Evolving phenotype of the head and neck surgeon

OBJECTIVE: Characterize the evolution of head and neck (H&N) surgical practices in the United States over two decades by using resident case log data as a surrogate. METHODS: National residency case log data from all Accreditation Council for Graduate Medical Education-accredited otolaryngology residency programs was reviewed for the past 20 academic years (1996-2015). Key indicator procedures in each subcategory of H&N were analyzed to characterize standard ablative H&N surgical practices. Mean number of cases completed per resident each year was calculated. RESULTS: The proportion of H&N surgeries contributing to the total number of otolaryngology cases performed yearly remained relatively stable during the study period, ranging from 6.4% to 8.7%, indicating concurrent growth of H&N cases with all otolaryngology surgeries. Although each subcategory within H&N demonstrated modest increases in the number of cases performed per resident each year over the study period, the most significant growth occurred in the endocrine surgery subcategory: a 288% increase from 18.4 in 1996 to 71.5 in 2015. The proportion of H&N cases represented by each subcategory decreased, except for endocrine, which more than doubled in proportion from 21% in 1996 to 43% in 2015. CONCLUSION: Our findings suggest that the modern H&N surgeon is increasingly becoming an endocrine and H&N surgeon. The proportion of endocrine surgeries performed in residency, which serves as a surrogate for H&N practices, has more than doubled over the past 20 years and now represents the largest subcategory of H&N surgery. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1150-1154, 2019.