ENT vs dermatology

[VisionaryTics]

You can check out library for a book called "Dermatologic surgery." I hope it will help.

I looked it up. It covers how to use cautery, cryosurgery, cutaneous excisions, Mohs, local flaps, and skin grafts.

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[neutropeniaboy]

If you're defining the quality of your education by how many audio books you've completed rather than by the education provided by hands on patient care and human interaction, I believe you've made the right choice.

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[IceHouse]

If you're defining the quality of your education by how many audio books you've completed rather than by the education provided by hands on patient care and human interaction, I believe you've made the right choice.

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Different specialties require different skills. It would be silly to argue dermatologists don't see many patients and don't have enough "hands on patient care and human interaction." Have you tried seeing 40-50 patients a day, 5 days a week? I think it's plenty of hands on patient care and human interaction for anyone. Furthermore, by your reasoning then Radiologists and Pathologists receive the lowest quality of education. I'm sure some orthopods think of ENTs not having enough OR time but that only shows their ignorance, no point in arguing there.

I always think of those trashing other fields as someone unhappy with what they do. If they were happy with what they are doing, they would care less about other specialties. In fact, such attitudes were some of the reasons I was not interested in working 5-7 years in residency with unhappy people and maybe for the rest of my life. I've heard subspecialty surgeons calling general surgeons "stupid general surgeons." If extensive "hands on patient care and patient interaction" turns some into a#$holes, I will pass on that sort of comprehensive training experience and would rather avoid working with such experienced physicians.
Truthfully, although a few may exist but I have never met a dermatologist bad mouthing other specialties and they served a good example for me to follow.

 

[neutropeniaboy]

I'm not trashing any specialty; you should be able to figure that out by reading my posts closely. I'm simply suggesting that residency is a fixed time and anyone who believes audio books and clock watching can make you a better doctor is mistaken.

In fact, a few posts back I suggested that one should choose his specialty bcca see on what he wanted to do for the rest of his life - whether that be Surgery or dermatology, Otolaryngology o TV orthopedics.

I don't care to argue whether dermatologists or OBs are surgeons or not. I'm quite sure general surgeons often think of me as just a medical doctor who does some surgeries. That's not my point, although this thread seems to want to steer in that direction.

I don't care to argue whether dermatologists have a better lifestyle or not (since I did say earlier that you can make your career as easy or difficult as you choose).

You assume to much in your post about my opinion of radiologists, but in a career that involves the direct care of human beings, nothing substitutes for dealing directly with them.

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[Pir8DeacDoc]

Can you show me where anyone here is trashing the dermatologists? I couldn't care less what other people do with their careers. I enjoy what I do. It's harder than what some people do and easier than what some people do. Personally I'd call a Moh's person a proceduralist, but it's mainly semantics

 

[neutropeniaboy]

I always think of those trashing other fields as someone unhappy with what they do. If they were happy with what they are doing, they would care less about other specialties.

As a follow-up, this statement may be true. But, it is illogical to conclude that this seems from anything related to the timing, difficulty or length of residency.

In my experience, most people who are unhappy with their chosen careers are unhappy because of what the field has become, reimbursements, how hard they must work and loss of work-life balance - not their residency experience.

Many of my neurosurgery colleagues hated their residencies and faculty mentors. It always perplexes me how they can go through residency visibly hating their attendings and then cry at graduation and later on praise their mentors.

Don't confuse the rigors of residency with the outlook on your career. It's almost impossible for medical students to see beyond their cell phones and take the advice of people who have been through it, but your career is long and residency is short. Make the most out of it and don't sweat the beat down that can occur during it.

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[IceHouse]

Can you show me where anyone here is trashing the dermatologists? I couldn't care less what other people do with their careers. I enjoy what I do. It's harder than what some people do and easier than what some people do. Personally I'd call a Moh's person a proceduralist, but it's mainly semantics

I was not talking specifically about dermatology being trashed here , I just saw it (trash talking about other specialties) too often on surgical rotations. Frankly, I found it amusing and pathetic. It's great you enjoy what you're doing, and if I or my family had oto problems, I would prefer to see physicians who love what they do.

I guess it doesn't really matter what everyone personally calls anything. There is a definition of "surgery" and by that definition Mohs docs are surgeons.

 

[DrBodacious]

I looked it up. It covers how to use cautery, cryosurgery, cutaneous excisions, Mohs, local flaps, and skin grafts.

I don't have a huge knowledge base regarding what dermatolgists do, but it seems like dermatologists rarely do any local flaps or skin grafts. A guy in my area does XRT in his office, but he doesn't really get to aggressive with excisions, at least on the patients he sends me.

I think that is the point that many of us are trying to make (and that a few people seem to be arguing) is that dermatologists are much less surgical than ENTs. As NPB pointed out, general surgeons would likely say the same about ENTs vs general surgery. Most ENTs do surgery involving general anesthesia at least one day a week. Within ENT, individual physicians tailor how complex they want to get with surgeries. There are some who don't operate, and some who do 24+ hour marathon flap cases. So there are a lot of options once you get out in practice. In residency, you get a healthy exposure to most of the spectrum, including the advanced stuff, hence the tougher residency.

It seems like a common theme for ENT applicants is that a high percentage of them have an interest in head and neck surgery. Few residents actually choose to follow through and become head and neck subspecialists. But, you have to at least be excited about the bigger cases to choose ENT residency.

 

[IceHouse]

I don't have a huge knowledge base regarding what dermatolgists do, but it seems like dermatologists rarely do any local flaps or skin grafts. A guy in my area does XRT in his office, but he doesn't really get to aggressive with excisions, at least on the patients he sends me.

I think that is the point that many of us are trying to make (and that a few people seem to be arguing) is that dermatologists are much less surgical than ENTs. As NPB pointed out, general surgeons would likely say the same about ENTs vs general surgery. Most ENTs do surgery involving general anesthesia at least one day a week. Within ENT, individual physicians tailor how complex they want to get with surgeries. There are some who don't operate, and some who do 24+ hour marathon flap cases. So there are a lot of options once you get out in practice. In residency, you get a healthy exposure to most of the spectrum, including the advanced stuff, hence the tougher residency.

It seems like a common theme for ENT applicants is that a high percentage of them have an interest in head and neck surgery. Few residents actually choose to follow through and become head and neck subspecialists. But, you have to at least be excited about the bigger cases to choose ENT residency.

I agree. ENT is significantly more surgical than dermatology (especially in general dermatology practice).

However, Dermatologic Surgery fellowships provide more training in surgery but it is still less than otolaryngology. It depends how much and to what extent one wants to operate. Some enjoy OR 80 hours a week while others enjoy outpatient surgeries. Like many have said before, one should pursue what they love. However, if there are two fields they think they will equally enjoy, maybe this group of applicants should look into other factors like residency and post-residency work hours, pay, personalities in the field, work environment, stress, etc.

 

[IceHouse]

Personally I'd call a Moh's person a proceduralist, but it's mainly semantics

Btw, there are two fellowships in dermatology:
"Dermatologic Surgery" and "Procedural Dermatology"

They overlap a bit (and sometimes can be combined), but the main focus of each is in the name.

 

[bobby6]

Btw, there are two fellowships in dermatology:
"Dermatologic Surgery" and "Procedural Dermatology"

They overlap a bit (and sometimes can be combined), but the main focus of each is in the name.

It is interesting how the MOHS "surgeon" can't get Surgical operating room privileges at a Hospital. I recently got called by the ER to assess a nasal infection from a MOHS procedure the guy did because he doesn't take call. I told the ER that I didn't care if he doesn't take call but he needs to come in to see his patient. Period.

Dermatology is a sweet cush lifestyle but a polar opposite from any of the surgical specialties. The type of person who picks Dermatology and the one that goes into a surgical specialty are completely different types of personalities. Not saying one specialty is better than the other but there is some truth to the mantra of the specialty choosing you and instead you choosing the specialty.

I can say that my residency was brutal but as an attending, I probably work less than 40 hours a week and grateful all the surgical skills I acquired during the 80+ hour work week. To this day, I still feel you cannot train a competent surgeon in less than 80 hrs/week and under 5 years. There is too much to learn and know. When **** hits the fan, you will be grateful for that training so you can competently handle the situation.

 

[resxn]

I think it's so funny when my dermatology pal says he did surgery. I'm sorry, but draping the patient with a few towels and numbing up the skin, regardless of how great your recon flap is, is not surgery. It's a minor procedure.

Surgery requires anesthesia. Dermatology requires Lidocaine.

 

[IceHouse]

I think it's so funny when my dermatology pal says he did surgery. I'm sorry, but draping the patient with a few towels and numbing up the skin, regardless of how great your recon flap is, is not surgery. It's a minor procedure.

Surgery requires anesthesia. Dermatology requires Lidocaine.

I don't know , these pics look pretty "surgical" to me.

http://www.the-dermatologist.com/content/five-tips-anat-omical-dermatologic-surgery

also, varicose veins removal can be done by a trained dermatologist (under local, in the office) for half the price of what vascular surgery would charge doing it in O.R. So the level of anesthesia required for a procedure for it to quialify as a "surgery" is a ludicrous argument.

 

[SouthernSurgeon]

also, varicose veins removal can be done by a trained dermatologist (under local, in the office) for half the price of what vascular surgery would charge doing it in O.R. So the level of anesthesia required for a procedure for it to quialify as a "surgery" is a ludicrous argument.

 

[resxn]

I don't know , these pics look pretty "surgical" to me.

http://www.the-dermatologist.com/content/five-tips-anat-omical-dermatologic-surgery

also, varicose veins removal can be done by a trained dermatologist (under local, in the office) for half the price of what vascular surgery would charge doing it in O.R. So the level of anesthesia required for a procedure for it to quialify as a "surgery" is a ludicrous argument.

Almost as ludicrous as calling those pictures surgery. Seriously. If you want to be a surgeon, fine be a surgeon. But don't go be a dermatologist to call yourself a surgeon. It's just as stupid for an Ob/Gyn to call themselves a pelvic surgeon rather than just saying they're an Ob/Gyn.

A rose by any other name.

If all you do is remove skin and sew it back together in your clinic, you're not a surgeon. Same for veins. Pure and simple. Sorry. When I've removed SCCa by lopping off half the auricle in my clinic, and doing an awesome star recon that takes 1.5hrs, it's still not surgery.

My point about anesthesia was obviously tongue and cheek, but c'mon, really? you don't have to be so easily offended.

 

[IceHouse]

Almost as ludicrous as calling those pictures surgery. Seriously. If you want to be a surgeon, fine be a surgeon. But don't go be a dermatologist to call yourself a surgeon. It's just as stupid for an Ob/Gyn to call themselves a pelvic surgeon rather than just saying they're an Ob/Gyn.

A rose by any other name.

If all you do is remove skin and sew it back together in your clinic, you're not a surgeon. Same for veins. Pure and simple. Sorry. When I've removed SCCa by lopping off half the auricle in my clinic, and doing an awesome star recon that takes 1.5hrs, it's still not surgery.

My point about anesthesia was obviously tongue and cheek, but c'mon, really? you don't have to be so easily offended.

lol I think you got easily offended that dermatologists can be doing surgeries. I must admit those are often minor surgeries but nonetheless they are surgeries. I really don't care about anyone's personal opinion about what constitutes surgery. Like I said, other than personal opinion you have nothing to back your argument. There is a definition of surgery. Check it out.

also, it's not stupid for an ob/gyn who went through subspecialty fellowship in "Female Pelvic Medicine and Reconstructive Surgery" to call themselves surgeons. Same goes for dermatologists with 'Dermatologic Surgery' fellowship.

 

[rigid]

lol I think you got easily offended that dermatologists can be doing surgeries. I must admit those are often minor surgeries but nonetheless they are surgeries. I really don't care about anyone's personal opinion about what constitutes surgery. Like I said, other than personal opinion you have nothing to back your argument. There is a definition of surgery. Check it out.

also, it's not stupid for an ob/gyn who went through subspecialty fellowship in "Female Pelvic Medicine and Reconstructive Surgery" to call themselves surgeons. Same goes for dermatologists with 'Dermatologic Surgery' fellowship.

It is actually, because you would think people go into dermatology to BE dermatologists and be proud of that fact. Why are they fighting so hard to be called "surgeons" when they didn't go into a surgical field to begin with?

 

[Pir8DeacDoc]

New definition.

If what you do doesn't require you to take call to deal with potential complications then you aren't a surgeon. That should weed out the skin "surgeons".

You guys pop zits and put cream on rashes. That's cool I guess. But just admit you do it for the hours and pay. Not a burning desire to freeze AKs all day. Overall it's insulting to real surgeons for the zit poppers to claim such.

 

[IceHouse]

New definition.

If what you do doesn't require you to take call to deal with potential complications then you aren't a surgeon. That should weed out the skin "surgeons".

You guys pop zits and put cream on rashes. That's cool I guess. But just admit you do it for the hours and pay. Not a burning desire to freeze AKs all day. Overall it's insulting to real surgeons for the zit poppers to claim such.

lol, I've never insulted your specialty but you showed your true colors. You don't think there is something to say about your specialty? Grow up.

 

[IceHouse]

It is actually, because you would think people go into dermatology to BE dermatologists and be proud of that fact. Why are they fighting so hard to be called "surgeons" when they didn't go into a surgical field to begin with?

So dermatologists going into derm path fellowship are not pathologists? they are, they are DERM pathologists. Believe me if you have skin cancer or rare skin disease, you would want DERM pathologists to look at it.
Dermatologists who specialize in derm surgery are surgeons. They are skin surgeons, they are good what they do. They are not trying to operate on the heart or brain. They operating on what they are experts on. They also see patients in the clinic as they ARE dermatologists and I'm pretty sure they are proud of the fact.

 

[Pir8DeacDoc]

lol, I've never insulted your specialty but you showed your true colors. You don't think there is something to say about your specialty? Grow up.

Make the cerumen or snot jokes. I'm cool with it. I don't try and overvalue the work I do. I'm proud of my career and the amount of work and hours I put in to get here. I don't need to thump my chest and act tough. And for what it's worth, plastic surgeons are skin surgeons. You're a dermatologist.

 

[IceHouse]

Make the cerumen or snot jokes. I'm cool with it. I don't try and overvalue the work I do. I'm proud of my career and the amount of work and hours I put in to get here. I don't need to thump my chest and act tough. And for what it's worth, plastic surgeons are skin surgeons. You're a dermatologist.

You made me laugh. The thumping on the chest is EXACTLY what you're doing. Be happy with what you do. Really be happy. Whether you think derm surgeons are surgeons or not has absolutely no influence on what they think of themselves. They are happy with what they do, not what you call them. You may think that they are not surgeons. They care less.

 

[VisionaryTics]

They care less.

Says the guy posting how dermatologists are surgeons on an otolaryngology forum.

 

[rigid]

So dermatologists going into derm path fellowship are not pathologists? they are, they are DERM pathologists. Believe me if you have skin cancer or rare skin disease, you would want DERM pathologists to look at it.
Dermatologists who specialize in derm surgery are surgeons. They are skin surgeons, they are good what they do. They are not trying to operate on the heart or brain. They operating on what they are experts on. They also see patients in the clinic as they ARE dermatologists and I'm pretty sure they are proud of the fact.

Do they go around telling people they are skin pathologists? I doubt it

 

[Fah-Q]

I don't know , these pics look pretty "surgical" to me.
http://www.the-dermatologist.com/content/five-tips-anat-omical-dermatologic-surgery

I just have to say that this "article" is pretty much the worst thing I have ever read. So many errors and face-palm moments. The unintentional comedy is epic.

OK, carry on with the dick measuring.

 

[resxn]

I just don't understand why a dermatologist can't just say they're a dermatologist. Why do they have to say they're a surgeon? I don't say I'm a surgeon, I tell people who ask that I'm an ENT. I'll even say I'm a booger doctor. But I don't go out of my way to call my self a surgeon even though a large part of my practice is surgery. I think people who try to aggrandize what they do just have an inferiority complex about what they do--that it's not valued enough. If you are an egg, but call yourself a junior chicken, you're just ashamed of being an egg.

 

[IceHouse]

I just don't understand why a dermatologist can't just say they're a dermatologist. Why do they have to say they're a surgeon? I don't say I'm a surgeon, I tell people who ask that I'm an ENT. I'll even say I'm a booger doctor. But I don't go out of my way to call my self a surgeon even though a large part of my practice is surgery. I think people who try to aggrandize what they do just have an inferiority complex about what they do--that it's not valued enough. If you are an egg, but call yourself a junior chicken, you're just ashamed of being an egg.

Actually they say they are dermatologists. I haven't met a single dermatologist who is not proud in what they do. They're happy people enjoying what they do. They don't go around saying they are surgeons. It's what some of them do is considered surgery.

 

[SouthernSurgeon]

It's what some of they specialize in is considered surgery.

Not by anyone with a lick of sense

 

[IceHouse]

Not by anyone with a lick of sense

Definitely not by anyone who is ignorant of what IS actually surgery.

 

[IceHouse]

I think people who try to aggrandize what they do just have an inferiority complex about what they do--that it's not valued enough

You forget that there are certain stereotypes associated with the word "surgeon." So I doubt it's about the inferiority complex.

 

[ThePursuit]

I'd rather spend every weekend with my wife in the next 3 years before we have kids with a derm audiobook playing in the background over taking consults after consults, managing post-op patients for attendings, etc.

I'm an ENT resident. I spend 80% of my weekends with my wife at home. I can't say I would ever listen to a derm audiobook "in the background" though. I would rather kill myself. If I did derm, my wife would also probably hate me because I would hate myself and be INCREDIBLY dissatissfied with my job. That's why diversity in interests is so great. Also, your wife probably hates the audiobook thing. You should try some Frank Ocean if you're still thinking about kids some time....

 

[DermatoFIGHT]

Why all the fighting here? Both are great specialties and there is overlap in both with cutaneous oncological treatments, wound healing, types of patients you see, and satisfactions.

Does anyone really care if they are called "surgeon" or "doctor"? With all this bickering, you can call yourself a surgeon/dermatologist/ENT/whatever, but the reality is and any practicing physician knows you lose money by going to the OR vs. the office.

The statement "Surgery requires anesthesia. Dermatology requires Lidocaine. " is rather silly. I know dozens of plastic surgeons doing in office rhytidectomy, blephs, lipo, and excisions without anesthesia.

If anyone picked a career based on what they will be called, then you need a good shrink

 

[IceHouse]

I'm an ENT resident. I spend 80% of my weekends with my wife at home. I can't say I would ever listen to a derm audiobook "in the background" though. I would rather kill myself. If I did derm, my wife would also probably hate me because I would hate myself and be INCREDIBLY dissatissfied with my job. That's why diversity in interests is so great. Also, your wife probably hates the audiobook thing. You should try some Frank Ocean if you're still thinking about kids some time....

I'm yet to meet an "incredibly" dissatisfied dermatologist or just simply dissatisfied one. Have I met dissatisfied ENTs? You bet I did, even incredibly dissatisfied ones.

 

[ThePursuit]

I'm yet to meet an "incredibly" dissatisfied dermatologist or just simply dissatisfied one. Have I met dissatisfied ENTs? You bet I did, even incredibly dissatisfied ones.

I had meant my earlier post to be more tongue-in-cheek than it appears to have come off. I love my derm friends. It's a great specialty for some, and obviously the lifestyle is better - if your goal is to spend less time on your career, and more time on other pursuits in life. My point was more that I love what I do, so the extra hours aren't onerous, they're simply doing something I enjoy. I was also trying to bring a little balance to the implication that ENT folks never get a weekend to spend with their wife

 

[resxn]

Why all the fighting here? Both are great specialties and there is overlap in both with cutaneous oncological treatments, wound healing, types of patients you see, and satisfactions.

Does anyone really care if they are called "surgeon" or "doctor"? With all this bickering, you can call yourself a surgeon/dermatologist/ENT/whatever, but the reality is and any practicing physician knows you lose money by going to the OR vs. the office.

The statement "Surgery requires anesthesia. Dermatology requires Lidocaine. " is rather silly. I know dozens of plastic surgeons doing in office rhytidectomy, blephs, lipo, and excisions without anesthesia.

If anyone picked a career based on what they will be called, then you need a good shrink

1 - Stupid to fight, agree. Interesting angle for someone with your handle, btw.
2 - Obviously, people care if they are called "surgeon" otherwise you wouldn't have people trying to label themselves as one. I'm fully comfortable with only general surgeons calling themselves surgeons, btw. I'm an ENT. Part of that speciality involves surgery. But to throw a wide net and say taking off a nevus is equivalent as doing a heart transplant is equally as silly.
3 - Any practicing physician knows that if you think you lose money by going to the OR vs the office doesn't understand all of the nuances of both. This is another example of the narrowed understanding of surgery by a dermatologist. I made more money as a partner in a surgery center than I did in my clinical practice in the last 12 months. Granted, this includes the investment part of it, but any practicing physician should clearly understand that if you operate somewhere you don't own, you are giving money to someone else. Apples to apples, yes, you will lose money per CPT by going to the OR instead of doing a procedure in the clinic. But, when you practice the business of medicine taking the forest for the trees, that's simply not true.
4 - You know "dozens?" As in 24+? I'm not arguing my statement on anesthesia vs lidocaine was accurate. It was a clever (IMO) soundbite. Buy you can't argue the poor merits of hyperbole using the poor merits of another hyperbole.
5 - Agree, shrink needed for those individuals.

 

[Mad Jack]

Are you telling me that when ENT docs remove skin cancer or skins lesions and do reconstructive work is not considered surgery?

How would you define 'surgery' ?

Here is a simple definition from wiki

"Surgery (from the Greek: χειρουργική cheirourgikē (composed of χείρ, "hand", and ἔργον, "work"), via Latin: chirurgiae, meaning "hand work") is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas."

So yes, people who know the meaning/definition of 'surgery' and are familiar with Mohs would consider Mohs surgeons to be surgeons.

Are dermatopathologists not pathologists because they did not go through pathology residency before completing derm path fellowship? Derm path guys went through general derm residency first, then derm path fellowship. And as far as what they do is by all means considered dermatopathology.

It's minor surgery. It doesn't make you a real surgeon any more than stitching up lacs makes you a real surgeon.

If you don't need anesthesia present in any capacity, it's not a major surgery.