Author(s)
Andrew J. Rothka, MD
Nathan Barefoot, BS
Taylor J. Stack, MD
Priya Desai, BS
Brent A. Senior, MD
Adam J. Kimple, MD PhD
Affiliation(s)
1. University of North Carolina Hospitals, Department of Surgery2: University of North Carolina Hospitals, Department of Otolaryngology – Head and Neck Surgery
Abstract:
Educational Objective
At the conclusion of this presentation, the participants should be able to analyze and understand the distribution of fellowship-trained rhinologists across the United States.
Objectives
Rhinology has emerged as a rapidly growing subspecialty within otolaryngology, offering advanced care for complex sinonasal and skull base disorders. As fellowship training in rhinology has expanded, understanding the current distribution of fellowship-trained specialists is critical to addressing workforce needs and ensuring equitable access to care. Prior analyses of subspecialty distribution have highlighted disparities between urban and rural regions, yet similar data for rhinology remain limited. This study aims to characterize the geographic and practice setting distribution of fellowship-trained rhinologists across the United States. The objectives of this study are to identify current practice locations of rhinologists in the United States and compare distribution of rhinologists between urban and rural settings.
Study Design
Cross-sectional study
Methods:
This study utilized publicly available data and results of a survey study to identify fellowship-trained rhinologists, their primary practice location, and their fellowship training location. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and non-metropolitan sites (codes 4-9) and determine local populations.
Results:
A total of 407 rhinologists (76.7% men) were identified across 46 states/territories as of 2024. Slightly more than half of rhinologists practiced in academic settings (n=216, 53.1%). There were 398 rhinologists (97.8%) in metropolitan counties serving 146,202,159 people with 0.3 rhinologists per 100,000 people (0.3/100k). Conversely, there were only 9 rhinologists (2.2%) in non-metropolitan counties. Overall, these 9 rhinologists served 549,574individuals (1.6 rhinologists/100k people). The majority of rhinologists are located in urban counties designated by code 1 (n=310, 76.2%).
Most rhinologists practice in California (n=61, 15.0%), followed by New York (n=37, 9.1%) and Texas (n=26, 6.4%). A majority of rhinologists completed residency training in New York (n=65, 16.0%), California (n=41, 10.1%), and Pennsylvania (n=33, 8.1%). Regarding fellowship, most rhinologists trained in Pennsylvania (n=83, 20.4%), Massachusetts (n=50, 12.3%), and California (n=40, 9.8%).
Conclusion:
98% of rhinologists are located in metropolitan areas. For a lucky 5 million people, they reside in a non-metropolitan area and have access to a rhinologist. Comprehending the implications of this counterintuitive distribution of subspecialists is essential for understanding gaps in access to care, referral patterns, and workforce planning, particularly in metropolitan settings where patient volume is typically higher.