Otolaryngology Practice Settings: Impact of Provider Gender and Age on Practice Size and Rural Location

Introduction: Otolaryngology is one of many specialties experiencing practice consolidation, raising concerns for access to care in underserved populations. The goal of this study is to explore otolaryngology provider preferences in practice size and location based on gender and graduation year, with the purpose of informing conversations on providing access to underserved populations.

Methods: Cross-sectional study was performed based on the Doctors and Clinicians National Downloadable File from the Centers for Medicare and Medicaid Services. The October 2023 file was downloaded and filtered to “otolaryngology” as primary specialty. Providers were then organized into cohorts by graduation year, each cohort containing providers graduating within a 10-year interval. Data was collected and analyzed on gender, organization size, medically underserved and rural locations based on the Federal Office of Rural Health Policy.

Results: In total, 9,264 providers were included in the database, with 7,380 males and 1,884 females. Average organization size rose every decade, from 237 in the 1956-1965 group to 1,141 in the 2016-2023 group (p < 0.0001). Percentage of providers joining small practices ( < 25 members) decreased from 68.9% in 1956-1975 classes to 45% in 1976-1995 classes and 29.9% in 1996-2015 (p < 0.001). Females were more likely to join larger groups overall with an average organization size of 1,087 compared to 694 for males (p < 0.0001). This difference persisted even when controlled for graduation decade (p < 0.001). Number of providers belonging to an organization in medically underserved location did not change based on graduation year (p = 0.206). However, providers graduating before 1996 were more likely to practice primarily in a rural setting than those who graduated after 1996 (p < 0.0001).

Conclusions: Average organization size was greater for newer graduates and females. Newer graduates were equally likely to practice in medically underserved areas but were less likely to practice in rural areas than their more senior counterparts, raising concern for widening of the rural-urban divide in otolaryngology.