In "general community practice," there is a very wide range of possibilities with regards to employment.
A big decision point is self-employed vs practice-employed vs hospital-employed. I think any of these models has a potential to have either a very busy lifestyle or a less busy lifestyle.
Self-employed means either solo practice or being a partner in a group. Usually, in solo practice, you are going to work full time due to quick drop offs in efficiency and overhead, but it is certainly possible to work part time. You could either waste overhead by not utilizing your office, or you could share office space with another ENT or a non-ENT and run your business independently. After all, most offices are closed on the weekends, so therefore most offices are really running at 5/7 capacity as "full time," so you could just make that 3/7, instead.
Being a partner makes it easier to cut back on office hours without driving up your overhead percentage. Really, you could work any number of days that you want. You would need to have a relationship that contributes in a fair way to the practice, or the other partner(s) would kick you out. If you work less, you should probably expect to pay a higher percentage of the revenue you generate as overhead (IMO).
Practice-employed and hospital-employed positions are pretty variable, also. I know people who have part hospital-employed contract with a reasonable salary to match. When it gets down to it, the hospital is going to have the same efficiency issues as you would managing yourself in private practice, so a lot of positions will push you to be as productive as possible. I depends on how desperate the hospital is to have you on staff, how tight their budget is, and how "loose" the administrators and hospital system is with their pocket books. The hospitals have a little more leeway, because they cash in on the facility fees from your surgeries (which is big $$$) in addition to your office revenue. But in general, you do not profit as much for any given encounter, compared to being self-employed. So, if you think about the amount of patient care related work it takes you to make a given salary, employed positions are going to require more patient care related work compared to being self-employed.
Being hospital employed, there are a lot of things you do not have to worry about with regards to practice management, but you will still have to meet with administrators and office managers. You still can have issues with scheduling, issues with the competency of the office staff, and it may actually take longer to document complaints and make changes as opposed to just doing what you want. I hired a practice manager that does a great job, and does it the way I want it done. Overseeing billing is maybe the biggest headache in self-employment, but you are going to be responsible for coding and documentation in pretty much any job.
Call requirements are going to be dictated by the hospital by-laws and how many people are available to take call. Again, it depends on if they want or need you. If you are the only ENT in town, they may let you have privledges to operate while taking call q 2 or q 3. If there are more than 2 of you in town, then you will probably have to take call at that freqeuncy. In the city I did residency, you got out of the call pool at age 55. In my current city - you take call until retirement. Some communities have separate facial trauma call schedules.
Disadvantage to not doing a fellowship - More so in a highly saturated area (esp major city - San Fran, Chicago, NYC etc.) In a smaller city I do not think it matters much. If you really want to do general, I would think you would loose a lot of the other skills doing only the fellowship-related scope of practice for an entire year or two. I do chronic ears, sinus, thyroids and parotids and if I took a year off of doing any one of those, I would probably feel much less comfortable with them. In a big city, there are probably more detailed referral patterns to sub-specialists that you are less likely to see as much of that stuff without a fellowship. It is probably nice when you have a group practice that one person does peds, one does sinus, one does otology, etc, but that is hard to come by, I think.
Way to enter academics later in career - I can't give specifics. You can always do anything you put your mind to. It will probably cost you a lot of time and money to make that type of career change, but if that ends up being your passion, I would say you can always do it.
Hours - Just think about a clinic day. You could start at 7:00am or 10:00 am. You could take a 2 hour lunch or no lunch at all. You could see 12 patients a day or 70 patients a day. When I was interviewing at a hospital based practices, they seemed fixated on how many patients a day I saw in residency. I would guess I am at least in the top 25% with regards to speed and efficiency in both clinic and surgery, but I don't think I realized what they were getting at and didn't really want to sell myself that way. You are going to be more valuable to a practice or hospital if you are faster, and really, that is one of the reasons that when you finish residency, congratulations, you are back to the bottom rung of the ladder once again - you have to prove your financial viability. Academics lets you escape from that to a large degree by excelling with academic duties.
Some other general advice: Contact as many practices and hospitals as you can to feel out different opportunities. You will probably see advertisements and get head-hunters calling you for high need jobs, but there are a lot of other jobs out there if you just cold call. If you already know the area you want to practice in, I would contact every possible practice position to see what they have to offer. If a doctor is so busy he desperately needs a partner, he may be too busy to actively seek candidates. And also consider starting a solo practice. If you know you only want to work 4 days a week, then you can set that as a goal.
