The Laryngology Fellowship Crisis: Rising Training Capacity Amidst Declining Applicant Interest

Prior literature has identified gaps in the United States (US) laryngologist workforce. However, there are few studies analyzing the training pathway for laryngologists. The objectives of this study were to define trends in the number of applicants, training spots, and unfilled training spots for laryngology fellowship training.

This was a retrospective observational study of US laryngology fellowship applicants (2012 to 2025). Match outcomes from the National Resident Matching Program were calculated and linear regression was used to analyze annual trends.

Between 2012 and 2025, the annual number of laryngology training spots (22 to 24, 9.1% increase, p = 0.015) and programs (20 to 23, 15.0% increase, p = 0.010) increased. The number of laryngology fellowship applicants decreased (18 to 15, 16.7% decrease, p = 0.127) although this was not significant. The annual applicant-to-training spot ratio decreased (0.82 to 0.63, p = 0.367) while the annual rate of unfilled training spots increased (36.4% to 50.0%, p = 0.275) over the study period although these trends were not significant. The proportion of incoming fellows who graduated from US allopathic medical schools decreased (85.7% to 75.0%) while those from non-US allopathic medical schools increased (14.3% to 25.0%) although these trends were not significant (p = 0.619). Match rates for US allopathic medical school graduates exceeded those for non-US allopathic medical school graduates (95.0% vs. 42.2%, p < 0.001).

The capacity for laryngology fellowship training has grown at a faster rate than applicant demand. Efforts are needed to stimulate interest in laryngology fellowship training given forecasted US workforce shortages.

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