Current Trainee and Workforce Patterns for Thyroid and Parathyroid Surgery in the US.

Abstract Objective Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education and quality improvement interventions. Methods Tabulation of case numbers for patients privately insured patients undergoing thyroid and parathyroid surgery in Marketscan: 2010-2016, and trainee case logs for residents and fellows in general surgery and otolaryngology. Summary statistics and tests for trends and differences were calculated. Results Marketscan data captured 114,500 thyroid surgeries. The proportion performed by each specialty was not significantly different (p >0.13.) Otolaryngologists performed 58,098 (50.74% of all thyroidectomies, 95% CI 6,495 – 10,103) and general surgeons performed 56,402 (49.26% of all thyroidectomies, 95% CI 6,070 – 10,044). Otolaryngologists more commonly performed hemithyroidectomy (n=25,148, 43.29% of all thyroid surgeries performed by otolaryngologists) compared to general surgeons (n=20,353, 36.09% of all thyroid surgeries performed by general surgeons). Markestscan data captured 21,062 parathyroid surgeries: 6,582 (31.25%) were performed by otolaryngologists, and 14,480 (68.75%) were performed by general surgeons. The case numbers of otolaryngology and general surgery trainees completing residency and fellowship vary six to nine fold across different sites. The wide variation may reflect both the level of exposure a particular training program offers and trainee level of interest. Conclusions Thyroid surgical care is equally provided by general surgeons and otolaryngologists. Both specialties contribute significantly to parathyroid surgical care. Both specialties should provide input into and be targets of research, quality and education interventions.