It is unclear to me what bearing having an accredited vs non-accredited fellowship has on an ENT surgeon's future practice. I know that some subspecialties have a formal accreditation process and some do not, and that those that do have a more standardized system for both duration and types of cases one must log. However, to take an example, there are ear fellowships that are both accredited and non-accredited. If one does the latter and becomes extremely proficient in schwannoma surgery, but is not formally accredited in neurotology, what can they do with these skills? Certainly it precludes academic jobs in most cases, but there are conceivably institutions in which one could be referred schwannomas and other skull base lesions that are non-academic. Would that person then simply be at higher liability? Would their colleagues in general say that they should not be performing these procedures? Are there legal issues?