Manpower and portfolio of European ENT.

The aim of this study is to evaluate highly variable ENT manpower among European countries. A descriptive study design is used. Manpower in medicine is highly variable among European countries. EU and associated countries are keeping officially appointed representatives to the European Union of medical specialists--otorhinolaryngology section (UEMS--ORL section). UEMS--ORL section is running a working group for manpower in ENT collecting data regarding demographics and ENT manpower in European countries. These ENT manpower data are presented in this paper and compared to available data concerning manpower in European medicine in general. To further evaluate these huge differences, representatives of the particular countries were also asked to fill out a questionnaire concerning specifics of ENT healthcare in their country. Furthermore, typical tasks of ENT doctors based on the official UEMS logbook for ENT training were listed and could be rated regarding their frequency, performed in everyday routine of an average ENT doctor of the country. Divergences in doctors/inhabitants ratios were remarkable within European countries, but disparities in ENT manpower were even more so. The ratio of ENT doctors/inhabitants was the lowest in Ireland (1:80,000) and Great Britain (1:65,000). Greece (1:10,000), Italy, Czech Republic, Lithuania, Poland and Slovakia (1:12,000) were--at the time of the study--the countries with the highest density of ENT doctors. The EU average for 2009 was (1:21,000). The presence of non-surgical working ENT doctors was significantly associated with higher densities of ENT doctors, whereas the necessity of being referred to an ENT doctor (gatekeeping or similar measures) was not. Estimated average waiting times for an appointment in non-urgent, chronic conditions, respectively, diseases were highly variable and predominantly showed a significant correlation to the ENT doctors/inhabitants ratio in the investigated countries. But also for acute conditions like acute hypacusis, dysphonia and hemoptysis, significant differences correlating to the ENT doctors/inhabitants ratio in waiting times for an ENT appointment were found. Estimated frequencies of different ENT tasks in everyday routine were extremely diverse as well, however, without detectable correlations to the ENT doctors/inhabitants ratio. In countries like Great Britain, Ireland, Malta and The Netherlands ENT doctors are primarily seen and serving as surgeons. In most Central European countries like Germany, Austria, Czech Republic, Poland and Slovakia, ENT doctors aside of surgery are also dealing with high percentages of conservative medicine, which may include vast fields like the management of Allergology, Phoniatrics, Audiology, etc. In some countries ENT doctors are even playing a significant role in primary health care as well. These various portfolios of ENT may be one explanation for the huge difference in numbers of European ENT manpower.