The Global Otolaryngology–Head and Neck Surgery Workforce

Abstract

ImportanceA core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed.ObjectiveTo establish comprehensive workforce metrics for global otolaryngology–head and neck surgery (OHNS) with updated data from more countries/territories.Design, Setting, and ParticipantsA cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians.Main OutcomeThe OHNS workforce per capita, stratified by income and region.ResultsResponses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world’s population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally.Conclusion and RelevanceThis cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Ten years of ear, nose and throat (ENT) services in Southern Africa: a scoping review

“…In the included studies, workforce shortages, inadequate ENT knowledge among clinicians, and disparities in clinician density across income groups contributing to challenges in accessing ENT services were prominent findings [ 5–7 , 9 , 11 , 17 , 29 , 30 ]. The ENT clinician density in Southern Africa was significantly lower (0.18 clinicians per 100,000 population) than the global average of 2.19 clinicians per 100,000 population [ 7 ], particularly in Zambia and Malawi, where ENT specialists, audiologists, and speech and language therapists were critically short [ 9 , 11 , 31 ]. These few clinicians are largely confined to urban centers, leaving rural areas underserved [ 9 , 31 ].…”

“…The Southern African ENT clinician density of 0.18 per 100,000 population found in this scoping review is much lower than those in other low-resource regions, including Central America (0.68 per 100,000) and Southeast Asia (1.12 per 100,000) [ 38 ]. With 70% of lower-middle, and 100% of low-income countries having less than one ENT clinician per 100,000 population [ 38 ], this shortage of ENT specialists, audiologists, and SLTs noted is concerning, leading to disparities in access to care and compromised disease outcomes.…”

“…The Southern African ENT clinician density of 0.18 per 100,000 population found in this scoping review is much lower than those in other low-resource regions, including Central America (0.68 per 100,000) and Southeast Asia (1.12 per 100,000) [ 38 ]. With 70% of lower-middle, and 100% of low-income countries having less than one ENT clinician per 100,000 population [ 38 ], this shortage of ENT specialists, audiologists, and SLTs noted is concerning, leading to disparities in access to care and compromised disease outcomes. While targeted training programs for mid-level ENT cadres and specialists have been implemented in South Africa [ 17 , 39 ], Malawi [ 18 ], and Zambia [ 9 ] over the last decade, little progress has been made in improving the number of available ENT healthcare workers [ 5 , 6 ].…”

Editorial: sustainability in global otolaryngology

“…The inequality between high and low-resourced health systems, and the impact this has on the health of populations, is well documented. A survey [2] of the global Otolaryngology, Head and Neck Surgery workforce demonstrated, perhaps unsurprisingly, that higher-income countries are associated with a higher density of clinicians. Europe had the highest clinician density (5.70 clinicians per 100 000 population), whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest.…”