Seeking early residency planning advice

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mdhopeful99

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I am heading into my M2 year and I am still undecided in terms of what kind of physician I want to be. I know I still have rotations ahead of me, which will be enlightening, but there are also some things I am quite certain of that will help guide my planning and (hopefully) feedback from fellow SDNers. Further, with how competitive certain residency programs are becoming, I figure the more planning I do now, the better.

Some quick things about me: I'm currently attending a decidedly strong mid-tier program w/ an academic teaching hospital. My first year went very well, although my school is P/F and unranked, I've averaged 95% and above in all of my M1 courses (in house exams). While I have plenty ahead of me, I only bring this up to convey that I currently feel like it isn't completely unreasonable for me to hope to match into a competitive residency program. I've become involved in multiple leadership roles in different student orgs. I've also authored (1st and 2nd author) a couple of case reports. I am currently working on a substantial research project (CT Surgery) that I will be first author on, and in addition to local/regional presentations, hope to publish them in scientific journals.

As far as my likes and dislikes thus far:
- I am quite certain I want to be some type of surgeon. I cannot envision a future without the OR (I've spent dozens, if not hundreds, of hours in the OR as a pre-med and during M1 year, including scrubbing in, so I feel as though I have enough exposure to make this statement). I love using my hands to fix things and I like seeing tangible/immediate results. A future fully in clinic does not appeal to me as much.
- There are also aspects of traditional medicine that I enjoy. I like the mystery/problem solving of diagnosing patients, I like continuity of care and connecting with patients (within reason - i don't need to know a patient for decades, but the idea of operating on a patient and never seeing them again doesn't entirely sit right with me), I also like the idea of having knowledge of medications, diagnoses, and interventions commonly encountered in hospital medicine.
- My ability to feel fulfilled and know I am making a significant difference in patients lives matters most to me.
- Length of training is something I want to remain aware of. I am a non-traditional student and a few years older than most of my peers, but I would gladly spend a couple more years in training if it means spending my life doing something I'm passionate about.
- With the nature of my research I have grown increasingly interested in CT, but I am also weighing length of training, work-life balance, etc. (Any feedback about CT and how it aligns with what I've shared?)
- With my admittedly limited exposure, a few last minute thoughts. I don't like the idea of operating or specializing on eyes so I'm not very interested in Ophtho. ENT has some potential but I am not sure the bread and butter cases are really up my alley. I have the same concern about plastics in terms of their bread and butter cases (have little to no interest in being any type of cosmetic surgeon either). For reasons that are a little challenging to describe, I haven't loved ortho thus far, perhaps it doesn't have as much of the "traditional medicine" that I seek. Trauma surgery seems to miss the continuity of care I'm looking for. Gen surg without specialization doesn't tickle my fancy (not sure I want to spend the rest of my life repairing hernias and removing gall bladders). I also don't think urology is for me.

I know I've ruled out a lot of areas with little explanation above. Some of what I've ruled out could changed with more exposure so I'm not shutting the door on anything. Ultimately, I am hoping to get some advice on which surgical specialties might seem best suited for me considering my interests and preferences. I recognize I have time to figure it out, but knowing I want to pursue a surgical specialty means I'd like to do everything in my power to set myself up for success. With that being said, if there are any suggestions in terms of CV building, networking, research, etc. that anyone thinks I should be doing I am all ears!

Thanks everyone!

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You're still early, your 3rd year will help you figure it out
 
I think ENT may hit more of your wants than you think. We definitely have that longitudinal care aspect. We do quite a bit of medical diagnosis and management too.

There’s a lot of variety beyond the bread and butter. It’s not all just tubes and tonsils. Lots of head and neck big cases, complex airway recon, anterior and lateral skull base, plus even the bread and butter can be fairly broad. It really depends on how you want to build your practice. It might be worth spending a little more time around the department and getting a sense of how broad the field can be.

Beyond that residency is a pretty standard 5 year surgical one. Job options are endless and we’ve done a good job and reigning in supply of docs so job market seems solid.

Work life balance is pretty awesome too. Most of our patients are healthy and many of our procedures are same day or just one night obs, so usually not a lot of inpatients unless you end up doing lots of big head and neck cases. But either way, it’s totally up to you how you want to build your practice.

For me I do 3 clinic days, 1-2 OR days per week. Rarely do I have any inpatients unless I do a bigger case or am on call. My H&N partners do 1 clinic day and 4 OR days and always have an inpatient census. All of us tend to be out the door before 5pm most days.

All in all, I think it’s a great field with lots of flexibility.
 
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Breast surgery doesn’t have mysteries, but it does have closer patient relationships, technical challenges, and the ability to have a significant impact on the lives of patients.
 
I think ENT may hit more of your wants than you think. We definitely have that longitudinal care aspect. We do quite a bit of medical diagnosis and management too.

There’s a lot of variety beyond the bread and butter. It’s not all just tubes and tonsils. Lots of head and neck big cases, complex airway recon, anterior and lateral skull base, plus even the bread and butter can be fairly broad. It really depends on how you want to build your practice. It might be worth spending a little more time around the department and getting a sense of how broad the field can be.

Beyond that residency is a pretty standard 5 year surgical one. Job options are endless and we’ve done a good job and reigning in supply of docs so job market seems solid.

Work life balance is pretty awesome too. Most of our patients are healthy and many of our procedures are same day or just one night obs, so usually not a lot of inpatients unless you end up doing lots of big head and neck cases. But either way, it’s totally up to you how you want to build your practice.

For me I do 3 clinic days, 1-2 OR days per week. Rarely do I have any inpatients unless I do a bigger case or am on call. My H&N partners do 1 clinic day and 4 OR days and always have an inpatient census. All of us tend to be out the door before 5pm most days.

All in all, I think it’s a great field with lots of flexibility.
I appreciate the response. Do you mind if I ask how your role helps you feel fulfilled and like youve made a meaningful impact on your patients lives? A broad question I know, but as you mentioned if I were confined to bread and butter tonsils and tubes cases I don't think I would be able to get the sense that I'm having a massive impact on my patients lives, at least in the way that I want. For me, there is a lot more appeal regarding the larger head and neck cases. Wondering how you feel about this.

Also, not sure how familiar/connected you are to current residency placement in ENT but I hear it is only getting more competitive. I worry that with ENT (and plastics for that matter) that if I don't get some research in the area, I may hurt my chances of matching, especially into the more competitive programs. Do you have any insight here?

Thanks again for the thoughtful response!
 
I appreciate the response. Do you mind if I ask how your role helps you feel fulfilled and like youve made a meaningful impact on your patients lives? A broad question I know, but as you mentioned if I were confined to bread and butter tonsils and tubes cases I don't think I would be able to get the sense that I'm having a massive impact on my patients lives, at least in the way that I want. For me, there is a lot more appeal regarding the larger head and neck cases. Wondering how you feel about this.

Also, not sure how familiar/connected you are to current residency placement in ENT but I hear it is only getting more competitive. I worry that with ENT (and plastics for that matter) that if I don't get some research in the area, I may hurt my chances of matching, especially into the more competitive programs. Do you have any insight here?

Thanks again for the thoughtful response!
Sure! Excellent question. ENT is blessed in that many/most of our operations are extremely effective. So even the bread and butter tonsil can be life changing for the child with sleep apnea or the adult who gets strep every 6 weeks for years. Even take ear tubes - I always say one of the hardest conversations is with a young family getting ear tubes for their first child. The easiest: same family, second child. The difference it makes is huge. So even in the bread and butter you have extremely happy patients even if the issues weren’t acutely life and death.

In my practice, I do a lot of complex airway work so people who can’t breathe and have all the limitations that come with that, and then post op they tell me how they’re climbing mountains again and playing with their kids and enjoying life. I don’t as much bug head and neck stuff because I have fellowship trained partners who do a ton, but many docs do and obviously those patients are extremely grateful. I see a lot of these patients and make the initial diagnosis and get them plugged in with my head and neck partners. For me I do a lot of early glottic cancer work and can cure people surgically while preserving voice and swallowing and sparing them radiation. I do a lot of benign voice work too and those patients go from being unable to speak and literally singing on the OR table sometimes - pretty darn cool in my book.

I’ve done sinus work for chefs who lost their sense of smell and taste and were able to get it back. I’ve done ear surgery that gives people back their hearing. I guess I do a lot of work on senses which you don’t always think of as big impact until you’ve lost one of them. I don’t do much facial plastics but there’s huge opportunity for impact there too, especially if you get into the big reconstructive work.

Residency placement is definitely tough but sounds like you’re so far performing at a very high level. You’ll definitely want to get involved with research and start getting to know you’re department but it’s still pretty early for you so there’s plenty of time to put together a competitive application.
 
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Find my AMA on Surgical Oncology. Might be very useful for you. General surgery has many very, very good options that gives you more time to sort this out. Length of training realistically is not going to be *that* different between a gen surg+fellowship and an ENT or i6 CT program. People do fellowships out of those too, frequently, so it’s all sort of a wash.
 
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Find my AMA on Surgical Oncology. Might be very useful for you. General surgery has many very, very good options that gives you more time to sort this out. Length of training realistically is not going to be *that* different between a gen surg+fellowship and an ENT or i6 CT program. People do fellowships out of those too, frequently, so it’s all sort of a wash.
Thanks, I read through your AMA and it certainly provided a lot of insight. Was wondering if you had any nuggets or words of advice when considering the length of training, work-life balance, and compensation debacle. I'd be lying if I said money isn't a factor I am considering, but it's not the only factor for me and feeling fulfilled/making a difference carries more weight. I'm also hoping to have a family of my own and would ideally begin that phase of my life in the next several years, so these are also things bouncing around in my mind.
 
Thanks, I read through your AMA and it certainly provided a lot of insight. Was wondering if you had any nuggets or words of advice when considering the length of training, work-life balance, and compensation debacle. I'd be lying if I said money isn't a factor I am considering, but it's not the only factor for me and feeling fulfilled/making a difference carries more weight. I'm also hoping to have a family of my own and would ideally begin that phase of my life in the next several years, so these are also things bouncing around in my mind.
I think gen surg is mild to moderately more equipped to be supportive of having children in residency over the surgical sub simply because most programs have 4-6 residents per year +/- research years built in which creates a useful redundancy that the subs don’t always have. This is not universally true but is a generalization that mostly holds.

As long as you don’t do academic practice every road out of general surgery will likely pay you over 500k/yr once you are established, about 5 years in, if you are on productivity and operate ~3 days a week. The surgical subs will be more than that but I question how meaningful that is. I currently make 450 and one of my best friends is ultra sub special plastics and he’s making 650 and I have no resentment nor do I feel it’s all that meaningful. I’m on track to get a raise to 600-650 soon which will be very near my ceiling; he may eventually get up to 7 figures. That level of income though is… not really all that necessary. At 450 I have a 10 sq ft house and started a single family rental business. I have everything I want (and then some). My plastics buddy on the other hand has a small subtle home but goes sailing in the gulf almost every weekend. We do not live in the gulf. 🤣 So I would summarize with: if surgery, you will be paid well in all fields with almost no exception as long as you don’t do academia. I also did 7 total years of training, he did 10. But at that point it’s really not a big deal. The end years feel much different. You get used to middle income lifestyle and you find happiness there and fulfillment knowing you’re finally doing subspecialty training in something that you truly enjoy. So while residency, yes, can be painful… fellowship shouldn’t be that bad, or bad at all.

Work life balance takes time to iron out in EVERY surgery discipline. In residency there is very little and if you have children then the kids eat all of it. That’s just reality. As an attending it depends on how many partners you have. I’m in a solo practice and have horrible work life balance but extreme freedom in building my program which is important to me and makes me happy. If you aren’t happy at work then your time at home, even if you have a ton of it, is not worth the trade off to me. I’m hiring partners (yay) which will restore 90% of the needed things to have good work life balance.

Also worth noting that things like surg onc do generally take two research years but MANY of us have children during that time which works out very well. It’s not ‘wasted time’. Just depends how you use it.
 
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I think gen surg is mild to moderately more equipped to be supportive of having children in residency over the surgical sub simply because most programs have 4-6 residents per year +/- research years built in which creates a useful redundancy that the subs don’t always have. This is not universally true but is a generalization that mostly holds.

As long as you don’t do academic practice every road out of general surgery will likely pay you over 500k/yr once you are established, about 5 years in, if you are on productivity and operate ~3 days a week. The surgical subs will be more than that but I question how meaningful that is. I currently make 450 and one of my best friends is ultra sub special plastics and he’s making 650 and I have no resentment nor do I feel it’s all that meaningful. I’m on track to get a raise to 600-650 soon which will be very near my ceiling; he may eventually get up to 7 figures. That level of income though is… not really all that necessary. At 450 I have a 10 sq ft house and started a single family rental business. I have everything I want (and then some). My plastics buddy on the other hand has a small subtle home but goes sailing in the gulf almost every weekend. We do not live in the gulf. 🤣 So I would summarize with: if surgery, you will be paid well in all fields with almost no exception as long as you don’t do academia. I also did 7 total years of training, he did 10. But at that point it’s really not a big deal. The end years feel much different. You get used to middle income lifestyle and you find happiness there and fulfillment knowing you’re finally doing subspecialty training in something that you truly enjoy. So while residency, yes, can be painful… fellowship shouldn’t be that bad, or bad at all.

Work life balance takes time to iron out in EVERY surgery discipline. In residency there is very little and if you have children then the kids eat all of it. That’s just reality. As an attending it depends on how many partners you have. I’m in a solo practice and have horrible work life balance but extreme freedom in building my program which is important to me and makes me happy. If you aren’t happy at work then your time at home, even if you have a ton of it, is not worth the trade off to me. I’m hiring partners (yay) which will restore 90% of the needed things to have good work life balance.

Also worth noting that things like surg onc do generally take two research years but MANY of us have children during that time which works out very well. It’s not ‘wasted time’. Just depends how you use it.
Can't thank you enough for all of this insight. I don't have any family members in medicine so I'll be the first one, therefore when it comes to knowledge about compensation and income all I've really been able to do to gauge this is google searches. Would you mind shedding a bit more light on the academic vs private practice pay discrepancy. It makes sense one will get paid more privately than in academia, but is the difference substantial and if so, is it less significant depending on the surgical specialty one enters? Also, are there certain surgical subspecialties where you're more or less confined to working in academia? How does work life balance generally compare between academia and private (understanding that number of partners in private influences that aspect)?

I appreciate you!
 
The difference is extremely substantial. It is usually at least 100k pay difference straight out of fellowship, sometimes upwards of 200k in favor of private practice over academia. I do not know how these numbers translate later in your career but I do know it takes a fair amount of time to advance in academia and your pay is usually tied to academic rank which you do not progress through quickly. Academic positions may or may not (most do not) have a productivity component which greatly changes this calculus. In private practice you can ramp up your income even more under a productivity model within 5 years.

Work life balance is generally equal, just different. PP you do way more clinical work but also likely operate one to two days extra a week (which is fun) that academics might have protected for research. Some people legitimately like doing less clinical work and having a break. Many just want to operate. It is not universally true that academics will operate less (or that they will do more complex cases/pathology) but probably holds true if you average all of us. Non academics have and use the ability to transfer the really crazy awful stuff, but they generally do WAY more operating and the bigger non academic centers transfer essentially nothing.

At the end of the day we all work 50-60 hours a week until the later half of our career as a good rule of thumb, across all surgical disciplines.
 
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This may be helpful. I wrote this for Reddit and occasionally repost it, but some idea about how you get paid and contracting is key to understanding salaries as a surgical attending. Read it, and the comment by the guy talking about RVUs and then come back with additional questions if you have them and I’ll answer.

 
This may be helpful. I wrote this for Reddit and occasionally repost it, but some idea about how you get paid and contracting is key to understanding salaries as a surgical attending. Read it, and the comment by the guy talking about RVUs and then come back with additional questions if you have them and I’ll answer.


Thanks! Read through it and it was helpful. All of that knowledge and decision making is a bit down the road for me but its good to know what I'll be up against. Before getting there, I still need to spend the next few years figuring out what type of surgeon I want to become lol
 
Thanks! Read through it and it was helpful. All of that knowledge and decision making is a bit down the road for me but its good to know what I'll be up against. Before getting there, I still need to spend the next few years figuring out what type of surgeon I want to become lol
Agreed. The information there explains more about the compensation debacle and why there is a discrepancy between academics and private practice/community practice. Academics is driven by your research production and academic rank and volume or complexity of surgery is often irrelevant. You have parts of your job (1.0 FTE, or full time equivalent) that are block that keep you out of the operating room, such as a 0.2 FTE for admin time or for some people 0.2-0.4 FTE for protected research time. In surgery this is less common but still exists. 0.2 FTE would essentially be taking a full day of clinical time away to allow you to do other things to advance the science (and your academic rank) which is the only way you'll make more money.

Community practice on the other hand is driven by RVU production, and private practice is actually driven by collections which is very different from RVU.

I would definitely separate out training in your mind from attending life. Aim for what attending life you think you will enjoy. Many, many people on this forum will talk your pants off about the opportunity cost of long years of training in $$$ value but if you are going to be a surgeon, any flavor of surgeon, I believe that this is not a relevant discussion point. All surgery paths including subspecialists require at minimum 5 years (and that's becoming increasingly less common), six is usually the new floor for many paths, and 9 is not uncommon. The last two years are NOTHING like the first 5-7 and they are sometimes more work, but much much more fulfilling work because you're doing the subdiscipline that really entertains you and makes you happy. Every single community surgery job will pay you >500k after ~3-5 years. Most will have some version of 1:4 call where you work one weekend and one weeks worth of covering overnight. These things are generally universal when you average them out. Some are slightly better, some are slightly worse. I would also go a step further and say that most people should be ignoring the work-life balance aspect if they are going to be surgeons and focus far more on what interests them and makes them happy. As a surgeon you will work ~50 hours a week forever (again if you average it). Whether you work 40, or 65, they are all long days. It is *FAR MORE* important that when you come home you are energized and happy after a long days work to engage with your family and live your life than if you worked 40 hours vs 60 hours that particular week. Do not pick something that is 'easy' on the hours but that you do not absolutely freaking love as a surgeon. It will make you grumpy.

As far as training, it is an investment. You will die rich. You will have a cool skillset. Most of us do not have regrets. The training blows no matter how you slice it. The difference in 1-3 extra years is negligible as long as you use your training time wisely. If you have an interest (like surg-onc) PLAN to have research years. PLAN to have a family in that time. Utilize your time, forward think at all moments and aspects of your training, and have concrete and defined goals. If you do that you'll be just fine be it 5 years of training or 10. None of it is wasted. The goal is not how many hours you don't spend at work. The goal is that when you aren't at work you are happy, full of energy and laughter, can switch off because you have good partners you trust, and can engage your family and be present and not a zombie.

I have met a great deal of surgeons who work 35 hours a week and hate everything. I have met surgeons who work 80 and are energizer bunnies. Focus on what makes you into you and the rest will fall into place.

Closing thoughts: I have not met many lady CV doctors. CV is intense in many places. I am not sure how well that will translate for a woman who wants to have equality in her work life and her family life. Would strongly consider: surg-onc, colorectal, breast, vascular. Less $$$ collectively (again, negligible in the long run. You will die rich in all of these fields), better quality of life, extremely fulfilling. All specialties have community options outside of academics without exception.
 
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Ill add one point regarding lifestyle in any field of surgery that doesn’t get said enough: your quality of life will depend heavily on just how good you are.

If you take until 10pm doing a case that someone else finishes by 3pm, your lifestyle is going to take a hit. Within ent, the big head and neck cancer surgeons generally have the worst lifestyle with longer cases and more frequent complications. But within that group there are those who spend 16 hours on a big flap case and others who get them done by 4. In residency, one flap recon head and neck surgeon was so fast she would finish most big flaps between 1 and 2 pm and always picked her kids up from school afterward. She has a great work life balance but only because she’s an amazing surgeon.

My head and neck partners here are similarly gifted with our flap surgeon home by 2pm most days. Even his one day of clinic per week is from 9-2 and he just blitzes through it.

So keep that little tidbit in mind as you consider your options and especially down the road as you get into training. If you want a good work-life balance, make sure you get well trained and efficient.
 
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My head and neck partners here are similarly gifted with our flap surgeon home by 2pm most days. Even his one day of clinic per week is from 9-2 and he just blitzes through it.
That is amazing. My ENT oncology rotation in fellowship was excruciating because of the hours. Your partners must be androids or something.

But, very good point is very good. My whipples generally take 4.5 hours. I have never even *seen* these so called 8-10 hour whipples at academia that are standard all day affairs. The only one I've ever seen take 8 hours was a pancreatitis bleeding vein involvement disaster-piece so I give that one a pass.
 
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Agreed. The information there explains more about the compensation debacle and why there is a discrepancy between academics and private practice/community practice. Academics is driven by your research production and academic rank and volume or complexity of surgery is often irrelevant. You have parts of your job (1.0 FTE, or full time equivalent) that are block that keep you out of the operating room, such as a 0.2 FTE for admin time or for some people 0.2-0.4 FTE for protected research time. In surgery this is less common but still exists. 0.2 FTE would essentially be taking a full day of clinical time away to allow you to do other things to advance the science (and your academic rank) which is the only way you'll make more money.

Community practice on the other hand is driven by RVU production, and private practice is actually driven by collections which is very different from RVU.

I would definitely separate out training in your mind from attending life. Aim for what attending life you think you will enjoy. Many, many people on this forum will talk your pants off about the opportunity cost of long years of training in $$$ value but if you are going to be a surgeon, any flavor of surgeon, I believe that this is not a relevant discussion point. All surgery paths including subspecialists require at minimum 5 years (and that's becoming increasingly less common), six is usually the new floor for many paths, and 9 is not uncommon. The last two years are NOTHING like the first 5-7 and they are sometimes more work, but much much more fulfilling work because you're doing the subdiscipline that really entertains you and makes you happy. Every single community surgery job will pay you >500k after ~3-5 years. Most will have some version of 1:4 call where you work one weekend and one weeks worth of covering overnight. These things are generally universal when you average them out. Some are slightly better, some are slightly worse. I would also go a step further and say that most people should be ignoring the work-life balance aspect if they are going to be surgeons and focus far more on what interests them and makes them happy. As a surgeon you will work ~50 hours a week forever (again if you average it). Whether you work 40, or 65, they are all long days. It is *FAR MORE* important that when you come home you are energized and happy after a long days work to engage with your family and live your life than if you worked 40 hours vs 60 hours that particular week. Do not pick something that is 'easy' on the hours but that you do not absolutely freaking love as a surgeon. It will make you grumpy.

As far as training, it is an investment. You will die rich. You will have a cool skillset. Most of us do not have regrets. The training blows no matter how you slice it. The difference in 1-3 extra years is negligible as long as you use your training time wisely. If you have an interest (like surg-onc) PLAN to have research years. PLAN to have a family in that time. Utilize your time, forward think at all moments and aspects of your training, and have concrete and defined goals. If you do that you'll be just fine be it 5 years of training or 10. None of it is wasted. The goal is not how many hours you don't spend at work. The goal is that when you aren't at work you are happy, full of energy and laughter, can switch off because you have good partners you trust, and can engage your family and be present and not a zombie.

I have met a great deal of surgeons who work 35 hours a week and hate everything. I have met surgeons who work 80 and are energizer bunnies. Focus on what makes you into you and the rest will fall into place.

Closing thoughts: I have not met many lady CV doctors. CV is intense in many places. I am not sure how well that will translate for a woman who wants to have equality in her work life and her family life. Would strongly consider: surg-onc, colorectal, breast, vascular. Less $$$ collectively (again, negligible in the long run. You will die rich in all of these fields), better quality of life, extremely fulfilling. All specialties have community options outside of academics without exception.
Thanks again, for the record I am a guy. Only brought up thoughts about work-life/family planning because I don't intend to be an absent parents and just wanted to address those concerns. Especially considering I am a few more years older than my peers and intend on pursuing a surgical subspecialty that will likely entail long traning.
 
Thanks again, for the record I am a guy. Only brought up thoughts about work-life/family planning because I don't intend to be an absent parents and just wanted to address those concerns. Especially considering I am a few more years older than my peers and intend on pursuing a surgical subspecialty that will likely entail long traning.
Oh. What's your wife/significant other do? That makes a big difference. I'm one year into attending land and my wife quit work two months ago to be a SAHM because we made more money than we needed and it was just unnecessary for her to work and we were all way happier.
 
Oh. What's your wife/significant other do? That makes a big difference. I'm one year into attending land and my wife quit work two months ago to be a SAHM because we made more money than we needed and it was just unnecessary for her to work and we were all way happier.
Don't think SAHM is in the future w my SO lol, simply put there are a lot of moving pieces and plenty of uncertainty ahead. I am just trying to be as informed as possible and prepare myself to be as competitive as I can be for residency without being naive to the demands and schedules that lie ahead.
 
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I appreciate the response. Do you mind if I ask how your role helps you feel fulfilled and like youve made a meaningful impact on your patients lives? A broad question I know, but as you mentioned if I were confined to bread and butter tonsils and tubes cases I don't think I would be able to get the sense that I'm having a massive impact on my patients lives, at least in the way that I want. For me, there is a lot more appeal regarding the larger head and neck cases. Wondering how you feel about this.

Also, not sure how familiar/connected you are to current residency placement in ENT but I hear it is only getting more competitive. I worry that with ENT (and plastics for that matter) that if I don't get some research in the area, I may hurt my chances of matching, especially into the more competitive programs. Do you have any insight here?

Thanks again for the thoughtful response!
Just wanted to add, don’t discount the kind of effect bread and butter can have on a patients life. The farther I get on the training path the more respect I have for bread and butter surgery and just how needed it is.

I used to want to be some big badass surgical oncologist like @Lem0nz , now I just want to be the workhorse general surgeon who cranks through bread and butter general surgery because I like it so much.
 
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