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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 24  |  Issue : 3  |  Page : 137-142

Assessment of the current rhinology workforce in Saudi Arabia


1 Department of Otorhinolaryngology, Mouwasat Hospital, Dammam, Saudi Arabia
2 Department of Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, Saudi Arabia

Date of Submission18-Jul-2022
Date of Decision21-Aug-2022
Date of Acceptance22-Aug-2022
Date of Web Publication24-Sep-2022

Correspondence Address:
Dr. Mashael Abdulaziz Alharbi
Department of Otolaryngology and Head and Neck Surgery, King Fahad Specialist Hospital, Ammar Bin Thabit St, AlMerikbat, Dammam 32253
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoh.sjoh_30_22

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  Abstract 


Introduction: Workforce planning is a relatively new approach to identify the supply and demand of labor. The goal of workforce planning is to identify talent surpluses and shortages, project future needs, and facilitate matching training decisions. Methods: An online survey was sent to otolaryngologists with a high volume of rhinology practice. Results: Twenty-nine surgeons participated in the survey. All respondents had completed a rhinology fellowship and 20% practiced exclusively rhinology. The majority of surgeons reported <5 days of access to the operative room. More than 50% of surgeons reported having access to image-guided surgery. According to 65% of respondents, the number of surgeons practicing rhinology in Saudi Arabia is adequate. Overall, 62% of respondents were satisfied with their careers. Conclusion: The outcomes from this survey provided the necessary information required for rhinology physicians workforce modeling and allow us to begin strategically planning for Saudi Arabia's future rhinology needs and local fellowship requirements.

Keywords: Otolaryngology, rhinology, workforce


How to cite this article:
Alshaikh NA, Alharbi MA. Assessment of the current rhinology workforce in Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2022;24:137-42

How to cite this URL:
Alshaikh NA, Alharbi MA. Assessment of the current rhinology workforce in Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2022 [cited 2022 Nov 28];24:137-42. Available from: https://www.sjohns.org/text.asp?2022/24/3/137/356931




  Introduction Top


The Saudi rhinology workforce and future needs are not well defined. Workforce planning is an essential component of human resources management at the level of the Saudi Ministry of Health (MOH), Saudi Commission for Health Specialties (SCFHS), and hospital levels. It helps to identify the supply, demand, and shortage of labor.[1] The health workforce development program's policy goals are to promote the workforce transformation required to enable a value-based health-care strategy, which necessitates a significant increase in work capacity, redistribution, and diversity of workforce across various areas. Another goal of rhinology workforce planning project is to estimate future needs and avoid issues related to patient access to care and quality of care. It also facilitates the planning of training needs and guides establishing the local rhinology fellowship training in Saudi Arabia. We believe that rhinology diseases are one of the most common presentations to otorhinolaryngology clinics. This was one of the driving forces to conduct this study. A study performed in Qassim, Saudi Arabia to examine the pattern of otolaryngological head-and-neck disease in an outpatient clinic showed that the most commonly affected regions were the nose accounting for 47.7%.[2] However, there is no current available data on the optimal number of per region rhinologists in Saudi Arabia. To our knowledge, this is the first conducted survey to estimate a subspecialty workforce in Saudi Arabia.


  Methods Top


A web-based survey was distributed among otolaryngologists. The authors created the rhinology workforce survey after reviewing the available literature and it was modified so that it accommodates our population. All participants received an e-mail with a link to the survey and an invitation to participate in the workforce survey. The invitation to complete the survey was directed to otolaryngologists who are classified by the SCFHS as rhinologists based on their fellowship training certificate and to those whose ear, nose, and throat practice is mainly (>80%) rhinology. The completion of the survey is considered an informed consent to participate. There was no personal information collected, and all survey replies were fully anonymous.

Data entry was performed through Microsoft Excel software version 2016 by Microsoft Corporation in Redmond,Washington,United States then statistical analysis was conducted. Descriptive data analysis was presented using frequency and percentage for different qualitative variables.

The primary outcome is to define the workforce and demographics of the current rhinologists in Kingdom of Saudi Arabia (KSA). Secondary outcomes include education background, medical training, current scope and volume of rhinology practice, access to care for rhinology clinics and operations, and job satisfaction with rhinology.


  Results Top


A total of 50 otolaryngologists were identified as having a large volume of rhinology practice or/and rhinology fellowship in different regions in Saudi Arabia. Twenty-nine responded and completed the survey, representing a 65% response rate.

Demographics and education

Our study included 29 Saudi rhinologists from different provinces and cities in the Kingdom. [Table 1] summarizes the demographic data of the respondents, including gender, age, and nationality. The majority of respondents were males (82.8%). More than half (55.2%) of the study participants were aged <40 years and 37.9% were 40–50 years old. The details of society memberships of our participants are shown in [Table 2]. Participants have a membership at the Saudi Otorhinolaryngology-Head and Neck Surgery Society, European Rhinology Society, and Pan Arab Rhinology Society in 27 (93.1%), 10 (34.5%), and 12 (41.4%), respectively.
Table 1: Demographic of participants rhinologists

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Table 2: Society memberships of the participants

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Education and fellowship training

The training details of the respondents are outlined in [Table 3]. All our respondents have completed rhinology fellowship. Sixty-two percent of them had fellowship training in Canada, Italy, and KSA. The participants had spent 1 year (51.7) or 2 years (48.3%) in the rhinology fellowship training. Most rhinologists who participated in the current research had completed clinical training only (62.1%), and about one-third of them had completed clinical and research training (27.6%). Most of the training scope was about endoscopic sinus surgery (93.1%), endoscopic skull base surgery (75.9%), and then endoscopic orbital surgery (37.9%).
Table 3: Education and fellowship training details

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Current scope of practice

The practice location of the respondents is described in [Table 4]. The majority of respondents worked in tertiary hospitals (65.5%), MOH hospitals (44.8%), and university hospitals (37.9%). Our results showed that some of our participants work at more than one institution. Most of the study participants were consultants (72.4%) and 27.6% were assistant professors.
Table 4: Practice location

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Their experience in rhinology is generally <15 years. Sixty-two percent of study participants were practicing as rhinologists for <5 years, 24.1% for 5–10 years, and 13.8% of them for 10–15 years.

The most common scope of practice was endoscopic sinus surgery, septoplasty, and turbinate surgery. Approximately half of the respondents (55.2%) reported that the volume of rhinology practice is >75% of their total practice and 20.7% of them reported it was exclusively rhinology. The scope and volume of practice are reported in [Table 5].
Table 5: Scope and volume of practice

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Productivity

Almost 58% of physicians reported 5 or less operative room (OR) days and specialized rhinology clinics days per month. Ten percent of respondents never use image guidance (navigation) in OR practice. About 44% of participants had performed 10–12 rhinology surgeries per month. The waiting time to schedule elective rhinology surgery was >90 days in 41.4% of respondents, between 30 and 90 days in 34.5% of them, and <30 days in 24.1% of them. This is summarized in [Table 6].
Table 6: Productivity in terms of operative room time

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While 34.5% of respondents reported 2–4 weeks to schedule new outpatient department (OPD) appointments at their rhinology clinic, 27.6% reported more than 12 weeks to schedule new OPD appointments. Approximately half of the respondents (51.7%) reported that there were 2–3 rhinologists in the same department. The majority (69%) stated that there was a specialized allergist or immunologist in the same department.

The total number of published researches in rhinology was <5 in about half of the participants (48.3%), while 37.9% of them had published 5–10 researches in rhinology. This is shown in [Table 7].
Table 7: Work assessment

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Job satisfaction

Job satisfaction was measured using the Net Promoter Score with a visual analog scale scoring system from 0 to 10 where 0–3 is unlikely, 4–7 is moderately likely, and 8–10 is very likely. The higher the score, the more likely to recommend the workplace and workload, and thus, the higher the satisfaction. This is reported in [Table 8]. The majority of surgeons were satisfied with their job and workload (62%). At the time of the survey, 65% of the respondents feel that the number of surgeons practicing rhinology in Saudi Arabia is appropriate.
Table 8: Job satisfaction

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  Discussion Top


The aim of our study is to analyze the current rhinology workforce in Saudi Arabia in terms of demographics, regional distribution, training background, and current practice. It was reported that a response rate of 41% in an online survey in a population of less than a thousand participants is considered average. While >60% response is considered excellent.[3] We had a 65% response rate that could represent the Saudi rhinologist population.

Workforce planning is crucial to promoting the quality of health care in Saudi Arabia.

However, the workforce necessary to provide current and future otorhinolaryngology/rhinology care has not been established. Decision makers should actively participate in health workforce planning and budget for the resources required to ensure the ability to afford enough health professionals as well as to train, recruit, and retain the right number and mix of health workers.[4] It is essential for this planning to generate evidence on the dynamics of the health labor market, including concepts of labor market supply and labor market demand.[4]

Saudi Vision 2030 is a road map for Saudi Arabia's future. It was unveiled in 2016 as a game-changing and far-reaching strategy to realize the Kingdom's enormous potential. The Health Sector Transformation Program is one of the vision realization programs that were established to promote the Kingdom's sustainable growth of health-care services and to focus efforts.[5] Its goal is to increase access to health care by providing optimal coverage and geographical distribution that is both comprehensive and equitable.

Our study showed that there is a geographical variation in rhinologist distribution within the country. It was demonstrated that only one rhinologist is available to cover the North province which has almost two million people.[6] Similar numbers of our rhinologists are found in the central and western provinces. This represents up to 24% of our participants each. The populations of the two provinces are nearly equal.

Our study showed that the age of more than half of the participants was <40 years old. There is little data on the age distribution of the health workforce employed at various facilities. According to a recent study in Najran, Saudi Arabia, the average age of the health workforce employed in hospitals is 35.81 years.[5] In our opinion, the young age of our rhinologists reflects the recent provision of MOH scholarships in subspecialty programs for physicians in minor specialties such as otolaryngology.

Our entire participants were Saudi. This could be due to the adoption of the Saudization program. The country's health system used to be dependent on a foreign workforce. In 2017, the Ministry of Health reported that Saudi physicians account for only 30% in the health sector.[5] However, Saudization of workforce is one of the fundamental aspects of “vision 2030.”

The results of this survey demonstrated that the majority of rhinologists are men. This finding was similar in Canada and the United States rhinology workforce.[7],[8] Data showed that there is an underrepresentation of females in both the public and private health sectors. Female physicians account for 34.3% of all Saudi physicians working at MOH in 2017 and 31% of all Saudi physicians employed by the private health sector.[5] In our survey, the greatest numbers of rhinologists are working in MOH hospitals, followed by university hospitals. Currently, MOH has 282 hospitals and it is considered the major public health provider and the country's largest employer of health workers.[5]

All our respondents have completed a rhinology fellowship. Only 17% obtained a local fellowship while the majority had abroad rhinology training. In comparison to the Canadian rhinology workforce, 17% of their participants did not pursue any rhinology fellowship.[7] Among the goals of “Vision 2030” was the implementation of the National Transformation Program. One of its many objectives to the health sector was medical education and training. This led to the development of educational institutions and collaboration with international universities. Moreover, the budget allocation advocated for training and scholarships aided to continue higher studies abroad. These strategies resulted in the enhancement of local health workforce skills.[5]

It was found that only <20% of rhinologists reported practicing exclusively rhinology in both our survey and the Canadian rhinology workforce study. However, more than half of Saudi participants and around 30% of Canadian participants dedicated 75% of their available time and resources on rhinology practice.[7]

A majority of the respondents, 41% reported that the time needed to schedule an elective surgery was more than 90 days. Moreover, the time needed to book a new outpatient appointment in their clinic was more than 1 month. This may suggest the persistent need for more rhinologists to improve access to rhinology care. Therefore, it is crucial to find the ways to determine the ideal number of rhinologists and to balance the number of fellowship posts with the needs of the Saudi population. We have only one recognized rhinology fellowship at King Saud University in Riyadh that is accredited by SCFHS. Based on the current geographic distribution of rhinologists, in our opinion, at least another two fellowship programs can be initiated at the two major cities in Saudi Arabia, namely Jeddah and Dammam.

Since it has been proposed that physicians' satisfaction at work has a negative impact on health-care systems, there is a growing focus on the general wellness and contentment of physicians.[9] As shown from our survey, the majority of our rhinologists surveyed were satisfied with their workload and workplace.

One of the limitations of our study is the use of a nonvalidated survey. In addition, the method of identification of rhinologists may represent an underestimation of otolaryngologists practicing rhinology in our country. Some of the questions included in our survey were dependent on the surgeon's opinion rather than objective measurement, which could lead to reporting bias.

In conclusion, we believe that we have a reasonable number of rhinologists in our country with a mixture of experience and diversity of skills that makes them strongly competent. In addition, their engagement in the different societies of otolaryngology/rhinology and other subspecialties demonstrate their ability to participate in training and academic activity. Taking these facts into consideration helps guiding authorities to consider creating our own joint rhinology fellowship training programs to close the gaps and promote patients' access to rhinology care.


  Conclusion Top


This study identifies the rhinology workforce in Saudi Arabia. Utilizing the outcome of our study may improve the access to otolaryngology/rhinology services. Moreover, it can guide MOH to invest in training and planning to provide otolaryngology/rhinology services that meet the public health-care needs. In addition, this current rhinology workforce can be the basis for the SCFHS to establish structured rhinology fellowship programs in different provinces of Saudi Arabia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sinclair A. Workforce Planning: A Literature Review. IES Research Networks, Institute for Employment Studies; 2004. p. 1-20.  Back to cited text no. 1
    
2.
Alhazmi WA, Almutairi AN, Al-Muqbil AA, Al-Ali AI, Alhasson MA. Pattern of ear, nose, and throat disease seen by otolaryngologists at Qassim University outpatient clinics, Saudi Arabia. Int J Med Dev Ctries 2021;5:1430-6.  Back to cited text no. 2
    
3.
Hamilton M. Online Survery Response Rates and Times: Background and Guidance for Industry. Ipathia, Inc. SuperSurvey; 2003.  Back to cited text no. 3
    
4.
Lin TK, Bruckner TA, Alghaith T, Hamza MM, Alluhidan M, Herbst CH, et al. Projecting health labor market dynamics for a health system in transition: Planning for a resilient health workforce in Saudi Arabia. Global Health 2021;17:105.  Back to cited text no. 4
    
5.
Albejaidi F, Nair KS. Building the health workforce: Saudi Arabia's challenges in achieving vision 2030. Int J Health Plann Manage 2019;34:e1405-16.  Back to cited text no. 5
    
6.
General Authority for Statistics, Kingdom of Saudi Arabia 2010, Distribution of Population In Administrative Districts. Available from: <https://www.stats.gov.sa/en/2>. [Last accessed on 2022 May 16].  Back to cited text no. 6
    
7.
Smith KA, Sommer DD, Grondin S, Rotenberg B, Tewfik MA, Kilty S, et al. Assessment of the current Canadian rhinology workforce. J Otolaryngol Head Neck Surg 2015;44:15.  Back to cited text no. 7
    
8.
Heineman TE, Ramakrishnan V, Hwang PH, Suh JD. Workforce analysis of practicing rhinologists in the United States. Laryngoscope 2020;130:1116-21.  Back to cited text no. 8
    
9.
Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator. Lancet 2009;374:1714-21.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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