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2018 Newsletter v2
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President's Message
As the planning committee prepares for the fall meeting we are charged with providing a theme around which we can build a program. Our post-meeting survey last year asked participants to list three topics that they would like to see presented the following year. Upon review of these entries the following themes were most prominent:

Physician wellness
Faculty career development: mentorship, education training, on boarding, life transitions
Resident education: innovation and remediation
Diversity and inclusion

These and other themes are evident in the word cloud generated from these responses.

The planning committee and I have settled on the following theme for the 2018 SUO meeting:

Academic Otolaryngology across the Career Continuum: Managing Change and Transition.

November’s meeting will include a Friday afternoon workshop on Burnout, followed on Saturday by a full day line-up of interesting keynote speakers and panels. This will be an opportunity to acquire a better understanding of prevailing forces, future health system trends, and strategies to sustain a vibrant academic mission with meaningful impact. Stay tuned.

Howard W. Francis, MD, MBA, FACS
SUO President


A Remembrance of James Kelly, MD
We would like to offer this remembrance of a teacher and friend who loved the SUO, an organization that he promoted and helped to cultivate in its early years.

James Kelly, MD finished medical school at the Medical University of South Carolina and then was an intern and assistant resident in surgery at Vanderbilt University before serving in the Army Reserves at Tripler Army Hospital, Madigan General Hospital and Fort Hood Army Hospital. He completed residency at the Massachusetts Eye and Ear Infirmary in 1977. He then joined the faculty of several training hospitals of the Harvard Medical School and helped to establish the Joint Center of Otolaryngology with Drs. Marshall Strome and Marvin Fried – a joint program of Brigham and Women’s and Beth Israel Hospitals. Dr. Jo Shapiro joined this practice not long before Jim left to become the chairman of Otolaryngology-Head and Neck Surgery at the Greater Baltimore Medical Center (GBMC) in Maryland as its residency merged with that of the Johns Hopkins University.

Dr. Kelly was the consummate professional and teacher. He was an accessible and encouraging mentor and generous friend to all who were fortunate to serve as residents under him, and he modeled team-based leadership and inclusion in his interaction with staff, colleagues and learners. He was an accomplished surgeon and those fortunate enough to reap the benefits of his mentorship will remember it always. Jim’s joie de vivre endeared him to everyone he met. He had a passion for cooking and fly fishing, and we will miss his wonderful sense of humor.

Dr. Kelly is survived by his wife Jane Hill and children James H. Kelly Jr., Erin Tilghman and Alexander Kelly. The family has established an endowed lecture fund in Dr. Kelly’s name in the Johns Hopkins Department of Otolaryngology-Head & Neck Surgery: https://secure.jhu.edu/form/oto (under designation select “other” and write “James Kelly Lecture”)
Published Obituary: http://www.baltimoresun.com/news/obituaries/bs-md-ob-james-kelly-20180212-story.html

Howard Francis, MD, MBA, FACS
Marvin Fried, MD
Jo Shapiro, MD, FACS


AADO Update
On behalf of the AADO Council, I would like to bring the SUO membership up to date on AADO activities. 

We are pleased to announce two changes in the 2018-19 residency application process.  In conjunction with SUO and OPDO, AADO has agreed eliminate the program-specific paragraph in the personal essay.  In addition, the American Board of Otolaryngology/Head & Neck Surgery has decided to perform the mandatory ORTA assessments to incoming residents after the match, rather than to candidates before the match.  Because of this change, it will be important for department chairs to support their program directors in their efforts to have ORTA assessments completed for all incoming otolaryngology residents. 

To increase medical student interest in otolaryngology applications, AADO has also provided language to assist chairs in communicating our changes and inclusivity to Deans of Student Affairs at each of our medical schools.  Some chairs have also developed pipeline programs.  Many have made relatively small but important investments into Otolaryngology Interest Groups for early medical students which have increased interest. 

We are also pleased to announce that the ACS has added additional support for SUO/OPDO/AADO.  Katie Fitzgerald will be supporting AADO moving forward, which will give Emily Maurer more time to focus on SUO and OPDO.  We thank Denise Goode from ACS for her leadership in making this addition. 

Perhaps most importantly, we would like to remind chairs that the annual productivity survey will start soon.  We are now working with the Association of Otolaryngology Administrators to do this work together.  This is a critical activity, because the FPSC benchmarks favored by many hospitals and medical schools can overstate our productivity.  For example, last year the FPSC data overstated wRVU productivity by 300 wRVU per full-time faculty member.  This has the effect of inflating expectations for otolaryngology productivity requirements, and reducing otolaryngology payments from hospitals and others. 

A large response will make our data more robust and credible.  AADO had full data on 427 academic otolaryngologists last year, compared to 317 in FPSC, and we'd love our numbers to rise further this year.  Rest assured that all data are anonymized by the ACS, so no AADO officers or members can associate data with individual programs. We are moving the timeline up so that results can be distributed to departments by the time of the fall meeting, so please respond promptly to the requests for data.   

Bevan Yueh, MD, MPH, FACS


SUO Communications Committee Update
It is a pleasure to provide all with the 2nd newsletter from the communication committee of the SUO. The 1st was a resounding success and I am hopeful that this will become a mechanism of communicating amongst the executive group and the membership of the SUO. It has been an exciting time since the last communication. We have seen the match come and go. We have faced increased issues with the input into the match pool and many innovative ideas have been advanced on many fronts on how to improve and solve this issue. I expect we will have much discussion about this at the upcoming annual meeting. Our annual meeting will take place on November 9/10 in DC at the Ritz Carlton. The program is just being finalized and should be available at some point in the near future on our website. An exciting time with many panels and didactic discussion. The otolaryngology program Directors organization will meet on the Friday prior to the meeting with more details to follow.

This year we are going to record the sessions and provide their presentation on our website under the meeting link.

We are still awaiting any innovative ideas or commentary on behalf of the members what they would like to see in this newsletter or if you have an opinion you wish to express. Please forward that on.

As summer draws to an end we look forward to seeing everyone in November.

Mark Wax MD, FACS, FRCS(C)


AAO-HNSF Update
The AAO-HNSF has many resources available for lifelong learning for all stages of career—in particular resident education. This section of the newsletter highlights various new and innovative approaches available through AcademyU.org, your online otolaryngology education source.
Home Study Course+

The Academy has made some exciting enhancements to the upcoming 2018-19 Home Study Course+ (HSC+) program to continue providing quality resident education materials from the AAO-HNSF. We are confident HSC+ provides unparalleled resident education, developed by Academy leaders and academic faculty practicing in the field of otolaryngology-head and neck surgery. We invite you to take advantage of this offer in the coming academic year.

The upcoming 2018-19 package now includes: NEW! 400 webcasts from the AAO-HNSF 2017 Annual Meeting & OTO Experience; NEW! AcademyQ® Knowledge Assessment (Set 4, released February 2018) – mobile app-based learning with 350+ new otolaryngology-head and neck surgery study questions to test recall, interpretation, and problem-solving skills; Home Study Course, a compendium of select scientific journal articles across all eight specialty areas in a convenient four-section format; and access to 200+ courses in AcademyU®, your otolaryngology education source.

The fee for resident members for HSC+ is $375. The total value of all four products in this package is $1,075. This is a great opportunity to provide additional training materials for your residents at a very affordable rate. The special HSC+ package is available only to resident members who enroll in the HSC+ online format. For more information and to register, visit www.entnet.org/hsc.


Current Stats for Otolaryngology and Gender Disparity
The SUO’s Gender Disparity Committee has been actively looking at academic appointments and chair positions for women within Otolaryngology and a natural question is to determine the current status of women as a percentage of medical students, residents, faculty and chairs.

The AAMC last year announced for the first time ever that the enrollment of women in medical schools exceeded that of men. Of the 21,338 enrollees, 50.7% are women. In 2017, ERAS reported that 33% of applications to Otolaryngology programs were female. While that may seem impressive, it is a drop from 2013 when 41.7% of applications were female. While we know that all applicants do not secure residency positions, the drop may be of concern for future trends and should be at least put on the radar screen for changes to be aware of.

The current status of women faculty within Otolaryngology is much different. Data from 2015 shows that 13% of women hold the rank of Full Professors, 27% are Associate Professors, 34% Assistant Professors and the vast majority, 63% hold the rank of Instructor.

There are currently 106 Otolaryngology residency programs and there are five female chairs which is 4.7%. This number has not changed in the past 10 years despite, multiple changes in chair positions during that time frame.

Much has been written regarding the differences in gender disparities within Otolaryngology academic leadership positions. The question arises whether it is an issue of “pipeline” which is measured as the rate at which trainees enter and advance through the pipeline to the workforce or a glass ceiling that qualified candidates are not being advanced.  Much work in this area has been done in the fields of Science, Technology, Education and Mathematics (STEM) where there is a dearth of minorities and women.

If Otolaryngology recognizes that the number of women in medical school is now greater than men, and our residencies are more than a third female, it is important to monitor the “pipeline” as well as conscious or unconscious bias to leadership positions within our specialty. There are career points where “leakage” can occur and developing strategies to maintain and eliminate barriers for progression is an opportunity to improve current gender disparities.


Massachusetts Equal Pay Law
Despite the fact that an Equal Pay Law was passed by the national legislature and signed into law by John F. Kennedy in 1963 and was followed one year later by the passage of the Civil Rights Act of 1964, a significant wage gap persists. According to the U.S. Department of Labor, in 2014 women working full time earned 78 cents for every dollar earned by a man. As a field we may not want to believe that healthcare is not impacted by the wage gap; however, the same Department of Labor study demonstrated that female healthcare practitioners are paid 21.7 percent less than their male colleagues at equivalent positions. Clearly, this early legislation did not have the intended effect of fully rectifying the gender-based wage gap. A useful way of thinking about this discrepancy was described in a 2017 article in the Washington Post article written by Xaquin G.V. “Can we talk about the gender pay gap”. This article pointed out that women physicians and surgeons start working for free on September 8th of each calendar year, representing the almost four months a year that would be uncompensated if they were paid at the same rate as their male colleagues for the first 8 months of the year. Given the preponderance of data on gender wage gap, the field of Otolaryngology Head and Neck Surgery is most likely not immune to pay discrepancies. In fact, the pay gap is even more dramatic in fields that are male dominated and require many years of advanced training. The American Association of Medical Colleges reported in 2015 that only 15.8% of all practicing Otolaryngologist were women and only 4.7 percent of all Department Chairs are currently women. These facts place our field at a potentially even greater risk of significant discrepancies in compensation.  The question is how are we going to take the lead on this issue ensure pay equity for our members. 

In response to the continued evidence of pay inequity the Commonwealth of Massachusetts passed the Massachusetts Equal Pay Law which will go into effect on July 1st 2018. There are four provisions in the new MA Equal Pay Law. The first is TRANSPARENCY. Employees are now allowed to talk about their compensation and cannot be penalize for having these discussions. The second is that parents cannot be penalized for parental leave.  For example, if a woman (or man) has 4 children and takes off 3 months with each child she MUST be considered at the same level of seniority as an individual who did not take 12 months of parental leave. The third provision provides for an affirmative offense which protects both employees and employers.  If a company performs a good faith compensation review then they cannot be found liable. However, if they do not perform the review and a compensation discrepancy exists then they are liable for twice the amount of the discrepancy. Lastly, employers are not allowed to ask about previous salary history. This is very important because currently women graduating from school will earn 7-11% less than their male peers at their first job. Asking about previous salary history perpetuates the wage gap.  Employers instead must value a new hire based upon merit and the importance of a particular job for organization. 

To discuss the implications of this new law, the Professional Equity committee of Joint Commission on the Status of Women Committee (JCSW) at Harvard Medical School (HMS) recently hosted their Spring Symposia to discuss its implications for the multiple academic medical institutions affiliated with HMS.  The event included a presentation by Victoria Budson, the Executive Direction of the Women and Public Policy Program, at the Kennedy School of Government, Harvard University and a panel including James L. Heffernon, Senior Vice President of the Finance and Treasurer, Massachusetts General Physicians Organization, Kathleen McDaniel, Chief Human Resources Officer, Harvard Medical School, and Alayna Van Tassel, Deputy Treasurer and Executive Director of the Office of Economic Empowerment. The panel was moderated by M. William Lensch, PHD, Chief of Staff, Dean’s Office, Harvard Medical School and Dr. George Q. Daley, Dean of the Faculty of Medicine at Harvard Medical School was in attendance. Victoria Budson discussed the economic importance of the new Massachusetts Equal Pay Law. She highlighted the fact that closing the pay gap will improve companies’ ability to hire and retain talented employees. Importantly she noted that even when controlled for all external factors that can impact pay and job performance, a 7% gender pay gap still exists which can only be explained by gender bias.  In fact, the higher the level of education required by a field then the higher the wage gap is in that particular field. It seems likely that this is related to the fact that with higher level positions administrators have more discretion in setting base salary and overall compensation than they have with hourly employees. Therefore, the overall compensation packages for female hires are at a greater risk to be negatively impacted by “unconscious bias”. The lowest pay discrepancy in the country is in Washington D.C. because of the larger number of military and government jobs in which total compensation at all levels of seniority are set in a very transparent way by years of service, job description, geographic region, and rank. These data provide the basis for Victoria Budson’s assertion that pay transparency will help to dissolve the wage gap.

Questions from the audience addressed individual concerns that women would be penalized for asking for an equity review if they had suspicions that a gap might exist. The panel as a whole felt that pay equity was going to become an important part of risk management for organizations making it risky for business to allow pay gaps to exists within and organization. It was pointed out the financial liability of not performing a review is ultimately much higher than the cost of the review. Relevant to the field of Otolaryngology Head and Neck Surgery, it was discussed that total compensation for physicians goes beyond base salary and must include incentive pay, the availability of OR blocktime, clinical work space, and support staff.

The panel was also asked what HMS is doing to prepare for the new law. Kathleen McDaniel, Chief Human Resources Officer, Harvard Medical School responded that they are in the process of performing a salary review of all individuals employed directly by HMS. James L. Heffernon, Senior Vice President of the Finance and Treasurer, Massachusetts General Physicians Organization informed the audience that MGPO already performs annual compensation reviews within the organization. It was also asked if HMS could work with the multiple affiliated hospitals to guide leadership on how to implement the new law within individual institutions, including to develop best practices to ensure transparency and consistency.  This idea was well received by the HMS leadership and they will start working towards this goal.

Previous generations fought so that women could become Otolaryngologists but the battle for true equality in our field is not yet won. It is our time to build on the efforts made in the past to not only allow women to become an Otolaryngologist but to have equal pay, equal academic advancement, and equal opportunities to become leaders in our field. This is our time and it will require both men and women working together to overcome historical pay gaps and unconscious bias.  We have the power to lead by example but it will require increasing transparency and honesty about the mistakes in the past.  These types of laws will likely be adopted nationwide as working professionals learn about the Massachusetts law. Even for states that currently do not have a similar law it is good economic policy and risk management to ensure pay equity. It seems wise for administrators to be open to conversations about compensation concerns, and to develop transparent systems to evaluate equitable, total compensation that limits unconscious bias. Importantly, pay equity that is brought about through salary transparency helps organizations to have employees that are actively engaged in the health of the organization and feel honored and valued, increasing job performance. Transparency also allows individuals to know exactly how much effort is needed to increase their compensation. At the end of the day, these policies are both good for business and the future of our field.


Utilizing an Interview Management System or Not?
In this ever-changing world of technology, Coordinators must strive to keep up. Interview season is rapidly approaching and there are a few tools out on the market that can make interview scheduling a breeze. The top three interview scheduling tools available right now are ERAS Scheduler, Interview Broker and Thalamus. According to a study conducted in 2015 by Willis et. al, an online scheduling system is preferred by applicants. In another study, Hoops et. al found that computerized scheduling programs (CSP) decreased workload for Program Coordinators and improved applicant satisfaction. But which interview management system is the best fit for your program? To aid in identifying the best system to suit your program, I will briefly highlight each of the systems previously mentioned.

Let’s begin with ERAS Scheduler. Since ERAS is the only system that applicants applying to ENT programs can utilize, it makes sense for them to incorporate a unified system to schedule the applicants as they apply. ERAS Scheduler boasts a self-scheduling option for applicants, the ability to schedule and pair applicants and interviewers for each interview day, as well as wait listing and cancellation options. There is no cost associated with ERAS scheduler and it makes it convenient to view photos, applications, and print interview lists and other documents directly from one system. Users have the ability to send interview invitations within the scheduler and attach any necessary documents. However, the ease of these features is diminished by a slight lack of user-friendliness. ERAS is continuously releasing updates and working to improve the experience for their users. They offer webinars, videos, and technical support. If your program is still utilizing phone calls and emails to schedule interviews, this system is a good one to start with. Once the nuances of the ERAS system are learned, it is can be an easy way to have applications, interview scheduling and communication in one centralized location.
Interview Broker touts itself on “Offering relief from the need to field telephone calls, read through emails, and update calendars.” Some of the key features of the system include: online self-scheduling of applicants; online self-scheduling of interviewers; sending configurable interview offer, rejection and acceptance and waitlist emails with the click of a button; the ability to import applicant data from ERAS; and the system supports a full-day or Am/Pm interview schedules. As many of the testimonials boast, you can literally sit back and watch as multiple applicants are scheduled in minutes. Having utilized Interview Broker, I can personally attest to the ease and convenience of the tool. Though, convenience does not come without a price. Interview Broker charges $1.99 per interview invitation sent through their system, plus a one-time $25.00 activation fee. If you are looking for an affordable and convenient way to simply manage the scheduling aspect of interview season, Interview Broker may be the interview management system for you.

Of the three interview scheduling systems, Thalamus is the only one created by individuals who have experienced the residency interview process first-hand. The company was established by a Pediatric-Anesthesiology resident and Anesthesiology Program Director in 2013. Thalamus is a cloud-based system that can be utilized from anywhere on any device. It takes applicant self-scheduling to the next level by integrating the program preferences of the applicant. Applicants are not only able to self-schedule their interviews, but Thalamus will coordinate their travel as well. The program can handle all the confirmations and cancellations as well as automatically creating interview day face sheets and building customizable scoring/ranking algorithms. Like Interview Broker applicant lists can be imported from ERAS, additionally, Thalamus offers the ability to import the ERAS application. There is not a published price for the cost of the system , however, a demo is strongly encouraged as pricing information is based on program size. Thalamus streamlines the entire interview process from start to finish. If you are looking for a technologically advanced, user-friendly and convenient interview management system Thalamus would be a good fit for your program needs.

No matter which one you choose, interview management systems are rapidly becoming the most- efficient and effective way to schedule applicants during interview season. Good luck this interview season!

Credits:
Wills, C., Hern, H., & Alter, H. (2015). Residency Applicants Prefer Online System for Scheduling Interviews. Western Journal of Emergency Medicine, 16(2), 352-354. doi:10.5811/westjem.2015.1.24615
Hoops, H. E., Brasel, K. J., Stephens, C. Q., Anderson, E. M., Leblanc, L., & Krishnaswami, S. (2017). Computerized Residency Interview Scheduling: A Randomized Controlled Trial of Categorical General Surgery Applicants. Journal of the American College of Surgeons, 225(4). doi:10.1016/j.jamcollsurg.2017.07.936
(n.d.). Retrieved August 10, 2018, from https://www.interviewbroker.com
(n.d.). Retrieved August 10, 2018, from https://www.thalamusgme.com