MD General Surgery vs. ENT

[Milotic_2022]

Current MS3 considering General Surgery vs. ENT. Curious to see what the SDN community's thoughts/opinions are, when it comes to residency in both and beyond. Thank you very much.

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[slowthai]

Early Nights & Tennis vs general slavery? I'll take "Easiest decision ever" for $200, Alex

 

[Dr. Doctor MD]

Early Nights & Tennis vs general slavery? I'll take "Easiest decision ever" for $200, Alex

Agreed!

ENT is a much easier 5 years of residency
ENT has a much better lifestyle both during and after training
ENT makes a healthy amount more than GS ($450k+ vs $350k+) despite working less hours
ENT is (arguably) a more interesting organ system
ENT allows for a mix of surgery and clinic/procedures - more career flexibility

The only reason to do GS is if you truly have no idea what you want to do surgically and want to keep your options open for a fellowship, or you just find general surgery pathology fascinating.

Otherwise ENT > GS in every single aspect. There is a reason you need a 250+, AOA, and Research to match ENT and why you can easily match GS without any one of those things.

 

[OnePunchBiopsy]

I’m a GS resident. Shadowed ENT and didn’t care for it. Let me tell you why I chose GS.

1. You not only learn surgical knowledge, but you also get medical experience and can learn to manage complex patients instead of admitting all/most of your patients to medicine.
2. You get to operate head to toe. If it’s below the clavicles, ENT won’t touch it.
3. I hate respiratory secretions.
4. If you love to do thyroids/parathyroids, you can still do those through an endocrine fellowship after GS.
5. If you love craniofacial recon, you can do plastics after GS.
6. ENT lifestyle is not always nice. If you work at a big center, you’ll still get calls in the middle of the night for atypical intubations, bleeding tracheostomy’s, etc.
7. I hate respiratory secretions.

 

[COMMANDER CLOWN]

General surgery is unique in the sense that things get WORSE after residency unlike virtually every other specialty. Terrible hours, terrible call, terrible pay considering hours worked, terrible culture. I'm going to get hate for this, but GS is what people settle for when they don't have the stats to match a subspecialty (unless they want a specific GS fellowship or really love the abdomen specifically for some baffling reason).

 

[Neopolymath]

1. You not only learn surgical knowledge, but you also get medical experience and can learn to manage complex patients instead of admitting all/most of your patients to medicine.

This is a feature not a bug 😉

 

[ACSurgeon]

General surgery is unique in the sense that things get WORSE after residency unlike virtually every other specialty. Terrible hours, terrible call, terrible pay considering hours worked, terrible culture. I'm going to get hate for this, but GS is what people settle for when they don't have the stats to match a subspecialty (unless they want a specific GS fellowship or really love the abdomen specifically for some baffling reason).

Operating in the abdomen is fun. Much better than operating in a tiny hole.

My full time GS job is 2 weeks on/2weeks off. The 2 weeks on are half call half back up. So in essence my full time job is to be busy 25% of the year. During those days I can’t make important plans, but I end up seeing my kids, having at least one meal at home, and put the kids to bed at night the vast majority of call days.

GS training is broad, you retain a lot of general medical knowledge and you can use as much of it as you want or have IM do all the medical stuff so you’re not bothered by it.

After residency life gets so much better unless you’re itching to make a million dollars a year, then you keep working like a resident.

The culture in training can be bad, but once you’re an attending, outside of academic centers it’s very collegial and fun.

No one outside of medicine thinks ENT is glamorous or cool. Just keep in mind no one knows what the pay will be like in 10-15 years so make sure you enjoy the actual pathology.

 

[ace_inhibitor111]

I liked the general surgery procedures more than the ones in ENT. The hours and training environment are just so much worse unfortunately. Also, hate that half the programs have 2 year mandatory research years now.

 

[operaman]

I think they’re both great fields and your choice will largely depend on a combination of scores with what your ultimate goals might be. There are ways to have a great or crap lifestyle in either one. Ideally you would want to have some idea of your ultimate goal before selecting. The things I wanted to do and the kind of patients I want to see meant ENT was my only option. Other things about it:

1) incredible range of procedures.Everything from an ear tube up to massive head and neck cancer resections and free flap reconstructions. There’s also opportunities to do anterior and lateral skull base work alongside neurosurgery. I love microsurgery and we have tons of that with otologic procedures and phonosurgical procedures. I got to do some cleft lip and palate as well as some other craniofacial work as a resident and could do a year fellowship if I wanted to make those a big part of practice. I probably logged more facial plastics cases than most plastic surgery fellows so you also get incredible training there, both for functional as well as cosmetic procedures. Oh and we work with kids and adults - I’ve definitely had days where I saw consults on both a 3 hour old infant and a 102 year old man.

2. wide range of practice options. This is mainly because we can actually make good money in clinic. I have to scope 90% of my patients so all those visits get billed for a procedure.Every ear cleaning, sinus debridement, Botox injection - translate into more money in clinic. You can even do many surgical procedures on awake patients in your office while also seeing clinic patients. What this means for you is an ability to build whatever kind of practice you want. If you want to be in the OR 3-4 days a week you can do it. If you want a balance of both that’s fine too. If you’re getting older and want to cut back on effort and time but keep making great money, then that’s doable too. We’ve had a couple retired ENTs come back and just be non operating generalists who refer any surgical candidate to their younger partners.

3. ENT operates on the organs we used to interact with the world - hearing, speaking, singing, smelling, tasting, eating, swallowing, sleeping, breathing - that’s all our real estate. Obviously lots of overlap with other fields too. Many of these senses and systems may be looked on as non vital, but people definitely suffer when they’re gone. Restoring someone’s ability to speak or to hear or to eat a meal with their family or to get their first good night of sleep in years - we have some very grateful patients.

4. most of our patients are pretty healthy and our overall outcomes are very good. if you do head and neck cancer or complex airway you’ll have sicker patients - a third of my last clinic came in on stretchers- but most ENTs see patients who are generally pretty happy and healthy. Don’t underestimate the value of having procedures that work well. Saving a life only to have them go to a trach/peg vent farm is much less rewarding to me than restoring hearing or speaking or breathing.

 

[slowthai]

Agreed!

ENT is a much easier 5 years of residency
ENT has a much better lifestyle both during and after training
ENT makes a healthy amount more than GS ($450k+ vs $350k+) despite working less hours
ENT is (arguably) a more interesting organ system
ENT allows for a mix of surgery and clinic/procedures - more career flexibility

The only reason to do GS is if you truly have no idea what you want to do surgically and want to keep your options open for a fellowship, or you just find general surgery pathology fascinating.

Otherwise ENT > GS in every single aspect. There is a reason you need a 250+, AOA, and Research to match ENT and why you can easily match GS without any one of those things.

I agree with most of this, but as far as I know, ENT is pretty known for having one of the worst lifestyles during training, up there with ortho and plastics.

 

[rulerkk]

I agree with most of this, but as far as I know, ENT is pretty known for having one of the worst lifestyles during training, up there with ortho and plastics.

This definitely depends on the program but some ENT residencies are shifting to night float. 10 weeks out of residency will be rough 7pm to sign out shifts but all of your other weeks in the 5 years will be without call. Call is the number one responsibility that wears out our residents according to the ones I've spoken to, as well as faculty

 

[longhaul3]

I agree with most of this, but as far as I know, ENT is pretty known for having one of the worst lifestyles during training, up there with ortho and plastics.

There's one specialty that stands alone for the worst lifestyle during training...and it ain't ENT, ortho, or plastics.

ENT seems pretty cool if you can stand the ears, nose, and throat part. Not for me but the ENT residents I work with are cool and seem happy with their work and excited about what they do.

 

[slowthai]

There's one specialty that stands alone for the worst lifestyle during training...and it ain't ENT, ortho, or plastics.

ENT seems pretty cool if you can stand the ears, nose, and throat part. Not for me but the ENT residents I work with are cool and seem happy with their work and excited about what they do.

Yeah, we all know it's nsg, lol. I'm just saying that among the ones with the worst lifestyles besides nsg, it's pretty up there.

 

[Dr. Doctor MD]

I agree with most of this, but as far as I know, ENT is pretty known for having one of the worst lifestyles during training, up there with ortho and plastics.

Maybe that's just your specific program where ENT and Plastics have bad lifestyles throughout. From what I've seen PGY 1-2 are pretty intense for ENT (similar to most other surgical fields) PGY-3 is still busy, but PGY4-5 are very cush. I've seen the same pattern for integrated plastics. The last 2-3 years of training are not that bad (45-50 hours per week), minimal to no call, etc.

Again this may be institution specific, as I'm sure there are brutal ENT/Plastics programs that work hard all 5-6 years, but that hasn't been what I have seen. And at my institution the GS PGY-5s were working pretty much just as hard as the GS PGY-1s.

 

[Smurfette]

I thought I would like ENT but hated it as a student. Went into GS. Hated my ENT rotation again as a GS resident. As I joke with the OR staff, I don't like dealing with things leaking out of "entrance holes". That's all going in the wrong direction. So nosebleeds, respiratory secretions/sputum, snot, etc. gross me out. No thanks.

Academic general surgery and community general surgery (which is what the vast majority of people end up doing, only a small percentage of people stay in academics) are very different and your exposure as a student is generally only to academics. Most of the time if I get a student rotating with me, I get feedback like "wow, this is so much better and more enjoyable than at the academic center". They also are amazed at how much faster cases are when there aren't residents involved.

I do a large variety of case types although I have a huge breast practice. I like my breast practice but I love a good ex lap "what will I find and how can I fix it" case. I also like the weird and rare things that keep things interesting. There is a lot of problem solving intraoperatively, especially with cancers or emergency cases. This week, I did multiple appys, a colostomy reversal, mastectomy, a chole, an amp and an ex lap. This week was light on elective cases. The amp was unusual for me but the usual guy who does them was off, the patient needed it done, and I am capable. I don't do vascular. Among other things, I saw 5 new breast cancers, multiple elective bowel case referrals, and multiple gallbladder/various hernia types/lumps and bumps in the office this week. I do robotic, lap and open cases. I get called to help out other specialists, which is a double edged sword---it's great to be the specialist who they need to back them up, but it sucks to have to fix someone else's complication.

Given how everyone these days wants to do a fellowship and not take GS call when they finish, call pay and salaries are becoming increasingly competitive.

 

[Wordead]

I always find it incredibly amusing when general surgeons are like ew snot and then go spleunking through a perf'd bowel with poo just geysering everywhere.

 

[WinslowPringle]

General surgery is unique in the sense that things get WORSE after residency unlike virtually every other specialty. Terrible hours, terrible call, terrible pay considering hours worked, terrible culture. I'm going to get hate for this, but GS is what people settle for when they don't have the stats to match a subspecialty (unless they want a specific GS fellowship or really love the abdomen specifically for some baffling reason).

This is not necessarily true. Attending life after general surgery residency can be very customizable depending on what you want to do, your location, skill-set, and comfort level. I had multiple attendings that worked the hours they wanted with minimal call. Just about every attending was married with a stable family life, knew their kids, etc. General surgery outside of major academic centers can have much better work-life balance than many general surgery residents see before they graduate. And the culture is not uniformly terrible.

Residency for both will have long hours and stressful situations. You will have more 'life and death' conversations in general surgery. You will pick fewer noses in general surgery. (I'm not kidding - ENT rotation in medical school the residents were removing boogers endoscopically; granted, they called those snot-flakes 'crusts' but we all know they were literally picking strangers' noses.) You will do more DREs in general surgery though.....

ENT has much more clinic than general surgery - so much more clinic. Fewer deathly sick people as your primary responsibility. If you look at non-academic private practice, more likely to not have the 'big whacks' with ENT than general surgery. Both will allow you to find good compensation.

I thought @operaman 's write up was nice for ENT; the flip side for general surgery is:

1) incredible range of procedures - really, general surgery covers it all and opens pathways for you to do just about anything. GS does open, robotic, laparoscopic, endoscopic, microscopic, and endovascular surgeries. Also huge range of patient ages and presentations.
2) wide range of practice options - but also less clinic. And you can set up your clinic to be like long winded breast cancer discussions or all quick pre/post op visits, or tons of procedures (in-office biopsy, lumps n bumps, or flex sigs, etc.).
3) GS saves lives.
4) We have surgeries that work well, too.
5) You get exposed to a broad range of sub-specialties and can remain a generalist and do a ton, or sub-specialize if you want. Gives you time to further decide if something is your thing or not.