Head & Neck Fellowship for General Surgeons

[TIGER STYLE]

There are a few of them around. Does anyone know if Cleft lip/Palate repair is a part of this fellowship training? Also, how competitive are these fellowships? I don't think all the spots were filled last year. Any other info. would be greatly appreciated. Thank you.

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[doc05]

No, it's not. Moreover, general surgery graduates aren't particularly qualified for H/N fellowships since most programs provide very little head and neck exposure during residency.

 

[TIGER STYLE]

No, it's not. Moreover, general surgery graduates aren't particularly qualified for H/N fellowships since most programs provide very little head and neck exposure during residency.

Thanks Doc05 for the info. One of the surgery residents at my program told me that he was interested in Head and Neck fellowship, and I've never heard of it as a general surgery fellowship, so I thought I'd inquire on this forum. Thanks again...

 

[TheThroat]

"Head and Neck surgery" fellowships really are head and neck cancer fellowships where you learn how to manage complicated cancers. The best ones also teach microvascular reconstruction, becase many residencies prepare residents how to perform the ablative surgeries.

I can't imagine that G-surg trained residents would be well-prepared to enter the field. Iowa's g-surg program certainly doesn't.

The field is not competitive and many spots go unfilled every year, likely because of the challenges that head and neck cancer presents: sick patients, most of whom have smoked all their lives, have a cancer that will likely (not always) kill them. You try to take it out with a usually long and meticulous surgery that doesn't pay that well. Then about a quarter of those patients have some sort of post-op complication. Get the picture?

That said, one of my buddies loves Head and Neck and is doing a fellowship next year. It takes all kinds...

 

[Radpimp]

Head and neck oncologic surgery fellowships are available for general surgeons and plastic surgeons to apply for. Check out

http://www.headandneckcancer.org/residentfellow/programs.php

There was a general surgeon last year at MD Anderson doing a head and neck oncologic surgery fellowship. They are not hard to obtain as Head and Neck cancer surgery is not lucrative and the because of the challenges mentioned in the above post. However, the general/plastic surgery candidate will not be trained on other aspects of Otolaryngology-Head and Neck surgery such as sinus, otology-neurotology-skullbase, laryngology, and allergy.

 

[Leukocyte]

Are these fellowships accredited by the ACGME?...A.K.A are they legit?

 

[flashman]

At my institution I work with a head and neck surgeon, and I think that he serves as a good example of a general surgeon's role in HN surgery. He trained in GS then surg onc then HN. In his practice he performs most of the thyroids, parathyroids and HN cancer cases in this mid-sized town. So I guess you might see him as someone who used this as a way to, slightly, spread out his domain with the fellowship. Especially since he did thyroids and parathyroids in all three of his training periods. What does his background add to his practice? I think that his training in GS and surg onc means that he likes the challenge of big cases and sick patients: this is a guy who does huge 10 hour cases, so he doesn't shy away from a large HN case. At least in this community the ENTs seem to focus on quick outpatient cases, with larger stuff going to the aforementioned surgeon or to a larger academic center. It makes sense for someone who does a large number of thyroids to have advanced HN experience; he is prepared to do a radical neck for any case.


flashman

 

[TheThroat]

Are these fellowships accredited by the ACGME?...A.K.A are they legit?

In a word, no. In reality, almost all fellowship-trained HN surgeons work at academic centers. It is such a small field that all the staff at the academic centers know of each other and know whether the training is "legit."

Many post-oto fellowships are not accredited. Right now, only Neuro-oto is moving to accreditation. Laryngology fellowships, rhinology fellowships, head and neck fellowships are all "unaccredited."

As far as g-surgeons doing HN, there may be examples, but they are few and far between. I'm not saying that they can't. Just saying that its not that common.

 

[TheThroat]

Head and neck oncologic surgery fellowships are available for general surgeons and plastic surgeons to apply for. Check out

http://www.headandneckcancer.org/residentfellow/programs.php

There was a general surgeon last year at MD Anderson doing a head and neck oncologic surgery fellowship. They are not hard to obtain as Head and Neck cancer surgery is not lucrative and the because of the challenges mentioned in the above post. However, the general/plastic surgery candidate will not be trained on other aspects of Otolaryngology-Head and Neck surgery such as sinus, otology-neurotology-skullbase, laryngology, and allergy.

Actually, many HN fellowships do get some anterior skullbase work. One of the premier skullbase surgeons (Paul Donald) has a HN fellow out of UC-Davis.

 

[droliver]

I think you need to distinguish what we're lumping in as head and neck CA. Thyroid, parathyroid surgery, melanoma, basal cell,SCC, and even Parotid surgery (to a dwindling degree) are pretty mainstream general surgery. Floor of mouth, skull base, acoustic neuroma, sinus, and tonsillar CA would be more ENT exclusive.

There are a # of fellowships that you can do in head & neck CA still after General Surgery, but increasingly this is more under the umbrella of Endocrine Surgery fellowships focusing on thyroid/parathyroid dz.

 

[TheThroat]

I think you need to distinguish what we're lumping in as head and neck CA. Thyroid, parathyroid surgery, melanoma, basal cell,SCC, and even Parotid surgery (to a dwindling degree) are pretty mainstream general surgery. Floor of mouth, skull base, acoustic neuroma, sinus, and tonsillar CA would be more ENT exclusive.

There are a # of fellowships that you can do in head & neck CA still after General Surgery, but increasingly this is more under the umbrella of Endocrine Surgery fellowships focusing on thyroid/parathyroid dz.

Obviously things differ from institution to institution, but where I am at, g-surg has a thy/pth guy. Other than that, oto does pretty much all the melanoma, skin bcc and scc, and parotid stuff. Of course, the upper aerodigeestive tract malignancies went our way, until you got to the esophagus. we do plenty of thyroid as well, but not as much parathy as I would like.

 

[toofache32]

Obviously things differ from institution to institution, but where I am at, g-surg has a thy/pth guy. Other than that, oto does pretty much all the melanoma, skin bcc and scc, and parotid stuff. Of course, the upper aerodigeestive tract malignancies went our way, until you got to the esophagus. we do plenty of thyroid as well, but not as much parathy as I would like.

This is how it is at my institution as well. Gen Surg has an endocrine guy that does a lot of thyroids, but ENT does the vast majority of the other malignancies. I've never heard of a general surgeon working above the thyroid except maybe tying off a bleeder in the trauma bay. One of my buddies is finishing his chief year in general surgery to do plastics next year. He is borrowing some of my face texts right now because he has never done more than a few trachs and thyroids above the clavicles. But I guess it depends on where you are and who else is there.

 

[Celiac Plexus]

One of my buddies is finishing his chief year in general surgery to do plastics next year. He is borrowing some of my face texts right now because he has never done more than a few trachs and thyroids above the clavicles.

Wow. I'm in my 3rd year of gs residency and I've done about a dozen trachs in the last 6 weeks. Half of those were at the bedside in the ICU. Also I've done 2 thyroids, and 2 parathyroids in a 4 week period earlier this year. My experience isn't uncommon either. Some of the fours have done >50 trachs. The ENT residents do a lot of trachs as well, and do a lot more thyroid and parathyroid than we do for sure, but at my program there are more than enough trachs for everyone, and there are enough thyroids so that most gs residents get about 10 or so in their 3rd year, and another 10 or so in their chief year. There is the potential for more thyroids if one is interested. Parathyroid numbers are slightly lower. We get these cases on our surg onc rotations, and during our months in the ICU (trachs).

 

[toofache32]

Wow. I'm in my 3rd year of gs residency and I've done about a dozen trachs in the last 6 weeks. Half of those were at the bedside in the ICU. Also I've done 2 thyroids, and 2 parathyroids in a 4 week period earlier this year. My experience isn't uncommon either. Some of the fours have done >50 trachs. The ENT residents do a lot of trachs as well, and do a lot more thyroid and parathyroid than we do for sure, but at my program there are more than enough trachs for everyone, and there are enough thyroids so that most gs residents get about 10 or so in their 3rd year, and another 10 or so in their chief year. There is the potential for more thyroids if one is interested. Parathyroid numbers are slightly lower. We get these cases on our surg onc rotations, and during our months in the ICU (trachs).

I guess that's what I mean. I hardly consider trachs a big deal, even though thryoids/parathyroids are more involved. But these are still nothing compared to the big Head & Neck composite resections. I find it interesting that a general surgeon would be performing such an involved and complicated surgery in a region where they have less experience than people who spend their entire residency there.

 

[TheThroat]

I guess that's what I mean. I hardly consider trachs a big deal, even though thryoids/parathyroids are more involved. But these are still nothing compared to the big Head & Neck composite resections. I find it interesting that a general surgeon would be performing such an involved and complicated surgery in a region where they have less experience than people who spend their entire residency there.

Doing a trach and doing one of these surgeries is not the same:

-total laryngectomy and bilateral modified radical neck dissection
-composite resection of the jaw and tongue with neck dissection and fibula free flap recon
-mastoidectomy parotidectomy and lateral temporal bone resection with latissimus free flap recon
-maxillectomy
-excision of melanoma, parotidectomy, and cervicofacial advancement-rotation flap
-craniofacial resection of sinonasal scca

I agree that g-surgeons should learn how to do trachs and the like, but if they are doing any of the above, then they are at a fantastic g-surg program.