ENT if only interested in head and neck surgery?

[Birdnals]

MS3 here who has whittled down my choices for specialties to just a few. Oto has been the front runner for a while now with my main interest being in the areas of head and neck surgery and reconstructive facial plastics. I haven't gotten to see much else in the field, but other areas like rhinology and otology are not overly appealing to me based on what I know from pathology and anatomy (I'm yet to do my ENT rotation so maybe/hopefully this will change).

That said, am I off my rocker to pursue a residency in ENT if I'm really only interested in those areas? Are there programs that are more HNS heavy which might be better suited for me, and if so, how can I find these programs? Luckily from what I understand, HNS fellowships aren't the most competitive, but I'd still appreciate some advice on going ENT with the sole intent of doing a HNS fellowship.

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[BigRedBeta]

I'm not a surgeon, so I guess take what I say with appropriate measure but, as someone who was deadset on a subspecialty and fellowship (Peds critical care out of pediatrics) by the time I was interviewing for residency, I think I can provide some relevant insight.

On my interview day my eventual department head told me "the best subspecialists start off as great generalists" and I honestly have never seen an instance where that is not the case. I'm sure there are skills that you'll learn from attendings in other subfields of OTO/HNS that will serve you well when you subspecialize, just as I'm sure there are cases and patients that don't neatly fall into one subfield, thus requiring baseline knowledge of the others to manage appropriately.

As for finding programs that HNS heavy, probably easiest to identify the places with strong HNS fellowships. May not precisely correlate, particularly at places with other strong fellowships, but is a reasonable place to start. Another way to figure it can be to look at where residency program's graduates go when they're done, programs frequently boast of their graduates successes so if you see what seems like a strong trend towards HNS fellowships, then the experience is probably good. Alternatively, in many fields fellowship programs have lists of their fellows and where they trained on their websites, so you may be able to track those down and reverse engineer a list.


Lastly, particularly at your stage of training, realize that every single patient you see is going to teach you something. Your psych rotation may seem like the absolute last place to develop skills for your future as a HNS physician, but maybe you get more efficient at taking a history or better at examining ears or mouths in uncooperative patients. Maybe on peds you learn how to deliver bad news or on IM how to better counsel for smoking cessation. Go in with the expectation there is something to gained from every patient and you'll come out ready to be a much more competent intern.

 

[Wordead]

Everything in ENT is word of mouth. Ask your attendings.

Also, you said yourself you havent seen any other subspecialty. Every med student thinks head and neck is the coolest. After enough days leaving at midnight and doing flap checks and seeing your patients fistulize you might change your mind. Rhino and otology have become more and more interesting as residency progressed.

 

[OtoHNS]

That said, am I off my rocker to pursue a residency in ENT if I'm really only interested in those areas? Are there programs that are more HNS heavy which might be better suited for me, and if so, how can I find these programs? Luckily from what I understand, HNS fellowships aren't the most competitive, but I'd still appreciate some advice on going ENT with the sole intent of doing a HNS fellowship.

If you are dead-set on HNS, then ENT is certainly the best option for your residency. 50 years ago, you could have done general surgery/surg onc, and while this is theoretically still possible, it would be crazy for you to deliberately choose this path over ENT. Another option would be to go back to dental school, then match into one of the 5 oral surgery programs that do some HNS (obviously not a good option).

If you are purely interested in reconstructive surgery of the head and neck (i.e. not taking cancer out, just putting the pieces back together), then plastic surgery would be a reasonable choice for residency. But then, you're probably in a worse situation dealing with 3 years of Gen Surg and all the parts of plastics (hand, burns, etc) that are not especially relevant to your career goals.

So, yes, go for ENT. But keep an open mind- you may find that your priorities and interests change. The good thing about ENT is that there is a lot of variety in such a small part of the anatomy.

 

[Pir8DeacDoc]

Would agree with the above. Head and neck cancer cases are what generally interests most of us first. The anatomy and the complexity of the operations is outstanding. But during residency you'll probably come to appreciate the other facets of the specialty. You don't have to be a rock star at all of it, just competent. I don't love otology, but I can drill out a mastoid and get good results on a TM perforation most of the time. At the end of residency I could do a nice stapes too. The extent of that sort of work now in practice is completely up to me.

 

[DrHerm]

Head and Neck is a really cool subspecialty. But I will say Otology and Rhinology become a lot more fun and interesting when you’re the one in the driver’s seat. I would also echo what a previous thread said, HNS starts looking a lot less cool after you’ve done your umpteenth flap, staying in the OR for hours without peeing or eating. Sewing up a flap is fun when you’re first allowed to hold an instrument in your hands, but tedious after you’ve operated for a long time. Plus, it takes a lot of emotional fortutude to have the “cancer talk” several times per day and watch your patients die. It is also incredibly rewarding having patients come back to see you after going through hell and coming out the other end cancer free. Either way, these are all decisions for you to make years after you’ve started your residency. Good luck!

MS3 here who has whittled down my choices for specialties to just a few. Oto has been the front runner for a while now with my main interest being in the areas of head and neck surgery and reconstructive facial plastics. I haven't gotten to see much else in the field, but other areas like rhinology and otology are not overly appealing to me based on what I know from pathology and anatomy (I'm yet to do my ENT rotation so maybe/hopefully this will change).

That said, am I off my rocker to pursue a residency in ENT if I'm really only interested in those areas? Are there programs that are more HNS heavy which might be better suited for me, and if so, how can I find these programs? Luckily from what I understand, HNS fellowships aren't the most competitive, but I'd still appreciate some advice on going ENT with the sole intent of doing a HNS fellowship.

 

[VisionaryTics]

Head and Neck is a really cool subspecialty. But I will say Otology and Rhinology become a lot more fun and interesting when you’re the one in the driver’s seat. I would also echo what a previous thread said, HNS starts looking a lot less cool after you’ve done your umpteenth flap, staying in the OR for hours without peeing or eating. Sewing up a flap is fun when you’re first allowed to hold an instrument in your hands, but tedious after you’ve operated for a long time. Plus, it takes a lot of emotional fortutude to have the “cancer talk” several times per day and watch your patients die. It is also incredibly rewarding having patients come back to see you after going through hell and coming out the other end cancer free. Either way, these are all decisions for you to make years after you’ve started your residency. Good luck!

Agree 100% with all of the above. H&N often excites medical students (because it is big dramatic surgery that you can get your hands dirty), but there's so much else in ENT that I really didn't appreciate as much until I did it.