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Transparent, Regular Data Vital to Reworking How We Think About Workforce Supply

by Andrew J. Tompkins, MD, MBA •

I stated in the last article that our workforce system lacked transparency and was unaccountable, but what does that really mean?

First, imagine a system that has accountability—one in which actual, or credible, projected workforce supply data allow for dynamic adaptation in the training construct. This system would demand some sort of feedback mechanism, but, perhaps more importantly (given what appears to be happening with our supply), a negative feedback loop to decrease training output, either more broadly or at the fellowship level.

As it turns out, in our otolaryngologist supply chain, no organizational negative feedback mechanism exists to apply supply controls (see Figure 1 to take a look at our supply construct and the organizations that surround it):

  • The American Association of Medical Colleges (AAMC) and American Medical Association (AMA) are set up to look at broader trends, their specialty data may be faulty (see the urology analysis in the Part I article in the May 2022 issue), and they have no control over otolaryngology positions—if anything, they push for more supply earlier on in the training pathway.
  • The Accreditation Council for Graduate Medical Education (ACGME) explicitly states that it does not take workforce numbers into consideration when approving new programs or spots.
  • The American Board of Otolaryngology– Head and Neck Surgery (ABO-HNS) focuses on individual competence, not the workforce.
  • Our academic administrator organizations (Association of AcademicDepartments of Otolaryngology (AADO), Otolaryngology Program Directors Organization (OPDO)) concentrate on education.
  • The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) is best positioned to look at these issues, but it lacks control over the spigot.

Think about how lucky we are that we have excess demand for our specialty—we can turn the spigot on or off as we choose, at least in theory. But no organization has oversight to exert that control. And so, given this construct, excess demand for our specialty has the potential to become a liability. Incentives don’t exist for reducing supply at the training program level. In fact, there are incentives for the exact opposite: to grow, even while academicians simultaneously recognize that we have too much supply, as shown in the previous article. You can’t blame them—they see demand and move to meet it.

Andrew J. Tompkins, MD, MBAWe should have a comprehensive understanding of what it means to be a practicing otolaryngologist, at a minimum assessing general and subspecialty skillset use by age and geography. Taking ownership of our data benefits our patients and our specialty —Andrew J. Tompkins, MD, MBA