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ENT vs dermatology
- Thread starter Sir Osis
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I think it depends on whether or not you want to be a surgeon. If you love surgery, then ENT is probably the way to go. If you want money and an easy residency and lifestyle, derm is the best bet. I too have two children but I love otolaryngology as a speciality enough to make it work. If you don't feel that strongly, a surgical residency probably isn't where you should be.
BTW, at my school most of the skin cancer stuff is done by the surg onc people > mohs derms. I don't know if that is universally true but it is worth looking into.
BTW, at my school most of the skin cancer stuff is done by the surg onc people > mohs derms. I don't know if that is universally true but it is worth looking into.
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It really is apples and oranges. Carefully evaluate what you like about ent. I wouldn't think of derm as ent light. They aren't really similar at all. Can you do and excel in a full dermatology residency if all you really want is procedures I.e moh's? That's a lot more to derm than MOHs.
More broadly you can likely have a similar lifestyle post residency (residency isn't even close). As far as call my opinion is as a surgeon you should take call at the very least for your patients. Though we do have one guy around here who doesn't take call. But that's embarrassingly lame and unprofessional IMHO.
Good luck. Sounds like to me the fact you are thinking about a change and are already burned out might mean ent isn't right for you. But none of us really know but you.
More broadly you can likely have a similar lifestyle post residency (residency isn't even close). As far as call my opinion is as a surgeon you should take call at the very least for your patients. Though we do have one guy around here who doesn't take call. But that's embarrassingly lame and unprofessional IMHO.
Good luck. Sounds like to me the fact you are thinking about a change and are already burned out might mean ent isn't right for you. But none of us really know but you.
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No it isn't. You are only seeing the skin cancer referred by community docs to the academic center. 99% of all skin cancer is treated by a dermatologist in an office.
To the OP, go for derm if you have the ability to get a spot. There is no other job that pays so much for knowing and doing so little. You will be in clinic everyday for the rest of your working life and seeing the most boring cases in medicine. However, you will be home for soccer practice and dinner every single night and you will never be on call. You will make roughly twice what your ENT friends take home and work about one-third as hard.
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From everything I've seen the average dermatology and ENT yearly salaries are roughly the same, ~375k. And the hours for ENT are usually not much more than derm, ~50ish hours a week.
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I also have 2 children (well, one is still baking) and I'd like at least one more one day. ENT's gone up the ranks in my head in the last year and change (thanks largely to personal experience with my firstborn). How bad is an ENT residency compared to general surg or other surgical subspecialties like ortho (which I know is supposed to be brutal)?
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It depends on the program. Some places are as bad as ortho or general, others are more relaxed. A big part of it the best I can tell is the flaps on the big cases. We do our own flaps and that can create some very long hours in the OR. I would say an average week for me is 65. If I am on call the weekend or we have a few flap cases, that ratchets up quickly. Probably not too different from other residencies, but I spend a lot of hours at night working on things for didactics, cases the next day, etc. There is a lot more to it that just the documented hours.
Thanks for the input. I'm sure the "work 1/3 as hard" is a slight exaggeration once out of residency. The bottom line is, if I like surgery, but it's not a "passion" per say, is the lifestyle offered in derm enough to make up for losing the OR? I'm not gonna be an academic doc, nor do I think I'd want to do much outside of general ENT. Is the 45 hour, bread and butter type deal a realistic thought?
ENT is very surgically intensive, probably more so than the other surgical subspecialties. I really believe you need to love the OR to go into the field. And if you are already thinking about having good hours, I would not consider this field....while I hear what you are saying, I also know that to be a good surgeon you need to put the hours in. No easy way around it.
Derm is a completely different field. No way you can even compare them.
Derm is a completely different field. No way you can even compare them.
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According to the AAO-HNS 15% of patients who see an ENT end up going to surgery. That doesn't sound surgically intensive to me.
what about from the physician's perspective? What is the ratio of OR/clinic time for an average practicing ENT?
Would you recommend that a student worried about working hours go into ENT? What percentage of time does an ENT resident spend in the OR vs. clinic? Just saying that there is a lot more OR time in ENT than people think.
From what I have heard, most ENT docs in private practice spend 3-3.5 days in clinic and 1.5-2 days in the OR. Some choose to do only clinic and refer all surgical cases to their colleagues. One thing to keep in mind is that OR days aren't necessarily long days. Most ENT cases in private practice are quick and you can make it home whenever you want. Neck dissections in academics is a different story.
Residency on the other hand is much more surgery-intensive with at least 50% of the time in the OR. this is the time period where you must have a love of the OR to make it through and be willing to sacrifice family life. Afterwards, sure there will be call and some emergencies that necessitate going into the hospital in the middle of the night, but it won't be nearly as bad as residency.
ENT is likely always going to be worse than Derm in terms of the time you sacrifice away from your family, but if you must do surgery to be happy, that is a price that you should be willing to pay to some degree.
A recent article I read in thoracic surgery news highlighted an ACS study dealing with surgeon burnout. The biggest predictors were trauma, young children at home, and frequent call. After that, vascular surgery, ENT, and urology were associated with the high burnout. Academics, pediatric, and CT surgery were protective against burnout. I was suprised by these results to say the least, patricularly for ENT, urology, and CT (No, the study wasn't done by CT guys). My thoughts were that the stress of having to crank out a large volume of small cases in a single day were what ENT, urology, and vascular had in common, and the likely cause of the increase stress in burnout for ENT at least, thoughts? Related to the topic, I think this shows that no surgery specialty is stress free. I'm a gen surg resident and I've seen how hard our ENT residents work on face call and would want no part of that.
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To OP, the reality is that the least flexible, more time-intensive part of your training will be the first 10 years post-med school when you'll be going through:
1. Residency (no explanation needed).
2. Starting your own practice/entering an existing practice/building a career in academics. In any case, you'll be at the bottom rung of the career ladder, and you climb your way up by taking on surgical volume and taking call. No one wants to hire a partner with no experience who won't take call and wants to work 40-hour weeks.
With that said, remember those 10 years overlap with your kids' childhoods. You can't get those years back. If you want to do a surgical speciality, you will have to sacrifice time with your kids.
1. Residency (no explanation needed).
2. Starting your own practice/entering an existing practice/building a career in academics. In any case, you'll be at the bottom rung of the career ladder, and you climb your way up by taking on surgical volume and taking call. No one wants to hire a partner with no experience who won't take call and wants to work 40-hour weeks.
With that said, remember those 10 years overlap with your kids' childhoods. You can't get those years back. If you want to do a surgical speciality, you will have to sacrifice time with your kids.
My guess on the burnout is that there is a significant number of people going into ENT and Urology who think that those specialties are "Surgery-Lite" where they get to do surgery and go home early with easy schedules. Then they hit residency which is hard and then many realize they never really had a passion for it to begin with and burn out. I think those who actually have a legitimate interest in the field and pathology and are willing to work hard do just fine.
As for vascular, I'm not really sure. Maybe its because almost every procedure they do is destined to fail...Or maybe because all their patients continue to smoke and ruin all their hard work. I think that would get pretty frustrating.
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To the OP - when you get out you have a wide variety of lifestyle options. You definately have potential to get a cush job. I know someone who just got out, is a mom with a kid and one on the way, and has a hospital based general ENT job where she works maybe 40 hrs a week and has 3-4 call nights per month for a decent salary. Call requirements just depend on the job opportunity. In general, call is going to be worse with ENT compared to derm (it cant really be better), but not terrible.
Of course, you have more earning potential if you are willing to work harder. And as previously stated, ENT residency is a harder route than derm residency.
I don't even know why there is such a thread comparing two completely different specialties. It's like asking "should I turn pro in football or golf."
You have to remember for even the most cush ENT residency, you still get airway emergencies and bad infections. Yesterday, I had a 20 day old neonate who I trached got a mucous plug and almost died. We may have great hours averaged out over time, but you better be ready to be able to handle those few truly life-and-death situations. Oh, and there will be nights where you spend over 10 hours straight closing lacs in the ER and still have to operate the next day. I think I have seen my dermatology friend who went to med school with me in the ER once (I'm turning PGY 4).
Sure when you are out in practice, you can choose to do facial plastics or otology where you are doing almost all outpatient surgery. But you will still have to take care of your post-ops.
Good luck.
You have to remember for even the most cush ENT residency, you still get airway emergencies and bad infections. Yesterday, I had a 20 day old neonate who I trached got a mucous plug and almost died. We may have great hours averaged out over time, but you better be ready to be able to handle those few truly life-and-death situations. Oh, and there will be nights where you spend over 10 hours straight closing lacs in the ER and still have to operate the next day. I think I have seen my dermatology friend who went to med school with me in the ER once (I'm turning PGY 4).
Sure when you are out in practice, you can choose to do facial plastics or otology where you are doing almost all outpatient surgery. But you will still have to take care of your post-ops.
Good luck.
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somewhat related topic that may help the OP in his decision as well:
as has been pointed out, ENT is a surgical field and is likely to have more intensive hours than a non-surgical field even after residency
but time and again, it is mentioned that ENT has a relatively good lifestyle compared to other surgical fields. how much truth is there to this? obviously ENT will have better lifestyle than neurosurg and general surg. but compared to some of the other surgical specialties like ortho or urology, is there any lifestyle advantage to ENT? why or why not?
as has been pointed out, ENT is a surgical field and is likely to have more intensive hours than a non-surgical field even after residency
but time and again, it is mentioned that ENT has a relatively good lifestyle compared to other surgical fields. how much truth is there to this? obviously ENT will have better lifestyle than neurosurg and general surg. but compared to some of the other surgical specialties like ortho or urology, is there any lifestyle advantage to ENT? why or why not?
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so what did you decide on?
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This is a 3 year old thread and the OP hasn't posted since 2011 (when he posted in a Derm interview thread).
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Yeah, but the suspense has been killing me for the last three years.
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Haha. Ok
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Do you want to operate or don't you? Very different specialties.
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With sample sizes, that could easily be just a bad run, or there could be something going on there.
I guess you are suggesting the faculty "black ball" students? There are certainly opportunities to earn bad LORs and such, but usually, even if there is a personality miss-match that makes itself apparent during a sub-I, students with good scores and interview skills will match elsewhere.
I had a very similar problem as well. I liked ent but I eventually went with dermatology. Met quite a few people on the derm interview trail who had a similar dilemma but picked derm over ent. Even some ent docs told me they wished they've done derm
I couldn't be happier with my decision.
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I had a very similar problem as well. I liked ent but I eventually went with dermatology. Met quite a few people on the derm interview trail who had a similar dilemma but picked derm over ent. Even some ent docs told me they wished they've done derm
Why did you end up picking derm?
I will pm you
I think this happens in ENT.
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I guess you are saying you don't like ENT attendings as much as Derm attendings? Derm doesn't have the equivalent to head and neck rotations where you need to be pretty intense, or any life threatening situations, so derm attendings can afford to be nicer more of the time... Once a derm attending finds out you are smart, they probably just want to find out if they want to spend time with you or if you are going to be annoying, rather than if you have what it takes for a more demanding residency like ENT.
Don't be fooled, if you are working with an attending or resident (who is not preoccupied with what they are doing), you are being judged. I would say that at the handful of programs I got to experience throughout med school and residency, at a couple ENT programs I rotated through, the faculty had it together enough to be really nice to the students, even though they were being critical of them. At a couple programs, attendings tended to me more hardasses and call things what they are.
As far as receiving unfair negative evaluations or being "black balled," ENTs have a range of personalities, but in more so academics, attendings are less "laid back." Any given program you are going to have some that are pretty intense. Expectations for students are [and should be] high. So, if you are doing your ENT sub I and give the impression that you are nonchalant or lazy, or full of yourself because you got a 260 on step 1, you may earn yourself a bad LOR. I do think it is pretty rare that an attending is going to write bad evals on a regular basis, but may there is someone out there who is a big enough jerk to do this.
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id rather have the one who calls a spade a spade then the one who is very nice then writes a terrible eval/LOR. If im screwing up, tell me, tell me how to improve, then watch what happens.
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I'm surprised anyone struggles between ENT and derm (do people really consider Mohs surgeons to be surgeons?). I know quite a few ENTs I've met that said they were also considering nsg, plastics, or ophtho. I'm personally having trouble deciding between ENT and ophtho.
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Derm residency has nice hours but u have to be disciplined about doing at least 1-2 hours of reading every day at home. ENT residency is a lot more rigorously in terms of the hours spent in the hospital. One of my colleague is married to an ENT and he wishes he had done derm...and he advises his students to think about derm. He is in a super rigorous ENT residency breaking duty hours every day so he's a bit bitter about his wife who goes home at 5 and study at home.
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Agreed..there really is little similarity. Though as noted above the grass is always greener on the other side. My guess is no one not in the field can appreciate how boring and awful a clinic of acne and skin checks could be. Yuck. I did a month in med school and I just found it painful and boring. I know the occasional oddball thing comes up in derm but usually it's just smart people that don't want to work so they choose the cushy life of zits.
I strongly considered plastics and also (maybe oddly) considered urology. The body parts are different obviously but they use scopes etc for diagnosis and do simple things but they also do some big whacks for cancer like we do. Very happy with what I do, though I do wish I saw fewer people with otalgia NOS, dysequilibrium NOS, and headache NOS.
I strongly considered plastics and also (maybe oddly) considered urology. The body parts are different obviously but they use scopes etc for diagnosis and do simple things but they also do some big whacks for cancer like we do. Very happy with what I do, though I do wish I saw fewer people with otalgia NOS, dysequilibrium NOS, and headache NOS.
Your friend may change his tune once he graduates residency...
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These kinds of posts confuse me and simultaneously suggest to me that people don't put a lot of thought into what they want to do with life.
Rigorous hours and wanting to do something else can be mutually exclusive. Residency is a means to an end, so every time I hear some student talk about work duty hours, lifestyle and work-life balance of residency, it makes the hairs on the back of my neck stand up and I start getting palpitations and I eventually bit my lower lip.
Residency is a time to learn skills and maximize your educational experience so that when you are out on your own you have the capacity to make your practice what you want it to be. This is a fixed time, and like all things in life, residency, too, will come to an end.
If you want a great lifestyle just because you feel entitled to a great lifestyle, then invent something or work for Apple. Any profession with an advanced degree requires hard work. Law. Investment banking. Medicine. All require hard work before and after. I have friends who wish they went into medicine because I work fewer hours than they do as lawyers and bankers. (I work on average 60 hours per week.)
So, if you like Otolaryngology, do Otolaryngology. Pick the specialty you like because that's what you are going to enjoy for the rest of your career. Survey after survey of practicing physicians show high work dissatisfaction, and many wish they had gone into some other faction of medicine or another career path entirely. Don't pick it on hours or income. Pick it based on what you like.
Make your hours later in life. Work as hard or as little as you want when you actually have a career.
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Are you telling me that when ENT docs remove skin cancer or skins lesions and do reconstructive work is not considered surgery?
How would you define 'surgery' ?
Here is a simple definition from wiki
"Surgery (from the Greek: χειρουργική cheirourgikē (composed of χείρ, "hand", and ἔργον, "work"), via Latin: chirurgiae, meaning "hand work") is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas."
So yes, people who know the meaning/definition of 'surgery' and are familiar with Mohs would consider Mohs surgeons to be surgeons.
Are dermatopathologists not pathologists because they did not go through pathology residency before completing derm path fellowship? Derm path guys went through general derm residency first, then derm path fellowship. And as far as what they do is by all means considered dermatopathology.
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I wonder if OBs care about who you consider surgeons
If you've ever referred to them as not a surgeon you would know just how much they cared
If you've ever referred to them as not a surgeon you would know just how much they cared
I guess it just speaks more about you than them. It's like patients calling NP "a doctor." I wouldn't argue much with that, it just says something about their knowledge (or lack thereof) about the extent of NP's or MD's practice.
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No, it's just inter-specialty dick measuring.
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Being capable of doing a procedure does not make one a surgeon.
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Mohs surgery is a legitimate surgery. Is there another example for derm?
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So you're debating money vs. money.
Have you thought about GI vs Neurosurgery?
That's a tough call.
good luck.
Have you thought about GI vs Neurosurgery?
That's a tough call.
good luck.
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How about OMFS (dent school) vs ENT/Plastics (med school)?
Aughh, pre-health choices...
Aughh, pre-health choices...
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I disagree with neutropeniaboy; you do have to factor in residency and residency hours in your choices of a field. I know I did...and matched Derm. Medicine is all about delayed gratification...work hard in high school so you can get into a good college. Study hard in college for those grades so you can get into a great medical school. Don't worry, med student, it gets better in residency! Residency is just the last step...it'll get better in Fellowship. Wow, now we've made it. New Attendings...except we replaced the stress of learning a field of medicine to running a practice, earning political capital in an academic department, winning grants, etc.
Physicians, unlike other fields (banking for instance or consulting), have less time to work given the length of training. Let's say the average doc finishes all of their training (4 years bachelors, 4 years medical school, 6 years of training average across surgical, non-surgical and fellowship training) leaves a person at the age of 34. Leaves about 31 years of 'full time practice'. 6 years of residency/37 years of total career time = 16%. That 16% is probably weighted more because your young, maybe dating, maybe starting a family, maybe still have the health and appetite for travel.
So yes, the hours of your residency do matter in your overall quality of life. You have to enjoy each year of your life instead of constantly believing it'll get better. You replace one stress with another. If you want to be in the hospital while your young and hungry, then by all means pick a high intensity surgery field. But, those 5-7 years will suck and they are not throw away years. If you're miserable for 5-7 years while training, stuck in the hospital, missing dinners and 1st birthdays and trips, I think it's a big price to pay indeed.
I'd rather spend every weekend with my wife in the next 3 years before we have kids with a derm audiobook playing in the background over taking consults after consults, managing post-op patients for attendings, etc.
Physicians, unlike other fields (banking for instance or consulting), have less time to work given the length of training. Let's say the average doc finishes all of their training (4 years bachelors, 4 years medical school, 6 years of training average across surgical, non-surgical and fellowship training) leaves a person at the age of 34. Leaves about 31 years of 'full time practice'. 6 years of residency/37 years of total career time = 16%. That 16% is probably weighted more because your young, maybe dating, maybe starting a family, maybe still have the health and appetite for travel.
So yes, the hours of your residency do matter in your overall quality of life. You have to enjoy each year of your life instead of constantly believing it'll get better. You replace one stress with another. If you want to be in the hospital while your young and hungry, then by all means pick a high intensity surgery field. But, those 5-7 years will suck and they are not throw away years. If you're miserable for 5-7 years while training, stuck in the hospital, missing dinners and 1st birthdays and trips, I think it's a big price to pay indeed.
I'd rather spend every weekend with my wife in the next 3 years before we have kids with a derm audiobook playing in the background over taking consults after consults, managing post-op patients for attendings, etc.
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I think you should consider which field you'd rather do if you couldn't do OMFS or ENT/plastics.
OMFS students are the top dental students and ENT/plastics are the top medical students. Would you be happy as a dentist if you didn't get an OMFS spot? Could you see yourself doing general surgery, internal medicine, or something other than ENT/plastics if you ended up with just average or above average grades?
