Specialty Choice (NSG vs PRS vs Ortho vs ENT)

[typhon]

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Hi all,

I have been reading on countless threads within studentdoctor but never and I think it's time to ask the question that has been constantly on my mind for the past 2-3 years with my first post!
(I apologize beforehand for the extremely loooooonng post, and I understand that this makes it hard for anyone to read it, but I hope that someone will help out 🙂

I have just graduated from a European medical school and I am about to start my residency (most likely in Switzerland). However, I cannot decide between the four specialties in the title: Neurosurgery, Plastics, Orthopedics and Otolaryngology. But I am certain I want to go into surgery.

I don't have extreme grades, but in the top 5 percent of my country. Probably 8-9th in my class.
However, during the past years I have done 3 electives abroad and have also done some research. As a result, I have 3 publications(available in pubmed) out of which 2 are in basic cancer science and in 1 of them I am the first author. The other one is in Surgery.

Here are my thoughts on these specialties as quickly as possible:

From my gen surg rotation I loved endoscopic/laparoscopic procedures, but open surgeries didn't seem very exciting.

Neuro:
At first I wanted to do Neuro, either -logy or -surgery.
After that I decided that I wanted to follow a surgical career because I want to have an active role in treatment (as opposed to the common "we have made a diagnosis, but there is nothing we can do" style of Neurology) and would like my work to be heavy on manual/mechanical procedures. I don't want to sit at a desk looking at lab results and waiting for the various treatments that I use to work. Also, could not think of myself of working on a system other than CNS-PNS...
However, I am starting to think that NSG's future is limited. Tumour treatment is heading to medical rather than surgical direction. Vascular malformation treatment could become solely endovascular(radiologists-neurologists). Also, there are the horrible stories that I read and hear about NSGs that never leave the hospital/never sleep/get divorced...And I wasn't very excited by the operations I watched(not like plastics for example)

Ortho:
Always had orthopedic problems and the physics/motion/impact force theories look very interesting to me. I also loved the whole "build the bone" way of thinking. It is also a medical specialty so I think that is more future-proof and gives more options(private practice etc). Huge scope of surgeries and patients that do generally well. And I love the gadgets, tools, implants that they work with.
On the negative side: Hip replacement surgeries look boring to me, most kinds of operations are crude and skills don't play that big a role, no CNS involved, bone research doesn't excite me as much(muscle,tendon,ligament is a lot better)

PRS:
I was fascinated by plastics. The attention to detail, the idea of reconstruction, the fact that the results depend so much on the surgeon's skills and experience and also a newly developed interest in wound healing made this specialty ideal. More positive aspects😛lenty of options to practice,remuneration,better lifestyle,needs artistic eye,not confined to a system,variety,microsurgery.
Negatives: Uncertain future(could aesthetic procedures move completely to dermatologists?), lack of gadgets , difficult to get into, had limited exposure during rotations, no CNS!!

ENT:I realized that ENT has some NSG, some PRS and is also a medical specialty. Making it seem ideal. Also it is heavy on procedures, patients are not very sick and there is a lot of endoscopy and gadgets!!Nice lifestyle and variety.
However, nose and larynx seem rather insignificant to me(e.g. for research). I consider the ear to be far more interesting but can't think of myself performing auditory tests all the time. No CNS, again.Probably the need to study allergies against my will..

I swear I cannot decide no matter how I look at it.
If anyone could give some insight based on personal experience, or otherwise, I would greatly appreciate it!!!
For example does one know that he is not right for one of the above specialties?
I have to decide within the coming month so that makes things very stressful.
Thank you in advance!!!

 

[badasshairday]

All those specialties are very different. What do you like in particular about each one?

 

[Maybeknot]

As far as ENT, remember that ENT also includes head and neck surgery, and if you're into cancer research, there are plenty of opportunities.

Also, no ENT ever does "auditory tests," all day. That's what audiologists are for (at least in the US).

 

[Winged Scapula]

Moving to Clinical Rotations (the residency forums are not the appropriate fora for medical student questions)

 

[rigid]

Your gut will tell you which one you can see yourself being 20 years down the line

 

[Poetic Silence]

If you're into cancer, I'd pick neuro or ENT.

 

[FSU2013]

As a neurosurgeon, you will live in the hospital. I swear, it doesn't matter what time of day, I always end up seeing our neurosurgeons at work. They have the reputation of working all the time for a reason. It's a different type of person that goes into neurosurgery. They consider working 100 hours a week a badge of honor. Also, their patients are rediculously sick - it seems like 1/2 of them die or are comatose.

Ortho is really fun. You use power tools and mallets. It is pretty repetitive and almost everyone does a fellowship. But they work a ton too. It's an extremely testosterone heavy field. I feel like most people who go I to ortho just kinda fit. They're really smart, but feel the need to show it.

Plastics - dont know much

ENT - they have an awesome lifestyle. I was 9-5 on clinic days and 8-3 on OR days. You see a lot of the same stuff regularly, but you do get to see adults and peds. Some procedures are really cool (h&n/cancer stuff), some are terrible (removing boatloads of nasal polyps).

 

[qmcat]

Have you considered interventional radiology? They do a lot of scoping/stents and play with lots of gadgets.

 

[typhon]

As far as ENT, remember that ENT also includes head and neck surgery, and if you're into cancer research, there are plenty of opportunities.


Also, no ENT ever does "auditory tests," all day. That's what audiologists are for (at least in the US).

I didn't know that...thank you!

Moving to Clinical Rotations (the residency forums are not the appropriate fora for medical student questions)

Just to justify the fact that I posted in the residency forums, I am not a medical student and the question is about the residency(future of) that I have just started, but you know best.

Your gut will tell you which one you can see yourself being 20 years down the line

That's the problem! I can see myself being any of those. I keep shifting from one to the other.It goes like this every 3-4 months Neuro->Ortho->Plastics->ENT then all over again. I guess in a parallel universe where one could mix specialties, I would choose Neurology with Plastics

If you're into cancer, I'd pick neuro or ENT.

The cancer research just happened because of circumstances and availability..but I suppose it'd be a plus in those two.

 

[AngkorWuT]

Just curious, do you do a year of general training and then pick a subspecialty?

 

[typhon]

As a neurosurgeon, you will live in the hospital. I swear, it doesn't matter what time of day, I always end up seeing our neurosurgeons at work. They have the reputation of working all the time for a reason. It's a different type of person that goes into neurosurgery. They consider working 100 hours a week a badge of honor. Also, their patients are rediculously sick - it seems like 1/2 of them die or are comatose.

Ortho is really fun. You use power tools and mallets. It is pretty repetitive and almost everyone does a fellowship. But they work a ton too. It's an extremely testosterone heavy field. I feel like most people who go I to ortho just kinda fit. They're really smart, but feel the need to show it.

Plastics - dont know much

ENT - they have an awesome lifestyle. I was 9-5 on clinic days and 8-3 on OR days. You see a lot of the same stuff regularly, but you do get to see adults and peds. Some procedures are really cool (h&n/cancer stuff), some are terrible (removing boatloads of nasal polyps).

This actually drives me further away from neuro...Because recently I discovered that I have very tangible limits in work hours. I certainly have greater endurance than the average trainee but there is a point when I simply stop functioning! 🙁

It is the routine work that I dislike in ortho. Other than that I did also find it quite fun. Sounds better than neuro and I guess spine and hand are always options. But plaster work and non-specific joint,back pain without any findings make me seriously drowsy

You are making an excellent point about ENT. So compared to ortho they have an even better lifestyle? I have always admired the h&n and also some of their reconstructive procedures (nasal septal, ear, tympanoplasties) but definitely hated polyp, adenoid, tonsil -ectomies.

Have you considered interventional radiology? They do a lot of scoping/stents and play with lots of gadgets.

As a matter of fact I have. Basically because I found that I have some kind of affinity towards neuroradiology. But I am kind of afraid of the radiation exposure (I know it sounds funny) and I don't want to be confined in just doing endovascular,stenting procedures.

 

[typhon]

Just curious, do you do a year of general training and then pick a subspecialty?

Exactly! And at the beginning of this general training I have to choose the more specific part...

 

[p30doc]

ENT is the best gig out of those options imho.

 

[Poetic Silence]

I'm also interested I'm the ENT specialty. The head and neck oncology as well as the auditory neuroscience aspects are what draws me to the field.

Either ENT pediatric oncology for me.

 

[FSU2013]

You are making an excellent point about ENT. So compared to ortho they have an even better lifestyle?

There's really not a comparison. Ortho pods work a ton. They're not quite up there with neurosurg, but they have got to be among the most worked - right up there with gen surg, OB, etc. Some older ortho pods work less, and there are a few that have better hours, but it seems like the vast majority work all the time. ENT is def a lifestyle specialty. They work bankers hours and make a solid salary. Some work a lot, but this seems to be the exception to the rule - where the orthopods who don't work that much is the exception to the rule. But, Ent is hard to match (as is ortho) and my understanding is that their residency is no walk in the park.

 

[qmcat]

I think it depends on where you are for ENT. Sometimes it is not so easy lifestyle-wise. When I rotated through ENT, it was pre-rounds at 5:30am, rounds with attending around 6:30am, first OR case started at 7:30am, quick lunch break around noon or 12:30pm, first afternoon OR case started at 1:00pm, last OR case finishes around 6-7pm. If we had teaching rounds or seminar, the day would go on until 8pm and I would have to be up by 4 or 5am the next day to get to work. And then you have facial trauma and call nights on top of that schedule.

On clinic days, it was 8am until 5 or 6pm for me. Most patients are kids and it's gets pretty repetitive.

I'm not sure how it is in Europe, but that's been my experience so far as a US med student.

 

[FSU2013]

I think it depends on where you are for ENT. Sometimes it is not so easy lifestyle-wise. When I rotated through ENT, it was pre-rounds at 5:30am, rounds with attending around 6:30am, first OR case started at 7:30am, quick lunch break around noon or 12:30pm, first afternoon OR case started at 1:00pm, last OR case finishes around 6-7pm. If we had teaching rounds or seminar, the day would go on until 8pm and I would have to be up by 4 or 5am the next day to get to work. And then you have facial trauma and call nights on top of that schedule.

On clinic days, it was 8am until 5 or 6pm for me. Most patients are kids and it's gets pretty repetitive.

I'm not sure how it is in Europe, but that's been my experience so far as a US med student.

Yea, some ENTs def work a bunch. I think this is generally true in academics, which is why they have supposed to have pretty tough residencies. I did my rotation with a private practice ENT and he had it GOOD.

 

[notbobtrustme]

This guy is in Europe, I think they have a much different residency system than the US. IIRC, many countries have strict work hour restrictions for medical residents, like 35-40 hrs/week.

 

[FSU2013]

This guy is in Europe, I think they have a much different residency system than the US. IIRC, many countries have strict work hour restrictions for medical residents, like 35-40 hrs/week.

That's a joke, right? If you start your work week on a Monday you can bang out 36 hours by, well, Tuesday around dinner, lol. What would you do with your other 5 1/2 days a week? That sounds awful.

 

[notbobtrustme]

That's a joke, right? If you start your work week on a Monday you can bang out 36 hours by, well, Tuesday around dinner, lol. What would you do with your other 5 1/2 days a week? That sounds awful.

yea, it's a weird system. They also stay residents much longer, sometimes for their entire career.

 

[Poetic Silence]

That sucks. I'd rather just rip the bandaid off all at once than slowly over twenty years.

 

[notbobtrustme]

That sucks. I'd rather just rip the bandaid off all at once than slowly over twenty years.

It's a totally different system and culture. Remember, most Europeans don't have any school debt to speak of and most countries actually pay their college students a stipend. Wages and benefits are excellent during residency (shorter work weeks, 6 weeks vacation, 3-6 months paid maternity/paternity leave, full health insurance, etc). It's a 180 degree turnaround from the US system which is indentured servitude for many, many years until you are done training.

 

[Poetic Silence]

It's a totally different system and culture. Remember, most Europeans don't have any school debt to speak of and most countries actually pay their college students a stipend. Wages and benefits are excellent during residency (shorter work weeks, 6 weeks vacation, 3-6 months paid maternity/paternity leave, full health insurance, etc). It's a 180 degree turnaround from the US system which is indentured servitude for many, many years until you are done training.

Damn! Where do I sign up?!

 

[ArcGurren]

As a neurosurgeon, you will live in the hospital. I swear, it doesn't matter what time of day, I always end up seeing our neurosurgeons at work. They have the reputation of working all the time for a reason. It's a different type of person that goes into neurosurgery. They consider working 100 hours a week a badge of honor. Also, their patients are rediculously sick - it seems like 1/2 of them die or are comatose.

Ortho is really fun. You use power tools and mallets. It is pretty repetitive and almost everyone does a fellowship. But they work a ton too. It's an extremely testosterone heavy field. I feel like most people who go I to ortho just kinda fit. They're really smart, but feel the need to show it.

Plastics - dont know much

ENT - they have an awesome lifestyle. I was 9-5 on clinic days and 8-3 on OR days. You see a lot of the same stuff regularly, but you do get to see adults and peds. Some procedures are really cool (h&n/cancer stuff), some are terrible (removing boatloads of nasal polyps).

ENT residency is HARD. Don't be misled purely by what someone who's been in private practice for a long time is doing. A lot of ENT doctors are able to endure the residency (which is as brutal as any surgical residency IMO) and then when they open up shop just do office procedures all day every day from 9-5. Just keep that in mind.

Ortho residency is also pretty brutal and typically requires you to have a certain personality to endure - once upon a time it was a bit more of a "boys club" and women had it pretty tough, for example. Now it's a lot better but you really have to love what you're doing (which of course goes for any specialty but doubly so for this).

 

[typhon]

This guy is in Europe, I think they have a much different residency system than the US. IIRC, many countries have strict work hour restrictions for medical residents, like 35-40 hrs/week.

I don't know about that, but most of the countries I've seen up to know are in the 45-50hrs/week range. And that doesn't include overtime, of course.

yea, it's a weird system. They also stay residents much longer, sometimes for their entire career.

It is like that for some EU countries(10 years after med school to completing residency) and the opposite for some others. So it really depends...

So Early Nights and Tennis seems to be pretty popular...
I suppose, all things considered, ENT is the most balanced of the 4.

 

[mosfet]

Plastics all the way my friend........its the best specialty out there!!!