Hello, cwbrd!
Okay, I admit it! This group of subspecialties was exceptionally
hard. The availability of information for plastic surgeons and
oral/maxillofacial surgeons, in particular, was next to nothing. There
are a few references I found for these two categories that you might
want to purchase, but I don't know how useful they will turn out to
be.
If you would like me to look into another specialty or two to make up
for this lack of information, I might be able to find something more
that you can use. As usual, I tend to find helpful articles that hit
the nail on the head -only to realize that they pertain to other
countries!!!
*****************************
ORAL/MAXILLOFACIAL SURGEONS
*****************************
I have provided several references below, but the most promising in
terms of job projections are not available online. Most of the other
information I have found pertaining to future needs is lumped in with
dentistry.
Some of the articles referenced are from the Journal of Oral and
Maxillofacial Surgery and cannot be accessed online. Should you wish
to order them, the website for the Journal is:
http://www2.joms.org/scripts/om.dll/serve?action=searchDB&searchDBfor=home&id=joms
=
"Demand for dental care should grow substantially through 2010. Oral
and maxillofacial surgeons, and other specialists, will continue to be
in demand as technology advances and more services can be performed to
treat and correct facial deformity and disease."
From "Saving Face." http://www.chc.hcwp.org/center_stage_spring2004.pdf
==
The US Dept. of Labor job outlook data lumps oral/maxillofacial
surgeons under Dentists.
"Most dentists are general practitioners, handling a variety of dental
needs. Other dentists practice in 1 of 9 specialty areas.
Orthodontists, the largest group of specialists, straighten teeth by
applying pressure to the teeth with braces or retainers."
* "The next largest group, oral and maxillofacial surgeons, operate on
the mouth and jaws."
"Employment of dentists is expected to grow more slowly than the
average for all occupations through 2010. Although employment growth
will provide some job opportunities, most jobs will result from the
need to replace the large number of dentists projected to retire. Job
prospects should be good if the number of dental school graduates does
not grow significantly, thus keeping the supply of newly qualified
dentists near current levels."
From the Occupational Outlook Handbook
http://www.umsl.edu/services/govdocs/ooh20022003/ocos072.htm
==
From the Career and Occupational Information Kingdom website:
Oral and Maxillofacial Surgeons:
* Education : First professional degree
* Employed : 152,000
* Projected Growth : 6%
* Earnings : $ 129,030
"Perform surgery on mouth, jaws, and related head and neck structure
to execute difficult and multiple extractions of teeth, to remove
tumors and other abnormal growths, to correct abnormal jaw relations
by mandibular or maxillary revision, to prepare mouth for insertion of
dental prosthesis, or to treat fractured jaws."
http://www.careeroink.com/career-reference/onet/ONET4.asp?soc_code=29-1022.00
==
One tidbit I found is the percentage of dentists that subspecialize
into oral/maxillofacial surgery:
"The vast majority of dentists, more than 80 percent, are in general
practice. The remainder are subspecialists, including orthodontists
(5.8 percent), oral and maxillofacial surgeons (4.1 percent)......."
From "Ageism in Health Care: Are our Nation's Seniors Receiving Proper
Oral Health Care?" American Dental Hygienist's Association. (Sept
2003)
http://aging.senate.gov/_files/fr110ks.pdf
==
The following reports and articles must be accessed offline:
1. The American Dental Association has a recent report for purchase
that might provide some projections (you can view the table of
contents)
"2002 Survey of Dental Practice-Oral and Maxillofacial Surgeons in
Private Practice (September 2004) -
"In a newly published report, oral and maxillofacial surgeons in
private practice had an average net income of $336,000 in 2001. "Oral
and Maxillofacial Surgeons in Private Practice" uses data collected by
the ADA's 2002 Survey of Dental Practice. The report also provides
data on income, gross billings, expenses, patient visits and
employment of dental staff, as well as a host of other practice
characteristics. The report is part of a series of reports on
individual specialties published by the ADA Survey Center throughout
2004.
http://www.ada.org/ada/prod/survey/publications_newreports.asp#oralmaxio
See table of contents
http://www.ada.org/ada/prod/survey/publications_newreports_private_surgeons.pdf
==
2. Not available online:
"Estimating future workforce and training requirements for oral and
maxillofacial surgeons." Patient Service Needs Committee of the
American Association of Oral and Maxillofacial Surgeons. J Oral
Maxillofac Surg. 1997 Aug;55(8):906-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9251627
==
3. Not available online:
"The future of oral and maxillofacial surgery." Davis WM Jr. J Oral
Maxillofac Surg. 1989 May;47(5):547.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2709230
==
The following dated abstract provides a bit of insight into the
characteristics of oral/maxillofacial surgeons:
"A survey of oral and maxillofacial surgeons concerning their
knowledge, beliefs, attitudes, and behavior relative to parameters of
care." Kelly JF, Helfrick JF, Smith DW, Jones BL. J Oral Maxillofac
Surg. 1992 Jan;50(1):50-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1727462
==
PubMed has some available abstracts, but they do not shed much light
on future job projections. They are also very dated.
"The manpower survey of oral surgery in 1974. Part 1 of two parts. 1.
Introduction and some general characteristics of oral surgeons."
McCallum CA, Walker RV, Wallace WR, Jamison HC. J Oral Surg. 1977
Aug;Spec No:A4-19.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=267746
==
"The majority of oral surgeons thought that there was enough dental
manpower to meet the demand for oral surgery service. Age had no
significant influence on this opinion. Oral surgeons in population
areas of less than 150,000 were less inclined to think there was
excessive manpower in the dental specialties than those in population
areas of more than 150,000."
From "Oral surgeons in full-time private practice." Graham JW. J Oral
Surg. 1979 Apr;37 Spec No A:A14-30.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=285249
==
I don't know that the following abstracts offer any help other than to
indicate that this is still a young specialty which suffers from a
lack of cohesiveness and general knowledge about what these
specialists can offer:
"Oral and maxillofacial surgery is a unique specialty based in
dentistry but requiring extensive surgical training. The vast
proliferation of medical and dental knowledge has resulted in extreme
pressure on educational processes in both professions and, as a
result, current medical graduates have little knowledge of dentistry
and dental education has suffered with a reduction in teaching in
medical and surgical disciplines. The specialty of oral and
maxillofacial surgery has become the referral base for a wide variety
of the surgical and pathological problems in the maxillofacial region.
The specialty, therefore, finds itself in a position where its
expertise in specialty procedures is frequently poorly understood by
both medical and dental colleagues. There is a need for strong
international cooperation in order to maintain a viable monospecialty
without fragmentation. This must include coordinated training
programmes placed on the now widely accepted guidelines for training
and education adopted by the International Association of Oral and
Maxillofacial Surgeons."
From "International oral and maxillofacial surgery: the medical/dental
interface." Cook RM. Ann R Australas Coll Dent Surg. 1998
Oct;14:134-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10895626
=
Also see "So you think they know what we do? The public and
professional perception of oral and maxillofacial surgery." Ameerally
P, Fordyce AM, Martin IC. Br J Oral Maxillofac Surg. 1994
Jun;32(3):142-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8068583
==
The impact of a medical degree on the specialty:
See "Integration of the medical degree in oral and maxillofacial
surgery: A 10-year follow-up." Herford AS, Pulsipher DA, Sinn DP. J
Oral Maxillofac Surg. 2001 Dec;59(12):1471-6; discussion 1477-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11732036
==
A study of women in the specialty:
RESULTS: "A total of 107 surveys were sent to practicing female
surgeons and 105 to oral and maxillofacial surgery programs. There was
a return rate of 71% and 70%, respectively. Practicing female oral and
maxillofacial surgeons tended to be young, Caucasian, and married.
Fifty-nine percent were boarded, and 47% owned their own practices.
Four of 76 had interrupted their residencies, and 18 had interrupted
their practices at some point. More than 64% of practicing female oral
and maxillofacial surgeons believed that there was a bias against
women in this field. Female residents showed an overwhelming
satisfaction with their career choice, but nearly half of them alluded
to the need for dedication, a restriction of social life, or a concern
for entering an male-dominated field. For students, the time
commitment during residency and while in practice, and compromised
family and social life, were the most commonly mentioned deterrents to
entering oral and maxillofacial surgery, and lifestyle and the
excitement of the field were its major attractions. CONCLUSION:
Despite some biases in the field, women are practicing oral and
maxillofacial surgery full time and are combining their career with
full family lives."
** Among dental students, the time commitment and social compromise
are the largest deterrents to entering the specialty of oral and
maxillofacial surgery."
From "Women in oral and maxillofacial surgery: factors affecting
career choices, attitudes, and practice characteristics." Risser MJ,
Laskin DM. J Oral Maxillofac Surg. 1996 Jun;54(6):753-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8648481
*****************
PLASTIC SURGEONS
*****************
After an exhaustive search of this specialty, I have not found any
comprehensive job outlook projections. Plastic surgery involves both
Cosmetic and Reconstructive Surgeons that are further subdivided by
specialty. While the American Society for Aesthetic Plastic Surgery
has compiled an extensive report on the types, numbers and demographic
makeup of numerous cosmetic procedures as well as physician fees and
percentage of procedures completed (see below), there is no job
outlook information on the site. PubMed has several articles that
touch on the topic of manpower, but no abstracts are available online.
For example, the following two articles must be accessed offline:
"Plastic surgical workforce: too many or too few?" McGrath MH. Ann
Plast Surg. 1999 Apr;42(4):349-56.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10213393&dopt=Abstract
"Manpower in plastic surgery." Luce EA. Ann Plast Surg. 1994 Feb;32(2):218-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8192376&dopt=Abstract
=
As stated in the following excerpt, the American Society of Plastic
Surgeons is attempting to gather data for manpower projections:
"The decreased interest in surgical specialties from medical students
has serious implications not only for the quantity but also the
quality of future surgeons for the United States, says Dr. Rohrich.
"Just in the plastic surgery community alone, we have seen people
turning to non-physician practitioners to fulfill their needs rather
than using a highly skilled, board-certified surgeon," stated Dr.
Rohrich. "I shudder to think how the quality of medical care will
decline as we feel the crunch of a surgeon shortage."
*** "ASPS is gathering information on plastic surgery manpower issues
to determine if there is a role the society can play in ensuring an
adequate supply of plastic surgeons in the future."
"ASPS is the largest organization of board-certified plastic surgeons
in the world and the foremost authority on cosmetic and reconstructive
plastic surgery. With nearly 5,000 members, ASPS is the definitive
voice of the plastic surgery specialty. Viewed throughout the world as
the pinnacle of information for new techniques, advances and plastic
surgery trends, the society represents 94 percent of all the
board-certified plastic surgeons in the United States. Ninety-four
percent of all ASPS members perform cosmetic plastic surgery and 89
percent of all ASPS members perform reconstructive plastic surgery."
From "Surgeon Shortage Will Negatively Affect Nation?s Health -
American Society of Plastic Surgeons Calls Attention to Nationwide
Dilemma." American Society of Plastic Surgeons. March 18, 2004
http://www.plasticsurgery.org/news_room/press_releases/Surgeon-Shortage-Will-Negatively-Affect-Nations-Health.cfm
==
"The American Society of Plastic Surgeons reported that more than 5.7
million people had reconstructive procedures in 2001, with more than
70 percent of those involving tumor removal."
From "Surgeons refine reconstruction techniques, improve
communication." Cosmetic Surgery Times.
http://www.cosmeticsurgerytimes.com/cosmeticsurgerytimes/article/articleDetail.jsp?id=33016
==
One fact that appears evident is that the number of cosmetic
procedures increases with economic ability and society's acceptance.
From the ASPS website:
"A strengthening economy means that people are more willing to invest
in the things that improve their quality of life," says ASAPS
President Robert Bernard, MD, of White Plains, NY. "Feeling good about
the way they look is high on the list of priorities for many
Americans."
"The number of surgical and nonsurgical cosmetic procedures in the
United States increased by 20 percent in 2003 to a total of nearly 8.3
million, according to statistics released today by the American
Society for Aesthetic Plastic Surgery (ASAPS). The number of surgical
procedures increased 12 percent and the number of nonsurgical
procedures increased 22 percent from 2002."
"The five most popular surgical cosmetic procedures in 2003 were:
liposuction (384,626); breast augmentation (280,401); eyelid surgery
(267,627); rhinoplasty (172,420); and female breast reduction
(147,173). Breast reduction may be covered by insurance, depending on
terms of the policy and individual patient factors."
From "2003 ASAPS Statistics - 8.3 Million Cosmetic Procedures:
American Society for Aesthetic Plastic Surgery Reports 20 Percent
Increase." American Society for Aesthetic Plastic Surgery.
http://www.surgery.org/press/news-release.php?iid=325
The full report is available on the ASPS website:
http://www.surgery.org/press/statistics-2003.php
==
Pediatric Plastic Surgery (abstract indicates enough manpower in this area)
"To determine the future needs in manpower for pediatric care as it
relates to pediatric specialists, a study was conducted by the
American Academy of Pediatrics to see the needs of manpower that will
provide access of pediatric care to all. A pediatric plastic surgery
survey was set in the form of a list of questions that was mailed to
the respective societies with pediatric plastic surgeons as members.
The survey was reviewed, and the results were studied. The outcome is
presented in the form of findings related to the overall practice of
plastic surgery. Based on the percentage of pediatric care that is
provided, there were two types of pediatric plastic surgeons. Those
with the high percentage of pediatric care tend to stay near health
science centers; however, both groups tend to spend time (each to a
different extent) tending to other plastic surgery problems. Today we
have adequate access to care in the health system for pediatric
plastic surgery problems despite the shift in the health care
environment. Managed care continues to use the pediatrician as a
"gatekeeper" in determining the overall access for patients with
problems related to pediatric plastic surgery."
From "Analysis of workforce, distribution of care, and practice
preference in pediatric plastic surgery." Brotherton SE, Habal MB.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10388420
==
In case you have any interest in the economics of Plastic Surgery and
the effect on physician practices:
"The changing health care marketplace: current industry trends, new
provider organizational structures, and effects on plastic surgeons."
Krieger LM. Plast Reconstr Surg. 1998 Sep;102(3):900-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9727464
"The economics of plastic surgery practices: trends in income,
procedure mix, and volume." Krieger LM, Lee GK. Plast Reconstr Surg.
2004 Jul;114(1):192-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15220592
******************************************
REHABILITATION SPECIALISTS - Physiatrists
******************************************
This is a very broad category which is commonly called Physiatry.
"Physiatrists are physicians who specialize in Physical Medicine and
Rehabilitation and are trained to diagnose, treat, and direct a
rehabilitation plan that provides the best possible outcomes for these
patients. Physiatry not only employs the usual tools of medicine, but
also uses physical agents and therapeutic exercise in the prevention,
diagnosis, treatment and rehabilitation of disorders that produce
pain, impairment and disability."
"Nationwide there has been a rise in demand for rehabilitation
services, brought on by an increasingly aging population and improved
survival rates after disease and injuries due to advancing medical
care and technology. Patients also seek treatment from physiatrists
for musculoskeletal pain syndromes."
"From the temporarily injured to the severely impaired, patients are
increasingly turning to the diagnostic and treatment expertise of the
physiatrist.
* The specialty is growing rapidly, and the number of resident
physicians has doubled in the last decade.
* Despite this growth, physiatry is one of the few medical specialties
in which there is a relative shortage.
From "AN INTRODUCTION TO PM&R." Association of Academic Physiatrists (1999)
http://www.physiatry.org/field/intro.html
==
"How competitive is this specialty? - PM&R residency positions are
among the most sought after specialty residency slots. This specialty
is not saturated in most areas of the country so job opportunities
abound."
From the University of Texas Office of Career Counseling.
http://www.med.uth.tmc.edu/student/ms4/2003CCC.htm
==
"Physical means of healing have been practiced since prehistoric
times, but Physiatry did not become recognized as a separate medical
specialty until 1947. Most widely known as the field of Physical
Medicine and Rehabilitation, the medical specialty of modern-day
Physiatry comprises the related disciplines of Physical Medicine,
Rehabilitation Medicine and Electromyography."
"As of 1994, the total number of Board Certified Physiatrists grew to
4642, with 2561 of those certified between 1984-94. The current decade
promises continued growth in the number of physiatrists. As a result
of so many newly graduated physiatrists entering the field, the
average age of a physiatrist is now under 40 and still decreasing.
Some areas of the country have an adequate supply of physiatrists,
while other areas continue to have a shortage of rehabilitation
services and/or physiatrists. As is true for other medical
specialties, there is a geographic maldistribution of physiatrists and
in certain geographic areas, no physiatric services are available. The
greatest unmet need in physiatry, however, is the need to increase the
number of academic physiatrists trained for research and teaching.
PM&R Residency Programs continue to experience a shortage of academic
talent to fill chairperson and faculty positions."
From "THE HISTORY OF PHYSIATRY." Association of Academic Physiatrists (1999)
http://www.physiatry.org/about/history.html
==
"Physical medicine and rehabilitation physicians can have general
practices or they can pursue special interests. They treat the
complete range of disabilities including newborns with congenital
birth defects, the elderly who have pain, and people of all ages with
traumatic injuries."
"These are just a few examples of the medical specialty called
physical medicine and rehabilitation (PM&R), also called physiatry.
Pronounced fizz ee at' tree or fizz eye' uh tree, this specialty
focuses on the restoration of function to people with problems ranging
from simple physical mobility issues to those with complex cognitive
involvement."
"Today, physiatry is a diverse specialty. Physiatrists practice in
major rehabilitation centers, in acute care hospitals, and in
outpatient settings. Their approach to patients requires listening and
observing, but also employs state-of-the-art technological support to
assist in the healing process. Physiatry allows physicians to pursue
special interests, touches on a wide variety of other specialties, and
has as its goal the fullest possible recovery for patients through a
truly interdisciplinary, team approach to medicine."
(See article for the wide range of physical disabilities that physiatrists treat)
History of field and workforce projections:
"In 1947, when PM&R became a board-certified specialty, there were 91
board-certified physiatrists; by 1975, there were 1,164. In only ten
years, that number doubled, reaching 2,377 in 1985. It more than
doubled again in the next decade. In 1995, there were nearly 5,000
board-certified physiatrists."
"A Workforce Study concluded in 1994 indicates that if the 1994-95
level of residency capacity is maintained, the supply of physiatrists
will continue to grow, roughly doubling over the next 20 years. Since
managed care penetration will continue to grow as well, it is crucial
that the profession is successful in informing managed care
organizations, the medical community and the public about its value
and cost effectiveness. If the level of residency capacity remains the
same and physiatry can inform the market about itself, excess supply
of physiatrists is not likely to emerge through 2015."
From "Physical Medicine and Rehabilitation: Diversity in a
Profession." American Academy of Physical Medicine and Rehabilitation.
http://www.aapmr.org/member/market/diversit.htm
==
You might want to order the following:
"Managed Care's Effect on Physical Medicine and Rehabilitation - A
monograph produced by AAPM&R, copyright 1995."
http://www.aapmr.org/media/managed.htm
*************************
IMMUNOLOGISTS/ALLERGISTS
*************************
Excerpted conclusions from the "A/I Physician Workforce Report (June 2000)":
1. "It appears that the demand for allergist/immunologists is likely
to rise over the next several years driven in part by the increasing
prevalence of allergy and asthma related conditions and the increasing
complexity of treatment interventions. The expansion of managed care
is unlikely to reduce demand for services by formally trained
allergists."
"Although the demand for allergy and immunology services in the future
is difficult to predict, the signals pointing to increased demand
appear stronger than those pointing to a decrease in demand.
Allergist/immunologists report patient volumes have been increasing
over the past two years. For example, 59% of allergists report an
increase in the volume of sinusitis cases, 58% report an increase in
the volume of asthma cases, and 51% report an increase in the volume
of urticaria cases they treat. Allergist/immunologists also report
that they expect that the incidence of these and other allergy and
immunology conditions will drive demand higher over the next five
years. While new medications and treatments are likely to influence
demand, most allergists expect these interventions will lead to an
increase demand for their services over the next five years."
3. "In light of the decrease in the number of new graduates of allergy
and immunology fellowship programs over the past decade and the aging
of the current supply of allergist/immunologists, it is expected that
the absolute number of allergists practicing in the U.S. and the per
capita ratio of allergists, will begin to decrease within the next few
years, leading to a decrease in access for Americans to physicians
with formal training in allergy and immunology."
"Fifty-four new allergist FTEs added to the supply each year is not
enough to keep up with the retirement of currently practicing
allergist/immunologists. The Center?s projection model which
incorporates the current effective production rate, age distribution,
proportion completing a formal allergy and immunology training
program, retirement and death rates projects that there will be a
significant decline in the supply of allergist/immunologists if
current trends continue. This downward trend is already underway."
"Under the assumptions that demand stays constant and current supply
is slightly higher than demand, the conclusion drawn from the model is
that there will be a shortage of allergist/immunologists within the
next ten years. Because current effective production cannot keep up
with the current retirement rate of practicing allergists, the supply
of allergist/immunologists will begin to drop below demand for allergy
and immunology services in the near future."
(See charts highlighted under this section)
(See remainder of article for demographic changes)
From "Careers in A/I: Allergy/Immunology Workforce Needs." American
Academy of Allergy Asthma and Immunology.
http://www.aaaai.org/professionals/careers/medical_students/workforceneeds.stm
==
"A recent study by the Allergy and Immunology Physician Workforce
Study concluded that if current trends continue there will be a
shortage of Allergists in the near future. This is based on an
analysis of existing data, a survey of physicians providing allergy
services, and surveys of allergy fellows completing allergy training
programs and their program directors in 1999. Not only has their been
a decline of 34 percent of physicians entering allergy training
programs, but many of the graduates of allergy programs return to
their native countries to assist in immunology programs in those
regions. Clearly, medical schools are not supplying enough trained
allergists to maintain the current number of allergy practitioners,
and certainly not enough to keep up with the growth of the US
population and the increasing prevalence and awareness of allergic
disease."
From "The Future of the Allergy and Immunology Workforce." Virginia
Adult & Pediatric Allergy and Asthma Online.
http://www.vaallergy.com/allergyworkforce.asp
******************
OTOLARYNGOLOGISTS
******************
From the USCF School of Medicine:
1. OTO/HNS is the most competitive field in which to secure a position
in the U.S., perhaps second only to neurosurgery.
2. ~100 programs in the U.S.A., none "bad", 280 positions
12. Otolaryngology Careers
a. Attrition equals new production
b. Approximately 9000 otolaryngologists in the U.S.A.
c. Estimated manpower shortage for 2010
d. Recommended Otolaryngologists per population
i. 1:30,000
ii. 1:100,000
From "OTOLARYNGOLOGY/HEAD AND NECK SURGERY MATCH ADVISING NOTES."
http://medschool.ucsf.edu/careermed/phase3/ENTMatchinfo.asp
Also from the USCF School of Medicine:
10. "How competitive is the job market after residency?"
"The job market in this field is wide open. In fact, by 2010, there
will likely be a shortage of otolaryngolgists in the U.S. About 280
new otolaryngologists are produced each year and the attrition from
death and retirement is approximately the same. There are about 9000
otolaryngolgists in the U.S."
From USCF Med Careers
http://medschool.ucsf.edu/careermed/phase3/career_advisors/murr.asp
==
"How competitive is this specialty? - Otolaryngology has been among
the most competitive program types over the past ten years. The
reasons are complex, but include the fact that the specialty has
continued to expand (often at the expense of other specialties, such
as general surgery and plastic surgery), and that future manpower
needs are projected to be on par with current training levels (as
opposed to the surpluses predicted for many specialties). With the
increasing governmental and institutional emphasis on primary care
training, most otolaryngology programs are expecting a decrease in
future medical student exposure to the specialty. Most programs
receive 150 - 350 applications for 2 to 4 slots per year, and
typically interview 20 - 40 of the more promising applicants."
From the University of Texas Office of Career Counseling.
http://www.med.uth.tmc.edu/student/ms4/2003CCC.htm
==
"The number of otolaryngologists practicing in the future is
particularly pertinent in light of the changes taking place in
American medicine today. A mathematical model is presented which
projects the growth of otolaryngology manpower in the year 2010,
taking into consideration the age distribution of practicing
otolaryngologists, death rates, and the current production of
residents. This model suggests that there will be a 21% increase in
the number of otolaryngologists from 1990 to 2010. The main reason for
the increase is the uneven distribution of otolaryngologists by age at
the present time, with 49% of otolaryngologists being less than 45
years of age. There is concern that the American medical community is
populated with too many specialists and that more emphasis should be
placed on training generalists. The manpower issue should be studied
in more detail, and future societal needs should be determined so that
a rational policy on the growth of otolaryngology can be developed."
From "Otolaryngology manpower in the year 2010." Miller RH.
Laryngoscope. 1993 Jul;103(7):750-3.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8341100
==
STUDY: "A large national survey and administrative claims databases
were examined to develop practice profiles and compile a physician
supply for otolaryngology. A focus group of otolaryngologists provided
information to model future scenarios. RESULTS: The current and
predicted workforce supply and demographics are at a satisfactory
level and are decreasing as a proportion of the increasing population.
Empiric data analysis supports the diverse nature of an
otolaryngologist's practice and the unique role for otolaryngologists
that is not shared by many other providers. Together with the focus
group results, the study points to areas for which more background and
training are warranted. CONCLUSIONS: This study represents a first
step in a process to form coherent workforce recommendations for the
field of otolaryngology."
From "The workforce in otolaryngology-head and neck surgery: moving
into the next millennium." Pillsbury HC 3rd, Cannon CR, Sedory Holzer
SE, Jacoby I, Nielsen DR, Benninger MS, Denneny JC 3rd, Smith RV,
Cheng EY, Hagner AP, Meyer GS. Otolaryngol Head Neck Surg. 2000
Sep;123(3):341-56.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10964321
==
"The head and neck surgery workforce in the United States over the
next 20 years is of significant interest to physicians, patients, and
others. Using election to fellowship in the American Society for Head
and Neck Surgery or the Society of Head and Neck Surgeons, or both, as
the criteria for designation as a head and neck surgeon, a
mathematical model was designed to project the growth of the head and
neck surgery workforce through the year 2014. The current combined
active membership of the two societies was analyzed to determine the
impact of age distribution on this model. The paradigm assumes 30 new
head and neck surgeons each year and includes the appropriate
mortality rate for each cohort. Based on this model, the total number
of head and neck surgeons should decrease slightly from 1109 in the
year 1994 to 1028 in the year 2014. A steady-state supply of head and
neck surgeons is therefore predicted."
From "Head and neck surgery workforce in the year 2014." Close LG,
Miller RH. Laryngoscope. 1995 Oct;105(10):1081-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7564840
***************
DERMATOLOGISTS
***************
I have excerpted one small portion from a recent, very comprehensive
article about Dermatology:
"The number of dermatologists has grown far more quickly than the U.S.
population, tripling over three decades from 1970 to 2002 (going from
1.9 to 3.5 per 100,000.) Yet, after decades of controversy concerning
impending surplus versus continuing shortage, at last "there is
considerable evidence that we face an undersupply.."
(See entire article...)
"Dermatology Workforce - Emerging Data Portend Future Changes."
Dermatology Focus. Volume 23, No. 1. Spring 2004.
http://dermatologyfoundation.org/pdf/pubs/DF_Spring_2004.pdf
==
From an article introduction (entire article can be purchased)
"Discussions of the dermatology workforce have been dominated in the
last 3 decades by concerns of an impending surplus. The aim of this
article is to provide new data on the supply of dermatologists and to
reassess estimates of future demand in light of growing anecdotal
evidence suggesting a shortage. The US supply of dermatologists has
risen to 3.3 per 100 000 population, and this growing workforce
continues to be geographically maldistributed. A number of factors,
including a possible increase in the number of surgical and cosmetic
procedures being performed, might make this growing supply less
available for the care of medical dermatology patients, complicating
any supply projections. Precise estimates of future demand are also
difficult because changes in disease prevalence, medical technology,
and the health care delivery system are not always predictable."
From "Too Few or Too Many Dermatologists? Difficulties in Assessing
Optimal Workforce Size," by Jack Resneck, Jr, MD. Arch Dermatol.
2001;137:1295-1301.
http://archderm.ama-assn.org/cgi/content/extract/137/10/1295
==
"Recent studies have shown that the current dermatologist population
is too small to service the demand for skin care. Patients may have to
see general physicians instead of dermatologists because of long wait
times for appointments and insufficient number of skin care
specialists. The shortage is attributed to a number of contributing
factors including:
* "Heightened public awareness of the effects of sun and air pollution
on the skin has led to an increased demand for skin care products and
services. In 2000, the market for dermatology products exceeded $3.5
billion."
* "Managed care systems recognize the cost-effectiveness of using
dermatologists to treat skin disease.
* "A recent study determined that approximately 3.3 dermatologists
were needed to service every 100,000 people. Based on this estimate,
the number of practicing dermatologists needs to be increased from
around 8,400 to more than 9,000."
* "The shortage of dermatologists is evident in waiting times for
appointments - the average waiting time for a dermatology appointment
is more than a month, while general physicians only keep patients
waiting for seven days."
* "The supply of dermatologists is limited by the capacity of
Medicare-funded residency programs providing training."
Read further...
From "Industry Trends Indicate A Shortage of Dermatologists." Florida
Society of Dermatology and Dermatologic Surgery.
http://www.fsdds.org/shortage.html
==
"There's clearly a shortage of dermatologists in the United States,"
says Alexa Boer Kimball, M.D., M.P.H., director, clinical trials, and
assistant professor, dermatology, Stanford University Medical Center."
"Regarding the dearth of dermatologists, Stanford's Dr. Kimball says,
"The factors that seem to be playing a role have to do with the fact
that we've had a steady state in terms of the number of residents
being trained in the United States. There's also the expanding scope
of practice - people are doing what appears to be more surgical and
cosmetic procedures, although the amount that cosmetic procedures
affect the supply of dermatology services is probably less than most
people have thought. Based on data from the AAD/A 2002 Practice
Profile Survey, for most people, cosmetics represents about 10 percent
to 15 percent of their practice. It is by no means the dominant
activity in most practices."
"Nevertheless, Alan B. Fleischer, Jr., M.D., says, "Our specialty has
experienced an increasing number of visits for non-medical, non-skin
cancer surgical dermatology addressing cosmetic issues, primarily. So
that is diverting some of the workforce from pursuing standard medical
and surgical dermatology."
"Dr. Kimball adds, "We're also seeing a trend where the younger cohort
of the workforce are tending to work slightly fewer hours than their
counterparts. Part of that seems to be related to gender, but part of
that is an overall trend."
"According to a report co-authored by Dr. Kimball, among 191 recent
dermatology residency graduates, men worked an average of 40 hours
weekly; women, 34. The same report shows that parenting duties seem to
intensify such differentials - male parents saw patients 34 hours
weekly; female parents, 24 hours weekly, for instance. However, women
on average spent 25 hours per week practicing medical dermatology
compared to 22 hours for men. And the number of hours per week that
both male and female dermatologists spent seeing patients declined by
three for men and four for women between 1999 and 2002."
"There's a maldistribution of dermatologists," adds Dr. Bystryn.
"There's a shortage in some places and an excess in others. The
challenge has been how do you balance these things, because pumping
out more dermatologists doesn't correct the problem if many go to
places where there's already an excess."
"Additionally, increasing the sheer number of dermatologists might do
little to shore up the ranks of medical dermatologists."
"Dr. Fleischer adds, "One of the reasons (the future) is unpredictable
is, will healthcare financing remain the same for the next decade? Or
will it change to restrict access? If it does, maybe then we'll have
too many dermatologists. But if it continues in its current guise,
then we'll increasingly have fewer dermatologists than we need to
service the community. It will not come to pass that there will be a
doubling in the number of dermatology residency positions. Physicians
will work as hard as they want to, and then they won't work any
harder. So the market will balance it out."
From "Dermatologist shortage fuels mounting wait for office visits, by
John Jesitus. Dermatology Times. Sept. 1, 2004.
http://www.dermatologytimes.com/dermatologytimes/article/articleDetail.jsp?id=124904&pageID=1&sk=&date=
==
"There?s a gross undersupply of dermatologists," says Clark Otley,
M.D., associate professor of dermatology at the Mayo Clinic and
president of the Minnesota Dermatological Society (MDS). The shortage
is nationwide, but it?s especially acute outside the major
metropolitan areas. "An imbalance between urban and rural is not
unique to dermatology. But when you add the urban/rural discrepancy on
top of an overall shortage, the waits can be frustratingly long. It
can be several months before you can see someone. In many communities,
there is no dermatologist."
"Finding people who want to go into dermatology isn?t a problem. In
fact, it?s become one of the most competitive fields for new doctors,
with a 40 percent increase in students pursuing it over the past five
years, according to a January 7, 2004, New York Times story."
"We have no shortage of applicants," says Ericson, speaking of the
medical school?s dermatology resident positions. "This year we had
more than 300 applicants for seven positions. Funding is the issue;
it?s a constant battle."
(This is an interesting article which includes a lot of information
about the changes in dermatology, and the reasons it is so appealing
as a specialty)
From "Dermatology?s Changing Face," by Kim Palmer. Minnesota Medicine.
March 2004/Volume 87
http://www.mmaonline.net/publications/MNMed2004/March/Palmer.html
****************
OPHTHALMOLOGISTS
****************
Objective: "To describe the distribution of the supply and
requirements for subspecialty ophthalmologists."
Methods: "Estimates from the Eye Care Workforce Study were used to
provide subspecialty-based assessments of the supply and public health
need, as well as market demand, for care provided by subspecialists.
Reconciliation with the boundary models (optometry first,
ophthalmology first) of the Eye Care Workforce Study and current
market status also were performed."
Results: "Whether subspecialists are in excess depends first on which
boundary model most closely approximates the current market
conditions. Under an optometry-first model, 70% of all
ophthalmologists are in excess, although subspecialists (39%) are
relatively less in excess than comprehensive ophthalmologists (91%
excess). Under an ophthalmology-first model, no ophthalmologists would
be in excess. Extrapolating from current market conditions, a slight
excess of ophthalmologists exists, probably proportional across
subspecialists and comprehensive ophthalmologists. Future growth in
the ophthalmologist supply will be almost entirely among
subspecialists."
Conclusion: "Under current market conditions, substantial excesses in
subspecialist ophthalmologists are likely to develop and grow worse
over time, given current training levels."
From "Subspecialty Distributions of Ophthalmologists in the
Workforce," by Paul P. Lee, MD, JD; Dan A. Relles, PhD; Catherine A.
Jackson, PhD. Arch Ophthalmol. 1998;116:917-920.
http://archopht.ama-assn.org/cgi/content/abstract/116/7/917
==
"Whether the current level of eye specialists will be available to
deal with the increase in elderly patients remains uncertain. Sloan
said, "The demand will be rising for optometrists and
ophthalmologists" but it will be difficult to predict if that will
create a shortage."
From "Elderly Vision Loss Expected to Rise." WTOP News. Sept. 8, 2003
http://www.wtop.com/index.php?nid=106&sid=122236
==
"Dr. Etzioni, a general surgeon at University of California, Los
Angeles, and lead author of the study, "The Aging Population and Its
Impact on the Surgery Workforce," predicts the sharpest increases in
demand will be in ophthalmology and cardiothoracic surgery, which will
see 47% and 42% increases in demand respectively by 2020, compared
with 2001. He based his findings on U.S. Census Bureau expectations
that the number of people older than 65 will jump 13.3% by 2010 and
53.2% by 2020 to 53.7 million, as baby boomers age and life
expectancies lengthen."
"Ophthalmologist Paul Lee, MD, who has analyzed work force demand
within his specialty, said the report's prediction of a 47% increase
in demand for ophthalmologic surgery doesn't necessarily mean that he
and his colleagues would become overwhelmed with cataract patients.
"An increase in demand for surgical services doesn't necessarily
translate into a shortage of surgeons to do the work," Dr. Lee said."
"Surgery is a significant part of ophthalmologists' work but not the
bulk of their daily routine, he said. One past work force study showed
ophthalmologists spend 17% of their time on surgery. An increase in
surgery would mean restructuring the work load, he said, and might
even include allowing optometrists to take over more tasks. "We don't
need 47% more time or 47% more doctors to take on a 47% increase in
demand," he said. "People won't have to put up with a Canadian waiting
list to get cataract surgery."
"Industry estimates pegged cataract surgeries at 2.3 million in 2002,
up substantially from the mid-1990s when there were 1.6 million to 1.8
million surgeries every year."
** "Work force shortages are notoriously difficult to predict accurately."
From "Aging population creating higher demand for surgery - A UCLA
study predicts surgeon shortages in ophthalmology and cardiology and
urges doctors to work even more efficiently," by Myrle Croasdale. AMED
News. Aug. 25, 2003.
http://www.ama-assn.org/amednews/2003/08/25/prsc0825.htm
==
"This is not to say that surpluses of physicians in some specialties
do not exist. A colleague characterized ophthalmology as already
"oversubscribed," and recruiters agree. It is slightly less evident
because some ophthalmologists have pursued refractive surgery, but
that appears to be tailing off, and the future is clouded by
competition from optometrists, who now have prescriptive privileges
and who have expanded their roles in eye care."
From "There's a Shortage of Specialists: Is Anyone Listening? by
Richard A Cooper, MD. Acedemic Medicine, Vol. 77, No. 8 Augusts 2002.
http://www.merritthawkins.com/pdf/articles/shortage_anyone_listening.pdf
====
Well, once again, I wish that I could have found more on a few of
these specialties. I do hope you can use what I have found. I want to
reiterate that I am happy to look into a few other specialties under
this same question to make up for what little I could unearth
concerning some of the categories.
Also - I have truly enjoyed working with you in finding information
for this project. If you still intend to delve into other areas aside
from the physician workforce projections, I would be delighted to work
further with you in the future.
Thanks again for your patience and generosity. I'll keep my eyes open
for a clarification on this question if you decide you would like me
to do a bit of extra searching under some other specialties.
Sincerely,
umiat
Search Strategy
shortage of oral and maxillofacial surgeons
workforce projections for oral and maxillofacial surgeons
occupation data for oral and maxillofacial surgeons
oral surgeons occupational outlook
oral surgeons projected need
shortage of plastic surgeons
too many plastic surgeons
reconstructive surgeons in United States
American Society of Plastic Surgeons
future of plastic surgery
future need for plastic surgeons
shortage of rehabilitation specialists
shortage of physical rehabilitation specialists
shortage of physical medicine specialists
shortage of allergists
shortage of immunologists
shortage of otolaryngologists
shortage of dermatologists
shortage of ophthalmologists in United States
Searches on PubMED for all these specialties |
