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[OtoHNS]

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Hello premeds-

I'm a new attending ENT physician. My schedule is pretty light at this point in my career so rather than staring at the wall for a large part of the day, I'll be around SDN some to offer advice and answer questions. I've been in your shoes not that long ago (well, kind of long ago...) and I'd like to offer some perspective from the other end of medical training. Any advice I give is just my opinion and may be completely wrong, so don't sue me, ok?

Post questions in this thread. I might just answer them...

 

[Mbeas]

Question 1: Are you serious?

 

[OtoHNS]

Question 1: Are you serious?

Ummm yes

 

[muhali3]

by light schedule you mean what? I've also seen in studies that ENTs have among the lowest job satisfaction compared to other specialties...thoughts?

 

[OtoHNS]

by light schedule you mean what? I've also seen in studies that ENTs have among the lowest job satisfaction compared to other specialties...thoughts?

Well, today I have 4 patients on my clinic schedule. I just started seeing patients on Thursday. A full day for a busy private practice ENT would probably be 30-40 patients, though some workaholics will see 50 or more. I have my first surgery day on Friday and have 4 cases booked (all little stuff).

For me personally, I love ENT and would absolutely choose it again. I can't speak for anyone else, but most other ENTs I've met seem happy.

 

[jvesco22]

Where did you go for residency, how many years was it, and how did you like the program?

We'll also need pics of the inside of your office to know you're not fraudin.

 

[OtoHNS]

Where did you go for residency, how many years was it, and how did you like the program?

We'll also need pics of the inside of your office to know you're not fraudin.

Well, I'd prefer not to broadcast my real identity out there to you crazy people. I did complete an American residency which lasted 5 years like (almost) all ENT residencies. ENT residency programs are very strictly regulated so you will get good training at any of them. I was fortunate to end up at a program where I fit in well personality-wise so I enjoyed my time there.

 

[McBatCommander]

I have never had strep throat.

Am I win?

 

[OtoHNS]

I have never had strep throat.

Am I win?

Me neither.

High five.

 

[bassvp]

well...we'll start with the typical stuff.

how many hours/wk during residency?
did you do this single or with a family?
would you do it all over again knowing what you know now?
worried about falling reimbursements (though you haven't had a long career of high reimbursements to compare it with)?
biggest sacrifice?
why is ENT ftw?

 

[45408]

Are you in academics or private practice?
If academics, what kind of research/teaching obligations do you have? Are you salaried?
If private practice, did you have to buy in? Is your income subsidized right now? For how long?

How did you find this job?
Are you rolling in the cheddar?

Did any of the jobs you looked at offer loan repayment assistance?

 

[RogueUnicorn]

do chicks' panties melt off when you mention you are a doctor?

 

[OtoHNS]

well...we'll start with the typical stuff.

how many hours/wk during residency?
did you do this single or with a family?
would you do it all over again knowing what you know now?
worried about falling reimbursements (though you haven't had a long career of high reimbursements to compare it with)?
biggest sacrifice?
why is ENT ftw?

1. Depended a lot on what rotation/service. On bad intern rotations, 80-90 hrs/week. Some easier ENT services, 40 hr/week. Chief on head and neck service, 65 hr/week.
2. Single sometimes with GFs, no kids (that I know about)
3. Travel back in time to age 22 and forget everything I know--> yes
Start over with med school now--> no way
4. Some. I don't have that much debt though and I don't have super expensive tastes. I don't ever think doctors will be making middle class wages, though. If I had >400K in debt, I might feel differently, though.
5. Biggest sacrifice = time! 9 years, man! That's almost a 3rd of my life spent learning to be a doctor. I'm overall very happy and it went by pretty fast, but damn!
6. ENT is awesome and I didn't know anything about it before med school. Generally good lifestyle and salary, awesome anatomy, wide variety of surgery, usually nice colleagues, no poop/genitals/guts. Check out otolaryngology forum on SDN, I think there's links that give an overview of the specialty for interested students.

 

[muhali3]

How much does your specialty overlap with oral/maxillofacial surgery?
What was your USMLE step 1 score and how much publications/posters/presentations did you have to match into ENT?
How many hrs/week do you work now, as an attending?

 

[OtoHNS]

Are you in academics or private practice?
If academics, what kind of research/teaching obligations do you have? Are you salaried?
If private practice, did you have to buy in? Is your income subsidized right now? For how long?

How did you find this job?
Are you rolling in the cheddar?

Did any of the jobs you looked at offer loan repayment assistance?

I'm actually doing locum tenens now at a facility that's part of a large hospital system. They are trying to hire a permanent ENT and haven't found anyone yet. I do 4 days of clinic and 1 day of OR a week and take q3 call (which seems to be very light). I'm planning on a mix of locums work and international travel for the next 1-2 years before getting a permanent job (almost certainly private practice or non-academic salaried). I'm definitely a bit unique in doing this right out of residency. I've never taken any time off though and I'd like to see the world before I'm old and lame.
There are a variety of locums agencies that you can find easily via Google (which is what I did). Pretty much any specialty can do locums work though most jobs tend to be those without long-term patient followup (EM, hospitalist, anesthesia, rads, etc).
As far as salary, let's just say the pay is substantially better than residency. The locums company also pays for a furnished apartment, travel expenses, car rental, credentialling. It's a pretty sweet deal. Good thing since I'm basically broke right now until that first paycheck rolls in

 

[OtoHNS]

do chicks' panties melt off when you mention you are a doctor?

Sometimes. Not like Greys anatomy though.

 

[OtoHNS]

How much does your specialty overlap with oral/maxillofacial surgery?
What was your USMLE step 1 score and how much publications/posters/presentations did you have to match into ENT?
How many hrs/week do you work now, as an attending?

1. We mostly overlapped with OMFS with facial trauma. At my residency we alternated every 3rd week covering face trauma with them and with plastics.
2. My step 1 score was pretty high. Average for matched ENT applicants back in my day was like 235 and maybe is a few points higher now. I think when I applied/interviewed I had 1 non-ENT presentation and a couple of ENT projects that had not yet been published.
3. Right now, I work 40 hours/week with on average every 3rd night call. Hoping to get busier as I'm paid by the hour. The call is pretty light so I'm on call like Thurs-Sunday for 2 weekends this month and 1 other random day.

 

[carbear02]

you said you wouldn't do it again knowing what you know now. what would you have done instead?

 

[OtoHNS]

you said you wouldn't do it again knowing what you know now. what would you have done instead?

Well, I would actually do it again you magically made me 22 years old in 2001 again and wiped my memory clean of the past 9 years.
However, if I had to start over medical school again today at age 31 and not finish until I'm 40, I'd probably start a virtual business ala Tim Ferris' 4 Hour Workweek.

 

[carbear02]

haha well what if we made you 22 again but didn't wipe your memory clean (so you would know exactly what you were in for in med school) - would you do it again?

why did you pick ENT? what do you like about it? dislikes?

 

[JeetKuneDo]

What specialty did you envision becoming before med school?

 

[Evergrey]

OtoHNS, thanks for answering our questions! I have never shadowed an ENT doc, but from reading about it, it sounds very interesting.

Do you do much recon work? Is there additional training you need to do to be able to to reconstructive facial surgery? Also, how often do you treat cancer, and what are the most common kinds of cancer that you work with/operate on?

 

[OtoHNS]

haha well what if we made you 22 again but didn't wipe your memory clean (so you would know exactly what you were in for in med school) - would you do it again?

why did you pick ENT? what do you like about it? dislikes?

LOL, alright you're getting too hypothetical. Bottom line: I love my job and I have no regrets. However, the thought of starting 9 years more training right now is very unpalatable.

As far as ENT, the main reasons I picked it are because I like the head/neck anatomy, I like surgery, the lifestyle/money is pretty good, the patients typically are not extremely sick/dying (aside from head and neck cancer patients).

Things I don't like about ENT: dizzy patients, nosebleeds, idiotic consults from other doctors (mostly because the exposure to ENT topics in med school is usually very limited). There's really not much I don't like, especially in comparison to other specialties.

 

[OtoHNS]

What specialty did you envision becoming before med school?

I always knew I wanted to be a specialist. Before med school, I thought I would probably do internal medicine and then cardiology, GI, or some other medical subspecialty.

 

[carbear02]

LOL, alright you're getting too hypothetical. Bottom line: I love my job and I have no regrets. However, the thought of starting 9 years more training right now is very unpalatable.

As far as ENT, the main reasons I picked it are because I like the head/neck anatomy, I like surgery, the lifestyle/money is pretty good, the patients typically are not extremely sick/dying (aside from head and neck cancer patients).

Things I don't like about ENT: dizzy patients, nosebleeds, idiotic consults from other doctors (mostly because the exposure to ENT topics in med school is usually very limited). There's really not much I don't like, especially in comparison to other specialties.

thanks! so glad to hear someone who loves their job - there are so many jaded attendings these days.

 

[integralx2]

do chicks' panties melt off when you mention you are a doctor?

The only question that anyone should care about on here. Finally someone mentioned it.

 

[OtoHNS]

OtoHNS, thanks for answering our questions! I have never shadowed an ENT doc, but from reading about it, it sounds very interesting.

Do you do much recon work? Is there additional training you need to do to be able to to reconstructive facial surgery? Also, how often do you treat cancer, and what are the most common kinds of cancer that you work with/operate on?

No problem, I enjoy doing this.

Facial plastics is actually a part of ENT and is tested on our boards. Depending on your experience in residency, you can go out and start doing facial plastics in your practice. There are also 1 year fellowships in facial plastics after residency which mostly involve holding retractors and watching some cosmetic guy do facelifts/nosejobs/blephs for a year.

I treated tons of cancer in my residency. The large majority of head and neck cancer is treated at academic centers because it doesn't make economic sense to do it in private practice. ENT generally does the bulk of it, but there are surgical oncologists and even a few oral surgeons who deal with H+N cancer too. We treat any cancer or benign tumor above the clavicles except for those in the brain/spinal cord/vertebrae. This includes skin, ear/temporal bone, sinonasal, skull base, mouth, throat, thyroid, salivary glands, lymphoma. Sometimes joint procedures with neurosurgery are necessary. Many patients are treated with radiation +/- chemotherapy and we frequently are trying to salvage radiation failures.

There are also 1 year head and neck oncology/reconstructive fellowships which are primarily to learn microvascular reconstructive techniques (free flaps). Basically this involves taking tissue from another part of the body, hooking that tissue's blood supply into the neck, and using it to reconstruct whatever hole you made in someone's face/head/neck. This is amazingly cool in theory but much less cool when you are standing there for 20 hours while your attending does the case. Most academic ENT departments have one or more faculty who do free flaps; the remainder usually have plastics do the reconstructions for them.

 

[OtoHNS]

thanks! so glad to hear someone who loves their job - there are so many jaded attendings these days.

LOL, well I've only been an attending for a week, I haven't had time to get jaded yet.

It's not all roses and sunshine, but the good definitely outweighs the bad.

 

[OtoHNS]

bump it up yo.

Keep 'em coming or I'll have to start asking myself questions.

For example:
1. OtoHNS, how did you get to be so awesome?
2. Would you describe yourself as amazing, super amazing, or super super amazing?
3. Are you as intelligent as you sound from your posts or even more intelligent in real life?

 

[noshie]

bump it up yo.

Keep 'em coming or I'll have to start asking myself questions.

For example:
1. OtoHNS, how did you get to be so awesome?
2. Would you describe yourself as amazing, super amazing, or super super amazing?
3. Are you as intelligent as you sound from your posts or even more intelligent in real life?

This thread is so awesome that I could scream... And you sir are hilarious! I have no questions... Yet! But I am going to come up with something!!! 😀

 

[iwantMD]

What did you wish you had known that you did not as a premed?
What is one thing you suggest for us to be successful in medical school?
What is your approximate salary?

 

[link2swim06]

What percent of the first two years of basic science has followed you into residency, and now as a new attending. Which of the classes did you find are the most important to know cold in the clinic setting?

 

[PrinceVersed]

bump it up yo.

Keep 'em coming or I'll have to start asking myself questions.

For example:
1. OtoHNS, how did you get to be so awesome?
2. Would you describe yourself as amazing, super amazing, or super super amazing?
3. Are you as intelligent as you sound from your posts or even more intelligent in real life?

What was the toughest part of med school?

What was the toughest part of residency?

Has being a doctor ever landed you a 3-way?

Note: you don't have to answer the last question. A winky face will suffice

 

[45408]

What kind of range in responsibilities/salaries/hours did you see in looking for locums jobs?

 

[OtoHNS]

What did you wish you had known that you did not as a premed?
What is one thing you suggest for us to be successful in medical school?
What is your approximate salary?

1. That's a good question. I would say that I placed too high a value on grades and test scores as a premed. Obviously you need to do well, but once you are over a certain point, you really don't gain much. i.e. someone with a 3.6 GPA and 31 MCAT is really not at that much a disadvantage to someone with a 4.0 and 40 MCAT as you might think. In my experience, the grades and scores get you the interview, but how you come across as a person will get you accepted.

2. Make sure to have a life outside of school. The amount of material and studying the 1st 2 years is a definite step up from college classes. Some 3rd year rotations are very hours-intensive. Make an effort to play sports, go to concerts, do whatever non-medical activity you like or you will go crazy. Of course there's always 4th year which is basically playtime.

3. If you extrapolate my salary to a year, I'd make around $250K. Average starting private ENT salary in desirable location ~$150K, once you make partner (usually after 2 years), probably ~$300-350K. Starting jobs advertised for $300-$400K in North Dakota and other places I'd never want to live. Academic jobs usually pay a little better starting off but a little less long term.

 

[huskerdye]

Were you formerly known as "Once" who roamed this forum acting like an attending?

Also I've been wondering this for a long time now; is six times two times zero really zero?

Thanks in advanced,

--huskerdye

(lol)

 

[RogueUnicorn]

What was the toughest part of med school?

What was the toughest part of residency?

Has being a doctor ever landed you a 3-way?

Note: you don't have to answer the last question. A winky face will suffice

clarification - the fun kind of 3-way

 

[PrinceVersed]

Yes. Girl Girl Guy 3 way not a Devils 3 way.

 

[OtoHNS]

What percent of the first two years of basic science has followed you into residency, and now as a new attending. Which of the classes did you find are the most important to know cold in the clinic setting?

Basically zero. Really, even most of my 3rd year rotations are not directly applicable to what I do today. My job is to recognize what (if anything) is wrong with the patient's ear/nose/throat area and provide whatever treatment (medical or surgical) is needed for that problem. I don't manage chronic problems affecting other parts of the body other than making sure the patient gets their proper home medications if I admit them after surgery, etc. I know the first steps of what to do for emergencies such as chest pain, shortness of breath, etc, but if anything is seriously wrong, I'm calling a consult.

 

[OtoHNS]

What was the toughest part of med school?

What was the toughest part of residency?

Has being a doctor ever landed you a 3-way?

Note: you don't have to answer the last question. A winky face will suffice

1. Studying for USMLE Step 1 pretty much sucked. 3rd year had some rough hours on certain rotations but I generally enjoyed it because I was finally out of the lecture hall.
2. Neurosurgery month, intern year- pure misery.
3. Actually I'll do this face: 😎 Interpret that how you will. (No...)

 

[LizzyM]

what part of basic science has followed you...?

Basically zero.

I think that you sell yourself short. Certainly the anatomy of the head & neck is something you learned once as a first year and have built on over the years.


Now a question: what is the oddest thing you've ever found in someone's nose or ear?

 

[OtoHNS]

What kind of range in responsibilities/salaries/hours did you see in looking for locums jobs?

Most were like what I'm doing: join into an established system, do clinic/OR and take call. Typically they are either trying to hire a permanent person or you are covering for someone who is out.

There are some positions where they just want someone to take call for X number of weekends or something like that.

 

[OtoHNS]

Were you formerly known as "Once" who roamed this forum acting like an attending?

Also I've been wondering this for a long time now; is six times two times zero really zero?

Thanks in advanced,

--huskerdye

(lol)

Nope. I used to lurk around here in medschool and have occasionally checked out the ENT forum for the past few years.

 

[OtoHNS]

I think that you sell yourself short. Certainly the anatomy of the head & neck is something you learned once as a first year and have built on over the years.


Now a question: what is the oddest thing you've ever found in someone's nose or ear?

Ah, very true. Though understanding anatomy from a surgical perspective is somewhat different than learning it M1 year.

What have I seen in ears and noses?
Ears: lots of dead bugs, beads, bullet fragment, cotton wads
Nose: wadded up piece of a balloon, obvious cocaine powder

 

[PrinceVersed]

Did you get enough exposure from your clinical electives (or 3rd year even) to make a "for sure" pick on what kinda MD you wanted to be?

 

[familyaerospace]

Ah, very true. Though understanding anatomy from a surgical perspective is somewhat different than learning it M1 year.

What have I seen in ears and noses?
Ears: lots of dead bugs, beads, bullet fragment, cotton wads
Nose: wadded up piece of a balloon, obvious cocaine powder

BULLET FRAGMENT??

I can understand cotton, I can understand bugs, I can even understand beads if the patient was a little kid who didn't really know better. I cannot imagine how a bullet fragment was in someone's ear unless they were shot.

Also, please tell me the piece of a balloon was in a child and not an adult.

 

[LizzyM]

BULLET FRAGMENT??

I can understand cotton, I can understand bugs, I can even understand beads if the patient was a little kid who didn't really know better. I cannot imagine how a bullet fragment was in someone's ear unless they were shot.

Just what I was thinking. Were the rest of the fragments in the skull or the brain? Did this require an ENT or an ME (medical examiner)?

And note that he did not find potatoes, which is what my grandma claimed were in my brothers' ears. 😉

 

[rainforests]

maybe an ME would suffice. 😕

Just what I was thinking. Were the rest of the fragments in the skull or the brain? Did this require an ENT or an ME (medical examiner)?

And note that he did not find potatoes, which is what my grandma claimed were in my brothers' ears. 😉

 

[LawNonTrad]

It's fair to say that ENT is in the top 4 of most difficult residencies to match, probably tied with radiation oncology and behind dermatology and plastics.

From what doctors have told me, ENT was not always this competitive.

Here's the question:

Given that ENT is more competitive to match than it was in the early 80s, do you ever look at some of your fellow ENT attendings (or your attendings while you were in residency) and tell yourself that they wouldn't have gotten ENT residencies had they gone through the match when you did?

 

[jvesco22]

It's fair to say that ENT is in the top 4 of most difficult residencies to match, probably tied with radiation oncology and behind dermatology and plastics.

From what doctors have told me, ENT was not always this competitive.

Here's the question:

Given that ENT is more competitive to match than it was in the early 80s, do you ever look at some of your fellow ENT attendings (or your attendings while you were in residency) and tell yourself that they wouldn't have gotten ENT residencies had they gone through the match when you did?

Of all the questions you could ask, I don't even...