We recently saw the effect transparency can have on the supply side. Emergency medicine had an average match rate of 99.5% in the 10 years preceding the 2022 match. Yet in 2022, the year after their workforce report was published showing how dire the job market looked in the near future, not only did their match rate drop significantly to 92.5% but their absolute number matched did as well (National Resident Matching Program, Results and Data: 2012-2022 Main Residency Match. National Resident Matching Program, Washington, DC. 2012-2022) (Figure 2).
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July 2022Transparency allows for more nimble and efficient decision-making for market participants and is the only apparent remedy to the otolaryngology supply construct, which is also set up to produce an oversupply.
We must, however, do more to keep up with the dynamism of the market. Technological advances in medicine should be praised for bringing gains to the broader market, but we should recognize their potential for idiosyncratic disruption and plan accordingly. Technology is increasingly putting diagnosis and treatment decisions in the palm of our hands, disrupting traditional primary care treatment paradigms. It has brought us stent technology with disruption to the thoracic surgery workforce. Might we see the same with hepatologists and liver transplant surgeons with effective hepatitis C drugs? Or in the field of gastroenterology with cancer screening tools like Cologuard? Are we not being disrupted currently by HPV vaccines and biologics for sinus disease? In the face of these disruptive forces, we can only plan for downside risk protection with buffer systems.
Within individual practices, APPs allow a buffer for practice continuation. They can join another specialty practice tomorrow—we can’t. Training buffers allow for resident case protection in the event of case declines for whatever reason. Retraining systems, which would allow for rebuilding generalist skillsets, allow for protection of those who face idiosyncratic risk in the future, or if we find ourselves with a glut of subspecialists who can’t find meaningful work. These last two buffers exist in private practice and nonacademic hospitals, and academic departments would be wise to engage them now.
Final Thoughts
More than anything, I hope this series generates a discussion and motivates us to come together to think of a better path forward for the betterment of our patients and our specialty. No one person has all the answers—this discussion and execution will need to involve all of us. We need to get our workforce right. Doing so affects whether we can serve our mission with grace, improve quality and our patients’ lives, and maintain a meaningful practice. Leadership on these issues now will pay dividends in the future and bring us closer as a specialty.