Workforce Trends and Evolving Roles of Physician Assistants in Otolaryngology: A National Longitudinal Survey

Objective: To characterize contemporary workforce trends among physician assistants in otolaryngology–head & neck surgery in the United States. Methods: Longitudinal analysis of annual survey of the Society of Physician Assistants in Otorhinolaryngology–Head & Neck Surgery (SPAO-HNS) data, collected 2015 to 2024. The survey captured self-reported practice patterns, compensation models, and clinical responsibilities. Statistical analyses included linear and logistic regressions to evaluate temporal trends and differences by practice setting. Results: A total of 1227 survey responses were analyzed. Most respondents were physician assistants (93.7%), predominantly working in private stand-alone otolaryngology practice environments (66.8%). Majority of respondents reported working an average of 40 hours per week with salary-based compensation (71.8%), though productivity-based bonuses rose over the study period (P =< .001). Common procedures performed independently included cerumen removal, foreign body extraction, and nasal endoscopy or flexible fiberoptic laryngoscopy. Practice setting influenced patient volume and scope of responsibilities, with stand-alone practices reporting higher outpatient volumes. The proportion of respondents planning to leave otolaryngology within 5 years nearly doubled from 17% in 2015 to 29% in 2024. Conclusion: This 10-year longitudinal analysis highlights the integral and evolving contributions of physician assistants and nurse practitioners to otolaryngology care across diverse practice settings. The findings document an expanding role in enhancing access to care and performing office procedures independently. However, the rising proportion of respondents intending to leave the field signals emerging workforce sustainability challenges. Proactive strategies to support recruitment, retention, and professional development are needed to ensure a stable and effective otolaryngology workforce capable of meeting growing patient needs.