1. I n t e g r i t y - S e r v i c e - E x c e l l e n c e Headquarters U.S. Air Force 1 OTOLARYNGOLOGY – HEAD AND NECK SURGERY 2008 Mark Boston, Lt Col, USAF, MC, FS

2. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 2 JULY 2008 MANNING 39 AD Otolaryngologists 3 in command/staff assignments 1 at USUHS 28 authorized billets at 13 bases All authorizations are filled in July 2008 ∆ - 4 by 2012 Does not include losses due to fellowship training or to command/admin assignments Additional staffing to support deployments and GME

3. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 3 MANPOWER PROJECTION Mission requirements (Deployments, GME, patient care) demand higher number of otolaryngologists than authorized Ten potential additional “authorizations” AFA – 1 Andrews – 1 Eglin – 1 Nellis – 2 Travis – 1 Elmendorf - 1 WHMC/SAMMC - 3

4. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 4 MANPOWER REALITY Despite “over-manned” status changing mission demands make us potentially under-manned Civilian ENT care is not only expensive, it is hard to find PLAN Work closely with MTFs to maximize use of current resources – ENT PA system Continue recruitment and retention initiatives Improve current practices (OR time, clinic support, etc) Assignment choices Unique practice opportunities (missions, etc) Community opportunities (VA resource sharing, etc) Training opportunities (CSTARS, etc) Money

5. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 5 OEF/OIF DEPLOYMENTS Currently deploy 2 otolaryngologists per AEF Only 25/39 “eligible” to deploy (~25% deploy/year) Only US otolaryngologists in Iraq or Afghanistan Head/Neck trauma care, critical airway management, routine ENT care, TBI evaluations, training local physicians as well as Army medics/18Ds Optimize manning at UTC MTFs (how many ENT docs do you need and can you keep them busy and trained when not deployed?) 10 FFENT UTCs 5 WHMC/SAMMC 1 Keesler  Eglin 1 Andrews 1 Travis 2 AFA  1 Nellis

6. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 6 RESEARCH AND EDUCATION Leading the way in research and publications 37 publications cited in PubMed in past 15 months Advancing trauma treatment protocols and outcomes and training the next generation of head and neck trauma surgeons Brennan, AAO-HNS Trauma Study Group, cooperative agreement with civilian trauma experts Lopez, “Safety of definitive in-theater repair of facial fractures” Archives of Facial Plastic Surgery 2007 Cited in several local and national publications including Air Force Times Continue to compile data and update

7. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7 SUPPORTING WOUNDED WARRIORS TBI Medical Support Hearing loss, tinnitus and balance disorders Approximately 40 patients/month in San Antonio Adding a second neurotologist and seeking funding for novel therapies Hearing and balance testing in-theater for the timely recognition of TBI ailments Cooperative agreement with Army and Navy Initiative from Center for Asymmetric Warfare AF otolaryngologists are the only hearing and balance medical experts currently in-theater

8. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 8 ADVANCING CARE AT HOME Only DOD Airway Management and Laryngology Course Expanding surgical options at WHMC Advanced endoscopic skull base surgery Cochlear implants, BAHA, and middle ear implants World-class plastic & reconstructive surgery Expanded in-office diagnostic and treatment options Transnasal esophagoscopy Endoscopic-assisted laser procedures Snoring/Sleep apnea procedures Reconstructive and restorative surgery

9. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 9 GRADUATE MEDICAL EDUCATION GME – The Foundation of Future Excellence TRICARE, etc effect on resident education AF ENT residents at 5 th percentile for surgical cases Adaptive response to low surgical case numbers Educational agreement with Darnell AMC, Ft Hood Resource sharing with VA Central Texas and S.A. Civilian pediatric otolaryngology opportunities AF ENT residents now at 20 th percentile and climbing 12 months later Plan to be at or over 50 th percentile within 2 years Cost – busier docs being pulled in more directions BRAC ???

10. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 10 PRIORITY ITEMS RETENTION/RECRUITMENT OPTIMIZE MANNING AT MTFs SUPPORTING UTCs/GME Convert “overages” to authorized positions Ensure index caseload supports manning TRAINING/MAINTENANCE OF SURGICAL SKILLS (GME/Currency) OR time (MTFs or at civilian/VA hospitals) Access to civilian cases via MOUs CSTARS and exchanges with major medical centers JOINT ASSIGNMENTS Right specialist at the right location Potential positive impact on all the above items

11. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 11 Air Force Otolaryngology Caring for our Warriors Much more than ear, nose and throat Advancing otolaryngology care through research and training Helping to keep our nation strong by caring for our warriors -

12. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 12 Air Force Otolaryngology Caring for our Warriors Future Warriors

13. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 13 Air Force Otolaryngology Caring for our Warriors Future Warriors Present Warriors

14. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 14 Air Force Otolaryngology Caring for our Warriors Future Warriors Present Warriors Past Warriors