Anesthesia is not a surgical subspecialty. It is heavy procedurally, but it is not surgery.
I can offer some more perspective on ENT. I know anesthesia does most of the airway work in the hospital on a regular basis, but I would also apply the "master of the airway" title to ENT; if that riles people up, maybe "master of the difficult and surgical airway." Reason being: whenever anesthesia can't get the airway, ENT takes over. ENT also does large number of tracheotomies and pretty much solely takes care of significant laryngotracheal injuries and reconstruction (sometimes with the help of thoracic surgery).
There are a lot of different routes you can take out of an ENT residency (1 year general surgery prelim, 4 years ENT). As a general otolaryngologist, you can hone your practice on the high volume bread and butter procedures - PE tubes, adenotonsillectomies, sinus surgery, septoplasties, skin cancer removal and reconstruction, etc. a lot of general ENT's will also do thyroids, parathyroids, parotids, etc., but if you're in the private setting and focused on bringing in revenue, you can earn a lot more doing in-office balloon sinuplasties, facial fillers, or vocal cord injections in the time it takes to do a thyroid.
If you don't want to take the general route, you can go into a subspecialty of ENT. These include:
Rhinology/Anterior skull base surgery - essentially much more aggressive sinus procedures, CSF leak repair, anterior skull base mucoceles and tumors, transsphenoidal approaches to the pituitary for the neurosurgeons, etc. Procedures range from 1 hour up to 4 hours depending on the scale of surgery you're doing and reimburse well. 1 additional year of fellowship.
Facial plastic surgery - most guys will set up or join plastic surgery centers offering facial peels, laser resurfacing, filler injections, botox, as well as face lifts, blepharoplasties, rhinoplasty, otoplasty, hair transplantation, etc. Private patient population, reimburses well, but definitely need good business sense to succeed and thrive. The facial plastic surgeons are also trained in facial trauma and can repair mandible, midface, orbital, ZMC fractures. 1 additional year of fellowship.
Laryngology/Professional voice - focused completely on disorders of the aerodigestive tract, common procedures include direct laryngoscopies, vocal cord microsurgery for polyps, masses, etc., vocal cord injections as well as bigger procedures like thyroplasty and arytenoid adduction. There's a boutique section of the specialty that deals exclusively with the professional voice, treating singers, TV personalities, and the like. Most procedures are brief < 1 hour, and a large number of their procedures can be performed in the office. 1-2 years of additional fellowship.
Head and Neck Oncology/Microvascular reconstruction - deals with the all malignancies of the head, neck, and aerodigestive tract that don't solely involve the brain or eyes and their extirpation and reconstruction. Common procedures include thyroids, parathyroids, parotids, maxillectomy, mandibulectomy, total laryngectomy, oropharyngectomy and reconstruction using a variety of local, regional, and microvascular free flaps. These are the longer, more intense operations that can go up to 12 hours or longer in length, but you probably see the best anatomy the body has to offer (in my opinion
). Also can use the da Vinci robot in this subspecialty for transoral robotic surgery. Don't necessarily have to be in the academic setting, but most jobs are going to be at the big academic centers. 1-2 years of additional fellowship.
Endocrine surgery - exclusively dealing with thyroid and parathyroid disease and surgery. Endocrine surgery was traditionally property of general surgery, but ENT is gradually occupying more and more of the endocrine market. 1 year of additional fellowship.
Otology/Neurotology - exlusively dealing with auditory and vestibular disorders. large part clinical, but also does a lot of surgery including tympanoplasty, mastoidectomy, labyrinthectomy, stapedectomy, cochlear implantation, translabyrinthine/middle fossa/retrosigmoid approaches to acoustic neuromas, resection of glomus tumors, etc. 2 years of additional fellowship.
Sleep medicine/surgery - up and coming in the field. Focused on treating sleep apnea with uvulopalatopharyngoplasties, hyoid suspensions, tongue base reduction, and other surgery.
Pediatric otolaryngology - Entirely pediatric based. Most pediatric ENT's are focused on pediatric airway management and reconstruction, doing laryngotracheal reconstruction, slide tracheoplasty, etc. You also have the opportunity to do pediatric craniofacial surgery such as cleft lip and palate repair if that's what you want to do; this is shared with plastic surgery. 1-2 years of additional fellowship.
Large scope of practice, and you can basically do as much or as little (
Early
Nights and
Tennis) as you want to in your post-residency practice. Lots of surgery in small spaces. In residency you will be exposed to all of it. Like an above poster said, if you don't want to deal with aerodigestive secretions or bleeding, ENT is not for you. The worst thing about the specialty right now is that it's gotten very competitive.
Hope that's informational. If you're interested, you need to schedule a meeting with the department chair or program director early in your 3rd year. It's a small specialty, and letters of recommendation and reputation go a long way, so you want ample opportunity to make a good impression and try to get on some research projects.
