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M1 student here with high interest in ENT. I wanted to ask what are interesting trends in field that one should be on the lookout and/or excited for next two decades or so.
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Are people worried about these monoclonal ab therapies eventually decreasing overall need for FESS? Bad for future rhinology market?There's been a rather dramatic change in my career so far away from surgical management of head and neck cancer and towards chemo/rads up front with surgical clean up if they fail. Downside for a general ENT Like myself- I'm not interested in salvage surgery. It's just exponentially more challenging and more prone to complications. So I function as a biopsy guy and do some T1/2 work in the oral cavity, Oropharynx, and sometimes larynx.
Other major change has been immunotherapy for nasals polyps. I used to have a subset of patients that would go to surgery every couple of years. Now, those patients really benefit from Dupixent. It's an amazing medication. I suspect there will continue to be advances in that area.
I'm sure there's more, but that's the first two things I think about.
I'm not. The price tag is astronomical, and these new meds are only for CRS with polyps. The only situation I would use one of these meds is in post-op FESS patients where the polyps aggressively recur within 1-2 years. Others may feel differently of course.Are people worried about these monoclonal ab therapies eventually decreasing overall need for FESS? Bad for future rhinology market?
I’m a pgy3 trying to decide between Rhinology and otology my goal is to go back to LA (born and raised) I love both of those fields. Compensation wise would one be better then the other I. High saturation areas?I'm not. The price tag is astronomical, and these new meds are only for CRS with polyps. The only situation I would use one of these meds is in post-op FESS patients where the polyps aggressively recur within 1-2 years. Others may feel differently of course.
well said. Exactly my experience as well.I think rhinology usually pays best amongst subspecialty trained docs.
The other thing I would consider is:
Almost everyone wants an otologist in their practice.
A lot of people don’t want a rhinologist.
The reason is that most people like doing sinus cases and sinus cases reimburse the best. So if I’m a general ENT and I hire a rhinologist, I’m likely going to have to give up a good share of my best cases to this guy so that I can support an occasional skull base mass.
A lot of people don’t like doing ear cases (or managing vertigo) so the opposite is true.
That has been my general experience, anyway. Since I got out of the Army, we have interviewed every otologist who has applied (even when we weren’t actively searching) and we’ve declined to interview every rhinologist. I have five rhinology trained docs within a two hour drive. I send them something once or twice a year. I just don’t need someone in house with that skill set.
This obviously would not apply to academic centers, or groups where everyone is fellowship trained (everyone has their schtick).
Los Angeles. There’s always a stupid joke about Los Angeles elitism that we abbreviate it as LA and expect everyone to know which one we’re talking about and I’ve totally fallen into the trap haha sorry about that* almost all of my advice will be general advice if you’re applying to work in my practice, then it’ll be specific advice.
Otherwise, as OtoHNS said, always check the local landscape.
Honestly I wasn’t sure if you meant Los Angeles or Louisiana.
Otology if you want to practice in a big city in California. Everyone loves sinus. Everyone wants the thyroids and parotids. Very few people want to manage the recurrent choles that need CWD, subtotal/total TM perforations, 99% occlusive exostotic ears, vague ET dysfunction/patulous ET issues and of course all our favorites vertigo.Los Angeles. There’s always a stupid joke about Los Angeles elitism that we abbreviate it as LA and expect everyone to know which one we’re talking about and I’ve totally fallen into the trap haha sorry about that