Existential Crisis: ENT Vs Plastics

[Melimelomed]

I discovered ENT late in my first year of medicine and I fell in love with it. I did extensive shadowing throughout the first half of Med-2 and worked on multiple research projects (including basic sc.) with multiple publications and oral presentation at conferences coming up.

I thought that ENT was for me and that nothing could make me change my mind until I started a pediatric plastic surgery elective (I am now a Med-3). I decided to do this rotation because I have always been fascinated by congenital malformations and because I love working with children. The problem is that I just fell in love with peds plastics! (And I am pretty sure I would love the rest of plastic surgery a well)
I feel stuck as plastics is so competitive and my CV is entirely tailored to applying in ENT.

Has anyone ever been in the same situation (i.e. being torn between plastics and ENT)? What made you decide one way vs the other?
How much peds plastics can you do if training in ENT? Is it possible to do cleft lips/palate and other congenital malformation repair? Any possibility of doing a peds plastics fellowship from ENT in the US (I am Canadian and planning to do my residency in Canada)?

Thanks!

Mel

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[chirurgino]

I'm currently applying in ENT (just certified my rank order list!!!!!), but I did rotations in both ENT and plastics because at one time I also was torn between the two.

Obviously the choice will be very personal, but the reasons I finally ruled out plastics were the following:
--I hated cosmetics
--I hated burns (the institution I was at shared burns with gen surg)
--I hated VAC dressing changes and the "non-healing butt ulcer" consults
--I thought hand was super-cool, but I knew I would hate hand call as an attending
--I liked some of the recon, but I realized it was mostly head and neck that I liked
--I liked the "ENT personality" MUCH better than the "plastics personality" (wait until your clinical rotations if you're not sure what I'm talking about--the differences will be crystal-clear)
--I liked almost everything in ENT

So in the end, the choice was pretty obvious for me.

As far as the peds craniofacial stuff is concerned, my understanding is that very few (Iowa is one) ENT programs do even cleft lip/palate here in the states, much less hard-core cranial vault reconstructions. I've never understood why this is the case, since at least cleft lip/palate would seem like obvious ENT territory. I do know that ENT people who are really interested in peds craniofacial have historically had to go back and do the 3-yr plastics residency, followed by a peds craniofacial fellowship--Dr. John Meara, chief of plastics at Children's Boston, comes to mind. So I guess if you are absolutely 100% set on doing peds craniofacial, you should go the plastics route and save some time.