(010) Geographic and Practice Mobility of Otolaryngologists: A Ten-Year Analysis

Introduction: Physician density affects outcomes; higher otolaryngologist density is associated with improved head and neck cancer mortality-to-incidence ratios. Prior studies describe otolaryngologist distribution, but few evaluate migration over time, especially after COVID-19 reshaped practice.

Methods: This retrospective workforce analysis utilized annual Medicare Physician and Other Practitioners datasets from the Centers for Medicare & Medicaid Services (2013-2023). Otolaryngologists were identified by specialty taxonomy, with providers classified by state, sex, and Rural-Urban Commuting Area (RUCA) codes. Migration events were defined as changes in five-digit practice ZIP codes between consecutive years for the same National Provider Identifier. Movements were aggregated into pre-pandemic (2017-2020) and post-pandemic (2020-2023) time-periods. Statistical analysis included chi-square tests and negative binomial regression models with robust standard errors.

Results: The otolaryngology workforce demonstrated gains in urban areas over the study period, with urban providers increasing 10.1% (7,421 to 8,170) while rural providers declined by 17.3% (774 to 640). Female representation increased substantially, particularly in urban settings (13.7% to 20.1%). Total state-to-state movements showed minimal change between periods (449 pre-COVID vs. 459 post-COVID, +2.2%). Regional migration patterns remained stable (χ² = 7.430, p = 0.945), with the South and West maintaining net population gains. However, urban-rural migration patterns shifted dramatically: cross-category movements (urban-to-rural and rural-to-urban) increased from 4.37% to 13.08% of total moves (p < 0.001). Urban-to-rural movements specifically increased from 2.3% to 8.2% of all relocations.

Conclusions: Overall mobility and regional redistribution were stable after COVID-19, but urban-rural migration shifted toward greater urban-to-rural movement. Ongoing urbanization may affect access in underserved rural areas.