Are more otolaryngologists enough to improve surgical access? Geographic distribution and health system barriers in Brazil.

OBJECTIVE: To examine the geographic distribution of otolaryngologists in Brazil and evaluate the association between specialist density and otolaryngologic surgical provision within the public health system between 2008 and 2024. METHODS: This nationwide longitudinal study used data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), combined with demographic and economic indicators obtained from the Brazilian Institute of Geography and Statistics. Otolaryngologist workforce density was defined as the number of practicing specialists per 100,000 inhabitants in each state. Surgical rates, procedure costs, and surgical productivity were analyzed by state and geographic region. Inequality in workforce distribution was assessed using the coefficient of variation and the Gini index. States were further grouped through k-means cluster analysis based on workforce density, surgical rates, and gross domestic product per capita. Mixed-effects regression models were applied to examine the association between specialist density and surgical provision over time, adjusting for economic indicators. RESULTS: During the study period, 730,757 otolaryngologic procedures were performed within the Brazilian public health system. The national density of otolaryngologists increased from 2.41 to 3.97 specialists per 100,000 inhabitants between 2011 and 2024. Workforce distribution remained uneven across the country, with higher concentrations observed in the South and Southeast and substantially lower densities in the North and Northeast. Statistical modelling identified a significant association between specialist density and surgical rates (p < 0.001). However, the estimated number of procedures corresponding to each additional specialist decreased over time, from 11.6 surgeries in 2011 to 2.8 in 2024. Measures of inequality showed a reduction during the study period, with the Gini index declining from 0.33 to 0.27, although differences between regions persisted. Procedure costs varied geographically, with higher mean expenditures reported in the South and Southeast. CONCLUSION: The expansion of the otolaryngology workforce in Brazil was accompanied by comparatively smaller increases in surgical provision across regions. This pattern may reflect structural limitations within the public health system that extend beyond specialist availability. The findings suggest that improvements in surgical access may depend on broader system capacity. LEVEL OF EVIDENCE: 3 - Ecological longitudinal (cross-sectional time-series) study.