H&N and PEDs Question

[nacholibre]

---

Members don't see this ad.

As a MS2 I know that I am going to be able to get a lot more info about this in clinical years, but I am asking as I am trying to decide where to commit my time research-wise...

I love everything that I have seen so far of ENT (i.e. my research, shadowing and observing cases), but I definitely love H&N the most (I am very interested in cancer and complex surgeries)

As I think about pursuing ENT I am trying to decide if I am not able to be a strictly H&N guy in the end, if I will still be happy/satisfied with ENT.

So I wanted some input on the amount of H&N that general ENTs are able to do in a practice, and how much do you deal with cancer as a general ENT.

Also (sorry LONG I know), what is the scope of practice for peds ENTs (do they do many H&N cases)?

Thanks.

 

[OtoHNS]

As a MS2 I know that I am going to be able to get a lot more info about this in clinical years, but I am asking as I am trying to decide where to commit my time research-wise...

I love everything that I have seen so far of ENT (i.e. my research, shadowing and observing cases), but I definitely love H&N the most (I am very interested in cancer and complex surgeries)

As I think about pursuing ENT I am trying to decide if I am not able to be a strictly H&N guy in the end, if I will still be happy/satisfied with ENT.

So I wanted some input on the amount of H&N that general ENTs are able to do in a practice, and how much do you deal with cancer as a general ENT.

Also (sorry LONG I know), what is the scope of practice for peds ENTs (do they do many H&N cases)?

Thanks.

If you are more interested in H+N, you should probably pursue H+N research. In general, H+N and otology tend to have more "serious" research going on than the other subspecialties (exceptions exist of course), so that helps as well with strengthening your eventual residency application.

If you want to do a lot of H+N, you will likely end up in academics- this is where the large majority of cancer cases get treated now, especially cancer cases requiring big operations. H+N cancer is actually pretty rare, so unless you are in an academic center where every case from 100 miles in every direction is funneled, you're not going to see that many cases. Obviously, you can do whatever cases you want in private practice, but it really doesn't make economic sense to do big whacks, and it's a huge drain on your time without residents to round and help with postoperative care.

Peds ENT do not do much H+N, because 95% of H+N CA comes from years of smoking and drinking. Peds subspecialists do a lot of tubes/tonsils/adenoids, sinus cases, congenital anomalies, airway evaluation and reconstruction, sometimes ears. Basically anything in the head and neck of a kid is fair game.

 

[resxn]

So I wanted some input on the amount of H&N that general ENTs are able to do in a practice, and how much do you deal with cancer as a general ENT.

It's not unusual for me as a general ENT (who doesn't want H&N cancer in my practice with the exception of thyroid) to see at least 1 new cancer each week. I defer to the local ivory tower as it's hard to run a private practice where you try to cater to lucrative surgeries (peds, sinus, otology, laryngology) when you've got a 40pack year smoker coughing through his stoma next to a mom reading a book to her 4yo. Doesn't create a lot of repeat business.

Also (sorry LONG I know), what is the scope of practice for peds ENTs (do they do many H&N cases)?

Thanks.

Peds H&N consists mostly of congenital benign neck masses and airway stuff. Not a whole heck of a lot of serious neck dissection in peds. There is some. I removed a lymphangioma bigger than the kid's head on a 1 week old in residency. You'll see it, but Peds is not the place to get your H&N fix.

 

[nacholibre]

Thanks for the replies.
2 more questions:

1)What's it like being an established academic H&N ENT ? i.e. Lifestyle, types of cases outside of cancer, compensation, amount of time spent researching?

2)I understand that I am going to do end up doing a lot of tonsils and tubes, but I just really can't see myself enjoying them day in and day out. Does this mean ENT is not for me, do you feel like you do enough other cases to make dilute tonsils and tubes?

 

[resxn]

Thanks for the replies.
2 more questions:

1)What's it like being an established academic H&N ENT ? i.e. Lifestyle, types of cases outside of cancer, compensation, amount of time spent researching?

2)I understand that I am going to do end up doing a lot of tonsils and tubes, but I just really can't see myself enjoying them day in and day out. Does this mean ENT is not for me, do you feel like you do enough other cases to make dilute tonsils and tubes?

Can't answer #1, because I'm not one of them, and too far from residency to answer effectively because things change and because it's different from institution to institution depending on pt volume, resident help, and if you do your own reconstruction or not.

As far as #2, I can't do enough tubes and tonsils. They are such a refreshing change from more high pressure, low reimbursement cases, that it's a pleasure knowing I'm doing a case with a high satisfaction rate, good reimburesment, and low risk. I do enough FESS, thyroid, parathyroid, OSA, parotid, septo/turbs, etc that it's relaxing to do the bread and butter when I can.

 

[OtoHNS]

Thanks for the replies.
2 more questions:

1)What's it like being an established academic H&N ENT ? i.e. Lifestyle, types of cases outside of cancer, compensation, amount of time spent researching?

2)I understand that I am going to do end up doing a lot of tonsils and tubes, but I just really can't see myself enjoying them day in and day out. Does this mean ENT is not for me, do you feel like you do enough other cases to make dilute tonsils and tubes?

1. These are all somewhat variable depending on what particular institution you are at. Generally you'd work more hours than an average ENT academic attending, but people who go into H+N tend to be self-selecting workaholics. Most academic H+N people I've seen do some general ENT as well, typically sinus, voice, and/or sleep apnea. Compensation probably low $200s starting, high $200s to low $300s once tenured. Research time would depend on your own goals as well as other factors like size of the department (huge department = more potential research time).

2. I'm in private practice and do plenty of tubes and T+As, but I do plenty of other stuff as well. While you may think these cases are less "important" or exciting than cancer cases, they do make a huge impact on the patients and their families, who are generally very grateful for your efforts. The kids are usually cute and fun as well and make a nice break between the crazy adult dizzy, reflux, and non-sinus "sinus" patients. I also enjoy doing pretty much any surgery, including the bread and butter stuff.