2019 HSC Section 2 - Practice Management

Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(6):1027-1033.

Original Research—General Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 154(6) 1027–1033 American Academy of Otolaryngology—Head and Neck

The Pursuit of Otolaryngology Subspecialty Fellowships

Surgery Foundation 2016 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816639038 http://otojournal.org

Meghan N. Wilson, MD 1 , Peter M. Vila, MD, MSPH 2 , David S. Cohen, MD 3 , John M. Carter, MD 4 , Claire M. Lawlor, MD 4 , Kara S. Davis, MD 5 , and Nikhila P. Raol, MD 6

academic pursuits in focused areas, helping our field to expand the limits of what we know and what we can accomplish as practitioners. However, there are also disadvantages of subspe- cialization, most notably implications on the role of the general otolaryngologist. In the 1960s, formalized otolaryngology fellowships began to develop. In 1960, there were fewer than 10 fellow- ship positions available, with this number increasing slightly to fewer than 25 positions in the 1970s. The number of fel- lowship programs rapidly expanded in the 1980s and early 1990s, resulting in 151 fellowship positions in 1993 and more than 190 fellowship positions in 2013. 1 From 1990 to 1992, 25% of graduating residents pursued fellowship train- ing. 2 In a 2011 study, 70% of surveyed otolaryngology resi- dents planned on pursing fellowship training. 3 Bailey 1,4,5 previously postulated the likely motives behind why residents decide to pursue subspecialty training as follows: (1) to gain additional experience to provide superior care, (2) to reach a sense of mastery in a subspecialty field, (3) to limit their practice to an area they find more satisfying, (4) to obtain a marketing advantage over colleagues who practice more broadly, and (5) to increase job security. 1 More recently, a 2014 cross-sectional survey performed in Canada 6 demonstrated that 78% of graduating otolaryngologists reported pursuing fellow- ship training, 90% of whom identified the pursuit of fellowship training as moderately influenced by limited job opportunities. The ability to find and secure full-time employment, losing 1 Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA 2 Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA 3 Department of Otolaryngology, Wayne State University, Detroit, Michigan, USA 4 Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA 5 Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 6 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA Corresponding Author: Meghan N. Wilson, MD, Department of Otolaryngology, Louisiana State University Health Sciences Center, 533 Bolivar St, Ste 566, New Orleans, LA 70112, USA. Email: mnw326@gmail.com

No sponsorships or competing interests have been disclosed for this article.

Abstract Objectives . To examine otolaryngology resident interest in subspecialty fellowship training and factors affecting interest over time and over the course of residency training Study Design . Cross-sectional study of anonymous online survey data. Setting . Residents and fellows registered as members-in- training through the American Academy of Otolaryngology– Head and Neck Surgery. Subjects and Methods . Data regarding fellowship interest and influencing factors, including demographics, were extracted from the Section for Residents and Fellows Annual Survey response database from 2008 to 2014. Results . Over 6 years, there were 2422 resident and fellow responses to the survey. Senior residents showed a statisti- cally significant decrease in fellowship interest compared with junior residents, with 79% of those in postgraduate year (PGY) 1, 73% in PGY-2 and PGY-3, and 64% in PGY-4 and PGY-5 planning to pursue subspecialty training ( P \ .0001). Educational debt, age, and intended practice setting signifi- cantly predicted interest in fellowship training. Sex was not predictive. The most important factors cited by residents in choosing a subspecialty were consistently type of surgical cases and nature of clinical problems. Conclusions . In this study, interest in pursuing fellowship training decreased with increased residency training. This decision is multifactorial in nature and also influenced by age, educational debt, and intended practice setting.

Keywords fellowship, residency

Received May 4, 2015; revised January 21, 2016; accepted February 24, 2016. T he field of otolaryngology continues to advance at an incredible pace. A major contributor to the progression of otolaryngology, subspecialization has encouraged

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