The geographic distribution of the otolaryngology workforce in the United States

Abstract

Objectives: To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States.

Study design: Cross-sectional study.

Methods: The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files. Multiple linear regression tested the association of population, physician, and hospital factors on the supply of Medicare-enrolled otolaryngologists/HRR.

Results: Two methods of measuring the otolaryngology workforce were moderately correlated across hospital referral regions (Pearson coefficient 0.513, P = .0001); regardless, the supply of otolaryngology providers varies greatly over different geographic regions. Otolaryngologists concentrate in regions with many other physicians, particularly specialist physicians. The otolaryngology supply also increases with regional population income and education levels. Using AMA-derived data, there was no association between the supply of otolaryngologists and staffed acute-care hospital beds and the presence of an otolaryngology residency-training program. In contrast, the supply of otolaryngology providers enrolled in Medicare independently increases for each HRR by 0.8 per 100,000 for each unit increase in supply of hospital beds (P < .0001) and by 0.49 per 100,000 in regions with an otolaryngology residency-training program (P = .006), accounting for all other factors.

Conclusion: Irrespective of methodology, the supply of otolaryngologists varies widely across geographic regions in the United States. For Medicare beneficiaries, regional hospital factors-including the presence of an otolaryngology residency program-may improve access to otolaryngology services.

Level of evidence: NA Laryngoscope, 127:95-101, 2017.

Keywords: Medicare; Workforce; access; distribution; otolaryngology.

Figure 1.

The supply of otolaryngologists enrolled in Medicare varies widely across hospital referral regions ranging from .53 to 11.3 per 100,000 (mean 3.05, standard deviation 1.4).

Figure 2.

For each hospital referral region, the supply of otolaryngologists identified in the AMA-Masterfile correlated with those obtained from the CMS dataset (Pearson correlation coefficient .513, p=.0001).