Head & neck surgical oncology: Success in private practice.

Background: Due to its complexity and multimodality treatment needs, traditional delivery of head and neck cancer care often occurs in a multidisciplinary cancer center, frequently in a university-based program in an urban setting. Fellowship training opportunities for subspecialty-focused head and neck surgeons have increased over recent years. There is a persistent concern that the number of newly minted Head & Neck Surgeons graduating each year outpaces the number of university-based employment opportunities, and that the workforce does not match the job opportunities. Recent publications examine this potential mismatch to better understand career choices, with a 2021 survey revealing that nearly 90 % of fellowship graduates were employed by a university or academic institution and only 10 % reported being in "private practice". However, it should not be an automatic assumption that academic practice is somehow superior to private practice. Moreover, not every patient can access university-based care, creating a societal mismatch between disease incidence, resources, and access to high quality care. The well-trained Head & Neck Surgeon may be able to deliver excellent care in a satisfying practice setting without an academic affiliation.

Methods: Two Head & Neck Surgeons who have practiced in both Academic and Community-based ("private") subspecialty settings offer practical and actionable tips to provide high level evidence-based head and neck surgical care without the trappings of a university, and with a focus on patient-centered care as well as career satisfaction. Further, since graduates of comprehensive otolaryngology training programs receive a robust amount of head and neck surgery training in residency, understanding these practical tips will potentially assist the Comprehensive Otolaryngologist in private practice to expand head and neck services within their practice.

Objectives: 1) Review recently published survey-based reports of practice patterns and career satisfaction of recent HNS fellowship graduates, recognizing self-reported rates of practice settings, academic versus non-university-based ("private practice"). 2) Analyze and report practice structure of HNS graduates over the years 2015 to 2021 to determine rates of practice structure change from academic to private or vice versa, using Public Use Files combined with Google search. 3) Outline tips and pearls for a successful Head & Neck Surgery practice in a non-university-based setting, with 11 practical and actionable items that will allow high level subspecialty care without the traditional attributes of academic employment.

Conclusions: Graduates of head & neck surgery fellowships in recent years may perceive a paucity of academic job opportunities. This article reviews practice patterns of recent graduates, and presents practical tips to achieve a satisfying Head & Neck Surgery career in a private practice setting.