How Far Women Have Come in Otolaryngology Compensation Parity and What Needs to Happen Next

On these pages in 2010, Linda Brodsky, MD, discussed the gender gap in compensation and leadership positions in otolaryngology (ENTtoday. February 1, 2010. Available here). How far have we come since she highlighted issues of gender inequity nearly a decade ago?

In the two decades since I was a medical student rotating in otolaryngology, women have made progress in leadership roles in our academic societies and training programs. However, progress toward equity in our specialty has not come quickly enough.

A pay gap still exists in salaries for women in otolaryngology. In 2004, Jennifer Grandis, MD, a professor of otolaryngology–head and neck surgery at the University of California San Francisco, reported a 15% to 20% gender pay gap even after controlling for confounding variables (Arch Otolaryngol Head Neck Surg. 2004;130:695–702). More recent data suggests this pay disparity persists. The 2018 Medscape survey of full-time otolaryngologists found that women were paid $75,000 (19%) less than men. A 2016 study of 10,000 university physicians also found a pay gap for female physicians despite controlling for experience, faculty rank, specialty, research productivity, and clinical volume, with surgical specialties demonstrating the largest absolute adjusted sex differences in salary (JAMA Intern Med. 2016;176:1294–1304) (See “Sex Differences in Physician Salary and Rank in U.S. Public Medical Schools,” below).

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ENT Today

How Otolaryngology Programs Are Working to Create a More Diverse Workforce

Increased diversity among medical professionals helps counteract the fears of racism, inequality, and other issues that may prevent patients of color from seeking out health care. A more diverse workforce also helps healthcare professionals learn from one another as the field expands to include people with differing backgrounds and perspectives.

For David Brown, MD, associate vice president and associate dean for health equity and inclusion and associate professor of otolaryngology-head and neck surgery at the University of Michigan Medical School in Ann Arbor, diversity’s benefits are rooted deeply in his career. He recalled a story one of his African-American residents told him when the resident first had to perform a tracheotomy on a child as an early-career otolaryngologist. The resident went to introduce himself to the patient’s family before beginning the procedure. Seeing that the resident was a person of color like themselves “created a sense of relief and trust,” he said.
“Seeing me, they said they didn’t feel like their child would be experimented on,” the resident told him.

Many marginalized communities have distrust of the healthcare system.“Having people who share their identities helps to foster stronger trust and communication and can lead to fewer healthcare disparities,” Dr. Brown added. Physicians of various ethnicities can help patients feel more comfortable, believing that the provider more fully understands their own cultural perspectives. Without that understanding, a patient’s lack of trust can be perceived as refusal to adhere to a physician’s orders.

As a result, “I no longer call a patient a non-compliant patient; if they don’t show up, you need to ask why,” said Dr. Brown. “Sometimes, they have transportation issues or there’s been a death in the family. If you are more open and more inclusive, you can find out more of the root cause, rather than just assuming they didn’t show up because they are ‘bad’ people.”

Efforts by medical schools and specialty associations and organizations to increase diversity helps build understanding among different groups of people, as well as improve the field of otolaryngology overall. Candidates with different backgrounds, perspectives, and experiences begin to fill the pipeline into medical schools, residencies, fellowships, and beyond.

“I would say [the subject of diversity] has become more front and center in the last few years, because the Accreditation Council for Graduate Medical Education has made it a priority to ask about the diversity composition of resident trainees,” said Cristina Cabrera-Muffly, MD, associate professor and residency program director in the department of otolaryngology at the University of Colorado School of Medicine in Aurora. “Unfortunately, otolaryngology has one of the lowest rates of underrepresented minorities (URM) among medical and surgical residencies.”

Diversity in the Workplace

Top Row: Carrie Francis, MD; David Brown, MD; Zainab Farzal, MD. Bottom Row: Cristina Cabrera-Muffly, MD; Duane Taylor, MD; Oneida Arosarena, MD

Top Row: Carrie Francis, MD; David Brown, MD; Zainab Farzal, MD. Bottom Row: Cristina Cabrera-Muffly, MD; Duane Taylor, MD; Oneida Arosarena, MD

The benefits of diversity in all workplaces, not just medicine, have been publicized. In 2013, the Harvard Business Review reported that diversity, both inherent (including the characteristics one is born with such as gender, ethnicity, and sexual orientation), and acquired (traits such as knowledge learned while living outside the country where one was raised), “unlocks innovation and drives market growth—a finding that should intensify efforts to ensure that executive ranks both embody and embrace the power of differences,” wrote Sylvia Ann Hewlett, the lead author of the study (Harvard Bus Rev. Published December 2013.).

A 2018 study of diversity in venture capital firms, also published in the Harvard Business Review, found that “diversity significantly improves financial performance… and even though the desire to associate with similar people—a tendency academics call homophily—can bring social benefits to those who exhibit it, including a sense of shared culture and belonging, it can also lead investors and firms to leave a lot of money on the table,” wrote lead author Paul Gompers (Harvard Bus Rev. Published July 2018. Available at: hbr.org/2018/07/the-other-diversity-dividend). And, finally, a 2004 study published in the Proceedings of the National Academy of the Sciences found that “groups of diverse problem solvers can outperform groups of high-ability problem solvers” (PNAS. 2004;101:16385–16389).

“From a social justice standpoint, increasing diversity in the physician workforce has been shown to reduce health disparities,” said Oneida Arosarena, MD, associate dean for diversity and inclusion at the Lewis Katz School of Medicine and a professor of otolaryngology at Temple University in Philadelphia.

What is medicine, and otolaryngology in particular, doing to address diversity in the field?

Diversity in Education

Different academic institutions are taking similar approaches to identifying the best candidates for their medical schools, even when those applicants might not be obvious by traditional measures. At Temple University, which in 2015 established its office of health equity, diversity and inclusion, a diversity council works among all members of the health system community to help address concerns among racial, ethnic, and gender minorities, and also implemented implicit bias training for the medical school’s admissions team. As a result, applicants are considered for admission under holistic review, which analyzes everything about a candidate, rather than merely looking for high marks on standardized tests.

“Traditional medical school and residency committees would just screen people with a cutoff based on a score on the MCATs or USMLE Step 1 test,” said Dr. Arosarena. “But by doing that, you really eliminate people who are great candidates but are not great test takers. Instead, we look at grades as a measure of academic performance, leadership qualities such as whether the candidate was involved as a leader in sports or other organizations, and also humanitarian qualities, such as how involved they were in the community.”

The process also considers how far a candidate has come to achieve what they have achieved. “If both your parents are doctors, it’s not so great a stretch to think you might be a doctor,” said Dr. Arosarena. “If you come from a single-parent and/or a low-income home, you had a lot to overcome to get to the point where you are applying to medical school.”

Holistic review takes longer than simply scanning through test scores for acceptance, and it requires more people to sit on the application committee. But more voices in the process produces a more diverse group of accepted applicants. In 2016, when Temple began using holistic review, there were six accepted URM applicants, out of a total of 210. Today, classes average between 20 and 30 URM.

The University of Michigan Medical School in Ann Arbor is currently three years into a five-year diversity, equity, and inclusion plan to improve diversity at every level so that the climate is more inclusive of all people, said Dr. Brown. Various initiatives, such as training in unconscious bias and other educational efforts, grants for diversity projects by different members of the Michigan community, and mentoring opportunities, all help to increase awareness about the importance of a diverse academic community. All medical departments are asked to attend the Student National Medical Association’s (SNMA) annual conference, where medical students can learn more about different clinical opportunities with the medical school. The students have the opportunity to work through medical simulations alongside Michigan medical faculty and residents.

At Michigan, about 20% of medical students each year are URM, said Dr. Brown, and that number has gone up about 1% each year for the past four years. The percentage of URM residents has doubled in the past three years, from 3% to 6.5% identifying as Black, Latino, Pacific Islander and/or Native American, he added.

Diversity in Otolaryngology

Otolaryngology, like other specialties, is eager to attract the brightest people to the field. To that end, there are several initiatives from organizations such as the Society of University Otolaryngologists (SUO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAOHNS).

Mentoring, coaching, and early exposure to the field of otolaryngology help bring more ethnically and culturally diverse talent and voices into the otolaryngology field, said Carrie L. Francis, MD, SUO’s diversity chair and associate professor and assistant dean of student affairs in the department of otolaryngology, head and neck surgery at the University of Kansas Medical Center in Kansas City. “Having an otolaryngology presence in medical school is helpful and harkens back to early exposure.” The society does this by developing relationships with various medical student associations and historically Black colleges such as Morehouse and Meharry Medical College as well as the SNMA and the Latino Medical Student Association.

Dr. Cabrera-Muffly cites mentoring as a way to increase diversity in the field of otolaryngology. “It’s important at all levels of the pipeline,” she said. “We need to mentor students to join our field, provide support to residents during their training, and ensure continued mentorship for URM faculty so that they will stay in academics to be examples for the next generation.”

Mentors needn’t be minorities themselves, either, she added. “As a Latina in otolaryngology, my mentors have not all been female or Latino, but they have made a huge impact in my life regardless.” Irrespective of their background or ethnicity, a senior-level person who has made her/his way through the otolaryngology field has a lot to offer earlier-career otolaryngologists. “Most senior faculty are not URM, but chances are that they will be in the position to mentor URM students and residents as the numbers increase.”

Without those increases, “we are doing a disservice to our patients and we are leaving talent on the table,” said Dr. Cabrera-Muffly. “If we discriminate against any group, we leave out the potential world-changing contributions of that group.”


Cheryl Alkon is a freelance medical writer based in Massachusetts.

Key Points

  • Efforts to increase diversity help build understanding and improve the field of otolaryngology overall.
  • Academic institutions are implementing implicit bias training for medical school admissions teams.
  • Mentoring, coaching, and early exposure to the field help attract more ethnically and culturally diverse talent and voices.

Ways to Increase Diversity in Otolaryngology

  1. Implement implicit bias training for medical school admissions teams: Doing so helps widen the scope when considering candidates for medical school admission. Holistic review, a process that analyzes everything about a candidate and not merely high marks on standardized tests, can help identify diverse candidates who can show a clear interest in medicine or ripe potential that may not be obvious if test scores and grades don’t meet a specific measure.
  2. Make mentoring a priority: Formal relationships between senior and junior-level otolaryngologists is a crucial way to help bring more diverse people to the field, though if collaborations happen on their own, that is fine, too. “Some of the best relationships happen organically, but we can assign them until people find their own mentors, because it’s important for all leaders to provide mentorship,” said Cristina Cabrera-Muffly, M., associate professor and residency program director, department of otolaryngology at the University of Colorado School of Medicine. “As a Latina in otolaryngology, several of my mentors have not been female or Latino, but they made a huge impact in my life regardless.”
  3. Find opportunities to showcase early exposure to otolaryngology as a specialty: SUO has developed relationships with historically black colleges and minority student organizations so that there is an SUO presence at annual national conference and regional events, said Dr. Francis. Having SUO available as a resource for earlier career medical students allows them to learn about the field of otolaryngology and to have enough information about it to properly consider it as a specialty.—CA

The Drawbacks of Lower Rates of Diversity

Without concentrated efforts to increase diversity in the otolaryngology field, let alone in medicine itself, the profession won’t reflect the patient population it serves and won’t benefit from new ideas that come from different perspectives, experts say.

That ultimately limits opportunities for both patient care and research and widens health disparities across different populations.

“If we don’t do it, we will do the same old things and hear the same old voices,” said David Brown, MD, associate vice president and associate dean for health equity and inclusion and associate professor of otolaryngology-head and neck surgery at the University of Michigan Medical School in Ann Arbor.

Michigan’s intent is to take the best care of patients and attract the best in the field for career opportunities. “If we are seen as monolithic, and people feel they are different, they won’t have a sense of belonging and won’t want to be a part of the team,” he said. “Instead, we want to make it so that anyone can be a part of our team.”

Efforts to identify promising candidates for medical school, residencies, fellowships, and medical careers should be intentional. “The medical profession loses out on the richness of what makes us different” if diversity isn’t encouraged, said Carrie L. Francis, MD, SUO’s Diversity Committee chair and associate professor and assistant dean of student affairs in the department of otolaryngology, head and neck surgery at the University of Kansas Medical Center in Kansas City. That includes diversity of culture, the richness of thought, “and everything else related to innovation,” she said.

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Virtual Surgical Planning and Custom Implants Can Help Treat Complex Facial Trauma

Advanced technology such as virtual surgical planning (VSP) and 3D-printed implants are helping otolaryngologists treat patients with complex facial trauma with more accuracy for improved outcomes.

Oral and maxillofacial surgeons use computer-generated modeling to plan for complex reconstructive procedures and order custom implants from manufacturers for patients who have facial bone loss due to trauma, cancer, or congenital deformities, said Shaun C. Desai, MD, associate residency program director and assistant professor of otolaryngology–head and neck surgery at Johns Hopkins School of Medicine in Baltimore. “We use the 3D technology for more complex cases, such as patients with complex loss of the maxilla or mandible or the skull. For a more complex defect, you can create a shape using the technology, and use it as a guide to make the bone cuts,” said Dr. Desai. “You can be more precise as you take a straight, long bone like the fibula and cut it into the shape of a jawbone. Even now, we often eyeball this technique, and there is asymmetry as a result. It takes a lot of time and surgical expertise. This technology gives you a more precise cut. You basically create a plan for where you will make the cuts into bone before you begin the surgery.”

Scan-Guided Surgery and Custom Implants

First, computed tomography (CT) scans are taken of the damaged facial areas. The surgeon analyzes these images using software designed for virtual surgical planning, said Dr. Desai. The data may also be sent to an engineer at a manufacturer to 3D print customized implants.

“If a patient has a facial fracture, such as a cheekbone that has collapsed, if you don’t fix it quickly, it can heal like that,” said Dr. Desai. The patient may require multiple revision surgeries as a result. To avoid this outcome, “we can use CT scanning to mirror the bad, damaged side of their face to the good side, and repair those maxillofacial injuries.”

VSP is useful for collaboration with an oral surgeon to perform reconstructive surgery on the maxilla, where both specialists use 3D software technology to guide the dental procedure and 3D printing of customized dental implants, said Dr. Desai.

With his patient’s CT scan data on his computer screen, J. David Kriet, MD, director of facial plastic and reconstructive surgery at the University of Kansas Medical Center in Kansas City, can examine a malpositioned cheekbone and orbit (such as a zygomaticomaxillary complex fracture) and then measure the patient’s “good side.”

“We can take the right half of the CT in virtual space and flip it over to map out a mirror image. That becomes our plan,” he said. “We can create an orbital implant using the mirrored image. We could either take an implant off the shelf or work with an engineer at a manufacturer to design a custom, patient-specific implant. By doing this, there are a number of advantages. We can do planning and create the implant before we get to the operating room. The time saved often offsets the more expensive implant. The less time we have a patient under anesthesia, the better,” he said.

Dr. Kriet has been using these technologies to plan for many oral and maxillofacial reconstructive surgeries for seven years. While 3D printing and VSP using CT scans are not yet the standard of care, these tools improve accuracy in more complex surgical cases, and they lower the risk of long-term discomfort or deformity for patients, he said.

Improved Outcomes

Image Courtesy of J. David Kriet, mD

Working model of frontal reconstruction.
Image Courtesy of J. David Kriet, mD

Do these technological advances really improve patient outcomes? In a 2016 retrospective review of 92 patients who underwent osteocutaneous free flap reconstruction of the mandible at a single cancer center from 2002 to 2013, researchers compared outcomes for 43 patients whose surgery was based on prefabricated models to those for 49 patients who had preoperative CT-guided surgical plans (Plast Reconstr Surg. 2016;137:619–623). The authors concluded that VSP refined mandible reconstruction with osteocutaneous free flaps through patient-specific cutting guides, improved reconstruction accuracy, and decreased operating time.

Christopher F. Viozzi, MD, DDS, an oral and maxillofacial surgeon at the Mayo Clinic in Rochester, Minn., uses these technologies to plan for many different procedures, including surgical reconstruction for patients who have had cancer, benign tumors that destroyed bone and soft tissue, or congenital deformities.

“In my own practice, I use [VSP] to plan for craniofacial surgery, including skeletal and soft tissue deformities. We try to normalize the bone and tissue as much as we can,” said Dr. Viozzi. “We use 3D models for virtual surgical planning all the time and for all sorts of operations, not just post-traumatic surgery. This technology is actually used more often for facial reconstruction than for post-traumatic corrections. To clarify, there are specific patients who come into the clinic with severe facial traumas and acute injuries. We will use computer-generated data to plan for their surgery.”

CT scans are used to help surgeons understand how their patient’s anatomy may vary from that of a normal patient, said Dr. Viozzi. He and his surgical team take precise measurements of the patient’s face or jaw and examine the patient’s unique facial symmetry. “We use this technology to see how an injured side of the face looks compared to the other, uninjured, side to help us plan for the surgery. The data can be used to create a model through 3D printing. There is a use for this in planning for acute, early treatment of a trauma patient as well, and we use the CT data for surgical navigation. We can use this data to pinpoint where certain things are located on or within the bony structures of a patient’s face,” said Dr. Viozzi.

Efficiency and Accuracy

VSP could reduce overall treatment time for patients with facial trauma or deformities because it improves the accuracy and quality of reconstructive surgery, not because it makes the surgery faster, said Dr. Viozzi. “Surgery has nothing to do with speed. We want to be efficient, careful, thoughtful, and accurate. We want to go into surgery with an accurate, well-thought-out plan. We want to do the procedure once, and get the patient to the end of the surgery as close to the surgical plan as we can,” said Dr. Viozzi.

Post-traumatic surgery patients often undergo multiple revision surgeries if the first surgery was performed incorrectly or if other factors prevented prompt treatment, and their bones have healed in incorrect positions, he added. “So, 3D technology can help us virtually plan the surgery, and 3D modeling can help us plan for revision surgery too.”

In a 2017 study of 10 patients who required orthognathic surgery, researchers found that VSP using CT and surface scanning of the upper and lower dental arch to generate 3D models of their skulls, as well as computer-aided design of fabricated surgical splints, improved surgical accuracy and facilitated planning (J Craniomaxillofac Surg. 2017;45:1962–1970).

To treat a patient with cancer in the mandible, Dr. Viozzi may work with a multidisciplinary team to virtually plan what portions of the jaw need to be removed along with the tumor and how to reconstruct the defect with a portion of the patient’s fibula, and to work with a prosthodontist to pinpoint where dental implants will be placed. “This approach takes a patient from an 18-to-24-month, multistep process to one surgery. It will make that surgery and time in the operating room longer for us, but it makes the surgery process more efficient for the patient,” he said.

Customized implants or plates based on CT scan data can be made in about one to three weeks, said Dr. Desai. Costs seem to be going down, and he believes they reduce operating time and improve aesthetic results. “These implants look more symmetrical. Outcomes, in terms of cosmesis, are improved. This may be subjective, but I get better results from it,” said Dr. Desai. “There is definitely a role for this technology, and people are still learning to use it. They are finding more indications for it.” He predicts that these technologies will become more widely available, cheaper, and available on a quicker turnaround.

Oral and maxillofacial reconstructive surgery can positively impact a patient’s quality of life, because facial defects or asymmetry are visible to others every day, said Dr. Viozzi. “Virtual surgical planning fits in perfectly with the concept of patient-specific and personalized medicine. It’s a perfect example of that, and for providing service to the patient with the lowest overall cost, morbidity, and complication possible.” 


Susan Bernstein is a freelance medical writer based in Georgia.

VSP and Custom Implants: Any Cons?

Custom implants secured.

Custom implants secured.
Image courtesy of J. David Kriet, MD

Are there any potential pitfalls for VSP or 3D-printed implant customization that head and neck surgeons should know about? In a retrospective analysis of 54 virtually planned craniofacial surgeries performed from July 2012 to October 2016 at the University of Montreal Teaching Hospitals, researchers analyzed surgical errors. The study included 46 orthognathic surgeries and eight free bone transfers (Plast Reconstr Surg Glob Open. 2018;6:e1443).

While 85% of the orthognathic virtual surgical plans were completely adhered to by surgeons, 11% of the VSPs were partially adhered to and 4% of the VSPs were abandoned, they found. Reasons for partially or totally abandoning the plan included poor communication between surgeon and engineer, poor appreciation for condyle placement on preoperative scans, soft-tissue impedance to bony movement, rapid tumor progression, and poor preoperative assessment of anatomy.

The study’s authors concluded that while VSP is a useful tool for craniofacial surgery, improving outcomes and decreasing operative time, surgeons must be aware of potential pitfalls. They called for more surgical training and experience with these technologies.

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Otolaryngologists Discuss Keys to Treating Top Athletes

For James Kearney, MD, an interaction with professional athletes began as it does for most people: with passion, but from a distance. In 1974, the Philadelphia Flyers, his hometown hockey team, won the Stanley Cup, sparking city-wide euphoria.

“One of my enduring childhood memories was going out in front of my house when the Flyers won the Stanley Cup … and cars were beeping, people were jubilant,” Dr. Kearney said. “It was the first championship in Philadelphia in a long, long time, and the entire city had rallied behind the Flyers, who are a gritty bunch of players that Philadelphia could really identify with. From then on, I was a hockey fan.”

Now, Dr. Kearney, chairman of otorhinolaryngology at Pennsylvania Hospital of the University of Pennsylvania Health System, treats members of the Flyers team for otolaryngology conditions. As a physician, his interaction with the world-class athletes is much different than the connection he had with them when he was young. In the exam room, he’s no longer at a distance. He’s close up.

When it comes to being a fan, though, Dr. Kearney stays relatively dispassionate. A friendly remark about a recent game might be OK, but autograph seeking is not. Otolaryngologists who treat professional athletes say that, while they are aware of the stakes that are involved, a crucial part of the job is treating professional athletes as they would other people—as patients first.

They also emphasize availability and, when necessary, discretion. “You can’t let the celebrity aspect of it overwhelm your willingness to take care of this individual as a human being who needed your help as a physician and not as somebody who is a public figure,” said Dr. Kearney, who also provided care for the Philadelphia Eagles football team for two decades until 2018. “You need to treat them as real human beings.”

Medical Conditions

© Wikipedia/Keith Allison

Pro athletes frequently need custom-made protective masks so that they can continue to play while facial injuries heal.
© Wikipedia/Keith Allison

In terms of the care provided, there is a lot of overlap between professional athletes and other patients, otolaryngologists say. While a hockey or basketball player might be more likely than an average patient to come in with a laceration or a facial bone fracture, otolaryngologists typically see conditions that are run-of-the-mill—from sinus infections to chronic tonsillitis to earwax build-up.

“Most of the injuries or problems I see in these patients are not something that is an injury or a condition unique to a professional athlete,” said Christopher Larsen, MD, associate professor of general otolaryngology at the University of Kansas, who provides care for the Kansas City Royals baseball team and Kansas City Chiefs football team. “It’s more common conditions that every human being gets; it just so happens that it’s occurring in a professional athlete.” For these conditions, athletes receive the same treatment as most other patients would, otolaryngologists say.

Dr. Larsen said he screens baseball players for oral cancer, provides antihistamines for allergies, chooses topical steroid spray or surgery for swollen turbinates, and performs routine sinus, nasal, and throat surgeries on players who fail maximal medical management.

Many football players, and some baseball players, struggle with snoring and obstructive sleep apnea (OSA), which interrupts sleep and can have a big effect on focus and performance, he said. But in his experience, professional athletes struggle just as much with adherence to and tolerance of continuous positive airway pressure (CPAP) for OSA as other patients do.

During spring training, some players on the Royals team develop nosebleeds because they are unaccustomed to the dryness of the Arizona desert air, he said.

Pro athletes frequently need custom-made protective masks so that they can continue to play while facial injuries heal, and at Detroit’s Henry Ford Health System, some of their faces are pre-scanned so that the 3D printing process for the masks can be started right away, said Lamont Jones, MD, MBA, vice chair of otolaryngology, head and neck surgery at the Henry Ford, who treats members of the Detroit Pistons basketball team, Detroit Lions football team, and Detroit Tigers baseball team.

Pressure to Perform

With players being paid millions of dollars to perform on the field, otolaryngologists acknowledge there can be at least implicit pressure to get players back on the field quickly, although not nearly as much as orthopedic surgeons face in treating injuries such as, say, Achilles tendon tears or knee injuries. But they say they have to stay mindful of their obligation to the health of the person in front of them.

“As physicians, the key to remember is the patient is your first priority and then, as long as you remember that, you do what’s best for the patient and counsel them appropriately,” Dr. Larsen said. “Should they choose to do something outside of your guidelines or your recommendation, it’s only going to potentially be fraught with complications or problems…. What I know for a fact working with the Kansas City Royals is that it’s a team approach. The athletic trainers, physical therapists, physicians, and surgeons really work together as a team, and there’s constant communication, because at the end of the day, the investment is in the player and their future. Bringing them back too soon, or rushing them back to the field, is not always going to be in their best long-term interest.”

Sometimes, there can be conflicts of interest for a physician. “Somebody else is paying [the athletes] a lot of money to perform, and every time they are injured, they are not performing,” Dr. Kearney said. “And that is an issue for the team; it can be a competitive issue, it can be a financial issue. So there can be some conflicts of interest that come in particularly for physicians who are being
compensated by the team…. There can be a conflict in that they are being paid by the team that wants the athlete back on the field, but your obligation to the athlete is to provide what is best for them.”

While most otolaryngologists downplay the pressures they feel taking care of these athletes, they say there is a certain amount of pressure performing surgery on a player. “You treat every patient the same, and to say differently I don’t think is right,” Dr. Larsen said. “The flip side to that is, sure, you’re a little extra amped up that morning.”

Dr. Jones said surgeries are the most difficult scenarios he faces when treating pro athletes or celebrities. “In general, we want good outcomes, and sometimes if you have a high-profile player, it’s not that you would do anything differently, but the potential for, let’s say, good or bad publicity just magnifies itself,” he said. “In the era of social media, it’s easy for a routine or non-routine outcome to really be publicized.”

Privacy

The goal of a good outcome remains the same regardless of the public profile of the patient, but physicians say their centers do take steps to shield players from unwanted attention. Henry Ford  employs a concierge who coordinates care among physicians, the player, and the team, Dr. Jones said. Sometimes, he said, players are able to enter at a different location than the general public. Sometimes, he goes to see them rather than having them come to the medical center. “It depends on the person,” Dr. Jones said. “Some players are escorted; they may come in through a back entrance. For some of the players, I’ve actually gone to the sports arenas to evaluate them.”

Dr. Kearney said professional athletes coming to see him are typically not forced to stay in the main waiting area. “They are susceptible to their illnesses becoming public spectacle,” he said. “So if they’re coming into your office to be seen, if you keep them waiting out in your waiting area, it can be awkward for the athlete. People will wind up coming up to them, asking [them] to sign autographs or asking questions about why they’re seeing the doctor, things that people would not normally do to another patient. … I have always tried to go out of my way to help to preserve these athletes’ privacy.”

Professionalism and Availability

With time, otolaryngologists said it gets easier to regard the dynamic with a pro athlete as a typical physician–patient relationship, without worrying that inclinations as a fan will get in the way. Any references to their performance, they say, should be only for the purpose of rapport, much as they might converse with any other patient.

After a seven-foot-tall basketball player had a nasal bone fracture, Dr. Jones kidded him that he might have avoided the injury if only he had stood up tall and hadn’t had to bend down all that distance to pick the basketball up off the court. And, after a high draft pick in football had an unfavorable outing in his Eagles debut and got booed on his home field, Dr. Kearney good-naturedly told him, “Welcome to Philly.”

In the end, though, it’s professionalism that should guide the way, they say.

An indispensable ingredient in taking care of pro athletes is being available when they need care, they say. Usually, they can treat the player when needed. But if not, they find someone who can. “The nice thing about being in a large group practice is that we have redundancy,” said Dr. Jones at Henry Ford. “So, if for some reason I’m not available, there’s usually somebody available who can address the issue.”

“When I was in medical school, an otolaryngologist told me the three keys to success are availability, affability, and ability—in that order,” Dr. Larsen said. “And at the end of the day, even before I was associated with the Royals or any professional sports players, I would try to always be available for my patients and try to see as many people as I possibly could in a day while taking good care of them. And I think applying that philosophy … goes a long way with patients.”


Thomas Collins is a freelance medical writer based in Florida.

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