Geographic Disparities in the United States Otolaryngology Workforce: A County‐Level Analysis

OBJECTIVE: Access to otolaryngologic care is unevenly distributed across the United States, yet rural-urban disparities and their trajectory over time remain incompletely characterized. This study examined the distribution of otolaryngologists across U.S. counties over two decades (2003-2023), characterizing rural-urban disparities, temporal trends, and predictors of workforce availability. METHODS: County-level data from the Area Health Resources Files (AHRF) were analyzed at three time points (2003, 2013, 2023) across 3135 U.S. counties. Otolaryngologist density and lack of any provider were compared between metropolitan and nonmetropolitan counties, and predictors of density were examined using multivariable regression. RESULTS: In 2023, 67.7% of U.S. counties had no practicing otolaryngologist, including 83.8% of nonmetropolitan versus 41.0% of metropolitan counties (p < 0.001). Unweighted mean density was 2.21 per 100,000 in metropolitan versus 0.64 in nonmetropolitan counties (p < 0.001). The national workforce grew 17.5% from 2003 to 2023 (9404-11,050), with population-weighted density up 1.9%; growth was concentrated in metropolitan counties (+21.2%), while nonmetropolitan counties lost 28.6% of their workforce and 30.1% of population-weighted density. The proportion of nonmetropolitan otolaryngologists aged ≥ 55 rose from 42.8% to 68.1%. Nonmetropolitan classification (IRR 0.66), higher unemployment (IRR 0.56), and higher uninsurance (IRR 0.93; all p < 0.001) were associated with lower density, while higher median home value was associated with greater density (IRR 2.36; p < 0.001). CONCLUSION: Rural-urban disparities in otolaryngologist availability are substantial and widening. The rapid aging of the nonmetropolitan workforce and compounding economic barriers underscore the need for rural recruitment and retention strategies. LEVEL OF EVIDENCE: N/A.