Cases and future as an ENT

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qmcat

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So one of the specialties I'm considering is ENT (among other surgical specialties) because I like working with intricate and delicate structures. I recently spoke with a physician (non-ENT) and when I mentioned that I was looking into ENT, he quickly discouraged me from doing it.

He says that in order to make money in ENT, you have to go into facial plastics because (1) the otology and rhino surgical cases rarely have successful outcomes and (2) nobody really gets tonsils removed nowadays since they've found that it has little benefit.

What do you guys think about the cases and future outlook for ENT? As I mentioned, I'm not really interested in any kind of plastics (because I suck at art and drawing), and I'm more interested in doing the more therapeutic surgical cases.

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He says that in order to make money in ENT, you have to go into facial plastics because (1) the otology and rhino surgical cases rarely have successful outcomes and (2) nobody really gets tonsils removed nowadays since they've found that it has little benefit.

I think you should reconsider your source. Much of what he has told you is misinformation.

If you are comparing ENT to neurosurgery or orthopedics, then ENT is definitely the loser in terms of salary. However, if you compare ENT to general surgery and urology, ENT definitely does well.

Otology and Rhinology are two of the most profitable areas of otolaryngology. I question what this individual is considering a successful outcome.

You know, I thought about going into each individual point of what this guy said, but I decided that it wouldn't be worth my time.

The guy you talked to really is talking out of his derriere.
 
I think you should reconsider your source. Much of what he has told you is misinformation.

If you are comparing ENT to neurosurgery or orthopedics, then ENT is definitely the loser in terms of salary. However, if you compare ENT to general surgery and urology, ENT definitely does well.

Otology and Rhinology are two of the most profitable areas of otolaryngology. I question what this individual is considering a successful outcome.

You know, I thought about going into each individual point of what this guy said, but I decided that it wouldn't be worth my time.

The guy you talked to really is talking out of his derriere.

Yea, I kind of got that feeling when I was talking to him... especially since he is a non-surgeon advising me on a surgical specialty. The statistic he gave me talking about sinus surgery to improve drainage was something like only 1 out of 50 cases actually works/helps the patient where the others don't do any good. But, I did a lit search a few minutes ago and found that the success rates are actually much much higher than that. Well in any case, it is really good to have input from an ENT doc, and I'll definitely keep ENT in consideration.
 
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He says that in order to make money in ENT, you have to go into facial plastics because (1) the otology and rhino surgical cases rarely have successful outcomes and (2) nobody really gets tonsils removed nowadays since they've found that it has little benefit.

What do you guys think about the cases and future outlook for ENT?\

Neutropeniaboy is a little more politically correct than me because I will just say outright that the person you're talking to is an outright *****.

He clearly is completely out of touch with the specialty. I agree with the above that otology and even moreso, rhinology, are ridiculously lucrative portions of ENT. The former due to high value RVU's for cases and the latter because there is no global with high value post-op visits. FESS has an 85-90% patient satisfaction rate for first time surgeries one year after the procedure. That suggests more success than failure to me. Otology outcomes depend on the reason, but for most cases they are as good if not higher.

Nobody gets tonsils removed anymore? That is just ******ed. I'm very selective with tonsillectomy and the majority these days are for OSA as it should be, but I'm still doing a couple or more a week. Were you talking to Obama about ENT? After his idiot statements, the AAO-HNS released a statement demonstrating the clear improvement in quality of life following tonsillectomy for both recurrent strep and for OSA so to say it doesn't work is pure ignorance.

My apologies to this physician if he feels otherwise, but he's just clueless.
 
I agree with the Neutropenia boy and Resxn. ENT's do fine financially and have an excellent quality of life. Look at any MGMA survey for salary information, and I can assure the vast majority of practicing ENT do not do facial plastics exclusively. Your income, once you are done with training, has so many variables that influence your bottom line. FESS has no global and clean-outs postoperatively bill well. If you select the appropriate patient preoperatively, most are happy they had the surgery. Otology has good reimbursement and most patients go home the same day with a 1-1.5 hour surgery. Again, if you discuss the realistic expectations of the surgery, most are happy with the outcomes. Facial plastics (which I do very little of aside from trauma) is another separate issue. Can be very financially rewarding, but it takes years to establish a good practice and referral base. Different patient population, as well. I also notice that your mentor did not mention other aspects of ENT that patients are usually happy with and also bill well (Allergy, for example). Moreover, in my experience, H&N cancer patients are among the most grateful - and though the reimbursement vs time invested is less than the others, I get great satisfaction from treating these patients, too.

In the end, pick a specialty because you want to do it. Shadow an ENT. Talk with their patients. Don't listen to someone who has no clue about the specialty and is making wild assertions.
 
...in a good way I guess.

I noticed that LeForte is now an attending. It seems as though the major players on this forum are attendings ex-residente members like myself, resxn, throat, leforte, etc.

The grey hair cometh fast...
 
...in a good way I guess.

I noticed that LeForte is now an attending. It seems as though the major players on this forum are attendings ex-residente members like myself, resxn, throat, leforte, etc.

The grey hair cometh fast...

Everyone always forgets about me. Depressing.
 
Guys,
I have plenty of grays sprouting and I'm still early in residency. I do appreciate all the attending input on this board, as I am everyone else would agree.

I'm in the really tough phase of residency so I'm dreaming about attending life right now. Right now I'm working just under the 80 hour limit for 3 years straight...

Tell me it gets better!

:)
 
3 months out and WAY better for me. Probably 45-50 hrs per week. Many partners and very little call. The pay is far better too! :)

I probably put in about 50-60 hours per week, 60 on a bad week or when I am on call. That's at a University. Pay not as good as private practice, but I would say that without a doubt, it's a hell of a lot better than residency. The lower pay, stress of monitoring residents during surgery, and the frustration of dealing with university-level administration all detract from it, but as I said, it's so much better.
 
I'm not an Oto. But, I have never heard of anyone surgeon/non-surgeon suggest it is a poor lifestyle or poor income. ALL Otos I have ever met (private & university) have a practice closer to "boutique Medicine". Otos do excellent work, very specialized, and as such have aquired a good patient niche. It is one of the more competitive residencies for a reason. It's not a field I would be interested in personally but quite respected and successful field.

As noted Otos do a broad list of procedures that include but not limited to:
1. sinus surgery
2. ear procedures (including tubes)
3. tonsils
4. sleep apnea
5. Head & neck cancer (salivary glands, tongue to throat)
6. Thyroid/parathyroid procedures
7. maxillofacial reconstructions
8. etc.....

The list could go on.... but one thing to note, very little is emergent middle of the night.
3 months out ...Probably 45-50 hrs per week. Many partners and very little call...
...ENT's do fine financially and have an excellent quality of life. Look at any MGMA survey for salary information...Otology has good reimbursement and most patients go home the same day with a 1-1.5 hour surgery...
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm
 
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On the neuro/ortho > ENT > general/uro comment:
Do you think the pay is better in neuro/ortho because they have to work more hours? Or is the pay better because of the operations?
If you want to work 40-60 hours and have a family life will you make the same pay regardless of the field? Or in certain fields will that not be an option, you "have to" make a lot of money at the expense of working long hours? Insight into these issues would be helpful.

Also.. What do people think about going into a field because it's really interesting (i.e. the brain is so cool) vs going into a field because you can really change lives (i.e. giving someone hearing, curing a neck cancer, putting in a new hip so they can walk). How does that intellectual curiosity vs. helping people balance play out in ENT?
 
...If you want to work 40-60 hours and have a family life will you make the same pay regardless of the field? Or in certain fields will that not be an option, you "have to" make a lot of money at the expense of working long hours?...
No. It depends on the field. Certain fields require greater time to have greater "production". A general surgeon that works 40 hrs per week is likely to not be producing the same as a general surgeon that works 80-120 hrs. The same for plastics, etc.... Each field is unique and bread and butter procedures in each may require longer OR times then in another. I suspect tympanostomy takes less time then colectomy. There is also the factor of how much ER call you must take. It is said it takes around 10 crap consults for a general surgeon to get 1 good operative case..... Where as, most Otos I know take very little ER call and most of their referrals come from PCP after some sort of work-up. So, the answer to your question is No.
 
Tell me it gets better!

:)

It gets so much better--there truly is a light at the end of the tunnel. Money is no where near what it was in the hay-day and the older private guys are more than willing to share that, but it's light years ahead of residency in lifestyle, work load, and overall stress. It still has it's moments and there's a whole new learning curve on how to run a business, but I love it.
 
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