Hi,
Just to chime in, I'm a MD/PhD and in an ENT residency, finishing year 4/6. Our program includes at least 1 year of protected research time. I think about 1/3 of our residents have PhD's.
As I approach the next decision point I've been asking these questions again. Let me say that at my residency, we are able to get a real project done because we have at least 16 months (12 as a T32 year and then 4 more as a R3) of completely protected research time (some residents do 2 years of protected time, but most MD/PhDs opt to not do that path). I did a basic science project and will get a 1st author publication in a non-OTO journal. That's not to say you can't do that in a standard 5 yr residency, but it will depend on how much research time you get and how protected it is.
I'm planning on an academic fellowship and then career. I figure if I get frustrated with academics I can always change into PP, but it's hard to go the other way around. And I don't know about this "renting a small apartment" while my friends live in mansions...while there is some monetary disparity, it's not awful. One of our fellows was offered $300+ to start in an academic first year job with 3 years of salary until he gets his lab running, and that's at a good location. But the bottom line is that for me, doing the same thing every day in PP and sending the challenging cases to the local university (or never seeing them), and never doing any research and just collecting $ is boring to me. I seriously considered a facial plastics fellowship but am not doing it because of that reason (and some others).
To answer you a little more specifically, you can build your CV during an ENT residency, but it depends on 1. how hard you are willing to work, and 2. how supportive the residency is. For me, #2 was as good as possible. #1...eh, residency can be draining. Nevertheless, I was able to publish a few book chapters and got 3 grants awarded (one from industry, one from our own Children's Hospital, and one from the CORE). I'm submitting my basic science manuscript now, and even if it doesn't go to the first journal we send it to, it will go somewhere. Having shown "fundability," I think I'm in a good spot to write a K award when the time comes.
About the "crappy surgeon" thing, I will say that during the first two months back from the lab I felt rusty, both technically and clinically. But that doesn't last.
I guess to sum up, if you are seriously considering a career in academics that actually does real research, AND you want to be a surgeon, ENT is an excellent field. It's one of the main reasons I chose it in medical school. And I have not been disappointed in what can be accomplished vis a vis research/grants/papers during the training. How much can be done after residency and what that will look like regarding time/money, I don't know yet.
