Too Many Neurotologists?
Historically, it has been suggested that the population needed to support one neurotologist is approximately one million. Based on data from 2006, Vrabec (2013) reports that there is (most likely) one neurotologist for every 922,664 people in the United States, and the quantity of estimated surgical procedures per population appears stable (or declining) for lateral cranial base surgeries. Of note, lateral cranial base surgeries are also managed and addressed by (and overlap with) neurosurgeons and radiation oncologists. Lateral cranial base surgery consists primarily of acoustic neuroma surgery, with an incidence of 1.05 per 100,000 population.
Other surgeries performed by neurotologists overlap with general otolaryngologists (based on their areas of expertise, interest, and ability). Vrabec reports less invasive and more conservative treatment protocols reduce overall operating time and indeed, more time is spent in outpatient clinics than in the operating room. For example, management of the vestibular patient 25 years ago may have emphasized endolymphatic shunt surgery, vestibular neurectomy, or other in-patient surgical procedures.
In 2013, the emphasis for these same patients has shifted to out-patient treatment with intratympanic steroids and gentamicin. Likewise, acoustic neuromas are now being treated "with a greater emphasis on radiation treatment" and other non-surgical management protocols (i.e., "watch and wait"). All of which implies a "current or impending oversupply of neurotologists."
Vrabec states that "…as the number of providers for an uncommon health problem increases, the experience of each individual declines. At some point, the supply of highly specialized cases is insufficient for development or maintenance of surgical skills." Vrabec reports that the demand for hearing, tinnitus, and balance services is expected to increase and importantly "not all care will be delivered by neurotologists or even other physicians…." Much of the care (in the future) will come from audiologists, physical therapists, and others.
For More Information, References, and Recommendations
Vrabec, JT. (2013) Workforce Analysis of Neurotologists in the United States. Otology & Neurotology 34(4):755-761.