ENT subspecialties... do they exist?

[daveshnave]

Just posted this on the clinical rotations board, but wanted to know if anyone in here had any info on this...

I was looking online recently for info about the ENT program at Kaiser Permanente in Oakland, CA and noticed it was a community-based program. No surprise, since it's Kaiser and they don't do research. Anyway, my question.... What kind of ENT subspecialties are out there? I'm starting to look into ENT possibly, and I really want to go back to the bay area. I'm MSII and so I haven't taken Step 1, and although I'm hoping I'll do quite well, I also don't expect to get into UCSF for ENT! Do many ENT docs do ENT fellowships? I'm only wondering because I want to know what I'd be missing out on if I went to a community-based program. In a field as competitive to get into as ENT, will ENT fellowship programs still look down on community-based programs? I know Stanford's also got a program for ENT that's university-based, but still that's only 3 programs in the SF area. Anyone know anything about this, or about this ENT program at Kaiser in Oakland? Thanks...



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[Crusher]

The quick answer is yes there are subspecialities...in fact a handful of them....inclduing facial plastics, head and neck surgery, otology, etc etc

I'm getting somewhat concerned...there seems to be an awful lot of ENT discussion going on as of late and I've noticed that there seem to be much more people interested in ENT in my class than what I percieve to be usual. For instance, my class of 153 -- at least 4 students including my self are 99.9% sure they are going to do ENT... with the very limited number of spots available I'm concerned that this field may become even more competitive than it already is....hope there is still a spot for me

 

[daveshnave]

Thanks Crusher.

It's funny you mention the buzz about ENT recently, both on this board and at your school. I was thinking the same recently on both accounts. I recently starting looking into it not
because I'd heard people talk about it, but rather because it seems like it would be a good match for what I want out of medicine as a career, balanced with a family at some point... It's only one of several things I'm considering, but it's also (semi)important for me to go back to the bay area, in which case ENT might not be for me, especially if doing a fellowship after residency seems doubtful at Kaiser.

Forgive me if I'm wrong, but can anyone clarify? I was under the assumption that since ENT is a surgical subspecialty, that all ENT docs are head and neck doctors, ergo head and neck surgeons. Do you have to do a special head and neck surgery fellowship (as Crusher mentioned), or are you a certified head and neck surgeon after residency? Again, forgive my ignorance... I am only a lowly second year in search of information. Can someone please help? Thanks.

 

[droliver]

I think he meant head & neck oncology fellowships, which is just more focused training in some of the more complex resections & sometimes training in delivering their own adjuvant chemotherapy & XRT (this seems to be a growth area for surgical oncologists of all stripes)

 

[Voxel]

I am suprised to hear that surgeons are now prescribing chemo and XRT therapy. Why is this occuring and where? Academic centers or out in the community private practice. I'd wager doing this in private practice would be a tough sell politically.

 

[neutropeniaboy]

Originally posted by Voxel
I am suprised to hear that surgeons are now prescribing chemo and XRT therapy. Why is this occuring and where? Academic centers or out in the community private practice. I'd wager doing this in private practice would be a tough sell politically.

I wouldn't worry about the XRT. That's usually referred out, Voxel. Head and Neck fellowship trained otolaryngologists are qualified to prescribe chemotherapy, but I doubt many of them will be directing the XRT. My old ENT head did a radiation therapy fellowship, and all he does is pick who does the therapy!

Most, however, involve oncologists in the chemotherapy.

 

[neutropeniaboy]

Originally posted by Crusher
The quick answer is yes there are subspecialities...in fact a handful of them....inclduing facial plastics, head and neck surgery, otology, etc etc

I'm getting somewhat concerned...there seems to be an awful lot of ENT discussion going on as of late and I've noticed that there seem to be much more people interested in ENT in my class than what I percieve to be usual. For instance, my class of 153 -- at least 4 students including my self are 99.9% sure they are going to do ENT... with the very limited number of spots available I'm concerned that this field may become even more competitive than it already is....hope there is still a spot for me

That's not an unusual number of people in a class applying for ENT.

You'll just have to outrank your classmates. May I suggest, however, that you treat your future ENT colleagues as colleagues; you'll be working in the same field for a LONG time.

 

[droliver]

Originally posted by Voxel
I am suprised to hear that surgeons are now prescribing chemo and XRT therapy. Why is this occuring and where? Academic centers or out in the community private practice. I'd wager doing this in private practice would be a tough sell politically.

Voxel,

training in doing your own adjuvant tx. is apparently a very common theme now in many of the surgical oncology subspecialty fellowships especially breast, endocrine, & colo-rectal. Driving this is several things including financial incentives & the less diffucult task of staying current on adjuvant treatments for these super-subspecialty physicians who tend have very focused practices. The idea of one stop shopping is also an attractive idea to many patients and may ultimately be a better and simpler way to mangage certain diseases. Surgical oncology is one of those fields that is rapidly adapting towards a future where many of the traditional surgeries will be obsolete and replaced by minimally invasive surgeries, genetic therapies, & neoadjuvant multimodal treatments. If you aren't fluent in those in the future you will be obsolete and replaceable.