark R Villwock ◽  
Jennifer Villwock
Keyword(s):  
Head And Neck ◽  
Incidence Rate ◽  
Fold Increase ◽  
Neck Surgery ◽  
The United States ◽  
National Database ◽  
Data Sets ◽  
Improvement Program ◽  
Outcomes Measures ◽  
Journal Publications

Objective: Health registries and discharge-level databases are powerful tools. Commonly used data sets include the Nationwide Inpatient Sample (NIS); Surveillance, Epidemiology, and End Results Program (SEER); National Cancer Database (NCDB); and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This study investigated the frequency with which these resources are being used and categorized their contributions to literature. Design: A literature review from 2005 to 2016 for papers utilizing the aforementioned databases and publishing in The Laryngoscope, JAMA-Otolaryngology, Head and Neck, Otolaryngology-Head and Neck Surgery, and International Forum of Allergy and Rhinology was conducted. Results were categorized based on the contribution(s) of the paper. The incidence rate of database publications was calculated for each year along with the 95% confidence intervals using a Poisson distribution. Results: Three hundred ten studies were identified. Seventy percent report descriptive findings, and 65% report outcomes/survival. Approximately 18% made clinical recommendations. In 2005, the incidence rate of database publications was 3 per 1000 journal publications (95% CI, 1-9) and remained relatively stable until 2008. From 2010 onward, there was a persistent increase in publications, culminating in the highest incidence rate in 2016 of 26 database publications per 1000 journal publications (95% CI, 20-32). Conclusions: There was a nearly 10-fold increase in database publications in 2016 compared to 2005. The majority provide descriptive data and outcomes measures. The role of these studies warrants further investigation.

Improved Comorbidity Capture Using a Standardized 1-Step Quality Improvement Documentation Tool

2018 ◽  
Vol 159 (1) ◽  
pp. 143-148 ◽  
Author(s):  
Robert J. Morrison ◽  
Kelly M. Malloy ◽  
Rishi R. Bakshi
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Clinical Severity ◽  
Quality Outcomes ◽  
Query Process ◽  
Implementation Period ◽  
Query System ◽  
The Impact

Objective To assess the impact of implementation of a “1-step” documentation query system on comorbidity capture and quality outcomes within the Department of Otolaryngology–Head and Neck Surgery. Methods Implementation of the 1-step documentation query system was instituted for all otolaryngology–head and neck surgery faculty at a single institution. Individual query responses and impact metrics were analyzed. Departmental case-mix index (CMI), risk of mortality (ROM), and severity of illness (SOI) were collated over a 14-month implementation period and compared to a 12-month preimplementation period. Results A total of 226 documentation queries occurred during the program pilot period, with an 86.7% response rate. Of queries with a response, 91.0% resulted in a significant impact for the hospitalization diagnoses-related group, ROM, or SOI. Departmental CMI increased from 2.73 to 2.91 over the implementation period, and observed/expected mortality ratio decreased from 0.50 to 0.42 pre- to postimplementation. Discussion With increasing emphasis on quality metrics outcomes within the United States health care system, there is a need for institutions to accurately capture the complexity and acuity of the patients they care for. There was a positive change in quality outcomes metrics, including ROM, SOI, and CMI over the first year of deployment of the 1-step documentation query process. Implications for Practice Clinical severity metrics are becoming increasingly important to otolaryngologists, as insurers move to severity-adjusted profiles. The 1-step documentation query process provides a reproducible and effective way for clinical documentation specialists and physicians to collaborate on improving departmental clinical severity metrics.

scholarly journals Napoleon C. Ejercito, MD (1921 – 2007)

2007 ◽  
Vol 22 (1-2) ◽  
pp. 41
Author(s):  
Joselito C. Jamir
Keyword(s):  
Head And Neck ◽  
Training Program ◽  
Residency Training ◽  
Chief Resident ◽  
Residency Training Program ◽  
Neck Surgery ◽  
The United States ◽  
The Philippines ◽  
Head And Neck Surgery ◽  
Martial Law

  A Strong Pillar   After completing his residency training program in the United States, Dr. Napoleon Ejercito came back to join the faculty of the then combined Department of Eye Ear Nose and Throat (EENT) at the Philippine General Hospital. Unhappy with the fact that ORL in the Philippines was not yet a separate and distinct specialty with no existing standard and organized form of training, Dr. Ejercito and seven other optimistic and young ENT surgeons gathered together to form the Otolaryngology Society of the Philippines under the leadership of Dr. Tierry Garcia. These men became the historic pillars of the society.   With the birth of this society, the development and maturation of the specialty was simply a matter of time.   Fifteen years later, Dr. Ejercito spearheaded the founding of the Philippine Board of Otolaryngology and Bronchoesophagology in order to standardize and professionalize the practice of ORL. Initially composed of diplomates and candidates of the American Board of Otorhinolaryngology, the rigorous process of accreditation and qualification was patterned after the American Board. This organization was subsequently incorporated and evolved into what is now known as the Philippine Board of Otolaryngology Head and Neck Surgery. This board became his youngest child whose growth he fostered and whose interests he promoted and protected.   A Dedicated Leader   Dr. Ejercito was Chairman of the Department of ORL of the UP-PGH from 1970 to 1974, when Martial Law was declared. He was a staunch critic of the Marcos regime, but the repression did not deter him from leading the department in achieving its goals.   During his time as chair of the department, only a total of 12 residency slots were available. It was Dr. Ejercito who pioneered the restructuring of the residency training program into three ORL residents per year level. Furthermore, it was during Dr. Ejercito’s term that a post-residency graduate was chosen as the chief resident.   His integrity was beyond question. Rather than face the possibility of naming his eldest son as chief resident, he compelled his son to seek further fellowship abroad. A Trailblazer   Dr. Napoleon Ejercito can be called the father of head and neck surgery in the Philippines. While Dr. Tierry Garcia initiated the expansion of the specialty of Otorhinolaryngology to include head and neck surgery, it was Dr. Ejercito who nurtured and strengthened it to what it is today. As a testament to Dr. Ejercito’s legacy, the stipend of the fellow of the Head and Neck Program of the Department of ORL –PGH was made available by an alumnus of the department, and was named after him.   His dedication to the discipline was beyond comparison. Even when he was the Chair, Dr. Ejercito continued to operate on charity patients and demonstrated operative procedures to residents on a regular basis.   His retirement did not dampen his zeal to further the cause of ORL. He continued to support the different programs of the society and attended society conventions and departmental conferences whenever possible, which gained the admiration of younger generation of residents. Dr. Napoelon Ejercito: A strong pillar, a dedicated leader, a trailblazer. Such a man will truly be missed.

Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review

2018 ◽  
Vol 158 (4) ◽  
pp. 627-636 ◽  
Author(s):  
John D. Cramer ◽  
Andrew G. Shuman ◽  
Michael J. Brenner
Keyword(s):  
Venous Thromboembolism ◽  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Review Of Literature ◽  
Mechanical Prophylaxis ◽  
Thrombotic Complications ◽  
Prevention Guidelines ◽  
Prolonged Hospital

Objective The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology–head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology–head and neck surgery in the United States. Data Sources PubMed/MEDLINE. Review Methods A comprehensive review of literature pertaining to VTE in otolaryngology–head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis. Data were then synthesized and compared with other surgical specialties. Conclusions We identified 29 articles: 1 prospective cohort study and 28 retrospective studies. The overall prevalence of VTE in otolaryngology appears lower than that of most other surgical specialties. The Caprini system allows effective individualized risk stratification for VTE prevention in otolaryngology. Mechanical and chemoprophylaxis (“dual thromboprophylaxis”) is recommended for patients with a Caprini score ≥7 or patients with a Caprini score of 5 or 6 who undergo major head and neck surgery, when prolonged hospital stay is anticipated or mobility is limited. For patients with a Caprini score of 5 or 6, we recommend dual thromboprophylaxis or mechanical prophylaxis alone. Patients with a Caprini score ≤4 should receive mechanical prophylaxis alone. Implications for Practice Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.

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