2017 HSC Section 2 - Practice Management

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pressures from payers to remain competitive. Reim-
bursement systems are changing under the Current Pro-
cedural Terminology and International Classification of
Diseases systems toward bundling procedures and
disease-based and/or patient outcome strategies.17
The practice of otolaryngology and many other sur-
gical specialties continues to rapidly change. New proce-
dures, not anticipated even 20 years ago, are now
performed by a variety of surgical specialists. The practi-
ces of head and neck oncologic and endocrine surgery,
skull base surgery, neuro-otology, and pediatric otolaryn-
gology have continued to develop, increasing the scope
and demand for otolaryngologists. New technology and
procedures, along with changes in surgical training
pathways and certification, have resulted in changing
referral patterns and a redistribution of surgical
specialties.
This rapidly changing landscape requires a compre-
hensive systematic analysis to assess the current
strength of the otolaryngology workforce, not only in
sheer numbers but in type of practice, distribution, and
productivity. The current patient need for otolaryngology
services must be assessed, and the current infrastruc-
ture of health care delivery and patient access must be
analyzed. These are the building blocks to begin to make
predictions of future need. The use of predictive models
can then be developed and tested to guide us in the
numbers needed and the way we train our students and
residents. The goal is to guarantee our ability to deliver
quality otolaryngology health care to the US population.
Models for Future Prediction
This article elected to use the Clinical Specialty
Supply Model to estimate otolaryngology future work-
force numbers. This is arguably one of the simpler for-
mulas to use and is not the only way a specialty should
assess their future workforce. Kim et al.9 proposed three
models to calculate demand to make a “best estimate”
for the future. The first two methods used data obtained
from the ACS Health Policy Research Institute’s publica-
tion, The Surgical Workforce in the United States, which
draws mainly from the AMA Physician Master File and
AAMC Data Warehouse.
Method 1: Demand was extrapolated into the future
based on a continuation of the number of otolaryngolo-
gists per 100,000 population over the period 2004–2008
(current demand ratio). It depended solely on population
growth.
Method 2: Demand was estimated by maintaining
the per capita supply of otolaryngologists from the past
5 years (2004–2008) but only for the insured population
(current insured demand ratio). It assumed a gradual
increase in coverage, achieving full coverage in 2020, as
the Congressional Budget Office assumes a reduction in
the uninsured population by 32 million by 2019.18
Method 3: Demand was extrapolated using two
models described by Cooper et al.19,20 The first was
based on the established historical relationship between
gross domestic product (GDP) and health care spending.
They assumed that for every 1.0% growth in inflation-
adjusted GDP, the demand for physician services would
increase by 0.5%. GDP was extrapolated at a historical
average growth rate of 4.4%. The second model was con-
structed based on predicted demand of the stated health
care reform goals (growth to decline from its historic lev-
el of 2.5% above GDP to 1.0% above GDP between 2010
and 2020).
Regardless of which model is used, there is a signif-
icant gap between supply and demand for all years, with
an increasing gap through 2025. This gap persisted
despite manipulation of the extrapolation data to include
an increase in number of residents trained, decreased
resident training time, adjustments to current physician
workload, or the addition of nurse practitioners and PAs.
The gap increased markedly when expansion of care sec-
ondary to the ACA was factored.
A number of online tools have been developed to
forecast the future workforce. Examples are the AMA’s
Health Workforce Mapper
and the FutureDocs Forecasting Tool
). These
tools give the user the ability to manipulate estimates of
supply and demand for health care services for many
types of services for different geographic regions at var-
ied future periods.
Forecasting Methods and Implementing Policy
Based on These Predictions
The work of forecasting the future heath care needs
of a population is complex. Many unknowns conspire to
make this process a difficult task, but physician input
and accurate workforce planning are essential to ensure
a supply of physicians adequate to meet the US popula-
tion’s future health care needs.
Two unprecedented unknowns are the effects of the
ACA and America’s aging population. The ACA is
expected to expand health insurance coverage to an esti-
mated 30 to 47 million previously uninsured persons
over the next few years. 21 At the same time, physician
shortages are expected to worsen across the nation.
According to the AAMC, a shortage of more than 90,000
doctors, including 45,000 primary care physicians and
46,000 surgeons and specialists, is likely to occur in the
next 10 years.
It is estimated that approximately one-third of phy-
sicians could retire in the next decade, contributing to
the concern that the current supply of physicians will
not be able to meet the growing demand for care.22
It is also believed that the US population is expect-
ing and using health care more than in the past. Work-
force planning today must take into account the
increasing demand on health care services per capita. In
an analysis in Health Affairs,23 Grover and Niecko-
Najjum predict that physician workforce proposals that
rely exclusively on implementing new models of care or
changing the distribution of medical specialties to
address shortages are likely to fail in meeting the health
care needs of a growing, aging population unless the
number of physicians is increased. The authors believe
Laryngoscope 126: October 2016 Hughes et al.: Otolaryngology Workforce Analysis
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