Hey, long time reader, first time poster here.
I'm trying to decide between orthopedics and otolaryngology, and oto is an early match so I've got to make a decision soon. I was wondering if any oto or ortho residents on this forum can help with some input.
here's my take on the pros and cons of both fields, from having done rotations in both
OTO pros
- medical management
- wide variety of surgical skills- from big whacks to microscopic surgery
- people seem chill and nice
- you don't get killed on call
OTO cons
- don't want to just be doing tubes and tonsils when I get out into private practice
- 15 hour long surgeries can be grueling

ORTHO pros
- you can operate almost anywhere in the body
- you can dramatically improve a patients function
- money is really good too

ORTHO cons
- sometimes it feels more like carpentry than surgery- unless doing fine hand stuff
- you get cremated on call at a level 1 trauma center
- unless you do sports or hand, lifestyle can be pretty tough


So there it is, I really don't care if you guys want to bash me for what I just posted, this is just my opinion, and no offense was meant. So neutropeniaboy and ortho2003,(and all you other orthopods and ents) I'm hoping for answers.

Both are awesome fields, but the bottom line is that you need to do what interests you most. Remember that, even though both are surgical, the scope of practice is different so I'm not really sure what's so hard to decide -- go with what you like.

I am applying to the ENT match this year but have thought about Ortho and plastics. Here is my view.

I decided on ENT because its one of the few specialties where you are train in both medicine and surgery. I always knew that I wanted to be a surgeon, but I realized during my MS3 surgery rotation that I didn't want to be in the OR all the time. Some people love the OR but honestly there is nothing magical about it.

I surprisingly liked medicine quite a bit. ENT has quite a bit of medical management especially with allergy/immunology which I am interested in. Cons are that ENT is a regional specialty dealing with diseases of the head and neck. However, I can't think of many fields that offer the wide scope of practice. You treat patients of all ages, pediatrics to geriatrics, oncology to facial plastics, and etc.

If your someone who loves being in the OR, and hate medicine and clinic, then Ortho would be the way. Same for plastics also.

don't underestimate the clinic component in ortho and plastics. how else do you book cases?

One thing to consider is that reimbursments change, whereas lifestyles tend to remain more constant. Orthopods might make more money now, but there no guarantee it'll stay that way. Whereas, ENT docs will most likely always have good lifestyles.

ENT has a lot of clinic. I heard that 1 in 15 patients you see actually need surgery.

However, if you focus on Head and Neck Oncology, you can operate till the cows come home with lots of surgery.

Thanks for your response guys
I'm starting the application process for ENT right now at this semi-late stage, but I've thought it over- and while I like the OR, I like medicine and clinic stuff too. The thing with ortho clinic is that most of the time the decision was- can i operate on you or not? And as far as reimbursements go- whats up must come down at some point.
and ent can be a better lifestyle (unless you do microvascular/free flap stuff)

Just thinking aloud....i guess one can't go wrong with either field.

one thing to think about and this is just a personal thing, not a slam on the field

it seems a fair amount of patients at the orthopod's office tend to be worker's comp. It sort of annoyed me to hear people complaining about their pain all the time and whining for a note to miss work. It is very possible that this is/was unique to the office that I happened to work with. Best of luck with your decision.

one thing to think about and this is just a personal thing, not a slam on the field

it seems a fair amount of patients at the orthopod's office tend to be worker's comp. It sort of annoyed me to hear people complaining about their pain all the time and whining for a note to miss work. It is very possible that this is/was unique to the office that I happened to work with. Best of luck with your decision.

yeah, one "good" thing about ortho is that if you're an unethical POS, you can make sick amounts of money working for lawyers.

It seems to me that one of the few surgical subspecialities that is currently escaping the rapid trend of downward reimbursements is orthopedics. Those guys who go off and do hand or spine fellowships make an insane amount of money. It's not surprising to see why ortho is so popular right now. However, I would be very surprised to see ortho evade the insurance companies for much longer; I think they're going to start seeing rapid decline in reimbursements as well.

Orthopedics is otherwise pretty damn cool. Surgeons always talk about the satisfaction of fixing something that is broken, etc. Well, what other specialty other than orthopedics has that instant satisfaction? I don't think there are others quite comparable.

Nevertheless, orthopedics in a large respect is based on trauma or pathologic fractures, and like all other specialties, I'm sure there are dry spells. I would think that a lot of the cutomers come from late night call-ins to trauma centers necessitating late night surgical repair. And for the guy who fancied ortho for its lack of clinic -- who do you think sees all the post-op patients? Orthopods have plenty of clinic. There's a lot of nonoperative management in orthopedics as well.

Picking ENT was somewhat a decision based on a combination of factors: complexity of cases, region of the body, lifestyle, pay, demand, academic and private practice opportunities, and OR and clinic lifestyle.

1) ENT cases can be pretty cut and dry or very complex. If you want to spend your career doing tubes (by the way, tubes can be very challenging folks; try putting tubes in a 2 month old with a subperiosteal abscess), tonsils, uncomplicated sinus surgery, septoplasties, laryngeal biopsies, and cancer work-ups, then you can do that and do very well. On the other hand, if you want to be the go-to-guy and do stapedectomies, endolymphatic sac shunting, facial nerve decompressions, vestibular nerve sectioning, and cochlear implantation, then you have that option as well.

2) In my opinion, there's no other place as complex as the head and neck. There are so many spaces, nerves, vessels, muscles, bony landmarks, and organs in this small region of the body. Above all, the face and neck are the most visible structures seen by the average human. There's just a lot of opportunity to be challenged here.

3) ENT lifestyle can be a breeze or a pain in the ass -- whatever floats your boat. As you can imagine, private practice with a team that effectively bargains minimal ER and call will reward you with short hours, great OR cases, and time to spend with your family (or whatever). They don't call it "Early Nights & Tennis" for nothing. On the otherhand, if you want to do a head and neck fellowship that trains you in microvascular anastomosis and do those 20 hour long cases, build up a huge patient population, perform research at an academic center, come in early for grand rounds, do resident reviews, prepare lectures, and be called multiple times per night when your own call by your residents, then you can do that as well. That lifestyle is very appealing for some who want to be constantly challenged and thrive on being the go-to-guy.

4) Pay for ENT isn't as high as it is for orthopedics -- not even close. It probably doesn't match neurosurgery either. The median east coast salary for all otolaryngologists is somewhere around $250,000. That's pretty good for anything, mind you. (Anesthesiology is around $275,000; general surgeon around $235,000.) It's a little bit higher if you're practicing out in the midwest. Most people in the east start around $125,000 to $150,000. In academics, it is, of course, much lower. But, academics has its trade-offs: you get residents to do all the sh*t.

5) The American Board of Otolaryngology and RRC limit the number of ENT residents very strictly. It's not like anesthesia where they just add residents according to demand. This, of course, keeps ENT doctors in demand. All ENTs are in demand, including generalists. Right now, pediatric otolaryngologists and facial plastic surgeons are in heavy demand, and even in academics, these guys make bank.

6) I've sort of already discussed private practice v. academics.

7) You can spend as much time in the OR as you want. A good doctor always tries to find a medical solution first. That's the way ENT is. If you want, you can do allergy and immunology and spend all week in clinic. Alternately, you can spend all week in the OR/minor procedure doing facial procedures. You could be a FESS factory if you wanted and had the patients. Of course, you could operate 2-3x a week and do clinic 2-3x a week. Whatever your practice affords you and whatever you want to do. It's unfortunate in ENT that many of the procedures we perform now as generalist actually cause you to lose money you would have made in clinic. If you spend the day doing 10-12 tubes and tonsils, you might have made more money in clinic seeing initials. It all depends. Of course, your reimbursements will be based on how savvy you are when it comes to billing.

I'm sure most of what I said is applicable to orthopedics, but this is just the ENT perspective.

Hope that helps.

hey neutropeniaboy,
Thanks for that detailed response, that just what i needed. To be quite honest, I think I had already semi-made up my mind to go into ENT before i posted my original message. Too bad I'm racing against time now to get letters and what not.
I think when I made the final decision, it was so close that I threw the rational factors out the window, and went with my gut feeling at the end of both subIs that I did (ortho and ent). Both rotations were close to 90-100 hours a week, but I got a much better vibe from my ENT subI. One big PRO for ENT is - the residents are some of the coolest/smartest people I've met in the hospital.
Once again, thanks for your replies.

PS This forum can be addictive when you actually post and not just lurk

Not to burst your bubble, but the San Francisco match application is due tommorrow, august 19.

One correction for neutropeniaboy in regards to hand surgery; compensation is down quite a bit for hand. The combination of ER call and significantly declining reimbursement has made hand a less attractive specialty for PRS/Ortho when compared to other aspects of their fields.

ENT is great stuff. I've loved my work with the ENTs during my training (so far).

trex: that deadline is just a suggestion. What really matters is the individual school deadlines, and I'll prolly miss some of the early birds. But thats ok....if i'm so far behind that i actually don't match, theres always next year (like the cubs)

Not to burst your bubble, but the San Francisco match application is due tommorrow, august 19.

That date is a conservative date given to applicants so that in addition to the 2-3 weeks of processing time, the application will hit 95% of programs by their individual deadlines.

On that note, if your SFMatch is not complete and you're feeling a crunch -- say, because that 3rd recommendation isn't in yet -- send in the application anyway, and forward any remaining documents to SFMatch AND individual programs later.

One correction for neutropeniaboy in regards to hand surgery; compensation is down quite a bit for hand. The combination of ER call and significantly declining reimbursement has made hand a less attractive specialty for PRS/Ortho when compared to other aspects of their fields.


Really? It seemed like everyone in my medical school class going into ortho were going to do "hand" or "spine." Even with all those cosmetic injections? Man. That sucks.

yeah, one "good" thing about ortho is that if you're an unethical POS, you can make sick amounts of money working for lawyers.


This can be sad about several specialties PM&R for example probably does more IMEs and they actually make more money by doing IMEs than they do by seeing patients. Pods tend to take a pay cut (compared to the OR, not clinic) by doing them and only do them occasionally unless they are finished operating.


By the way, ENT vs ortho?!?! How can you have picked two more opposite specialties. You are talking about throwing a nail down a femur vs. doing some intricate neck disection or tympanotomy tubes. I would take the nail any day, but to each their own.

Also, one of the reasons that ortho has not taken the reimbursement hits that several specialties have taken is because it evolves so rapidly. The technology regarding implants and hardware is changing weekly it seems. New technology is viewed by payers as worth the cost for some reason.

Check out www.orthogate.com for the Ortho residency forum and www.otomatch.com for the ENT residency match forum

killahB, best of luck to you. It seems like you have already decided and it sounds like you have done the right thing.

Learning a lot about each specialty and writing out the pros and cons is very helpful, but my earnest advice to everyone is: you have to go with your gut response. Trust your gestalt, as long as you've put some effort into obtaining a good gestalt (researching, traveling to different practice environments, etc.). Use the force Luke (you know what I mean). You've got to do what you love or you will not be happy in life.

A few extra points:
-I'm sorry, but the ortho guys are much cooler and funner to work with...working around the face just freaks me out :laugh: I guess someone has to do it, though.
-It is a shame to see so much discussion revolve around money. You'll make buckets in either specialty. You have to do what you enjoy or bitterness will surely be yours.
-There is PLENTY of clinic to be had in orthopaedics.
-There is an immense amount of satisfaction obtainable in orthopaedics. You can really make a difference in peoples' lives. The outcome and function returned with joint replacements is truly amazing. Traumatic reconstruction is also very rewarding - there's nothing like giving a young patient back a leg to walk on. The gen surg guys will work their arses off, but I've never heard a patient say, "doctor, my liver feels great...and I didn't need that spleen anyway. Thanks a lot." I have heard: "Wow, you fixed up my leg. Un-#$*&%^@-believable. It's even on straight! You're the man. (Tears/handshake). Can you pass me those Marlboros?"
-Ortho is absolutey not all based on trauma/fractures. Sure it is if you do trauma, otherwise it depends on specialty and what kind of practice you make for yourself.
-We're busy. I couldn't tell you about any "dry spells." That's funny.
-It's true that in general "lifestyle" will be better in ENT. But again, you have to do what you really enjoy and what makes you feel good about yourself, or maybe even what you're good at - or you will pay a dear price over your career. It's not like the ENT guys work 35 hrs. a week.

thanks for the advice kilgorian!
like that icon btw....

Thanks, killahB. I like it, too! It took forever to get it to work, but I chuckle each time I see it. What's he running from anyway??

Good luck!

I think ENT is a bad choice if you plan on living in a major city. Just like any family practice physician, you will have a hard time doing facial plastics and allergy as an ENT in a large city. Most patients will seek a plastic surgeon for their facial plastics and an Allergist for their allergy problems. That leaves with tubes and tonsils as your bread and butter. A member of my immediate family in an ENT and he claims it is a dying field and wouldn't pursue it now if given the choice. And contrary to what is being written here, ENT's spend MOST of their time in clinic. I think it appealed to many initially because it was a jack of all trades. You can do surgery and clinical work and the idea of doing allergies as well as facial cosmetic surgery drew a lot of people to the field. The realtiy is that those physicians don't get to practice a lot of those other skills in a large city with other specialists. But even ENT's in large cities still earn ~250K and have a great lifestyle as opposed to an orthopedic surgeon. ENT's take far less call and some work 4 days a week.