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The demand for pediatric otolaryngologists appears to be increasing, but many general otolaryngologists do not believe there is an increased need. The field of otolaryngology—head and neck surgery has seen the development of a number of subspecialties, including facial plastic surgery, otology and neurotology, head and neck surgery, and pediatric otolaryngology. Controversy exists regarding pediatric otolaryngology, usually centered around the appropriate practice setting for the pediatric otolaryngologist and the relationship of this subspecialist to the general otolaryngologist.
The diseases and types of surgical cases that are more appropriately handled by a pediatric surgical subspecialist have been debated. The most appropriate location of a pediatric otolaryngology practice has also been discussed, and many agree that such a subspecialist is most needed in a tertiary pediatric medical center. The need for postresidency pediatric fellowship training, the duration of such training, and the appropriate pediatric content of otolaryngology residency programs are subjects that are not settled.
Workforce issues in pediatric and general otolaryngology involve the determination of the appropriate number and distribution of otolaryngologists and pediatric otolaryngologists to serve patient needs adequately. Workforce studies of otolaryngology 4 - 6 and pediatric otolaryngology 7 have projected these numbers. We obviously need to ensure that we are training an appropriate number of otolaryngologists and subspecialty otolaryngologists to meet patient needs now and in the future.
As part of this project, key leaders in pediatrics addressed the future supply and training of pediatricians and pediatric specialists and the provision of pediatric care in the new millennium. As part of the FOPE II Project, a 5-page questionnaire was developed to obtain information from a variety of medical and surgical specialists who treat children.
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This questionnaire was designed to be applicable to most physicians and collected information on several areas, including specialty training, competition, referral sources, and demographic characteristics. An additional 3-page questionnaire specific for pediatric otolaryngology was developed in collaboration with the American Academy of Pediatrics Section on Otolaryngology and Bronchoesophagology AAP Section.
The pediatric otolaryngology questionnaire included questions on proportion of practice that involves care of children, the type and duration of pediatric otolaryngology training, the numbers of pediatric otolaryngologists in the community, referral patterns of children requiring otolaryngologic care, and the types of disease processes seen in them. These questionnaires were pretested by a small group of pediatric otolaryngologists.
Questionnaires were revised based on comments received. There was some overlap in membership; Five mailings of the survey went out between October and February to the otolaryngologists. Each mailing contained the standard questionnaire and the pediatric otolaryngology questionnaire, a cover letter emphasizing the importance of the survey, and a return envelope.
We received responses from physicians, We received 26 responses that were excluded because the physicians indicated they were retired, did not treat children, were temporarily not practicing, or were in training.
These were excluded from the sample size of , producing an effective sample size of Our response rate is therefore of Respondents were divided into 2 groups for all statistical analyses. The first group consisted of otolaryngologists with a pediatric focus. This group was operationally defined as those respondents who belonged to the ASPO, the AAP Section, or both, and will be referred to as the pediatric otolaryngologist group. The second group consisted of the respondents who belonged only to AAOHNS and will be referred to as the general otolaryngologist group.
For continuous variables, comparisons between the groups were made using independent group t tests.
The number of cases for each analysis fluctuated slightly based on the number of missing values for the individual question. There were several differences in demographic and practice characteristics between the pediatric otolaryngologist and the general otolaryngologist groups.
There was also a higher proportion of pediatric otolaryngologists who were women compared with the general otolaryngologist group The overwhelming numbers of pediatric and general otolaryngologists were white, non-Hispanic Nearly half of general otolaryngologists were in solo practice. Also as given in Table 1 , Furthermore, 5 times as many general otolaryngologists Table 2 shows that patient profiles and practice content also differed for pediatric otolaryngologists and general otolaryngologists. As expected, the percentage of pediatric otolaryngologists' patients who were younger than 18 years was much higher than the percentage of general otolaryngologists' patients for both office patients When we looked at the disease processes seen in children requiring otolaryngologic care, compared with general otolaryngologists, pediatric otolaryngologists had significantly lower percentages within their respective patient pools of patients with otitis media A higher relative percentage of the children seen by pediatric otolaryngologists had congenital anomalies 6.
Otolaryngologists were asked to describe the sources of their pediatric referrals.
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Pediatric generalists and family physicians were named the most often by both groups of physicians Table 3. Urgent care centers and school districts also were mentioned frequently. Pediatric otolaryngologists were more likely to receive referrals from pediatric medical and surgical subspecialists and pediatric nurse practitioners, while general otolaryngologists were more likely to receive referrals from general internists.
When asked to rank the importance of personal or community characteristics that influence referrals of children for otolaryngologic care in their community, pediatric otolaryngologists and general otolaryngologists had very different rankings Figure 1.
Although managed care affiliations and established referral patterns were considered influential by both groups, general otolaryngologists ranked the latter as a more important factor than did pediatric otolaryngologists. General otolaryngologists also ranked practice location and advertising higher than did pediatric otolaryngologists. However, pediatric otolaryngologists reported that fellowship training and practice concentration in pediatric otolaryngology were more influential characteristics affecting referral of children.
Otolaryngologists were asked about changes in the volume or complexity of pediatric referrals and shifts in the number of pediatric patients. Our otolaryngologists use advanced equipment and techniques to precisely diagnose and treat these conditions. Ear infections, the most common reason children seek pediatric care other than well-baby visits, can be acute, recurring or associated with chronic fluid buildup behind the ear drum. Ear infections can lead to various symptoms, including fevers, not sleeping at night and hearing loss that affects the child's speech and language.
We provide a comprehensive range of services to identify and rehabilitate children with congenital hearing loss. Our pediatric otolaryngologists are considered national experts on treating sinusitis. Together with our highly skilled allergy and asthma specialists and other physicians, they routinely treat children with complex cases of sinusitis and co-existing conditions. The pediatric otolaryngology team at Comer Children's treats ENT disorders ranging from common problems affecting children, such as ear, tonsil and sinus infections to more complex problems, like congenital hearing loss and neck masses.
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