What should I pick - ENT or Surgery

[ninjaSurgeon]

I'm a M3 with a 247 on Step 1 and top quarter of my class. So far I honored in all my rotations with surgery grade pending. I have no med school research on my resume. No junior status (which is probably due to lack of research also). I'm currently having a personal crisis over what I want to go into.

Like many students, a part of me wants to become a hardcore doctor, while the other part wants to go into a "lifestyle" specialty with good hours and good money. My grades are technically good enough to go into any specialty, which is part of the struggle. I do find surgical and anatomy stuff more stimulating, which helps me narrow down to:

Gen Surg: Good training and exposure to plenty of things before going into a fellowship. Good chance of matching into a major academic institution, which is what I prefer to do my training at. I do have the fear that I would feel overworked and underpaid one day when I compare myself to my friends who chose rads, derm, plastics, ortho, etc.

Integrated Vascular: Basically saves me time if this is what I end up doing after gen surg. However, I don't know if I am competitive enough for these spots, especially at major academic places.

ENT: To be honest, I haven't had much exposure to this field, but from what I heard it is a mix of outpatient and surgical procedures. Relatively good hours and pay, lower stress. Not sure if I'm competitive enough to get in.

Integrated Plastics or Ortho: Mixed feelings about them. Probably not good enough to get in anyways.

Radiology: I've considered this and concluded that while interventional is cool, I can't see myself going through the training, let alone doing, diagnostic rads.

I have very little interest in anesthesiology, derm, or IM specialties.

I'm not sure what kind of answers I'm looking for. Can you guys maybe shed some light as to what I need to do to pick a specialty? Or maybe weigh the pros and cons that I haven't thought about? Our school doesn't allow us to pick electives during 3rd year so I pretty much have no time to "fall in love" with a specialty that the attendings and residents speak of. Sorry I know this is vague as hell but I'm really struggling with this right now.

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[xrevision]

Personally I think ENT is the most badass surgical field, but I hate surgery so I'm going into rads.

 

[ninjaSurgeon]

Why do you say that? I personally have no experience in ENT so I don't have an opinion. I think vascular is cool because you can do anywhere from neck to feet.

 

[xrevision]

I also spent time on a vascular surgery service... theres really no helping those patients. It usually goes like this -- patient with 80 pack/year history of smoking/DM II with an A1c of 12 comes in for claudication. First is angioplasty, patient continues to smoke/eat himself to death, then he goes in for plasty + stent, patient continues to smoke/eat but less than before so he can be "healthier". Inevitably the stent goes down and now its time for a bypass. The bypass has a certain lifespan and it goes down. Now the patient needs an amputation and is pissed that you couldn't save his foot. The patient population is almost as bad as the chronic pain population.

 

[KinasePro]

I haven't picked my specialty yet so I can't give you much great advice... But try to look at the basic questions. Do you want to treat relatively healthy or sick patients? Gsurg/vascular definitely have sicker patients and more SICU work. At my med school, this is what normally lures people away from ent, ortho, urology, etc... Some people enjoy treating sick patients, and gsurg has them for sure.

Big surgeries or tiny surgeries? ENT has always been sold to me as a specialty that mostly deals with "tiny surgeries in tiny places," and while you can definitely do big whacks in H&N surgery, that branch of ENT generally won't afford the stereotypical lifestyle that ENT is known for.

Which subspecialties do you like better? There's an assload of fellowship options in both fields, probably worth your time to chew on them a bit.

Are you linked to a certain geographic region? I would think you would have better geographic flexibility in a gsurg/vascular practice than ENT. Though you may have to move to a new place for your ENT career, either pathway will have good opportunities.

Which bread and butter do you prefer: tubes & tonsils or butts & guts? You should probably enjoy the bread and butter work in whichever field you choose.

 

[badasshairday]

This all boils down to:

mucus / saliva VS poop / gangrene

 

[EmergencyMonkey]

You can't go wrong with S@!t. People are full of it. An endless stream of business

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visit the monkey at EmergencyMonkey.com

 

[Laryngophed]

You can't go wrong with S@!t. People are full of it. An endless stream of business

GE's just pull hundred dollar bills from anuses.

 

[xadmin]

GE's just pull hundred dollar bills from anuses.

This

 

[Tatastrophy]

Hey, I am going into ENT and spent a significant amount of time with the Dept at my undergrad in addition to med school.Thought I'd chime in.

ENT: while they certainly do have different typical working hours than Gen Surg guys, I would pause before calling this a lifestyle specialty. You are thinking of clinic but forgetting about the fact that they routinely perform 6+ hour surgeries. And it isn't like clinic=home free by 5 pm, I've seen residents having to call their SOs during clinic to let them know to not expect them til after 7 pm. Not sure if you want to call that lifestyle specialty experience. Private practice probably does allow for better hours, but I personally have no desire dealing with the other non medicine related issues that come with it so I haven't researched that part.

Gen Surg: not sure what is holding you back from it but I think its a great choice if you aren't 100% sold on any of the specialties. Hours in residency suck, thats true, but would you rather do something you love or be in another specialty and be always thinking "damn, I really wish I was doing what my friend in gen surg is doing". I liked gen surg a lot more than I imagined I would, I splashed around in guts, I cut off a limb, do some pretty cool Onc cases...but couldn't get over the stuff I did in ENT, so it was an easy choice for me. Unless you felt the same way about a specialty, I would advice you to stick with Gen Surg.

But I have a question to everyone saying ass=$$$$: what procedures are you talking about exactly? The docs I've spoken to basically unilaterally agree that stuff like major surgeries, colonoscopies, larger procedure stuff is where they lose money and small stuff especially that doesn't involve anesthesia is the money maker in their practice. Just wondering.

 

[member1000765]

ENT resident here. The notion about ENT being a lifestyle specialty is really confined to private practice otolaryngologists; it in no way applies to residency or most academic positions. I can write pages about why I think Oto-HNS is the best surgical specialty out there today, but it boils down to: huge variety of procedures ranging from small, quick cases (tubes, tonsils [which actually require a high degree of skill and can have severe adverse effects if performed incorrectly]) to 11-12 hour huge head and neck resections with microvascular free flap reconstruction, tons of cool technology, probably the most well-rounded surgical experience available (craniofacial is like face orthopedics, otology/neurotology is in line with neurosurgery, sinus is all endoscopic, head and neck requires great technical precision, facial plastics is plastics, etc.)

During residency it's a double edged sword; at my and many institutions, ENT residents are at the hospital more than the gen surg residents. For example, tubes and tonsils might be quick cases, but if you do 20 tubes/tonsils in a day, that's 20 pre-ops, 20 operations, 20 op notes, 20 discharges, 20 scripts to write, etc. The case might be quick, but the amount of work that comes with each case adds up quickly. And the really cool free flap that you just spent the last 12 hours scrubbed on, that patient is going to be in the ICU for the next 1-2 weeks, so if you're at a busy free flap program, you're going to be taking care of lots of very sick patients. We love having so much variety in our scope of practice, but that same variety is what keeps the pager going off all night long when we're on call; not only do we get called for the run of the mill ENT problems like foreign bodies (ear, nose, airway), epistaxis, peritonsillar/retropharyngeal/parapharyngeal etc. abscesses, but we split face trauma with plastics/OMS and are the emergent airway docs among other things...and we do this covering both the adult and children's hospitals. It's a lot.

That being said, I couldn't imagine being in any other area of medicine; I love my specialty. However, don't mistake it as a low hours, low stress specialty, especially during residency. It's hard work, and it's as stressful as any other specialty. I'd recommend you check it out to form your own opinion.

 

[rocketbooster]

ENT resident here. The notion about ENT being a lifestyle specialty is really confined to private practice otolaryngologists; it in no way applies to residency or most academic positions. I can write pages about why I think Oto-HNS is the best surgical specialty out there today, but it boils down to: huge variety of procedures ranging from small, quick cases (tubes, tonsils [which actually require a high degree of skill and can have severe adverse effects if performed incorrectly]) to 11-12 hour huge head and neck resections with microvascular free flap reconstruction, tons of cool technology, probably the most well-rounded surgical experience available (craniofacial is like face orthopedics, otology/neurotology is in line with neurosurgery, sinus is all endoscopic, head and neck requires great technical precision, facial plastics is plastics, etc.)

During residency it's a double edged sword; at my and many institutions, ENT residents are at the hospital more than the gen surg residents. For example, tubes and tonsils might be quick cases, but if you do 20 tubes/tonsils in a day, that's 20 pre-ops, 20 operations, 20 op notes, 20 discharges, 20 scripts to write, etc. The case might be quick, but the amount of work that comes with each case adds up quickly. And the really cool free flap that you just spent the last 12 hours scrubbed on, that patient is going to be in the ICU for the next 1-2 weeks, so if you're at a busy free flap program, you're going to be taking care of lots of very sick patients. We love having so much variety in our scope of practice, but that same variety is what keeps the pager going off all night long when we're on call; not only do we get called for the run of the mill ENT problems like foreign bodies (ear, nose, airway), epistaxis, peritonsillar/retropharyngeal/parapharyngeal etc. abscesses, but we split face trauma with plastics/OMS and are the emergent airway docs among other things...and we do this covering both the adult and children's hospitals. It's a lot.

That being said, I couldn't imagine being in any other area of medicine; I love my specialty. However, don't mistake it as a low hours, low stress specialty, especially during residency. It's hard work, and it's as stressful as any other specialty. I'd recommend you check it out to form your own opinion.

Yea I just rotated through general and ENT. I definitely liked ENT 100x more. However, I personally felt the procedures that make ENT stand out are mainly in the academic side of the job. The head and neck resections with microvascular free flap reconstruction are really only done at academic centers. While those surgeries are pretty cool, they also take 12 hours nonstop. If you choose to do those, you do a head and neck fellowship and then probably commit yourself to doing a few of these a week. I personally don't want to sign up for that time commitment haha. You're signing up to have bad hours the rest of your life. The ppl who choose to do head & neck absolutely love it and cannot see themselves doing anything else. That's why they do it.

As for the rest of ENT, which is basically the private practice side, the procedures are still pretty interesting but not as flashy. Lots of sinus surgeries and otology cases. They're not super exciting and it's those simpler things you'd be doing in private practice. The private practice side of ENT reminded me a weaker version of ophtho, IMO. Still not as good hours as ophtho and the eyes are a lot more interesting than the ears, nose and throat IMO.

 

[GalenAgas]

Pick surgery