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health care workforce projections have been unreliable
because they are often based upon idealized future deliv-
ery systems rather than current identifiable utilization
trends.
The shortage of physicians is expected to grow as
the US population expands and advances in care are
realized. This growing population lives longer, suffers
from multiple illnesses, and uses more than double the
health care services at age 65 years as younger adults.
“With looming changes in health care treatments, tech-
nology, finance, and delivery, researchers and policy
makers must understand that an adequate supply of
physicians will have to be achieved both through more
efficient health care delivery models and through an
increased number of GME training positions. . .. Current
attempts at payment and delivery system reform must
be complemented with an adequate supply of physicians
and other health professionals in primary care and in
medical and surgical specialties.”24
Complex changes such as improving efficiency,
reconfiguring the way services are delivered, and mak-
ing more effective use of physicians will certainly be
required, but an increase in the number of well-trained
physicians is also essential. It is estimated that if cur-
rent proposals before Congress to lift the cap on the
number of residency positions that Medicare partially
supports are accepted, an additional 4,000 physicians
per year could be trained, an expansion of approximately
15% over current training levels. However, this would
only meet 30% of expected shortages.25,26 If our specialty
does not take an aggressive lead in this process, other
policy makers may determine our future pathway.
If physician supply and use patterns stay the same,
the United States is expected to experience a shortage of
124,000 full-time physicians by 2025.26 To address the
predicted shortage, the AAMC recommended an increase
in medical school enrollment, although a corresponding
number of residency slots for these graduates have yet
to be assessed or developed. According to the AMA Wire
in 2015, a “record-breaking 20,630 students enrolled in
medical school for the first time, contributing to a 25
percent increase in medical school enrollment since
2002. Medical student enrollment in U.S. osteopathic
medical schools also increased by 3.5 percent over 2014
enrollment, with 7,025 students enrolling this year,
according to the American Association of Colleges of
Osteopathic Medicine.” 27 AAMC President and Chief
Executive Officer Darrell Kirch, MD stated “these num-
bers underscore a dire need for Congress to increase
funding for graduate medical education, so students can
continue to succeed in training and meet demands. . .. To
ensure that we have enough physicians to care for our
growing, aging population in the face of a real and sig-
nificant doctor shortage in the coming decade, Congress
also must increase federal support for residency train-
ing. . .. Unless lawmakers act without delay, patients
may not have access to the care they need in the
future.”26
Although this increase is necessary, it will not be
sufficient to meet predicted patient needs and demand.
Simply educating and training more physicians will not
be enough to address these shortages. To be successful,
complex changes such as improving efficiency, reconfi-
guring the way services are delivered, and making bet-
ter use of our physicians will be required.
CONCLUSION
Despite past findings and predictions of 8,000 to
8,500 otolaryngologists practicing in the United States,
this study places the total at 12,609, with 10,522 fully
trained and practicing in 2011. The 2014 findings of the
AAO-HNS Physicians Resource Committee, September
20, 2014, personal communication not subject to external
validation, placed practicing otolaryngologists in the
United States at approximately 10,800, with an addi-
tional 1,318 residents and 769 fellows.
Even when this correction is considered, the avail-
able trained otolaryngologists required to serve the oto-
laryngologic health care needs of the US population are
still insufficient. All current forecast models predict a
continued shortage of otolaryngologists to 2025. Policy
changes, if instituted, will take a decade to be even par-
tially realized. A comprehensive, systematic analysis to
assess the current strength of the otolaryngology work-
force, the current patient need for otolaryngology serv-
ices, and the current infrastructure of health care
delivery and patient access is required to make accurate
future predictions. To guarantee our ability to deliver
quality otolaryngology health care to the US population,
we must guarantee an adequate, well-trained workforce
supply. This requires we plan appropriately and form
the necessary policies to educate our future otolaryngolo-
gists. The impact of an aging population and 47 million
newly insured citizens under the ACA are unprecedent-
ed variables that must be considered. Further analysis
of differences in physician productivity and geographic
population density are needed to predict future public
health needs. Additional model formation of current
workforce utilization is also needed to predict the effects
of our aging population and the influx of 47 million new-
ly insured US citizens.
It is imperative that we as a specialty address these
issues, because our members and leaders have the best
grasp of the pertinent issues and possible solutions. It is
our obligation to provide access and serve our patients’
health care needs. We must accept this responsibility for
the future of our specialty.
Acknowledgment
The authors thank the staffs of the AAO-HNS, AMA, ABO,
ACS, AAMC, NCHS, HHS, and ACGME for their time and
support; the AAO-HNS PRC for its work and support; and
Drs. Michael Maves, Paul Rocky, Harold Pillsbury, and
David Kennedy for their insights.
BIBLIOGRAPHY
1. Cooper RA. There’s a shortage of specialists: is anyone listening? Acad
Med 2002;77:761–766.
2. Association of American Medical Colleges. The complexities of physician
supply and demand: projections from 2013 to 2025. 2015. Available at:
Accessed on 6 Feb-
ruary 2016.
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