DO seniors and IMGs have lower match probabilities than MD seniors after adjusting for specialty choice and USMLE Step 1 score.

CONTEXT: It is unknown if US residency applicants of different educational backgrounds (US allopathic [MD], Doctor of Osteopathic Medicine [DO], and international medical graduates [IMG]) but comparable academic performance have similar match success. OBJECTIVES: Our objective was to compare match probabilities between applicant types after adjusting for specialty choice and United States Medical Licensing Examination (USMLE) Step 1 scores. METHODS: We performed a secondary analysis of published data in National Resident Matching Program (NRMP) reports from 2016, 2018, 2020, and 2022 for US MD seniors, DO seniors, and IMGs (US citizens and non-US citizens). We examined the 10 specialties with the most available spots in 2022. Average marginal effects from a multiple variable logistic regression model were utilized to estimate each non-MD senior applicant type's probability of matching into their preferred specialty compared to MD seniors adjusting for specialty choice, Step 1 score, and match year. RESULTS: Each non-MD applicant type had a lower adjusted percent difference in matching to their preferred specialty than MD seniors, -7.1 % (95 % confidence interval [CI], -11.3 to -2.9) for DO seniors, -45.6 % (-50.6 to -40.5) for US IMGs, and -56.6 % (-61.5 to -51.6) for non-US IMGs. Similarly, each non-MD applicant type had a lower adjusted percent difference in matching than MD seniors across almost all Step 1 score ranges, except for DO seniors with Step 1 scores <200 (-2.0 % [-9.5 to 5.5]). CONCLUSIONS: After adjusting for specialty choice, Step 1 score, and match year, non-US MD applicants had lower probabilities of matching into their preferred specialties than their US MD colleagues.

Examining differences in trends in the orthopedic surgery match for osteopathic and allopathic medical graduates after the transition to single accreditation.

CONTEXT: The landscape of medical education in the United States has undergone significant changes, particularly with the rise of osteopathic medical students, constituting a substantial portion of medical school entrants. The merger of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) in 2020 opened residency slots to allopathic graduates that were previously historically allocated to osteopathic (Doctor of Osteopathic Medicine [DO]) physicians. This has impacted various medical specialties, notably orthopedic surgery. Despite an increase in orthopedic surgery applicants, the match rates for DO candidates have faced challenges, raising concerns about the impact of this merger on the future of orthopedic training for DO students. OBJECTIVES: This research aims to analyze the trends in orthopedic surgery match rates for DO vs MD applicants since the single accreditation merger, which began in 2015 with a 5-year transition period that was finalized by 2020. By examining factors such as application numbers, research output, standardized test scores, and program director preferences, the study seeks to identify disparities and challenges faced by DO applicants in securing orthopedic surgery residencies. METHODS: This study utilized publicly available data from the National Residency Match Program (NRMP) 2018, 2020, and 2022 reports. Data encompassed applicant characteristics, including standardized test scores, research experiences, and match outcomes. The study also incorporated insights from NRMP program director surveys, focusing on interview and ranking practices. The analysis involved comparisons of application numbers, match rates, research productivity, and test scores between DO and MD applicants. Statistical analysis was employed to identify any statistically significant differences among the examined variables for the 3 years included in the study. RESULTS: The research revealed a consistent increase in orthopedic surgery applicants from both DO and MD backgrounds. However, MD applicants consistently had higher match rates compared to their DO counterparts, with the gap narrowing over the years. Notably, disparities persisted in research output, with MD applicants demonstrating a significant advantage in publications and presentations. Standardized test scores, although slightly higher for MD applicants, did not significantly impact the differences in match rates. MD applicants had statistically significantly higher numbers of applicants (P = .0010), number of publications (P = .0091), and number of research experiences (P = .0216) over the years examined. However, there was no statistically significant difference in the scores on Step 1 (P = .5038) or Step 2 (P = .4714) between MD and DO candidates. CONCLUSIONS: Despite progress in the acceptance and ranking of DO applicants by program directors, the study highlights enduring challenges in orthopedic surgery match rates between DO and MD candidates. The lack of research opportunities for DO students stands out as a crucial area for improvement, necessitating systemic changes within medical education. Addressing this disparity and ensuring equal access to research experiences could mitigate the gap in match rates, promoting a more equitable environment for all aspiring orthopedic surgeons, regardless of their medical background. Such efforts are vital to fostering inclusivity and enhancing opportunities for osteopathic medical students pursuing competitive specialties like orthopedic surgery.

Analysis of Performance Trends from 2010-2019 on the American Board of Internal Medicine Nephrology Certifying Exam.

BACKGROUND: The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. METHODS: This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. RESULTS: Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. CONCLUSIONS: Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

Australian osteopaths as non-medical prescribers: comparison of healthcare practitioner characteristics from a nationally representative survey.

The study aimed to compare the characteristics of Australian osteopaths who definitely agree that prescribing scheduled medicines is part of their future scope of practice with those who do not. A secondary analysis of a cross-sectional survey of osteopaths from an Australian practice-based research network was undertaken. Demographic, practice and treatment characteristics were identified using inferential statistics and backward linear regression modelling. Over one-quarter (n=257, 25.9%) of the total participants (n=992) indicated that they 'definitely' agree that osteopaths should seek prescription rights. Adjusted odds ratios (OR) suggested these osteopaths were more likely to engage in medication discussions with patients (OR 1.88), frequently manage migraines (OR 1.68) and seek increased practice rights for referrals to medical specialists (OR 2.61) and diagnostic imaging (OR 2.79). Prescribing as part of the future scope of practice for Australian osteopaths is associated with patient management (medication discussions) and practice characteristics (increased referral rights for specialists and diagnostic imaging) that warrant additional investigation. Understanding of the practice, clinical and patient management characteristics of Australian osteopaths who see prescribing as part of the future scope of practice informs the case for regulatory and health policy changes for prescribing scheduled medicines.

Characteristics of ACGME Residency Programs That Select Osteopathic Medical Graduates.

BACKGROUND: The transition from American Osteopathic Association (AOA) and Accreditation Council for Graduate Medical Education (ACGME) residency matches to a single graduate medical education accreditation system culminated in a single match in 2020. Without AOA-accredited residency programs, which were open only to osteopathic medical (DO) graduates, it is not clear how desirable DO candidates will be in the unified match. To avoid increased costs and inefficiencies from overapplying to programs, DO applicants could benefit from knowing which specialties and ACGME-accredited programs have historically trained DO graduates. OBJECTIVE: This study explores the characteristics of residency programs that report accepting DO students. METHODS: Data from the American Medical Association's Fellowship and Residency Electronic Interactive Database Access were analyzed for percentage of DO residents in each program. Descriptive statistics and a logit link generalized linear model for a gamma distribution were performed. RESULTS: Characteristics associated with graduate medical education programs that reported a lower percentage of DO graduates as residents were surgical subspecialties, longer training, and higher US Medical Licensing Examination Step 1 scores of their residents compared with specialty average. Characteristics associated with a higher percentage of DO graduates included interviewing more candidates for first-year positions and reporting a higher percentage of female residents. CONCLUSIONS: Wide variation exists in the percentage of DO graduates accepted as residents among specialties and programs. This study provides valuable information about the single Match for DO graduates and their advisers and outlines education opportunities for the osteopathic profession among the specialties with low percentages of DO students as residents.

The Spanish Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross-sectional survey.

BACKGROUND: Despite the growth of the osteopathic profession in Spain in the last few years, reliable information regarding professional profile and prevalence is still lacking. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a European-based survey dedicated to profiling the osteopathic profession across Europe. The present study aims to describe the characteristics of osteopathic practitioners, their professional profile and the features of their clinical practice. METHODS: A voluntary, validated online-based survey was distributed across Spain between January and May 2018. The survey, composed of 54 questions and 5 sections, was formally translated from English to Spanish and adapted from the original version. Because there is not a unique representative osteopathic professional body in Spain, a dedicated website was created for this study, and participation was encouraged through both specific agreements with national registers/associations and an e-based campaign. RESULTS: A total of 517 osteopaths participated in the study, of which 310 were male (60%). The majority of respondents were aged between 30-39 years (53%) and 98% had an academic degree, mainly in physiotherapy. Eighty-five per cent of the respondents completed a minimum of four-year part-time course in osteopathy. Eighty-nine per cent of the participants were self-employed. Fifty-eight per cent of them own their clinic, and 40% declared to work as sole practitioner. Thirty-one per cent see an average of 21 to 30 patients per week for 46-60 minutes each. The most commonly used diagnostic techniques are movement assessment, palpation of structures/position and assessment of tenderness and trigger points. Regarding treatment modalities, articulatory/mobilisation techniques followed by visceral techniques and progressive inhibition of neuromuscular structures is often to always used. The majority of patients estimated by the respondents sought osteopathic treatment for musculoskeletal problems mainly localised on the lumbar and cervical region. The majority of respondents manifest a robust professional identity and a collective desire to be regulated as a healthcare profession. CONCLUSIONS: This study represents the first published document to determine the characteristics of the osteopathic practitioners in Spain using large, national data. To date, it represents the most informative document related to the osteopathic community in Spain. It brings new information on where, how, and by whom osteopathy is practised in the country. The information provided could potentially influence the development of the profession in Spain.

Osteopathy in the French-speaking part of Switzerland: Practitioners' profile and scope of back pain management.

BACKGROUND: Osteopathy is commonly used for spinal pain, but knowledge about back pain management by osteopaths is scarce. OBJECTIVE: The aim of this study was to survey osteopaths across the French-speaking part of Switzerland about the scope of their practice and their management of patients with back pain. DESIGN: This cross-sectional observational study was based on an online survey conducted from March to June 2017. Setting and participants: All registered osteopaths of the French-speaking part of Switzerland were asked to complete the survey. Outcome measures: In addition to descriptive statistics (practice characteristics, patients' profiles, scope of treatment modalities, health promotion, research, and osteopathic practice), we explored variables associated with osteopaths' practice, such as age and gender. RESULTS: A total of 241 osteopaths completed the questionnaire (response rate: 28.8%). Almost two thirds of osteopaths were female. Ages ranged from 25 to 72 years with an overall mean of 42.0 (SD 10.7) years. Male osteopaths reported more weekly working hours than female osteopaths did (38.2 [SD 11.0] vs 31.6 [SD 8.9], respectively, p<0.001). Almost a third (27.8%,) of osteopaths could arrange an appointment for acute conditions on the same day and 62.0% within a week. Acute or subacute spinal conditions, mainly low back and neck pain, were the most frequent conditions seen by our respondents. For 94.4% of osteopaths, one to three consultations were required for the management of such conditions. CONCLUSION: Osteopaths play a role in the management of spinal conditions, especially for acute problems. These findings, combined with short waiting times for consultations for acute conditions, as well as prompt management capabilities for acute low back and acute neck pain, support the view that the osteopathic profession constitutes an added value to primary care.

Characteristics of complementary medicine therapists in Switzerland: A cross-sectional study.

OBJECTIVE: More than 27,000 complementary medicine (CM) therapists are registered in Switzerland, but limited data are available on their occupational profile and role in the healthcare system. Herein we aimed to gain a better understanding of the professional profile of non-physician licensed therapists, focusing on acupuncture, osteopathy, and European naturopathy. DESIGN: This cross-sectional study was based on an online anonymous survey conducted from March to June 2017. SETTING AND PARTICIPANTS: All 1549 non-physician registered osteopaths, acupuncturists, and naturopaths in the French-speaking part of Switzerland were asked to complete the survey. MAIN OUTCOME MEASURES: We measured the therapists' demographics, training and practice characteristics, and workload. RESULTS: A total of 426 therapists returned the questionnaire (response rate: 27.5%). The mean age of the respondents was 46.0 years (SD 11.6) and most were women (67.8%). CM represented the main professional activity for a majority of therapists (82.8%), most of whom were independent (86.3%). The length and number of consultations per month varied across professions. Multivariate analysis showed that acupuncturists and naturopaths performed significantly fewer consults per month than osteopaths did. However, consultation length was significantly longer for acupuncturists and naturopaths than for osteopaths. Acupuncturists (71.6%) and naturopaths (64.4%) were significantly more favorable than osteopaths (27.7%) to have consultation costs covered by basic health insurance. Professional profiles differed between osteopaths, on the one hand, and naturopaths and acupuncturists, on the other, mainly regarding workload, treatment duration, and main reasons to consult. CONCLUSIONS: This first study to investigate a variety of therapist profiles in Switzerland provides useful information about their activities and role within the Swiss healthcare system. Although all three professions are encompassed under the same umbrella term (CM), our study showed that they have specific work cultures and areas of intervention in the healthcare system.

An investigation of Australian osteopaths' attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey.

BACKGROUND: Osteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia. METHODS: National cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE). RESULTS: A total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0-5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials. CONCLUSIONS: Osteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.

Prevalence and profile of Australian osteopaths treating older people.

OBJECTIVES: To explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints. DESIGN: Secondary analysis of a cross-sectional survey of osteopaths. SETTING: The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. MAIN OUTCOME MEASURES: The demographic, practice and treatment characteristics of osteopaths who identify as 'always'or 'often' treating patients aged 65 years or over. RESULTS: Over half (58%) of total participants (n = 992) indicated often treating older people and this was associated with referral patterns with other health professionals and a non-urban practice location. Osteopaths providing care to older people were more likely to discuss diet/nutrition and medications, and provide pain counselling. Osteopaths who treated older adults were more likely to treat shoulder musculoskeletal disorders, degenerative spine disorders, chronic or persistent pain, and tendinopathies. CONCLUSIONS: A substantial proportion of Australian osteopaths treat older adults frequently. The potential value and impact of osteopathy in managing the health needs of an ageing population warrants close examination from both researchers and policy makers.

The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross sectional survey.

The prevalence of osteopathic practitioners, their professional profile and features of their clinical practice, particularly where statutory regulation does not yet exist, are still significantly underreported. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as an European-based census dedicated to profiling the osteopathic profession across Europe. The present study aimed to describe the osteopathic practitioners and the profession in Italy. A voluntary, online based, closed-ended survey was distributed across Italy in the period between February and June 2017. An e-based campaign was set up to reach the Italian osteopathic professionals. Participants were asked to complete the forms by filling in the information regarding the demographics, working status and professional activities, education, consultation fees, patient complaints, treatment and management. The survey was completed by 4816 individuals. 196 people started the survey but did not finish, which corresponds to a 4% attrition rate. The majority of respondents were males (66.7%). The modal age group was 30-39 (40.0%). 73.8% of respondents had a previous academic degree, mainly in the fields of sports science (36.4%) and physiotherapy (25.3%). 25.6% declared not to have a previous academic degree. The majority of respondents declared to work alone (58.4%), while the remaining declared to work in association with other professionals. The osteopaths /citizens ratio was 8.0 osteopaths/100,000 citizens. The profile of osteopaths in Italy seems to be characterised by a self-employed young adult male working mostly as a sole practitioner, who has been trained as osteopath through a part-time curriculum and had a previous degree mostly in the fields of sports science or physiotherapy. These results provide important insights into the osteopathic profession in Italy. The varied professional educational backgrounds need to be considered with regard to the implementation of a professional licensing process and future pre-registration education in the country. The number of respondents is an estimate of the actual number of Italian osteopaths. Only the completion of the regulatory process and the creation of the mandatory official register will allow to know the number of Italy based osteopaths.

Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.

Background: Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored. Methods: A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality. Results: The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients. Conclusions: The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.

The role of osteopathy in the Swiss primary health care system: a practice review.

OBJECTIVES: The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system. DESIGN: A questionnaire survey that included a patient record-based retrospective clinical audit. SETTING/POPULATION: Osteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association. QUESTIONNAIRE: The survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016. RESULTS: The response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider. CONCLUSIONS: In Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system.

A workforce survey of Australian osteopathy: analysis of a nationally-representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project.

BACKGROUND: Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally-representative sample of Australian osteopaths. METHODS: Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. The survey questionnaire was distributed to all registered osteopaths across Australia in 2016 as part of the Osteopathy Research and Innovation Network (ORION) project. RESULTS: A total of 992 Australian osteopaths participated in this study representing a response rate of 49.1%. The average age of the participants was 38.0 years with 58.1% being female and the majority holding a Bachelor or higher degree qualification related to the osteopathy professional. Approximately 80.0% of the osteopaths were practicing in an urban area, with most osteopaths working in multi-practitioner locations, having referral relationships with a range of health care practitioners, managing patients a number of musculoskeletal disorders, and providing multi-model treatment options. CONCLUSIONS: A total of 3.9 million patients were estimated to consult with osteopaths every year and an average of approximate 3.0 million hours were spent delivering osteopathy services per year. Further research is required to provide rich, in-depth examination regarding a range of osteopathy workforce issues which will help ensure safe, effective patient care to all receiving and providing treatments as part of the broader Australian health system.

Dermascope Use by Osteopathic Primary Care Physicians.

CONTEXT: Osteopathic physicians (ie, DOs) in primary care may play a critical role in the early detection of skin cancer. Dermoscopy improves diagnostic accuracy; however, its use among primary care DOs remains understudied. OBJECTIVES: To document dermascope use among DOs in primary care, to examine physician and practice characteristics associated with having used and having heard of a dermascope, and to examine the barriers to dermascope use. METHODS: Osteopathic physicians were recruited to complete an anonymous survey assessing demographic factors, physician and practice characteristics, confidence in differentiating skin lesions, knowledge and dermascope use, and barriers to dermascope use. Bivariate analyses were conducted, and the significant factors were entered into 2 separate logistic regressions. RESULTS: A total of 768 participants were included in the study. Four hundred ten (54%) had heard of a dermascope, and 123 (15%) had used one. The statistically significant multivariate predictors for having used a dermascope (model 1) were graduating from medical school after 1989 and having greater confidence in differentiating skin lesions (OR, 2.2; 95% CI, 1.66-2.79). Those who graduated after 2009 were 9.5 times more likely and those graduating between 2000 and 2009 were 4.3 times more likely to have used a dermascope than those graduating before 1990 (95% CI, 4.29-20.90 and 95% CI, 2.04-9.23, respectively). Ever having heard of a dermascope (model 2) was associated with being female (OR, 1.4; 95% CI, 1.02-1.87); practicing in a group (OR, 1.6; 95% CI, 1.05-2.36), academic (OR, 2.2; 95% CI, 1.26-3.86), or community center (OR, 2.2; 95% CI, 1.20-4.00); and having greater confidence in differentiating skin lesions (OR, 1.3; 95% CI, 1.15-1.55). Both models were statistically significant and correctly classified 605 (84.1%) (model 1) and 444 (58.4%) participants (model 2). CONCLUSION: Dermascope use could help primary care DOs improve their diagnostic accuracy for skin cancer and reduce unnecessary referrals to specialists. Efforts to disseminate knowledge about the benefits of using a dermascope to primary care DOs are needed.

Geographic distribution of otolaryngologists in the United States.

We conducted a study to determine the demographic traits, training characteristics, and geographic distribution of otolaryngologists in the United States using publicly available data. We then correlated our findings with U.S. census data. Univariate analysis was performed to analyze results, with a p value of <0.05 determined as significant. We used data from the American Board of Otolaryngology's list of 18,587 board-certified allopathic otolaryngologists through 2013 and the American Osteopathic Colleges of Ophthalmology & Otolaryngology-Head & Neck Surgery's list of 428 osteopathic otolaryngologists. From these two databases, 9,642 otolaryngologists met inclusion criteria, which included an active practice in the United States and an age of 70 years and younger. This group was made up of 8,185 men (84.9%) and 1,449 women (15.0%); we were not able to identify the sex of 8 otolaryngologists (0.1%). The median age of the women was significantly lower than that of the men (54 vs. 48 yr; p < 0.001). A total of 8,510 otolaryngologists (88.3%) graduated from a U.S. allopathic medical school, and 8,520 (88.4%) graduated from a U.S. allopathic residency program. We determined that 25.9% of otolaryngologists established their practice in the same metropolitan statistical area where they completed their residency training. Older practitioners (p < 0.001) and women (p < 0.001) were significantly more likely to stay in the same area than younger physicians and men. In terms of population, 61.8% of the otolaryngologists practiced in metropolitan areas with more than 1 million residents; by comparison, these areas represent only 55.3% of the total U.S. population, indicating that otolaryngologists are over-represented in larger U.S. cities.