Cons of being an ENT?

[YetundeF]

Hello! I am not a pre-med or med student yet lol, just a senior in high school. I'm really passionate about pursuing a career in medicine. I've considered SO many different specialties, but ENT has caught my eye recently, and honestly, it seems like the perfect specialty. So perfect to the point where I can't really think of any cons. I've heard that a good idea when choosing a specialty is to consider how much you can tolerate all the things about it that suck, so I wanted to know what you don't like and/or your least favorite parts about being an otolaryngologist physician/resident. 🙂

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[OtoHNS]

See the thread from a couple months back: "The bad and ugly of private practice".

At this point, focus on getting into college and then see if you still want to apply to med school in 3-4 years. (I say this as someone who wanted to be a doctor from age 10 onward. But, I saw a ton of people who came into college pre-med and decided to pursue another path).

Assuming you do end up in medical school in a few years, there is really no substitute for spending time on your rotations through various specialties to get a real feel for them.

 

[HighPriest]

The biggest downside, I think, is how often you’re seeing patients for either non-issues (they have an asymptomatic mildly white tongue and they have been treated 9 times for thrush and have been told they probably have AIDS) , or for issues for which they need to see someone else. (Ie: GI, Pulmonology, Neurology, etc).

ENT complaints are a huge portion of primary care visits, and (I assume) because PCPs are overburdened (or in the case of some NPs, undereducated) there’s a huge, irresistible urge to just forward patients to the ENT without really giving much thought as to their diagnosis. There’s a major “it’s above the clavicle, so go see ENT” attitude.

Some of this is exacerbated by insurers being unwilling to allow primary care providers to order testing and imaging that could help direct their referral process. Some of it is patients demanding to see a specialist, but a lot of it is just not having the time or gumption to deal with QoL complaints. I also firmly believe that a lot of it is people just not knowing what an ENT doc does. Like when I get referrals for neck pain due to arthritis, or when I get a referral from a dentist who got a referral from a PCP for an oral cancer.

Some days 80% of my patients need an ENT. Some days almost none of them do. That can wear on you after a while. It’s balanced by the fact that most of the people I can help I do help, and they leave feeling better than they came in. There are plenty of specialties where that isn’t necessarily or frequently true.

A lot of ENT docs deal with this problem by expanding their practice to include the diagnosis and management of problems that aren’t traditionally part of the ENT field, but they see it so frequently that they decide to take it on. Migraine would be one example. I don’t manage migraines at all because, (rimshot) it would give me a migraine. But I know guys who do because they see so many patients referred for sinusitis or vertigo who actually have migraines.

 

[avalon10]

Snot

 

[HighPriest]

Meh. Snot is no big deal. I’ll take another over @$$ contents or gyn pathology any day.

 

[VisionaryTics]

HighPriest totally has it correct. A lot of time sorting through the worried well in clinic.

 

[HighPriest]

Then there’s the ER plugged ear circuit (ERPEC).

It goes like this:
-Patient has a plugged ear. Maybe it just started, maybe it’s been like that for 10 years and they just up and decide they can’t deal with it anymore.
-Patient goes to ER or Urgent Care.
-ER doc assesses patient, determines that patient is not in fact stroking, having an MI, or septic. ER doc realizes this is a waste of his time and tells patient to follow up with ENT.
Or
-PA or NP sees patient in urgent care. The PA or NP has never actually looked in an ear before, had no idea what an ear should look like. 50% chance that they don’t look in the ear this time either. They tell patient that they have fluid behind the eardrum and treat them with keflex or Flonase.
-ER doc or PA/NP refer patient to ENT
-Patient is happy because they don’t have to wait two weeks to see their PCP. Maybe they don’t have a PCP at all.
-Patient pays $800-1200 to skip the line at the ENT clinic because they were seen in the ER/Urgent Care.

It’s like paying for the fast track pass at Epcot.

They rarely have fluid behind the ear. Or ETD for that matter.

 

[TonsilPlucker]

Then there’s the ER plugged ear circuit (ERPEC).

It goes like this:
-Patient has a plugged ear. Maybe it just started, maybe it’s been like that for 10 years and they just up and decide they can’t deal with it anymore.
-Patient goes to ER or Urgent Care.
-ER doc assesses patient, determines that patient is not in fact stroking, having an MI, or septic. ER doc realizes this is a waste of his time and tells patient to follow up with ENT.
Or
-PA or NP sees patient in urgent care. The PA or NP has never actually looked in an ear before, had no idea what an ear should look like. 50% chance that they don’t look in the ear this time either. They tell patient that they have fluid behind the eardrum and treat them with keflex or Flonase.
-ER doc or PA/NP refer patient to ENT
-Patient is happy because they don’t have to wait two weeks to see their PCP. Maybe they don’t have a PCP at all.
-Patient pays $800-1200 to skip the line at the ENT clinic because they were seen in the ER/Urgent Care.

It’s like paying for the fast track pass at Epcot.

They rarely have fluid behind the ear. Or ETD for that matter.

I like the Epcot fast pass analogy. Will start using it in my clinic.

Echoing what others have said, the amount of non-operative BS that rolls through my clinic can wear you down. In my experience, the more educated you are, the more likely your encounter will be painful for me. That’s like 95% of my patient population sadly.

I’ll add dealing with chronic tinnitus, persistent ETD, facial pressure pain NOS, and “sore throat” gives me vestibular migraines.

Finally, the stress of dealing with complications from “elective” surgeries is always in the back of my mind.

 

[Pir8DeacDoc]

I like the Epcot fast pass analogy. Will start using it in my clinic.

Echoing what others have said, the amount of non-operative BS that rolls through my clinic can wear you down. In my experience, the more educated you are, the more likely your encounter will be painful for me. That’s like 95% of my patient population sadly.

I’ll add dealing with chronic tinnitus, persistent ETD, facial pressure pain NOS, and “sore throat” gives me vestibular migraines.

Finally, the stress of dealing with complications from “elective” surgeries is always in the back of my mind.

This is all very well said and pertinent

 

[Jenghiz_Khaan]

I don’t know about you but whenever I think of tonsillitis my throat low-key starts hurting