Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Assessing the geographic movement of Otolaryngology Residency Graduates (ORGs) is crucial to optimizing healthcare delivery and understanding regional disparities in specialist surgical care. This study aims to explore the migration patterns of ORGs from medical school to residency (T1), residency to fellowship (T2), and residency to the first attending position (T3).
Methods: We analyzed data from 661 graduates across 131 ACGME-accredited otolaryngology programs between 2019 and 2022. Migration distances were measured in miles across the four U.S. Census regions (Northeast, Midwest, South, and West). Statistical tests, including Welch two-sample t-tests and ANOVA, were used to compare travel distances, with a specific focus on graduates from Top 40 NIH-funded medical schools (T40MS). Socio-economic data were sourced from the U.S. Census and County Health Rankings, with regression analyses assessing factors influencing mobility.
Results: Trainees traveled significantly farther in T2 (869 mi) compared to T1 (591.5 mi) and T3 (641 mi) (p<0.001), with 80% relocating >200 mi. Thirty percent of T2 trainees stayed in the same region compared to T1 (46%) and T3 (47%). The Western region demonstrated the highest retention across both T1 (58%) and T3 (69%). ANOVA indicated no significant variance between transitions, and t-tests showed no difference in distance traveled based on T40MS. Attendings in their first job, without fellowship, tended to practice in areas with a 7.5% higher median income and a 98.4% higher degree of rurality compared to the region in which they trained. In T1, regression analysis indicated that rurality had a negative impact on distance traveled (-8.6 mi, p<0.01). Conversely, uninsured populations, college education levels, and population older than 65 had a positive impact on distance traveled (increased distance traveled by 35, 15, and 28 mi, respectively, p<0.01). For T2, income was a significant positive predictor of distance (17 mi, p < 0.001). Higher population education levels were associated with shorter distances traveled (Beta = -22 mi, p < 0.001), indicating a preference for areas with better education systems. For T3, T40MS traveled significantly shorter distances to their fellowship (Beta = -461 mi, p = 0.007) reflecting local availability of high-quality fellowship programs.
Conclusion: Graduates traveled farthest to their attending roles from residency, compared to distance traveled to fellowship and to residency. Additionally, attendings coming straight from residency traveled to notably more rural populations for their first job. Regression determined NIH status was significantly predictive in determining shorter distance traveled to fellowship from residency. The Western region exhibited the highest retention, hinting at potential regional disparities. Addressing these disparities is essential to ensure equitable access to specialized care across all regions.