Geographic Distribution of Otolaryngologists and Disparities in the United States

ABSTRACT Objectives To characterize the geographic distribution of otolaryngologists across the United States and evaluate rural–urban and regional disparities in population‐adjusted otolaryngologist supply. Methods A cross‐sectional county‐level analysis included 3144 US counties and county‐equivalents. Otolaryngologists were mapped to counties using ZIP code linkage. County‐level data were obtained from the 2023 American Community Survey and Small Area Income and Poverty Estimates, and rurality was defined using 2023 Rural–Urban Continuum Codes. The primary outcome was county‐level otolaryngologist supply. Negative binomial regression with county population as an offset evaluated geographic and sociodemographic associations with supply. Results Overall, 12,322 otolaryngologists were identified, corresponding to 3.71 per 100,000 residents. Although 65.8% of counties lacked a local otolaryngologist, these counties contained 13.5% of the US population. Rural areas had 1.63 otolaryngologists per 100,000 residents compared with 4.04 in urban areas; 58.6% of rural residents lived in a county without a locally practicing otolaryngologist. Adjusted supply was lower in rural counties (IRR, 0.46; 95% CI, 0.40–0.51; p < 0.001) and in the Midwest (IRR, 0.75; 95% CI, 0.63–0.90; p = 0.002), South (IRR, 0.56; 95% CI, 0.47–0.66; p 0.001), and West (IRR, 0.81; 95% CI, 0.65–0.99; p = 0.042) compared with the Northeast. Poverty rate and Hispanic population percentage were not significantly associated with supply, while a greater Black population percentage demonstrated a modest positive county‐level association. Conclusion Otolaryngologists are unevenly distributed across US counties, with rural counties demonstrating substantially lower population‐adjusted supply and a greater proportion of residents living without a local otolaryngologist. Rurality and region are independently associated with geographic availability, supporting the need for targeted workforce strategies to improve otolaryngologic care. Level of Evidence 3.