Espinel A, Poley M, Zalzal GH, Chan K, Preciado D. Trends in US Pediatric Otolaryngology Fellowship Training. JAMA Otolaryngol Head Neck Surg. 2015;141(10):919-922. doi:10.1001/jamaoto.2015.1570
Interest in pediatric otolaryngology fellowship training is growing. The workforce implications of this growing interest are unclear and understudied.
To analyze trends in pediatric otolaryngology training, determine where fellows who graduated over the past 10 years are currently practicing, and test the hypothesis that graduates from Accreditation Council for Graduate Medical Education (ACGME)–accredited programs were more likely to have academic tertiary positions with faculty appointments.
Design, Setting, and Participants
We conducted a web-based analysis of pediatric otolaryngology fellowship graduates. The names of all 274 applicants who were matched to pediatric otolaryngology fellowships from May 31, 2003, to May 31, 2014, were obtained from the SF Match website. Accreditation status of each program for each match year was obtained from the ACGME website. We then performed an Internet search for the current practice location of each matched applicant. Analysis was conducted from January 1, 2015, to May 1, 2015.
Main Outcomes and Measures
Practice setting per year of fellowship match and accreditation status of program.
For the 2003 to the 2014 match years, there was an increase from 5 to 22 accredited pediatric otolaryngology fellowship programs overall; simultaneously, the number of yearly matched applicants increased from 14 to 35. More graduates with ACGME accreditation practice at academic settings compared with graduates without ACGME accreditation although the difference was not statistically significant (67.1% vs 50.7%; P = .15). Graduates from accredited programs, however, were significantly more likely to practice at a hospital-based setting compared with those from nonaccredited programs (81.7% vs 65.5%; P = .003). Fellows trained in the last 10 years are relatively well distributed across the country.
Conclusions and Relevance
The number of pediatric otolaryngology fellowship applicants as well as total number of matched applicants and ACGME-accredited positions has risen in the last 10 years. It appears that a higher proportion of fellows trained in accredited programs work in academic positions in hospital-based practices. The long-term effect on the pediatric otolaryngology workforce of training more fellows in accredited fellowships remains to be seen.
Interest in pediatric otolaryngology fellowship training is growing. From 2001 to 2011 the yearly number of registered pediatric otolaryngology applicants on the SF Match website nearly tripled, from 22 to 59, with the 2013 fellowship match having the highest number of registered applicants ever.1 This increase in registered applicants has coincided with a parallel rise in the number of training programs registered in the match and positions offered. This increased number of registered applicants has remained steady, exceeding 40 applicants per year since 2008. More important, a majority of fellowship programs have moved toward accreditation through the Accreditation Council for Graduate Medical Education (ACGME), with 22 of 31 programs currently holding accreditation, compared with only 5 programs in 2003.
As training in pediatric otolaryngology has increased, concerns exist that as more and more pediatric otolaryngology fellows graduate, there will be a saturation of the workforce, and as a result fewer trainees will be working in a tertiary setting and rather entering a general private community-based practice.2 Workforce data addressing whether this concern has validity are lacking. Furthermore, it is unclear how training at an accredited fellowship program influences eventual practice setting, if at all.
The goal of this study was to analyze trends in pediatric otolaryngology fellowship training, focusing on where fellows who graduated over the past 10 years are currently practicing. We hypothesized that graduates from ACGME-accredited programs were more likely to have academic tertiary positions with faculty appointments either at freestanding children’s hospitals or at university-affiliated pediatric hospitals.
We obtained the names of all applicants who applied for pediatric otolaryngology fellowships through the SF Match program from May 31, 2003, to May 31, 2014. Applicants who were not matched or did not submit a match list were excluded. Each program was categorized as ACGME accredited or nonaccredited for each fellowship year based on fellowship information publicly available on the ACGME website (http://www.acgme.org/ads/Public).
We then performed an Internet search via Google for the name of each applicant to obtain current practice information. Based on the search findings, we recorded the most current practice information listed and classified the practice as private or academic, urban or rural, community or hospital based, and affiliated with a freestanding children’s hospital. The practice location was also recorded (New England, Mid-Atlantic, South, Midwest, Southwest, and West in the United States; Canada; and locations outside of the United States and Canada).
Practice data were searched for all applicants who matched in 2012 and before. Applicants who matched after 2012 are currently in fellowship training; thus, practice data are unavailable. Categorical variables were analyzed by Fisher exact test using GraphPad Prism, version 5.0 (GraphPad Prism Software, Inc). P < .05 was considered significant. Analysis was conducted from January 1, 2015, to May 1, 2015. Institutional review board approval was not sought for this analysis of publicly available information.
Overall, for the 2003 to the 2014 match years, the number of yearly matched applicants increased from 14 to 35 (Table 1). The number of applicants matching into ACGME-accredited fellowships also increased from 4 (28.6%) in 2003 to 28 (80.0%) in 2014.
In all years except 2009 and 2012, the majority of fellows (54.7%), regardless of training accreditation, practiced in academic settings (Table 2). Notably, those who trained at an accredited fellowship vs those who did not were more likely to be practicing in an academic setting, but this difference did not reach statistical significance (67.1% vs 50.7%; P = .15). Overall, the proportion of academic positions accounted for by fellows trained in an accredited program increased from 37.5% in 2002 to 73.6% in 2012.
Similarly, the majority (73.0%) of fellowship-trained pediatric otolaryngologists work in hospital-based, urban settings regardless of fellowship accreditation (Table 3). Significantly, those graduating from an ACGME-accredited fellowship were more likely to be in a hospital-based practice setting compared with those from a nonaccredited fellowship (81.7% vs 65.5%; P = .003).
Overall, less than half of the graduates (46.0%) work at freestanding children’s hospitals. Again, a greater proportion of graduates from accredited programs practice at freestanding children’s hospitals compared with those from nonaccredited programs, although this difference did not reach statistical significance (50.7% vs 41.8%; P = .15) (Table 4). Notably, the proportion of graduates working at freestanding childrens’ hospitals after training in accredited programs increased from 29.5% in 2002 to 76.4% in 2012.
Geographically, most of the fellows trained during the study period now work in the South (21%), Midwest (20%), and West (18%), regardless of the accreditation of their fellowship program. In the United States, the greatest proportion of pediatric otolaryngologists trained in accredited programs now work in the Southwest and the least in the Northeast.
Trend analysis of SF Match data reveals that although the number of pediatric otolaryngology fellowship positions offered has nearly tripled from 14 to 35 over the past 10 years, there has been a steady and parallel increase in the number of applicants. However, in 2003 many pediatric otolaryngology programs did not participate in the match. Around that time, American Society of Pediatric Otolaryngology (ASPO) leadership espoused the goal of a uniform and transparent application process through the match, with the subsequent goal of universal ACGME accreditation for all fellowship programs. Therefore, the apparent increase in fellowship training programs captured in these data is in part accounted for by programs joining the match process from 2003 to 2005. Coinciding with this move, the interest level of applicants in pediatric otolaryngology provided enough fellows to easily fill those new available match positions. Further evidence for this increased interest is that in 2013 there was only 1 unfilled position. It is unclear what factors have led to an increase in the popularity of pediatric otolaryngology fellowship training, but it may have coincided with increased popularity in fellowship training in general. The 2008 recession may have led to a perceived decrease in the general otolaryngology job market, leading a majority of residency graduates to seek fellowship training. Second, work-hour restrictions placed on otolaryngology residents may be causing reduced general training,3 with the unintended consequence of having more graduates choose further training through a fellowship program.
The number of ACGME-accredited fellowships increased from 4 accredited programs offering 9 of the 14 total fellowship positions in the match in 2001 to 22 accredited programs offering 34 of the 45 total fellowship positions in 2015.4,5 The proportion of matched applicants in an accredited program increased accordingly, from 51.4% (18 applicants) in 2011 to 71.8% (11 applicants) in 2012. In a recent survey, ACGME accreditation was ranked of moderate importance to pediatric otolaryngology fellowship applicants when choosing a fellowship.6 Notably, there is a higher proportion of fellows trained in accredited programs currently working in academic centers or hospital-based practices as opposed to those trained in nonaccredited programs. We cannot comment on whether career choice was based on fellowship experience. However, in a survey of pediatric otolaryngologists who had recently had fellowship training, more graduates in accredited programs felt prepared for a career in academic medicine.7
A major limitation of this study is that the pool of fellows is based solely on data from the SF Match program. It is likely that many programs did not participate in the match in the early years of this analysis, such as 2003 and 2004 (by our estimate, approximately 10 fellowship spots were offered outside of the match during those years). As such, the apparent growth in the early 2000s of pediatric otolaryngology training is really a reflection of all programs joining the match as directed by ASPO. It is impossible to comment on the whereabouts of graduates who trained in programs filling positions outside of the match. Nonetheless, it is clear there has been a move toward participation in the match by most, if not all, training programs. Also, there is the potential for nonfellowship-trained pediatric otolaryngologists to make up part of our study population; however, given that our demographic results are in concordance with prior surveys of ASPO members, we believe such pediatric otolaryngologists are only a small proportion of our study population. In addition, the practice information obtained is based on the most up-to-date information on the Internet for each physician. This information will not reflect prior positions or new jobs that have not been updated on the Internet.
ASPO’s efforts have led to an increase in fellowship training positions being captured through the match process. In parallel, the number of ACGME-accredited positions and programs has risen sharply over the past 10 years. It appears that a higher proportion of fellows trained in accredited programs work in academic positions and hospital-based settings. The long-term effect on the pediatric otolaryngology workforce of training more fellows in accredited fellowships remains to be seen.
Submitted for Publication: May 26, 2015; final revision received June 25, 2015; accepted June 30, 2015.
Corresponding Author: Diego Preciado, MD, PhD, Division of Pediatric Otolaryngology–Head and Neck Surgery, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010 (firstname.lastname@example.org).
Published Online: September 10, 2015. doi:10.1001/jamaoto.2015.1570.
Author Contributions: Dr Preciado had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Poley, Preciado.
Acquisition, analysis, or interpretation of data: Espinel, Poley, Zalzal, Chan.
Drafting of the manuscript: Espinel, Poley, Preciado.
Critical revision of the manuscript for important intellectual content: Espinel, Poley, Zalzal, Chan.
Statistical analysis: Poley, Preciado.
Administrative, technical, or material support: Espinel, Poley.
Study supervision: Zalzal.
Conflict of Interest Disclosures: None reported.