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Gen Surg vs. ENT vs. Trauma vs. Ob/Gyn

Discussion in 'Surgery and Surgical Subspecialties' started by Mango, 02.15.03.

  1. Mango

    Mango Very Senior Member

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    You see my dilemma?!

    By the way, hi guys, it's been a long time since I've been around SDN. I've been enjoying the hell out of third year! And now that it's getting close to decision time, I'm still confused about what I want to do. Here's what I know so far: I want surgery in some form. But unfortunately my third year schedule has surgey LAST, so I still feel like I'm in the dark when it comes to specifics about surgical fields. What I'm really questioning, is what will I see most often in the feilds I listed. Here are my thoughts, please post yours:

    General Surgery: Lots of lap chole's, some breast stuff, some GI (?), and lots of hernia repairs

    ENT: I really like the people in this field, plus I know they tend to have continuity with many of their pt's, which I guess is a plus. But what procedures are their "bread and butter?" Is it all nasal polyps, and trachs? need more info!

    Trauma: This seems like a great field minus the lifestyle crap. But I have decided I'm flexible if I get to do what I love on a daily basis. Plus, I'm one of those people who planned on going into EM until I learned that it's mostly family practice without an appointment, and with irrate pts. So Trauma seems like a good thing...

    Ob/Gyn: I loved every bit of this field, except the office work. OB checks all day with paps and colpos mixed in. I've heard some estimates that say they spend 80% of their time in the office. I don't know if that would be enough OR time for me?

    So that's where I stand. I guess my biggest fear is that I will do my surgery rotation and hate some part of it! Becuase, right now, that's what I really see myself doing. Any input from those of you who've been through this, would be greatly appreciated!
  2. LaCirujana

    LaCirujana Smoking Gun

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    Just an FYI, trauma and general surgery are not separate fields--general surgeons manage trauma. (You can do a trauma and critical care fellowship after your general surgery residency, but you do not have to do the fellowship to manage trauma.)

    In addition, your view of what general surgery is all about is pretty limited--we do much more than just lap choles, breast, hernias, and "some GI (?)". I guess your view does depend somewhat on where you do your surgery rotation, but general sugery also involves trauma and critical care (see above--which actually, not that many people are crazy about--I happen to love it) liver resections, other hepato-biliary procedures, organ transplantation, vascular surgery (AAA repair, carotid endarterectomy, etc.), Whipple procedures, splenectomy, hemicolectomies, ileoanal pull-throughs, sarcoma resection, thyroidectomy, laparoscopic adrenalectomy, pediatric surgery, and well, I could just keep going--it's a big world out there!

    What you'll see most often does depend on what kind of practice you end up having (private vs. academic), and whether or not you do a fellowship. I'm at a big academic center, so I'm seeing all kinds of cool stuff, whereas, if you're in a smaller, private hospital setting, absolutely, it's going to be lap chole after lap chole, after hernia, after lumpectomy, with a lap appy thrown in just for kicks.

    Good luck!
  3. neilc

    neilc 1K Member

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    i am also thinking both ob/gyn and gen surg...as far as or time and fun/interesting procedures, how does ob/gyn compare with gen surg?
  4. Mango

    Mango Very Senior Member

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    Thanks for your reply LaCirujana, that's exactly the kind of information I was looking for. Like I mentioned, I haven't had my surgery clerkship yet, so my only experience with surgery has been through my OB rotation, which was (thank god) at a wonderful small community hospital that specializes in obstetrics. So when I looked at the hospital surgery schedule everyday, it was exactly what you said: all lap choles and hernia repairs. I'm glad to hear that gen surg encompasses many more things.

    I guess what I was concerned about (and the reason I wrote "GI?"), was the rumor I've heard about surgical subspecialists taking a lot of procedures aways from general surgeons. For instance, here at UC, the colorectal surgeons would do many of the cases you listed. And things like thyroids would be done by ENT, etc. And I realize that trauma (critical care) is a specialty of gen surg, but are there really centers where general surgeons without that fellowship training are taking care of trauma cases?

    Thanks for your help again. I know don't know much about surgery yet, but I'm very interested in learning all these little details!
  5. mary

    mary Member

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    Mango-
    I am in much the same predicament that you are in, except that I have had my surgery rotation already. My first choice is ENT, but I do worry about getting stuck doing Tubes, Tonsils, and Sinus surgery for the rest of my life. The head and neck cancer surgery is pretty interesting, and cochlear implants and inner ear surgery is pretty cool, but each of those will probably require an extra year fellowship after five years of training. I like OB/GYN, but the office stuff does get boring. Infertility, with it's HSG's and interesting Endocrinology, seems like a decent solution- but is wrought with giant ethical dilemmas. General surgery also seems like a ton of fun and very fulfilling, but I am not a trauma girl. Best of luck in your decision- I am still making mine. I am applying for ENT aways since I have to get those done early for the SF match, and I figure if I change my mind after that I can squeeze in an ob/gyn or gen surgery away. Feel free to PM me if you want to talk more.
    Mary
  6. canuckfan

    canuckfan Junior Member

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    ENT's a great field, with lots of different areas that you can branch into. There's a lot of different bread and butter cases depending on what you end up doing.

    General ENT:
    Lots of ear tubes, tonsillectomies, adenoidectomies, septoplasties, cleaning out ear wax, nasal polyps, hearing tests if you have an audiology setup onsite. Can have lots of peds patients. Depending on your practice goals/previous training, also things like thyroidectomies, parotidectomies, tympanoplasties, cervical lymph node biopsies.

    Otology:
    Tympanoplasties, lots of mastoidectomies for chronic ear disease like cholesteatomas, stapedectomies/stapedotomies for otosclerosis. Depending on your practice goals/previous training, things like cochlear implants, BAHA's (bone-anchored hearing aids), acoustic neuromas/skull base surgeries.

    Head and Neck:
    All sorts of huge cancer resections involving the oral cavity, oropharynx, larynx, hypopharynx. Big day-long cases at times, and subsequent reconstruction of the surgical defects using free flaps (microvascular reanastamoses) or regional flaps. Not so big stuff like neck dissections, partial or total laryngectomies. Smaller cases like thyroidectomies, parotidectomies, submandibular gland excisions for ca, etc.

    Sinus:
    Lots of stuff done endoscopically. Lots done for chronic sinusitis (minimally opening up of sinus ostia to restore normal sinus aeration/drainage), or for resecting sinus ca/inverting papillomas, etc. Combines with neurosurgery for trans-sphenoidal approaches to pituitary adenomas.

    Laryngology:
    Be a vocal chord/larynx guy. Lots of laryngoscopies for hoarseness/vocal pathology, work with the music superstars/opera folks.

    Facial Plastics:
    Otoplasty, blepharoplasties, rhinoplastys, botox, facelifts, implants, +/- hair transplants, facial reconstruction with little local flaps post skin ca resections etc.

    Pediatrics:
    Lots of tubes, lots of tonsils/adenoids, lots of congenital peds problems (airway issues, hearing/speech development, congenital anomalies ie. branchial cysts/sinuses, thyroglossal duct cysts, etc). Depending on your practice goals/previous training, might do operative management of cleft lips/palates, although there's a big overlap with Plastic surgery, oral surgery here, and different cities likely have their own pattern as to who takes what.

    If you are taking call, generally lots of that call might include epistaxis/packing bleeding noses or draining peri-tonsillar abscesses. Lots of consults in-hospital for trachs if in that hospital you are the "go-to" specialty for trachs. Most other consults that need to be seen in hospital involve upper airway problems that require endoscopic assessment; most other things (ie. dizzy patients) can be seen in clinic instead. If you do facial fractures and stuff, then you get called for that, otherwise maybe your friendly Plastic surgery or oral surgery residents will handle those, again, depends on regional trends.

    Just my opinion.
  7. Mango

    Mango Very Senior Member

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    Wow, thank you for that great reply canuckfan! I have been interested in ENT ever since we did a one day "mini-rotation" through the ENT dept. during 2nd year. I though the people I met who were in the field were awesome, and not at all like the stereotypical surgeon type. So I deffinately wanted to do an elective in ENT this year, but was unable to due to scheduling conflicts. But I may be able to switch out of my neurosurg elective and into ENT. I think you have given me the reason to do that! Also, I will spend 3 weeks of my surgery rotation in ENT.

    My only concern about pursuing ENT is the competitiveness. My scores and grades are good, but I have no research or other ENT experience at all. How much of a problem would that be in your opinion? And how important is it that I get into AOA?

    Thanks so much for the help to all of you. I wish these major life-altering decisions weren't so hard to make! ;)
  8. neutropeniaboy

    neutropeniaboy Blasted ENT Attending

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    Dude-

    AOA is very important, but it isn't critical. I will say the same about research. If you don't do it, it won't hurt your chances of matching in otolaryngology; however, it certainly won't benefit you -- especially at IVY league programs and the more academic big rigs in the midwest.

    Your ENT experience will come. Most people don't have that much exposure to ENT by the time they become residents. I did 2 weeks as a third year and 3 months as a 4th year -- and that's more than most people do. On top of that, I did 6 years of ENT-related research, so that bolstered my resolve and experience. But, to be honest, there's still too much to know. (Of course, why else would there be a residency?)

    My recommendations for you.

    I suppose it's too late for Step I. If you didn't score over a 230, you battle will be uphill, but by no means impossible. If you scored less than 230, take Step II early and score big.

    Your clinical grades are important. You should honor as many as you can, especially surgery, medicine, and your ENT sub-Is.

    Get to know your local ENT department, and at your place, that shouldn't be too hard. Latch on to an attending and see if you can do research or come into the OR periodically, even if its not your surgery rotation during your 3rd year. Make sure you get a good recommendation from your school's chair.

    It will also help to do away rotations. This occurs on two levels: 1) you get to know whether you would like a specific program and 2) you can get a rec from a potentially well-known chair. Of course, it can hurt you if you end up looking like a turd in the OR or around the residents.

    I'm 4 months away from starting my ENT residency; frankly, internship has bored the hell out of me. If I have to do one more H&P on a transplant patient, I'm going to shoot myself. Ironically, I'll be working even harder next year -- and, honestly, I don't know how hard that is going to be since it's been a breeze this year. But, at least it will be something I enjoy...finally.

    Later, dude.
  9. canuckfan

    canuckfan Junior Member

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    I'm actually a fourth year med student up in Canada applying for the ENT match in Canada; Match Day for us is next week! Because of my lack of US experience, I can't comment too much on what is required to get an ENT spot outside of Canada.

    In Canada, I think the most important things are having strong letters of recommendation, doing well on your away electives, and getting along well and interviewing well with each program. Less important things, but still helpful, are getting good clinical marks and doing research. We don't have board exams until the end of med school, so they aren't a factor (unlike the USMLE Step 1 for you guys) in stratifying/ranking candidates up here.

    In Canada, you would be in the very vast minority of ENT applicants if you hadn't done at least one or two "away" ENT electives at other programs, in addition to an elective or two at your "home" ENT program. I'm a big proponent of going away for electives, and I think if you are a hard worker, get along well with others, and are willing to bust yourself for the duration of your away elective, that doing them can only benefit you in the end.

    As far as the competitiveness goes, ENT is (statistically anyway) eevn worse up here in Canada than in the US. In last year's match, only 54% of applicants who ranked ENT programs in Canada got accepted, for an Unmatch rate of 46%. Despite that, I think if you have an affinity for the specialty, you should go for it with all your enthusiasm.

    It's a tremendously diverse specialty based on the types of patients and procedures you can see and do, and I'm hard-pressed to think of any ENT staff or residents who have regretted their choice of specialty. I think the high level of job satisfaction, and relaxed, laid-back nature of most ENT doctors I've met were and are a huge factor in choosing this specialty. ENT folks are usually very happy folks.
  10. unregistered

    unregistered Senior Member

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    You're at UC, which has an outstanding ENT program, and i agree with the other posters that you should get to know them well. Although it is a competitive field, the match rate for 4th year medical school seniors (as opposed to FMGs or US grads that are "trying again") is greater than 80%. Of the people who match, about 20-25% are AOA, and many have little or no research. I totally agree that getting honors in your gen surg and gen med and ENT rotations is important. in other rotations, honors is not so important (i can tell you when i was interviewing at a program out west, the attending looked over my file, and said, "i see you got honors in almost everything except psychiatry... where you got a pass... that will actually help you here."). if you want to get into a "top" program, e.g., hopkins, michigan, univ of washington, harvard, ucsf, iowa (i'm not sure what neutropeniaboy meant by "Ivy League" programs, because U Penn and Harvard are the only great programs that are in the ivy league) then AOA, board scores >235 (the average for matched applicants in recent years), and solid research are very important. be that as it may, most of the programs in ENT are excellent, and one does not need to go to a huge name in research to get excellent training.

    The great depth and breadth of different surgical procedures in ENT make it an excellent surgical field for someone who enjoys variety in their lives. There are lots of different fellowships to pursue as well, including neurotology/skull base surgery, facial plastics, layngology/voice, head and neck oncology, pediatric ENT, endoscopic rhinology, etc. etc. You also get a great mix of patients, from neonates to nonagenarians... from super sick to relatively healthy... men, women, children... you get it all in ENT. Plus, ENT surgeons in general are more laid back than other surgeons.

    Anyway, I hope you consider our field and I hope to see you on the interview trail in the future if you do decide to join up.

    canuckfan... best of luck on your match!
  11. jooce

    jooce Junior Member

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    Hey unregistered....where are you getting that figure of "20-25%" of matched applicants having AOA? I would figure that at least half of applicants would have this status in something as competitive as ENT...
  12. Mango

    Mango Very Senior Member

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    Thanks for your reply unregistered. I am only just now realizing that UC has such an amazing ENT department. I agree with what you said about the people in the field. And I am really encouraged about the diverse pt population, and the ability to further subspecialize.

    So after reading all of your responses, I went ahead and changed my electives today. I'll be doing 2 weeks of ENT in March now instead of neurosurgery. It means I wont have to wait until my surgery rotation in May/June to find out if I really am going to pursue ENT. I just hope I enjoy it as much as I imagine I will!

    So maybe we will see each other on the interview trail! Hey, when do early match interviews take place anyway?
  13. hotbovie

    hotbovie Member

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    Of those you listed, ENT is probably the most meticulous. If you are a detail oriented person, that may be a surgical specialty you'd enjoy.

    Compare that to trauma, which often consists of quickly plugging up holes, or resecting a section of bowel without hooking it back up (because the patient is too unstable to stay on the table that long). YOu do a quick closure (sometimes even with towel clips rather than suturing) THen you take the patient to the ICU, and spend a lot of time pumping fluids and blood products into the patient. If he/she survives, you take them back to the OR the next day or so and finish things up... reattach bowels, etc. In other words, quite the OPPOSITE of meticulous (Now, some trauma cases requrie meticulousness, such as vascular injuries, but still, mostly it's not). In trauma, you wind up operating on almost any part...neck, chest, abdomen, extremities. And the way my institution handles trauma, the lifestyle isn't that bad. THere are 5 trauma attendings, plus a second year fellow who acts at an attending. When you're on call, you're on. When you're off, your off (much like ER). Most of them also cover the general surgery service for a day of the week as well (the fellow doesn't). They work 12 or 24 hour shifts. All these attendings are fellowship trained, and I seriously doubt that you will find any Level I trauma center hiring those who aren't. Level II centers, however, may very well not require fellowship training (our level II center here doesn't...it's the general surgeons who handle it) But all the big time stuff goes to Level I (like the type of things I described)

    General surgery can vary depending on where you practice. While you train on all the things mentioned by previous posters, what you do in private practice can vary greatly, determined by your patient population, your comfort level and the comfort level of your partners who must cover your patients when they are on call. Plus, there is a wide variety of fellowships to choose from if you want.

    OB: generally healty population, and delivering babies is definitely fun. Surgery is pretty limited. OF all the speciatlies listed, I felt that OB had the least variety. Plus, if you didn't like the office part (and OB is largely office based) you probably won't ever like it. Something to consider.

    BTW I also started med school thinking ER, but now I'm headed for trauma.
  14. unregistered

    unregistered Senior Member

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    The AOA stat is an estimate from the people at the SF Match. Otolaryngology, neurosurgery, and ophthamology are all competitive and almost equally so... Ophtho has a slightly lower average board score for matched applicants (228 vs 233 for ENT and 234 for nsg) but also a lower % US senior match rate (82% vs 84% for ENT and 85% for nsg). The % matchers in neurosurg that are AOA this year is 24%; for ophtho it's 22%. Although the AOA stats for ENT are not on the SFmatch report this year, sources at SFmatch estimate the numbers to be about the same. Hope this clarifies things.

    My interviews were from the end of October to mid-December. The last interviews nationwide are about a week before the winter holidays. Rank lists were due early January, and match day is a couple weeks after that. So... get your contacts established early so you can get the letters on time. Although the CAS application suggests that you get only 2 letters from ENT faculty and one from a faculty member from one of your core rotations, most people I've spoken with said they got 3 ENT letters. I did as well. If you had a great relationship with an attending from either your gen surg or gen med months, a letter from them would be ok, particularly if that person is a big name. I would suggest that you *not* get a letter from a psychiatry, family medicine, or pediatric attending, as such a letter would be not as meaningful as an ENT, gen surg, or gen med letter.

    Best of luck to you all!
  15. neutropeniaboy

    neutropeniaboy Blasted ENT Attending

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    Agreed. Nevertheless, the attitude and superiority complex are still shared among the IVY programs.
  16. mary

    mary Member

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    Mango,
    I think you are definitely on the right track since none of the other fields are nearly as competitive as ENT. Getting a lot of exposure to the field early is important and since your program is so good, aways may not be such a big deal for you. You should be able to do General or Ob/Gyn w/o too much trouble if you decide ENT is not your thing anyways. Good luck with your decision and clerkships!
    Mary
  17. Mango

    Mango Very Senior Member

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    Thanks Mary, I am very excited right now about ENT, and about surgery in general. It's nice to finally have found my "niche" in medicine. I still have lots of big decisions to make though.

    Also, one more question to all of you about the match and ENT. I was reading in the SF Match site about how ENT applicants have to apply for their PGY1 year through the regular (NRMP) match program. If that is the case, what happens if you are also applying for general surgery spots as a backup in case you don't match in ENT? Do you then have to apply for three things: ENT, a PGY1 year only, AND full General Sx spots? That sounds like an aweful lot of interviews if you do!
  18. Crusher

    Crusher Member

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    a good majority of ENT programs guarantee a first year gen surg spot...you just have to rank it to get it...no need for separate interviews...
  19. mary

    mary Member

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    The people I know who matched in ENT had backup interviews for general surgery scheduled for after the ENT match day, or would request Gen Surg interviews at the institution when there for the ENT interview. I am planning on applying for mostly programs with the surgery intern year included unless the program has something really good to offer that makes the extra interview and possibly moving again worth while. Any other suggestions/advice?

    Both the # of interviews and the money involved intimidates me, but hopefully I have found my "calling". My problem is that the ENT program here is rather rudimentary and I won't really be able to get good exposure and a "realistic" residency experience until I do my aways. Plus, there really aren't any great names to get LOR from, but hopefully my aways will solve this. Exciting, yet too much to think about for long at this point!
    Mary

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