Fellowship training

[Crash88]

Hey all,

I am starting to get far enough along in residency (midwest program) that I have to think about fellowships.

For an individual planning to practice in an SSG or MSG in a larger city, what extrinsic factors should one consider when deciding whether to pursue a fellowship (apart from interest, etc.)? Looking a decade or two down the line, do you anticipate fellowships will be necessary to keep a competitive edge or will there likely still be demand in major cities for the general otolaryngologist? Do certain fellowships increase your marketability and earning potential?

I thought I would keep this topic broad, but I have particular interests in rhinology. I feel that my training in most aspects of sinus surgery will be solid after residency. Is there any role for having additional training in skull base and revision cases in a non-academic setting, or will these cases be shunted off to big academic centers anyway?

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[Pir8DeacDoc]

What do you envision doing with your fellowship?
Most of us/all of us come out ready to do maxillary, ethmoids, straight ahead frontals/sphenoids (especially with balloons being so common now). A general ENT should be able to do an endoscopic medial maxillectomy for IP. Revision cases get punted sometimes for complexity and sometimes because the patient will never be "cured" of their disease and going to the Ivory Tower makes them feel better. So what does your fellowship get you that you might routinely see or do in a community? It depends on the size community I suspect. I've always practiced in smaller areas so I see a case that needs to go to a Rhinologist maybe 1-2 times a year (difficult frontal, osteoma..?)

To fully maximize a fellowship, I suspect, you would need to practice in a larger area. There are no where near enough cases in my community to support any sub-specialist who doesn't also want to do some general ENT work.