Switching into ENT

[MDapp06]

Hi All,

I was hoping to get some advice applying to ENT as a non-traditional applicant. I would like to apply to ENT this upcoming application cycle, and I was wondering if any of you can help me with some of my questions:

1. I will be completing my medicine intern year in June and I was wondering if it is possible to match into ENT after completing a medicine (ie. non-surgical) intern year?

2. Would I have to repeat my intern year if I match into ENT? I was wondering if there are programs where I could match into a PGY2 (ie. first year of ENT) position.

3. I do not have ENT research and I didn't do ENT away rotations as a medical student. I did a 2-week ENT rotation (received an Honors grade) at my home medical school and really enjoyed it, but I didn't think that I would be a competitive ENT applicant, therefore I didn't apply. My schedule during intern year doesn't really allow for me to do an ENT rotation. What is the best way that I can build ENT experience and demonstrate my commitment to the field?

4. Is it necessary to get a letter of recommendation from my current program director?

5. Who should I get letters of recommendation from, since I am already in the middle of my medicine intern year?

6. Are there programs that have research fellowships where there is a good chance that if you perform well during the research year, that you have a higher likelihood of matching into the residency program?

7. My Step 1 and 2 scores are between 200-210. Will this prevent me from getting interviews? This was a major reason that I didn't try to apply to ENT residency positions when I was a medical student. However, I have realized that ENT is my true passion and I want to do everything possible to be a practicing otolaryngologist. What can I do now to overcome the hurdle of sub-par Step 1 and 2 scores?

8. Should I take Step 3 and have a score available when I apply to ENT positions?

If anyone has advice for me, please let me know. I am really trying to gauge my chances of getting into ENT given that I am already in the middle of my intern year.

Thanks!

mdapp06

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[neutropeniaboy]

1. I will be completing my medicine intern year in June and I was wondering if it is possible to match into ENT after completing a medicine (ie. non-surgical) intern year?

Yes. I've seen it done. But I'm confused about your timing. If you haven't applied already, the cycle is complete. You'll have to complete your PGY-2 year in medicine before you would get into an ENT program.

2. Would I have to repeat my intern year if I match into ENT? I was wondering if there are programs where I could match into a PGY2 (ie. first year of ENT) position.

Possible go right to a PGY-2 spot, but highly improbable. Surgical internships are very different from medical internships. Different set of skills. Furthermore, most ENT programs open as PGY-1 spots. Many programs have the PGY-1s rotate for 3 months on the ENT service as a requirement. (That actually may be required now by ACGME -- not sure.) Rarely there are open PGY-2 spots, but many require surgical internships.

On the brighter side of things, you'll probably have a much easier time as a surgical intern.

3. I do not have ENT research and I didn't do ENT away rotations as a medical student. I did a 2-week ENT rotation (received an Honors grade) at my home medical school and really enjoyed it, but I didn't think that I would be a competitive ENT applicant, therefore I didn't apply. My schedule during intern year doesn't really allow for me to do an ENT rotation. What is the best way that I can build ENT experience and demonstrate my commitment to the field?

Probably not much you can do about it at this stage. Any research that you do for the next application cycle would be helpful. Otherwise, you could not renew your contract and do a year of research in a lab sponsored by an ENT or department of otolaryngology.

4. Is it necessary to get a letter of recommendation from my current program director?

I would not look at you if you didn't. Your program directors assessment of your performance as an intern would be vital to me and anyone else reviewing your application. In many ways, this would be weighed more heavily than your school performance.

5. Who should I get letters of recommendation from, since I am already in the middle of my medicine intern year?

Program director. Chair. ENT attendings.

6. Are there programs that have research fellowships where there is a good chance that if you perform well during the research year, that you have a higher likelihood of matching into the residency program?

There are quite a number of them, but no research track is a guaranteed pathway into that residency.

7. My Step 1 and 2 scores are between 200-210. Will this prevent me from getting interviews? This was a major reason that I didn't try to apply to ENT residency positions when I was a medical student. However, I have realized that ENT is my true passion and I want to do everything possible to be a practicing otolaryngologist. What can I do now to overcome the hurdle of sub-par Step 1 and 2 scores?

Your scores are not sufficient. I don't think there's much you can do other than to not renew your contract and take 1-2 years off to work in a lab doing otolaryngology research.

8. Should I take Step 3 and have a score available when I apply to ENT positions?

This probably won't make much of a difference.

 

[medstylee]

you'd actually have to complete a surgical intern year first. so, in other words, since the intern year is built into all ENT residency programs, you'd have to start at PGY1 again.

the acgme says that, for ENT internship, one must complete at least 5 months in any of the following: general surgery, thoracic surgery, vascular surgery, pediatric surgery, plastic surgery or surgical oncology. you also must complete at least one month in the following: anesthesiology, critical care, neurological surgery and emergency medicine.

so, you'd not be able to match into an ENT PGY2 spot after completing a medicine PGY1 year, unfortunately.

 

[OtoHNS]

I don't think you have a realistic shot at matching with USMLE scores barely over 200.

If I were in your shoes, I'd consider a procedure-heavy IM subspecialty (interventional pulm, cards, or GI), or switch into something like anesthesia.

 

[Leforte]

The other issue is funding for your spot in ENT. You are entitled to 3 years of funding, since your first residency was in IM. You have used 1 of these years, and assuming you get a spot next year, you only have 2 years of funding left - which would mean your program would have to forgo the $100k+ in Medicare funding for your position for 3 years.

 

[Fah-Q]

I am really trying to gauge my chances of getting into ENT...
mdapp06

It's just not going to happen. Sorry to be blunt but finding this out now is better for you then finding out 5 years from now after you have wasted away in some lab at some program that was never going to give you a residency spot. Feel free to prove me wrong but you have to realize that you will be battling up an icy hill for years to come and might come away with nothing to show for it.

 

[neutropeniaboy]

Have to agree with the other attendings. Nothing more to add.

 

[DoctorFuzz]

Hi all,

I am in a similar boat as the original poster, with some differences. I'm hoping to get feedback, particularly from the attendings.

I just finished an internal medicine residency at a top 5 program (summer 2012). My medical school has an average reputation, where I graduated AOA with Step 1 and Step 2 scores >265. I am board-certified in IM and have been working this year as a hospitalist in the MICU. I applied to ENT this cycle after having worked with the ENT department at my IM hospital with strong LORs from my ENT mentor and IM program-director. I didn't get many interviews in this ENT cycle (after applying to 25 programs). Although I interviewed well, I know there is a good chance I won't match.

What can I do to increase my chances of matching for next cycle should I not match this year? Apply for a research position? Try to schedule aways (this would be tough as I am no longer a medical student)? I didn't play much of a post-interview game as the PD at my home institution remarked that it is not likely to help and may even hurt my chances. Is this true, and if so, what can I do differently the next time around?

Thanks to everyone who replies.

 

[OtoHNS]

Hi all,

I am in a similar boat as the original poster, with some differences. I'm hoping to get feedback, particularly from the attendings.

I just finished an internal medicine residency at a top 5 program (summer 2012). My medical school has an average reputation, where I graduated AOA with Step 1 and Step 2 scores >265. I am board-certified in IM and have been working this year as a hospitalist in the MICU. I applied to ENT this cycle after having worked with the ENT department at my IM hospital with strong LORs from my ENT mentor and IM program-director. I didn't get many interviews in this ENT cycle (after applying to 25 programs). Although I interviewed well, I know there is a good chance I won't match.

What can I do to increase my chances of matching for next cycle should I not match this year? Apply for a research position? Try to schedule aways (this would be tough as I am no longer a medical student)? I didn't play much of a post-interview game as the PD at my home institution remarked that it is not likely to help and may even hurt my chances. Is this true, and if so, what can I do differently the next time around?

Thanks to everyone who replies.

If I were reviewing your application or interviewing you, my biggest concern would be whether you could drop back down the hierarchy and be an intern and resident again for the next 5 years. My advice would be to explicitly bring this up in your personal statement and interviews, because programs are certainly thinking about it, even if they don't ask you directly. I wouldn't want to hire someone who's overconfident and has trouble with authority because he's already completed another residency.

Otherwise, getting some ENT research experience would probably help you, though going from an attending MD salary to research peon salary sounds very painful. (As does going from attending salary to resident salary for that matter).

 

[DoctorFuzz]

OtoHNS,

You are right about that (ability to drop down the hierarchy). That was asked to me frequently during my interviews. One hypothetical was what would I do if a medical issue occurred during inpatient management of a H&N patient. Would I address it alone or involve a medicine consult? I answered these genuinely. My answer was along the lines of that while I have finished an IM residency, there is much I can still learn from a consult, and there is value to doing things through the right channels not just for learning but also from the standpoint of patient-care.

 

[neutropeniaboy]

DocFuzz-

I would have the same concerns. Less so would be my concern about you handling the medical issues that come up (hey, that's great -- a surgeon and someone who knows what an anion gap is) and more so the ability to rapidly descend from a position of complete autonomy to complete dependence.

Regarding the former, you'll have to remember that you would no longer be liable for the patient -- the attending otolaryngologist would be. So, 99 times out of 100 you'll be correct in what you do, but that 1/100th time, you might do something wrong, result in a complication, and the ENT attending would be liable for your actions. I highly doubt you would be serving in any official capacity as an internist, so from a medical and a legal standpoint, I suspect it wouldn't matter what your background would be.

Other issues that I could envision:
1. Being older and taking orders from people younger than you
2. Being much more knowledgeable than your seniors (and attendings) and finding ways to respectfully disagree or just do what they ask.
3. Being able to set pride aside and consult that PGY-1 medical intern for something you know already
4. The thought among some programs that you seem like someone who is searching for a career. Who's to say that once you complete an ENT residency program that you'll just want to go into PM&R afterwards? It's often brought up about people who switch careers.

I would get more research under your belt. Beyond that, I suspect that the lack of interviews are due to the issues OtoHNS brought up.

You've got to look at it from our perspective: You say you're interested in ENT; prove it. Show me the money. Rotations. Research. Presentations. Your medicine background would be quite helpful, but surgery isn't medicine in many ways.

Why take you instead of a fresh-out-of-medical-school young buck who's got research and demonstrated interest?

 

[Fah-Q]

I didn't get many interviews in this ENT cycle (after applying to 25 programs).

I would recommend you apply to more programs. 25 seems quite low especially for a nontraditional applicant with longer odds. 50-75 seems more like it to me.

 

[YanCanCook]

Hi,

Sorry to hijack this thread. I too am debating about switching out of my current medical specialty into OTO-HNS. It sounds like an uphill battle. I am a little bit of a hybrid of the two previous posters, and I would appreciate any insight/advice on my situation, if there are any good avenues to pursue, and if my fear that my chances to switch are small is valid.

My background:
Currently, I am finishing up a medical internship and will be doing radiology next year at a competitive NE program. I came from a top 25 medical school, Step I-250, Step II-255. I previously was interested in Otolaryngology, and I actually took a year off to do basic science HNSCC/cancer biology research during my schooling. I decided to pursue radiology as I was getting married and my wife was worried about the strain of a surgical residency would have on our lives/family.

Going through my internship, I am worried about my future career and losing touch with clinical medicine and high-end procedures being in radiology. I was planning on pursuing Interventional Radiology, but I have been hearing horror stories of futile turf wars and diminishing scope for the field.

I was wondering if the only avenues available are research fellowship gigs. Also, I was wondering how I would be viewed as non-traditional applicant even though I have shown previous interest in the field. I am aware that I would have to re-do a surgical/ENT internship. Also, I was wondering if my training funding would be transferrable as I would be coming from a 4 year radiology residency.

Thank you for your help in advance.

 

[Leforte]

To DrFuzz:

Your best chance is at your own institution. If you are known to be a hard worker, humble, interested in ENT and are working with your ENT department to improve your CV as a non-traditional applicant, then your chances are vastly improved.

As stated above - while I am sure we alll appreciate your abilities - ie that you know fluid management, current guidelines in ICU care, etc - the question that will be in the back of everyone's mind is that we consult medicine when we have a particular issue to help resolve. Medicine and surgery are very different. While there are patient numbers to get randomised trials in medicine, these numbers do not necessarily exist in sub specialised surgical medicine and much of our clinical decision making is based on not only the literature, it is also based on what we experience with our own hands and skill set. Some flap surgeons use ASA, some voodoo heparin, some other stuff - while there is some evidence, much is from small studies, etc. it would be difficult to have a junior resident/intern constantly question this, or in the worst case, make comments about care to the team which contradict that which we know works in our own hands and in our own institutions. While we appreciate your medical background - and will call upon it many times - there are many times when you will just have to accept that this is the way that things are done. That can be difficult at best for someone who is now at the top of the food chain and suddenly is back at the bottom. Believe me.

These things would be difficult to put into a personal statement, and would best be dealt by someone who knows your temperament - ie your home institution's chairman and residency director.