Ent 2004

[epistaxis75]

Well, I don't have a whole lot to say yet, but wanted to get people talking about the match process in ENT.

I go to UT Southwestern in Dallas and have applied to ENT. I applied to about 23 programs, and I hope to get at least 8 interviews but won't go to more than 10 if that many are offered. I've done no research, so I don't expect to get interviews at some of the programs where that's heavily emphasized. Here, though, the Chairman told me in an interview that unless I was bringing my own lab with me, whether I did research or not didn't matter a whole lot. He did say that he would tell any first through third year that if the choice comes down to spending your time getting great grades and board scores or doing research, the grades and scores win easily every time. I also haven't done any away rotations. I'm not sure if that will hurt me or what. I have good scores and GPA and will be AOA, and from what I've heard in the past, those three things are what count the most....

I'm applying to just two in Texas (here and Baylor in Houston), a few in California (UCSF, Davis, UCSD, Stanford), Colorado, Utah, Oregon, Washington, Emory, a couple in Virginia, all 3 in NC, MUSC (thats in SC), and a few in Florida.

Anyway...
anyone have any comments? Would love to hear about where people are interviewing and when, what they thought of each program and their interviews.

Looking forward to being a snot doc.
Late.

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[epistaxis75]

Hey,
I wanted to add some observations. Everyone seems to be talking about how competitive ENT is, but if you look at the statistics, there's been a steadily increasing match rate (85% last year) and steadily decreasing applicant rate over the last 10 years. In spite of this trend, people keep increasing the number of programs they're applying to (up about 15 over the last 10 years). It's like people are looking at only that number from the previous year and think they have to one up it each year. Last, year, on average, people applied to 40 programs!! Maybe that's WHY the match rate went up, but I suspect the drop in applicants was more the cause.

Comments?

 

[shigaT]

Hey,
Looking forward to seeing you on the interview trail. I applied to 40 programs partly because I'm interested in their locations and partly because ENT is so competitive. You're right, the match rate has been creeping up over the past couple of years. I asked a few residents at my school's program about this and they said it is merely a reflection of a decline in applications. However, they said this is deceiving because the applicants are actually getting more competitive (in stats) and that the students who are borderline are just not applying anymore. If you look at the last few years matching stats on sfmatch, there is definately a decline in apps. It will be interesting to see the trends this year with all the surgical specialties now that 405 is national. Good luck!

 

[epistaxis75]

What's 405?

 

[TulaneKid24]

Originally posted by epistaxis75
What's 405?

I think he is referring to the National Resident's Work Hours limiting residents to 80 hours per week.

 

[hrq]

Hi All,

Why do you think ENT is such a competitive residency to get into? I'm a budding medical student, and I would be really interested to hear your thoughts on this.

I've asked around a bit already and the answers I get focus on: variety of procedures, lifestyle (is this really true!?), and cash.

What do you all think?

Also, what sorts of research venues do you think would be most helpful in applying to an ENT residency? Right now I'm mainly doing craniofacial recon. type stuff. Do they look for more cell bio type stuff, or does it even matter?

Thanks!

-hrq

 

[The Pill Counter]

If an applicant hasn't been successful, is it realistic to start a preliminary surgical year and try again for programs that match that same year? Does anyone know if a fair number of people match this way or is the vast majority the ones that match before their prelim year?

 

[maxheadroom]

The majority fill through the match. I did know a girl who was screwed during the match a couple of years ago. She did a prelim year and found a program that lost a resident during internship, so she was able to move straight into her second year without missing any time. I think the most common route is to go through the match again and either repeat intern year or take that year off from research.

 

[shigaT]

sorry, I was referring to the restrictions on resident work hours (commision 405). I'm guessing that because it is a nation wide law now, there will be more seniors applying for surgery residencies. And why not? At 80 hours a week you're practically working the hours of a medicine resident.

I think ENT has remained so competitive for several reasons:

1. Very few number of residency positions (250 I think). While this is good for the field itself (high demand for ENT docs), it makes for a competitive match.
2. It's surgery and medicine - for those of us who love the OR but also enjoy the patient interaction and diagnostic workups of medicine.
3. Very cool surgeries - no other surgical specialty has the breadth of ENT..otosurgery, facial plastics, head and neck....
4. Known for more laid back surgeons, less hierarchy than general surgery
5. Good lifestyle both during residency and as an attending. Any surgery training will be tough but ENT is known to be less than general surg.
6. Good salary - not on par with ortho or rads, but you can make a decent living. Probably comparable with the average general surgeon but working less hours.

Things to do to be competitive for ENT:
1. Good grades - especially in anatomy, medicine, and surgery
2. Good board scores - average for those who matched last year was 233
3. Research - the earlier the better. It's pretty obvious when PD's see a thrown together research project in the fourth year.
4. Don't be an annoying gunner during your ENT rotation - remember, in general ENT attracts a more laid back personality type.


good luck

 

[maxheadroom]

Not to be nit-picky, but the ACGME 80 hour work regulations are RULES imposed by the governing body. LAWS are imposed by the government (local, state, federal). There was the threat of a law, but the ACGME enacted the current rules, placating legislators and tabling the proposed bill.

 

[epistaxis75]

I agree with all the reasons ShigaT said for what makes ENT desirable. I was really surprised by the breadth of surgeries availalbe -- it's not just tubes and tonsils like I thought in the past. One thing I do disagree with is the salary -- it's definitely higher than general surgery (AND with less hours). One of the things that really turned me on to it was the people I've met in it. Of any surgery specialty, these guys are the happiest, the most low-key, the most pleasant to their ancillary staff, etc. It was the people that really drew me to it -- and I think that's not a bad way to pick a specialty. Find the people you're most like, and you'll find the specialty that fits you.

About research -- as I said before, I haven't done any, but I wish I had. Would have been nice to have something in that big open space on my application. As to what you should research.... I don't think it really matters, except that it should be something you're genuinely interested in. If you like facial reconstruction, go for it. I don't think they're looking for anything in specific -- the heavy research programs just want see see that you're interested -- and they can see through it when it's not real interest.

As far as the stats on graduates matching: I think its something like 45%, as compared with 85% that match in their 4th year. There are occasionally spots that open up that you can apply for after your first or second general surgery year without really "matching," but I think that's less common.

Any of you guys have suggestions for paying for all the flights and hotels? 4th year's quite a bit slower and the free time means I can work. What are you all doing for extra $$$?

 

[droliver]

Originally posted by shigaT
no other surgical specialty has the breadth of ENT..otosurgery, facial plastics, head and neck....

Breadth & ENT.....? It's one of the more focused surgical disciplines as compared to General or Plastic Surgery

 

[Airborne]

droliver:

My limited experience as a 3rd year in general surgery lead me to think that General surgeons, although able to perform a wide variety of surgeries, really select a few for which they are "know" for in - Whether this be bariatric or otherwise. Sure, I met a few who did it all (General, Vascular, Thoracic, etc), but these were also the ones who were in the OR until midnight twice per week.

ENT's on the other hand, are uniquely trained in microsurgery of the ear - can perform free-flaps if they trained at the right place (although many choose not too), - can do skull base, facial plastics (although I know your opinions on ENTs in plastics), sinus surgery, etc, etc, etc - Indeed we have an attending here who does EVERYTHING except cochlears - from acoustic schwannomas to rhinoplasty to radical neck dissections to transphenoidal approaches for pituitary adenomas - On top of this, he has a great lifestyle outside of the hospital - Truly he is a role model.

Regardless, each of us will find our own niche. My application went to CAS for ENT 2 weeks ago.

Best of luck to the other candidates - see you on the trail!

Airborne

 

[droliver]

I'll stand my philosophical ground on this one. Your point re. how some people restrict their general surgery practice to frequent procedures (for financial reasons) is I think even more true for many general ENT practices where tubes & tonsils tend to be a disproportionate part of the surgical practice (its what pays the bills). It really is not rare for general surgeons to operate head to toe including more then a few who do a lot of head and neck oncology as part of their practices. When you think about general surgeons who are fluent in anatomy & procedures on ump-teen different organs & systems as well as competency in critical care, trauma,nutrition, burns, etc...I find it a little amusing to conclude that breadth is lacking in comparison.


That being said.... I really like ENT as a field. Head & neck surgery is really interesting and I love the challenge of the anatomy.

 

[neutropeniaboy]

Originally posted by Airborne

ENT's on the other hand, are uniquely trained in microsurgery of the ear


This is highly institutional-dependent. Some residents leave their programs never being able to do more than simple mastoidectomies, and -- more to the point -- never do anything beyond that in private practice (where most ENT docs are).


can perform free-flaps if they trained at the right place


Again, few. Again, highly institutional-dependent


can do skull base, facial plastics (although I know your opinions on ENTs in plastics),


As above.

I'm sure that everyone will agree that within the field of ENT, there are many possibilities in terms of what one can do or limit oneself to do. The field is a subspecialty, and even the generalists most often perform a select number of cases or see only certain populations of patients. There are few "do it all" kind of ENT docs out there. "Breadth" is not the term I'd apply to ENT either.

Having said that, I do enjoy watching general surgeons do neck procedures. The only ones I've seen do them well are the vascular surgeons. Some do thyroids really well...some.

 

[droliver]

Ah...the voice of reason

BTW Neutropeniaboy... Have you any experience with the endoscopic thyroids? Our endocrine surgeons have started playing around them. It sounds like they're taking an easy operation & making it a hard one. Just curious for your insight.

 

[DuneHog]

They don't do endoscopic thyroids at my institution, but they've considered them. It definately seems like taking an often easy operation and making it more difficult. Besides, most thyroids go home the same day where I'm at, so what would be the advantage? You still have to get the thyroid out so the scar can't be that much smaller. Sounds like a marketing ploy to me.

As far as the breadth of ENT, what first struck me is not how broad ENT is compared to a general specialty like gen surg, but how broad it is for a subspecialty. This is especially apparent when you compare ENT to a general surgery subspecialty (like vascular or colorectal). This seems to be to be due to the fact that ENT subspecializes in a specific body region rather than a type of surgery. I suppose it all depends on your perspective.

BTW, I don't think it's appropriate to mention general surgery in the same breath as plastic surgery when talking about breadth of specialty. It is a rare plastic surgeon in the community that ever does any general surgery, and although a private practice plastic surgeon may do cosmetics, hand and some reconstruction (mainly breast) this doesn't compare to the breadth of practice of a general surgeon, particularly one practicing in a rural area.

 

[droliver]

While there are more and more Plastic Surgeons who would like to limit the breadth of their practice to aesthetics for financial reasons, pretty wide-ranging procedures are the norm for a lot of people in private practice. The surgeon in private practice I've been working with this week has done for instance - reduction mammoplasty(x4), two cleft lips, a celft palate, 6 candella laser procedures in the OR, a facial nerve graft for reanimation, three abdominoplaties, two rhinoplasties, a cleft nasal deformity, a number of hand cases, several scar revisions, a few skin cancers/nevi excisions, several ER face injuries,and an implant breast reconstruction. A relative (in private practice) recently did an ear amputation with sentinal node disection for a glomus tumor, a few breast reductions, several trigger finger releases, a carpal tunnel, disection and excision of a granular cell tumor off a tendon sheath,a couple of skin CA & melanomas with SLN biopsy, a rectus flap around an infected aortic conduit,and a secondary rhinoplasty in addition to seeing consults for everything from sternal infections,breast reconstruction, cleft palate, hand injury, skin CA, and some new aesthetic patients. Conversely there is another Plastic Surgeon I work with who did something like 12 breast augs, a few abdominoplasties, a few blephs, and a brow in addition to a number of BOTOX, laser, and minor procedures in the office.

Coming from a General Surgery background, I feel that the field of Plastic Surgery has even more widely based procedures and intellectual demand in the broad sense. The pressures from the progressive collapse of the 3rd party payer system have blunted the interest in a lot these areas from people in practice, but the opputunities are there if you're interested in them. You see the same thing in ENT I guess as fewer and fewer people are interested in some of the more complex procedures because they're money losers and you end up taking care of very morbid patients.

 

[neutropeniaboy]

Originally posted by droliver
Ah...the voice of reason

BTW Neutropeniaboy... Have you any experience with the endoscopic thyroids? Our endocrine surgeons have started playing around them. It sounds like they're taking an easy operation & making it a hard one. Just curious for your insight.

We don't do them, but I've read about them.

The first question I asked was, "why do it endoscopically?" Of course, that was promptly answered by the rhetorical question "why do anything endoscopically?" The answer's obvious.

Anyway, this stuff seems popular in Asia. Supposedly, operative times are significantly reduced, surgical scar length is minimized, and patient satisfaction may be higher. But, I have to ask how complex the thyroid pathology is. It can't be that complex. These can't be significant goiters or nodules. How do they take care to avoid the RLN and all its variance? How do they protect the parathyroids? What if a neck dissection is needed? What do you do if there's substernal thyroid tissue? What if the neck is previously operated on?

I'm sure the stuff is fine for simple thyroid disease. I just can't fathom not doing the case open (or at least there'd be high sphincter tone during these cases). It would seem as though it's a lot of fluff and expense for minimal gains. It's like someone telling me I should start using the CO2 laser to do a tonsillectomy. Why??

(But, I'm sure people said the same stuff before lap appys/choles were routine.)

 

[ENTwannabe]

I'm so happy I discovered this site.

I'm a third year med student interested in ENT but I don't know if I'm being unrealistic given my numbers. I attend a "top ten" school but my board scores were mediocre (222/90.) Would my application even get looked at? (I do have some other redeeming qualities if they could just get past my scores...)

And what does anyone think about the strategy of taking Step 2 early to make up for mediocre Step 1 scores?

Thanks all around!

 

[neutropeniaboy]

Originally posted by ENTwannabe
I'm so happy I discovered this site.

I'm a third year med student interested in ENT but I don't know if I'm being unrealistic given my numbers. I attend a "top ten" school but my board scores were mediocre (222/90.) Would my application even get looked at? (I do have some other redeeming qualities if they could just get past my scores...)

I don't know what you mean by "top ten" school. Please clarify. I'm sure being in a "top ten" school will help your application, but it won't be a clincher.

You can see the average board scores of those who matched into ENT and the average board scores of those who applied and did not match into ENT. They are something like 235/215, respectively. That puts you more or less in the middle, but less than 1 standard deviation above the mean isn't something spectacular.

I think you'll get interviews, and you stand a reasonable chance at matching somewhere, but I don't think your chances at top ENT residencies are very good.

What you can do to strengthen your application is to perform well during your sub-I rotations. Unless you're incompetent, your own chair isn't going to screw you; you're more than likely to get a good rec from him.

This leaves you with the dilemma: do you do away rotations at places to get the awesome letter of recommendation (e.g., at places like Hopkins for Cummings, Pitt for Myers, etc.) to pad your SF Match application, or do you do away rotations at places you stand a reasonable chance of getting into so that they can get to know you really well. I can't tell you which to do -- both choices have their plusses and minuses.

If you haven't done any, start some research. It's not essential, but you have borderline Step I scores. Research will only help you.

And what does anyone think about the strategy of taking Step 2 early to make up for mediocre Step 1 scores?

Are you confident you'll do much better? If you're not, I'd wait.

 

[doc05]

right now I'm a 3rd year looking at a few specialties including ENT. My step-1 was 257, good preclinical grades (probably not AOA though). I just started ms3 so no grades yet.

my last research project was in college (published though); there's not much time for that here. any thoughts on my chances? is research essential for a top program? also, how many/when to take an ENT elective? is late in 3rd year too early?

thanks.

 

[neutropeniaboy]

Originally posted by doc05
right now I'm a 3rd year looking at a few specialties including ENT. My step-1 was 257, good preclinical grades (probably not AOA though). I just started ms3 so no grades yet.

my last research project was in college (published though); there's not much time for that here. any thoughts on my chances? is research essential for a top program? also, how many/when to take an ENT elective? is late in 3rd year too early?

thanks.

You're actually serious, aren't you?

I think you can figure this one out on your own.

 

[ent_doc]

Originally posted by doc05
right now I'm a 3rd year looking at a few specialties including ENT. My step-1 was 257, good preclinical grades (probably not AOA though). I just started ms3 so no grades yet.

my last research project was in college (published though); there's not much time for that here. any thoughts on my chances? is research essential for a top program? also, how many/when to take an ENT elective? is late in 3rd year too early?

thanks.

You have plenty of opportunities to do research just starting M3.

 

[carpe diem]

A lowly MSII has an interest in ENT and perhaps a dumb question that I hope someone can answer.

An earlier poster said he/she applied to 40 ENT programs. How can anyone afford to apply to 40 programs and how do you find the time ( or money) to interview, say for instance, even if you "only" get 20 interviews?

 

[shigaT]

I'm applying for ENT this year and 40 programs costs roughly $600 for the application fee. Even if one were to be offered interviews at all 40 programs, it would be impossible to make it to all of these because many are offered on the same dates. Because ENT is so competitive, applicants apply to many programs and become selective when (and if) they receive interview offers. I'm planning on only attending between 10 and 15 interviews (if I even get that many). As far as paying for this process, there are several private loans available to fourth year medical students for this. They are typically between 0.5% and 1% above prime rate (currently around 4%) and do not have to be paid back until after residency. I think you can take up to $13K which would obviously be plenty for interviews.

Good luck, ENT is an awesome field.

Shiga

 

[carpe diem]

Thanks ShigaT for clueing me in. Best wishes to you also in your pursuit.

 

[OtoNerd]

I am currently in the process and applied to 30 programs. There was an article in Laryngoscope a few years ago that ran the stats, which showed the following:

Keep in mind, this is based upon statistical analysis and there will always be anecdotal stories to contradict it.

1) There is no statistical benefit to applying to greater than 20 programs with regard to whether you will match somewhere.

2) There is >90% chance you will match if you interview at 8+ places.

3) There is no statistical benefit to interviewing at greater than 10 institutions (aside from the operational difficulty given the date overlap)

I don't think 15 is even possible unless you have the good fortune to get interviews starting in early October, through December. If you are that strong, you don't need to even go to that many.

So, why did I apply to 30? Because you don't know which programs will offer the interview...it's a game of chance. You have to list programs that for whatever reason, sound good enough to spend the next 5 years there.

Same goes for interviews and who/how you rank programs.

Keep your head down and work hard...don't worry about apps except for the LORs which need to be finessed during year 3.

OtoNerd

 

[maxheadroom]

Yeah, there are lots of people trying to predict the "magic number" of how many apps required to score the number of interviews that will grant a >90% chance of matching. You know what? It's all crap. Those analyses can't control for personality, which becomes a HUGE factor in the surgical specialties. I met a guy on the PRS trail last year with amazing credentials (other candidates wept and gnashed their teeth when they heard about him). The cocky SOB didn't match, though.

Takehome message: the "magic number" is fun late night semi-sober conversations on the trail, but please, please, please don't believe the hype. Way too many people in ENT, Ortho, Uro, NS, and PRS say, "I have 12 interviews, so I must be golden." And then they scramble . . .

 

[OtoNerd]

The anecdote told by max is not unique, which is why I qualified my last post. That is also why the stats are >90% vs. >99% etc. It is true that one cannot control for personality - no matter what...if you have a bad one, you are screwed.

I think any candidate with sense should take all the interviews they can complete for the sake of seeing programs and improving the odds that they will end up at a desired location (or one at all). All that said, mere logistics dictate the number of interviews one can complete for ENT. The earliest interviews will be mid-October and the latest mid-December.

There may be a few extra dates, but for most of us, we are looking at about 8-10 "windows", many of which overlap with other programs. Even the most ambitious traveler with no rotations going on for October, November and December would be hard pressed to exceed 12 interviews.

As a final thought, (perhaps fodder for an even less sober conversation) the stats I gave are meant to provide comfort to the majority. There will always be upsets, and it could even be me, but worrying about it will not make me a better interviewee.

Best of luck to all of you on the OTO/HNS trail...hope to see you there.

OtoNerd B)

 

[ent_doc]

Originally posted by OtoNerd
The anecdote told by max is not unique, which is why I qualified my last post. That is also why the stats are >90% vs. >99% etc. It is true that one cannot control for personality - no matter what...if you have a bad one, you are screwed.

I think any candidate with sense should take all the interviews they can complete for the sake of seeing programs and improving the odds that they will end up at a desired location (or one at all). All that said, mere logistics dictate the number of interviews one can complete for ENT. The earliest interviews will be mid-October and the latest mid-December.

There may be a few extra dates, but for most of us, we are looking at about 8-10 "windows", many of which overlap with other programs. Even the most ambitious traveler with no rotations going on for October, November and December would be hard pressed to exceed 12 interviews.

As a final thought, (perhaps fodder for an even less sober conversation) the stats I gave are meant to provide comfort to the majority. There will always be upsets, and it could even be me, but worrying about it will not make me a better interviewee.

Best of luck to all of you on the OTO/HNS trail...hope to see you there.

OtoNerd B)

I interviewed at 15 progs, but when it was all over I wished that I had stopped at 10-12.