Please Help. Feeling conflicted

[FellowPaisan]

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So I have been a long time poster on sdn but had to make a new profile because my username wasn't anonymous so here I am.

I am a third year USMD student. I scored a 243 on step 1 which I guess is decent. I will probably score similarly on step 2. Can't tell yet. I don't have my third year grades because we have a really odd curriculum that isn't worth going over so I don't know what they will be yet.

For the longest time I planned on applying to urology because I am doing research and have multiple things in the works and will prob end up with 1-3 publications to apply as well as a presentation. Also have some related research from undergrad. I also think I have pretty good connections in the department. However, I am unsettled and don't know if it is really for me. I like the GU system alot- always have. I like BPH, stones, and the robotic aspects of it. Really not sure about cystoscopy and some of the bread and butter stuff. But recently I have been thinking about ENT a lot. Yes both are very competitive fields but they are quite similar in the medicine and surgery ties ins while having life outside of the OR. This was after multiple people suggested that I would be a good fit for it. They said it attracts nice guys that are smart (no brag intended lol). Now yes I know my score is below average but its something I am still flirting with. I love the interdisciplinary parts of the field and I find the cases pretty cool and there is a nice diversity of things and pathology. Being able to do neuro-oto or facial plastics is really sweet too. I am pretty conflicted overall. It is really hard with uro being an early match to even entertain these things but I am wondering should I just shut this new love down.

I hate that one has to know so early for these fields when third year you are just really being introduced to them. 😕 Either way thanks!

 

[bannie22]

I think your stats are about average but you would be a stronger Uro applicant just given your background. ENT is probably the easier match given how they went 11 programs unmatched this cycle though.
Getting some shadowing done if you cant do a real rotation should do the trick.

 

[OnePunchBiopsy]

I think you're a good applicant (on paper) for both uro or ENT. Do an ENT rotation early in 4th year. If you love it, you could maybe squeeze 2 letters out of it and could still apply.

 

[yoyoni]

For what advice from an incoming M1 is worth, if I were feeling unsettled about the bread and butter cases (a red flag to me), I would get some experience/exposure (through speaking with upperclassmen friends about this decision making process and asking about ENT attendings that are great mentors, asking to shadow and shadowing an ENT attending, in that order) to ENT ASAP and make a decision one way or the other. This is not a small decision, and you don't want to have any "what ifs" down the line. Get the exposure, compare the two, and only then make a decision. Best wishes!

Edit: I wouldn't worry about the stats quite yet.

1) If you end up sticking with Uro, they won't be a problem.
2) If you end up deciding on ENT, snag a 4th year rotation, etc. and you'll make it work.

Do what you love, not what is easiest.

 

[Lexicon0]

My 2 cents having just gone through the process myself:

From an application standpoint I think you're solid (right at average per NRMP charting outcomes for research and Step 1), however as you mentioned yourself, switching into ENT at this point will put you at a disadvantage moving forward, particularly the lack of exposure to your home ENT department and ENT research. If you do decide to move forward I foresee two options:

1. Do an additional year of research with your home department - Be productive, publish ENT-specific research, get to know faculty. This will be helpful in obtaining LORs (which are HUGE when it comes to ENT and I think underrated in the application process) and will give you a solid 'in' with your home program for the match

2. Apply this year - Get to know your home department more over the coming months (getting in the OR, picking up small clinical research project(s), attending grand rounds). Start connecting with faculty and be on the lookout for potential LOR writers. Meet with your home PD and realistically assess your application and chances of matching. Start looking into away rotations ASAP (get the VSAS ball rolling in terms of completing applications, immunizations, etc as it takes quite a bit of time) as this will be a potential source of LORs as well.

Option 1 would be the safe bet, Option 2 is also feasible, but will require some careful planning on your part.

I would also be wary of deeming ENT as trending less competitive because of the 11 unfilled spots this application cycle. There were a lot of external factors (program-specific paragraph requirement instituted last cycle, automated telephone interview instituted this cycle) that could have made this year an anomaly.

Feel free to PM me if you have any further questions.

 

[cbrons]

I don't have any advice on selecting one or the other, but I feel a need to point this out:

They said it attracts nice guys that are smart.

This is a completely worthless assessment of the field of ENT and you should put absolutely 0 stock into it.

 

[FellowPaisan]

I don't have any advice on selecting one or the other, but I feel a need to point this out:


This is a completely worthless assessment of the field of ENT and you should put absolutely 0 stock into it.

agreed. it was just the catalyst for me to go check it out. good and bad people in all fields.

 

[Stagg737]

I think the real question you need to ask yourself is how much do you like d*** jokes...

 

[FellowPaisan]

I think the real question you need to ask yourself is how much do you like d*** jokes...

I am definitely always in the mood for a good d*** joke

 

[HooliganSnail]

ENT is a very solid specialty. I have often thought that if I didn't do ER, I would do ENT.

There is not a medical version in your specialty, you are both the surgeon and the medical doc (unlike ortho and PM/R, Uro./Nephro, Neuro/Nerusurg) that kind of thing. The result is that your practice is a nice mix of office and surgery. Plus your patient always seem to love you, you always get to save the damn day. And you have some cool toys.

There are very few ENT emergencies (posterior epistaxis, Upper airway obstruction) is about it, maybe a really nasty complicated facial laceration, and fortunately they are not everyday occurrences, that means most of your consults can wait until the morning or follow up in the office. This is very important when you are an attending, because you don't want to be getting called into the ER all night.

 

[Donald Juan]

Like others have said, both fields are similar in pay, lifestyle, surg/medicine mix. Both seem to attract people who like surgery but are more laid back than the general surgeons.

It really comes down to are you ok with handling balls all day.

 

[FellowPaisan]

Like others have said, both fields are similar in pay, lifestyle, surg/medicine mix. Both seem to attract people who like surgery but are more laid back than the general surgeons.

It really comes down to are you ok with handling balls all day.

My dad seems to think urology is more stable overall and has less risky surgeries. He seems to think that every urologist is very rich. But facial surgeries and the cerebral nature of ENT is incredibly appealing.

What is stressing me out is the need to have away scheduled for one rotation while having thoughts about the other. I wish I could see how another urology dept works while at the same time doing a subI in ENT and then choosing accordingly. Unfortunately that's not how it works today.

 

[cbrons]

They said it attracts nice guys that are smart.

I love the interdisciplinary parts of the field and I find the cases pretty cool and there is a nice diversity of things and pathology.

the cerebral nature of ENT is incredibly appealing.

My dad seems to think urology is more stable overall and has less risky surgeries.

I think you have no understanding of what the actual practice of otolaryngology is about aside from what people who also have no understanding have told you.

"Cerebral nature"? "Interdisciplinary parts"? "Attracts nice guys that are smart?" These are some of the things that a clueless 14-year old high school pre-med would say. They don't mean anything. Neurology is "cerebral" (literally and figuratively), so is radiology and pathology (and every other specialty). Every field has "nice" guys and jerks in it. I think the fact that you've never actually rotated on an ENT service or even probably spoken to an actual ENT has really caused you to romanticize the specialty. The truth about ENT and pretty much every other specialty is that it is very nuanced, and things that "sound cool" are decidedly very uncool in actual practice. Vice versa for some other things. It is all relative and individualized. Don't go based off what other medical students with no experience tell you.

At any rate, you can also seek out actual head and neck surgeons directly on this board, e.g. @neutropeniaboy @VisionaryTics

 

[FellowPaisan]

I think you have no understanding of what the actual practice of otolaryngology is about aside from what people who also have no understanding have told you.

"Cerebral nature"? "Interdisciplinary parts"? "Attracts nice guys that are smart?" These are some of the things that a clueless 14-year old high school pre-med would say. They don't mean anything. Neurology is "cerebral" (literally and figuratively), so is radiology and pathology (and every other specialty). Every field has "nice" guys and jerks in it. I think the fact that you've never actually rotated on an ENT service or even probably spoken to an actual ENT has really caused you to romanticize the specialty. The truth about ENT and pretty much every other specialty is that it is very nuanced, and things that "sound cool" are decidedly very uncool in actual practice.

At any rate, you can also seek out actual head and neck surgeons directly on this board, e.g. @neutropeniaboy @VisionaryTics

WRONG!
I am not looking to argue. I can write and specify far more then you are implying I know about the field but I don't know where that would get us. ENT has a well developed reputation for being nice while being incredibly intelligent (you can't talk about the different types of brachial cleft cysts or think out how one can dissect out a large facial mass that will be the least disfiguring if you weren't). Yes these are generalizations and stereotypes but as I am sure you are aware they didn't evolve out of thin air. I am quite well informed about the field this post was never about that it was about gauging a decision I am struggling with and trying to find perspective. I also have spent time in ENT surgeries and I have liked it lot. I didn't come out of thin air thinking "oh wow I should do this." This is an enormous decision that will influence your whole life is it that surprising that I take opinions from a variety of people and relay that with my own experiences. As you said, actual practice is quite different, hell even residency is quite different than watching and observing. You can't know how a field is and how you would feel about it until you were doing it really. I have done things in the past that were boring or not as interesting to watch but taking the role is a transformative experience.

The difficulty with everything is the current residency match system is unbelievably competitive and leads one to really have to know early on before they can have a better feel about how they would feel about the field long term. I don't know how you can knock me for gathering as much information as possible. Sorry if I didn't put everything in writing one way or another.

 

[cbrons]

WRONG!

Lol. Kids these days.

Sent from my SM-N910P using SDN mobile

 

[AcademicNeurosurgery]

Lol. Kids these days.

Sent from my SM-N910P using SDN mobile

Why the hostility regarding his generalizations? While there are exceptions to every generalization, many specialties definitely have unique vibes. This is particular true for surgical sub-specialties and seeing who you like hanging around can be important in terms of career satisfaction.

 

[FellowPaisan]

Why the hostility regarding his generalizations? While there are exceptions to every generalization, many specialties definitely have unique vibes. This is particular true for surgical sub-specialties and seeing who you like hanging around can be important in terms of career satisfaction.

Spot On

 

[neutropeniaboy]

Well, I was just alerted to this post and read through it with some amusement. I don't know what kind of resident Lev0phed is, but his general assessment of things (at least in this thread) seems "spot on" (if I may use the term du jour). I don't find much of what I do "cerebral." It's pretty straight forward. It may be cerebral to you, but that's because most students don't know anything about ENT. Once you actually train and learn the field, it's mundane. I'm sad to say that a good percentage of my day is spent telling old ladies that their dizziness is from their diabetes, previous stroke, etc. and not from some grand old acoustic. I'd love for it to be an acoustic, but it's not. It's not even Meniere's disease. If I'm lucky it's BPPV and I can shake them around a bit and a week later get a bottle of wine for curing their life long dizziness. I watch my head and neck colleagues and their PAs run around 2 hours behind in clinic trying to wipe up saliva oozing from fistulas or wiping up mucus on the walls from trachs. Those grand old head and neck whacks are being swallowed by the radonc people, and when they do come our way, I hear that many of them are "unresectable." The laryngologists are hoping the next voice complaint is some local artist instead of a 50 year old 30 pack-year smoker who has Reinke's edema. The rhinologists never stop complaining about how every other patient coming in for sinusitis has either migraines or reflux, sometimes both, but never sinusitis. 90% of ENT sucks. 90% of it is garbage a primary care doctor doesn't want to treat and refers. If it's not that, it's something an NP doesn't know how to diagnose and refers. Every once in a blue moon we take off someone's face and brain and put it back together and have a group hug while high fiving each other. While most of us are nice good looking guys, there are certainly ugly mean and detached people in the field. It attracts smart people, but also people who have no common sense. There are lazy people. There are technically incompetent people. There are truly great people, but there are plenty of average people. I'm hoping to be great, but I didn't go into the field to stay average. I certainly didn't go into the field because it was "cerebral," "interdisciplinary," or because it attracted nice smart people. I went into the field actually because I liked ear disease and I actually was decent under the microscope. I loved head and neck anatomy, but I had the common sense not to talk about the "amazing and intricate anatomy that my ENT attendings skillfully and artfully dissect on a daily basis."

Some days I wonder if something else would have been better, but I know for sure most of the others would have been worse (for me). In the end, I love neurotology. The 10% that's great makes up for the 90% that sucks. My patients do well, and they thank me for what I do. I sell ENT because when we can treat medically and surgically, we can make a big difference for everyday common problems that affect quality of life. That, and I like teaching -- the right way of doing things.

Go into a field for those things, not because of stereotypes.

 

[TMP-SMX]

Grass is always greener. Every specialty has its drawbacks. OP just talk to as many people in practice as possible and get as much experience on your electives as possible to make that decision.

 

[AcademicNeurosurgery]

Well, I was just alerted to this post and read through it with some amusement. I don't know what kind of resident Lev0phed is, but his general assessment of things (at least in this thread) seems "spot on" (if I may use the term du jour). I don't find much of what I do "cerebral." It's pretty straight forward. It may be cerebral to you, but that's because most students don't know anything about ENT. Once you actually train and learn the field, it's mundane. I'm sad to say that a good percentage of my day is spent telling old ladies that their dizziness is from their diabetes, previous stroke, etc. and not from some grand old acoustic. I'd love for it to be an acoustic, but it's not. It's not even Meniere's disease. If I'm lucky it's BPPV and I can shake them around a bit and a week later get a bottle of wine for curing their life long dizziness. I watch my head and neck colleagues and their PAs run around 2 hours behind in clinic trying to wipe up saliva oozing from fistulas or wiping up mucus on the walls from trachs. Those grand old head and neck whacks are being swallowed by the radonc people, and when they do come our way, I hear that many of them are "unresectable." The laryngologists are hoping the next voice complaint is some local artist instead of a 50 year old 30 pack-year smoker who has Reinke's edema. The rhinologists never stop complaining about how every other patient coming in for sinusitis has either migraines or reflux, sometimes both, but never sinusitis. 90% of ENT sucks. 90% of it is garbage a primary care doctor doesn't want to treat and refers. If it's not that, it's something an NP doesn't know how to diagnose and refers. Every once in a blue moon we take off someone's face and brain and put it back together and have a group hug while high fiving each other. While most of us are nice good looking guys, there are certainly ugly mean and detached people in the field. It attracts smart people, but also people who have no common sense. There are lazy people. There are technically incompetent people. There are truly great people, but there are plenty of average people. I'm hoping to be great, but I didn't go into the field to stay average. I certainly didn't go into the field because it was "cerebral," "interdisciplinary," or because it attracted nice smart people. I went into the field actually because I liked ear disease and I actually was decent under the microscope. I loved head and neck anatomy, but I had the common sense not to talk about the "amazing and intricate anatomy that my ENT attendings skillfully and artfully dissect on a daily basis."

Some days I wonder if something else would have been better, but I know for sure most of the others would have been worse (for me). In the end, I love neurotology. The 10% that's great makes up for the 90% that sucks. My patients do well, and they thank me for what I do. I sell ENT because when we can treat medically and surgically, we can make a big difference for everyday common problems that affect quality of life. That, and I like teaching -- the right way of doing things.

Go into a field for those things, not because of stereotypes.

What? You argue at the end to not use stereotypes after stereotyping each ENT subspecialty...

 

[FellowPaisan]

Honestly, I would prob do facial plastics when I am done.

 

[neutropeniaboy]

What? You argue at the end to not use stereotypes after stereotyping each ENT subspecialty...

Obviously you missed the point. But...I feel perfectly entitled to stereotype my own specialty since I've been in the thick of it for a while. What's your profession? Neurosurgery?