. 2023 Oct 1;149(10):904-911.

doi: 10.1001/jamaoto.2023.2339.

The Global Otolaryngology-Head and Neck Surgery Workforce

Beatriz Petrucci¹, Samuel Okerosi², Rolvix H Patterson³, Sara B Hobday⁴, Valerie Salano⁵, Christopher J Waterworth⁶, Robert M Brody⁷, Holly Sprow⁸, Blake C Alkire⁹, Johannes J Fagan¹⁰, Sharon Ovnat Tamir¹¹, Carolina Der¹², Mahmood F Bhutta¹³, Ivy W Maina⁷, Jonathan C Pang¹⁴, Davina Daudu¹⁵, Allan G Mukuzi¹⁶, Tarika Srinivasan¹⁷, Carolina A Pietrobon¹⁸, Sheng-Po Hao¹⁹, Doreen Nakku²⁰, Amina Seguya²¹, Taseer F Din²², Olga Djoutsop Mbougo²³, Lilian W Mokoh²⁴, Farizeh Jashek-Ahmed²⁵, Tyler J Law²⁶, Elizabeth A Holt²⁷, Ali Haider Bangesh²⁸, Yilkal Zemene²⁹, Titus S Ibekwe³⁰, Oumar Raphiou Diallo³¹, Jaqueline Alvarado³², Wakisa K Mulwafu³³, John E Fenton³⁴, Adrian M Agius³⁵, Pavel Doležal³⁶, Édouard Amani Mudekereza³⁷, Karen M Mojica³⁸, Ricardo Silva Rueda³⁹, Mary Jue Xu^{26

40}

Affiliations

¹ Unified Health System, Ministry of Health, Brazil.
² Ear Nose and Throat Department, Kenyatta National Hospital, Nairobi, Kenya.
³ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
⁵ Ear Nose and Throat Department, Nyahururu County Hospital, Nyahururu, Kenya.
⁶ Nossal Institute for Global Health, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia.
⁸ Tufts University School of Medicine, Boston, Massachusetts.
⁹ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston.
¹⁰ Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
¹¹ Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Israel.
¹² Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Hospital Dr Luis Calvo Mackenna, Chile.
¹³ Brighton & Sussex Medical School, Brighton, United Kingdom.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine.
¹⁵ Faculty of Surgery, University of Western Australia, Perth, Western Australia, Australia.
¹⁶ Department of Otorhinolaryngology Head and Neck Surgery, University of Nairobi, Kenya.
¹⁷ Medical student, Harvard Medical School, Boston, Massachusetts.
¹⁸ Universidade do Vale do Taquari, Brazil.
¹⁹ Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Fu-Jen University, Taiwan.
²⁰ Department of Otolaryngology Head and Neck Surgery, Mbarara University of Science and Technology, Uganda.
²¹ Department of Otolaryngology Head and Neck Surgery, Mulago National Referral Hospital, Uganda.
²² Division of Pediatric Otolaryngology, Head-Neck Surgery, Department of Otolaryngology, Head-Neck Surgery, Stanford University, Stanford, California.
²³ Bel Campus University of Technology, Kinshasa, Democratic Republic of Congo.
²⁴ Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya.
²⁵ The International Center for Recurrent Head and Neck Cancer, the Royal Marsden Hospital, London, United Kingdom.
²⁶ Department of Anesthesia & Perioperative Care, University of California, San Francisco.
²⁷ The Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand.
²⁸ STMU Shifa College of Medicine, Islamabad, Pakistan.
²⁹ St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
³⁰ University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria.
³¹ University of Conakry Médical Faculty, Conakry, Guinea.
³² Pan-American Otolaryngology Association, Miami, Florida.
³³ Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi.
³⁴ Department of Otorhinlaryngology-Head and Neck Surgery, University of Limerick, Limerick, Ireland.
³⁵ Department of Otorhinolaryngology, University of Malta, Malta.
³⁶ Department of Otorhinolaryngology and Head and Neck Surgery, Slovak Medical University, Bratislava, Slovakia.
³⁷ Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo.
³⁸ Department of otolaryngology, Vivian Pellas Hospital, Managua, Nicaragua.
³⁹ Servicio de Otorrinolaringología, Bogota, Hospital Militar Central, Bogata, Colombia.
⁴⁰ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.

PMID: 37651133
PMCID: PMC10472262
DOI: 10.1001/jamaoto.2023.2339

The Global Otolaryngology-Head and Neck Surgery Workforce

Beatriz Petrucci et al. JAMA Otolaryngol Head Neck Surg. 2023.

. 2023 Oct 1;149(10):904-911.

doi: 10.1001/jamaoto.2023.2339.

Authors

Affiliations

¹ Unified Health System, Ministry of Health, Brazil.
² Ear Nose and Throat Department, Kenyatta National Hospital, Nairobi, Kenya.
³ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
⁵ Ear Nose and Throat Department, Nyahururu County Hospital, Nyahururu, Kenya.
⁶ Nossal Institute for Global Health, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia.
⁸ Tufts University School of Medicine, Boston, Massachusetts.
⁹ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston.
¹⁰ Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
¹¹ Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Israel.
¹² Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Hospital Dr Luis Calvo Mackenna, Chile.
¹³ Brighton & Sussex Medical School, Brighton, United Kingdom.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine.
¹⁵ Faculty of Surgery, University of Western Australia, Perth, Western Australia, Australia.
¹⁶ Department of Otorhinolaryngology Head and Neck Surgery, University of Nairobi, Kenya.
¹⁷ Medical student, Harvard Medical School, Boston, Massachusetts.
¹⁸ Universidade do Vale do Taquari, Brazil.
¹⁹ Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Fu-Jen University, Taiwan.
²⁰ Department of Otolaryngology Head and Neck Surgery, Mbarara University of Science and Technology, Uganda.
²¹ Department of Otolaryngology Head and Neck Surgery, Mulago National Referral Hospital, Uganda.
²² Division of Pediatric Otolaryngology, Head-Neck Surgery, Department of Otolaryngology, Head-Neck Surgery, Stanford University, Stanford, California.
²³ Bel Campus University of Technology, Kinshasa, Democratic Republic of Congo.
²⁴ Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya.
²⁵ The International Center for Recurrent Head and Neck Cancer, the Royal Marsden Hospital, London, United Kingdom.
²⁶ Department of Anesthesia & Perioperative Care, University of California, San Francisco.
²⁷ The Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand.
²⁸ STMU Shifa College of Medicine, Islamabad, Pakistan.
²⁹ St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
³⁰ University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria.
³¹ University of Conakry Médical Faculty, Conakry, Guinea.
³² Pan-American Otolaryngology Association, Miami, Florida.
³³ Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi.
³⁴ Department of Otorhinlaryngology-Head and Neck Surgery, University of Limerick, Limerick, Ireland.
³⁵ Department of Otorhinolaryngology, University of Malta, Malta.
³⁶ Department of Otorhinolaryngology and Head and Neck Surgery, Slovak Medical University, Bratislava, Slovakia.
³⁷ Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo.
³⁸ Department of otolaryngology, Vivian Pellas Hospital, Managua, Nicaragua.
³⁹ Servicio de Otorrinolaringología, Bogota, Hospital Militar Central, Bogata, Colombia.
⁴⁰ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.

PMID: 37651133
PMCID: PMC10472262
DOI: 10.1001/jamaoto.2023.2339

Abstract

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed.

Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories.

Design, setting, and participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians.

Main outcome: The OHNS workforce per capita, stratified by income and region.

Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally.

Conclusion and relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

**Figure 1.. Otolaryngology–Head and Neck Surgery Ear, Nose, and Throat Clinicians Per Capita**
Countries/territories in gray are without estimates.

**Figure 2.. Otolaryngology–Head and Neck Surgery (OHNS) Workforce Per Capita by World Bank Income Group**
Range and quartiles represented by the box plot; outliers for the box plots are excluded. The horizontal line within the box represents the median value and the dot within the box represents the mean value. The top end of the box represents the 75th quartile and the bottom of the box represents the 25th quartile. The very top of the vertical line, indicated by the short horizontal bar, represents the maximum value. The very bottom of the vertical line, indicated by the short horizontal bar, represents the minimum value. Per capita by World Bank income group represented by the point in the box plot.

**Figure 3.. Otolaryngology–Head and Neck Surgery (OHNS) Workforce Per Capita by World Health Organization Region**
Range and quartiles represented by the box plot; outliers for the box plots are excluded. The horizontal line within the box represents the median value and the dot within the box represents the mean value. The top end of the box represents the 75th quartile and the bottom of the box represents the 25th quartile. The very top of the vertical line, indicated by the short horizontal bar, represents the maximum value. The very bottom of the vertical line, indicated by the short horizontal bar, represents the minimum value. Per capita by World Health Organization region represented by the point in the box plot. The regional per capita of the Western Pacific region is outside of the IQR given exclusion of extreme outliers for the visualization using the box plots to show dispersion of these data.

**Figure 4.. Percentage of Countries/Territories in Which Otolaryngology–Head and Neck Surgeons (OHNS) Manage Most of the Disease Processes**
ENT indicates ear, nose, and throat.

See this image and copyright information in PMC

References

1. Jamison DT, Gelband H, Horton S, et al. , eds. Disease Control Priorities: Improving Health and Reducing Poverty. International Bank for Reconstruction and Development/The World Bank; 2017. - PubMed
1. Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery. 2015;158(1):3-6. doi: 10.1016/j.surg.2015.04.011 - DOI - PubMed
1. Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015;3(suppl 2):S8-S9. doi: 10.1016/S2214-109X(14)70384-5 - DOI - PubMed
1. McColl E. Best practice in symptom assessment: a review. Gut. 2004;53(Suppl 4)(suppl 4):iv49-iv54. doi: 10.1136/gut.2003.034355 - DOI - PMC - PubMed
1. Global Strategy on Human Resources for Health: Workforce 2030. World Health Organization; 2016.

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The Global Otolaryngology-Head and Neck Surgery Workforce

Affiliations

The Global Otolaryngology-Head and Neck Surgery Workforce

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources