(119) Mapping Workforce Distribution and Future Trends in Puerto Rico's Otolaryngology Workforce

Introduction: This study addresses the lack of data characterizing the otolaryngology–head and neck surgery workforce in Puerto Rico, a U.S. territory with economic challenges, physician migration, and regional health disparities. The purpose was to quantify workforce size, geographic and subspecialty distribution, and retirement trends to identify inequities in access to ENT care and inform workforce planning.

Methods: This cross-sectional database study used physician licensure registry data from the Puerto Rico Board of Medical Licensing and Discipline and a supplemental workforce survey of practicing otolaryngologists. The study examined the ENT workforce rather than a specific disease and included all actively practicing otolaryngologists across Puerto Rico. No interventions were performed. Outcomes included workforce size, geographic distribution, ENT density per 100,000 population, subspecialty training distribution, years in practice, workload patterns, and anticipated retirement timelines. Independent variables included practice location, years in practice, and subspecialty training status. Analyses were descriptive, with no interim analyses conducted.

Results: 73 practicing otolaryngologists were identified, corresponding to a workforce density of 2.27 ENTs per 100,000 population. The Metropolitan region had the highest density at 5.40 per 100,000, while non-metropolitan regions ranged from 0.87 to 1.64 per 100,000. The mean years in practice were 24.0 ± 13.9 years, with 62.9% practicing for more than 20 years. Among 42 survey respondents, 85.7% planned to reduce workload prior to retirement, and 40.5% anticipated retiring within 15 years. No confidence intervals or p-values were calculated.

Conclusions: Puerto Rico’s ENT workforce is small, centralized, and aging, with significant regional disparities and limited access to subspecialty care outside the metropolitan area. Although most physicians plan to remain on the island through retirement, projected workforce attrition may worsen access gaps, underscoring the need for workforce planning and policy interventions.