Is there a point in doing 2 year otology fellowship vs 1 year non-accredited if planning on private practice?

[javksmith93]

Honestly I’m pretty burned out from academics. I love ENT but I just want to take care off patients and have a secure job so I can take care of my family.

so I’m pretty sure I’m going to go into private practice trying to decide between Rhinology and otology, but I’m trying to figure out if I’m doing private practice is there any reason to do the 2 year route rather than just get the experience I need and do the 1 year route?

Also how is the job market in rhino?

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[Wordead]

If your goal is to go into PP why are you doing a fellowship? Are you not comfortable doing otology or rhinology cases?

Job market for rhinology is mediocre. Most generalists do sinus. It's a cash cow.

Job market for otologists is generally pretty good. A lot of people are not comfortable doing even basic otology.

 

[TonsilPlucker]

Honestly I’m pretty burned out from academics. I love ENT but I just want to take care off patients and have a secure job so I can take care of my family.

so I’m pretty sure I’m going to go into private practice trying to decide between Rhinology and otology, but I’m trying to figure out if I’m doing private practice is there any reason to do the 2 year route rather than just get the experience I need and do the 1 year route?

Also how is the job market in rhino?

If you are planning on PP, just do the one year fellowship if any. Having gone through the hiring process a few times now, we look for fit and personality first, skill set/interest second, maybe fellowship third. Where you trained sometimes is irrelevant unless there were mutual contacts to chat about.

 

[TonsilPlucker]

If your goal is to go into PP why are you doing a fellowship? Are you not comfortable doing otology or rhinology cases?

Job market for rhinology is mediocre. Most generalists do sinus. It's a cash cow.

Job market for otologists is generally pretty good. A lot of people are not comfortable doing even basic otology.

Agreed.

Rhinology is only helpful if you are also interested in setting up an allergy service to a practice without allergy.

 

[HighPriest]

Even then, ENT allergy is one of the only things left you can get “fellowship certified” without doing a fellowship. Although you do have to go to a bunch of meetings, which is off the table for now.

I agree you don’t need a 2 year fellowship for PP. I also agree you probably don’t need one at all unless you 1-don’t feel comfortable doing ears but want to do them or 2-want to get referrals from the local ENTs. Keep in mind that they’re usually going to send to a tertiary center if they’re going to send out at all, and unless they just don’t do ears at all they’re mostly going to send you the stuff they don’t want (bad revisions, difficult patients, etc).

We have a guy nearby who did a 1 year oto fellowship. I send him stuff sometimes, but I do ears, so it’s usually not fun stuff.

Lastly, keep in mind that in most cases the PP is going to be happier if you’re capable and willing to do more than just subspec work. Rhinology in particular. If you show up to my practice and tell me that you want me to hire you and have me send you all of my sinus cases (which bill a lot), I’m probably going to ask you to beat your feet. But if you did a rhinology fellowship and want to do complex or revision sinuses, and also help out with the vertigo backlog, then I’m on board.

 

[javksmith93]

Even then, ENT allergy is one of the only things left you can get “fellowship certified” without doing a fellowship. Although you do have to go to a bunch of meetings, which is off the table for now.

I agree you don’t need a 2 year fellowship for PP. I also agree you probably don’t need one at all unless you 1-don’t feel comfortable doing ears but want to do them or 2-want to get referrals from the local ENTs. Keep in mind that they’re usually going to send to a tertiary center if they’re going to send out at all, and unless they just don’t do ears at all they’re mostly going to send you the stuff they don’t want (bad revisions, difficult patients, etc).

We have a guy nearby who did a 1 year oto fellowship. I send him stuff sometimes, but I do ears, so it’s usually not fun stuff.

Lastly, keep in mind that in most cases the PP is going to be happier if you’re capable and willing to do more than just subspec work. Rhinology in particular. If you show up to my practice and tell me that you want me to hire you and have me send you all of my sinus cases (which bill a lot), I’m probably going to ask you to beat your feet. But if you did a rhinology fellowship and want to do complex or revision sinuses, and also help out with the vertigo backlog, then I’m on board.

Are any of the fellowships worth it from a purely monetary standpoint avs just going into PP?

 

[HighPriest]

Are any of the fellowships worth it from a purely monetary standpoint avs just going into PP?

I don’t really think so. I could be wrong but at least when I was a resident, the information available said that rhinology was the only fellowship that had the potential to make you more money on average than general ENT. But that was, I am certain, assuming all they did was sinus surgery, all of the time.
It’s part of what makes ENT a great field: there are really only a few things where you really -must- refer to a fellowship trained guy.
1-Free flaps (primarily because you need to be credentialed to do them).
2-skull base tumors (acoustics, etc) primarily because of volume issues and because you need a neurosurgeon anyway.

And I know a couple guys who do all the cancers but have a PRS colleague put things back together with a free flap. I did that a few times in the Army.

Anything else you can do as a general ENT, assuming you’re comfortable doing it and have the support structure.

 

[Pir8DeacDoc]

Echo the others. If your goal is PP, then only do a fellowship if you feel like you need it to supplement your skill set.

Keep in mind that depending on the size community you may not see nearly enough of your chosen "thing" to only be a subspecialist.

And as was already mentioned, if I'm the guy across town in PP I'm not sending you my easy stuff- I'm probably doing that myself. And some guys won't send anything to a local subspecialist anyway (can't make it seem like someone local might be more equipped than you are to tackle a problem).

Good luck with everything

 

[javksmith93]

Echo the others. If your goal is PP, then only do a fellowship if you feel like you need it to supplement your skill set.

Keep in mind that depending on the size community you may not see nearly enough of your chosen "thing" to only be a subspecialist.

And as was already mentioned, if I'm the guy across town in PP I'm not sending you my easy stuff- I'm probably doing that myself. And some guys won't send anything to a local subspecialist anyway (can't make it seem like someone local might be more equipped than you are to tackle a problem).

Good luck with everything

Ahh okay that makes sense. This conversation really sprang from talking to my senior whose going through the job hunt currently and was telling me every practice seeming to want an ear guy, to do that /focus on that for them. So I was curious if that was being financially compensated by the ear guys being more sought after and consequently higher paid?

 

[HighPriest]

Ahh okay that makes sense. This conversation really sprang from talking to my senior whose going through the job hunt currently and was telling me every practice seeming to want an ear guy, to do that /focus on that for them. So I was curious if that was being financially compensated by the ear guys being more sought after and consequently higher paid?

Not really. People just don’t like to do ears. But that doesn’t equate to ear surgery being a particularly high-RVU producer. In fact, often just the opposite because a t-mastoid might take you an hour or three hours depending upon what you find, but you get paid close to the same amount for either one. (You can try to add a complex modifier but that doesn’t usually make up the difference). And most practices I know aren’t looking for a guy to do BAHAs and medial graft tympanoplasties. They want someone to do the chronically bad ears.

 

[Wordead]

Ahh okay that makes sense. This conversation really sprang from talking to my senior whose going through the job hunt currently and was telling me every practice seeming to want an ear guy, to do that /focus on that for them. So I was curious if that was being financially compensated by the ear guys being more sought after and consequently higher paid?

As said above ear cases are not particularly well paying (though not bad if you're reasonably fast). However, if the group or hospital system is desperate to keep it in house having that skillset can give you some negotiating leverage.