When know ENT right fit?

[AMedStud]

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When did you guys know when ENT was the right fit for you? During the head and neck section of anatomy? ENT rotation? If you were considering other specialties, what finally helped you chose?

 

[Pir8DeacDoc]

I didn't actually get a big kick out of head and neck anatomy as a first year. It was a bit overwhelming for me at the time. If you don't fall in love with the anatomy right away, don't let that dissuade you.

 

[resxn]

Pretty easy for me. I wanted surgery. I loved anatomy, especially head and neck.

And then I did ENT and fell in love with procedures. More importantly, it was the only clinic I did that I actually enjoyed as a student. I got bored in general surgery, sick of genitals in urology, bored in ortho, and just didn't like all the butt-kissing the plastics guys did to their patients.

So for me, it was pretty easy decision.

 

[HighPriest]

When I wandered into the house of surgery and the ENT porage was just right.

 

[TheThroat]

Loved surgery. Finally had to decide between oto and ophtho. More variety in oto, in my opinion.

 

[drivesmecraazee]

Loved surgery. Finally had to decide between oto and ophtho. More variety in oto, in my opinion.

WOOOOOORRRRRRD!!!

 

[Catalyst]

WOOOOOORRRRRRD!!!

no offense but the more i read your posts, the more weirded-out I become

 

[drivesmecraazee]

no offense but the more i read your posts, the more weirded-out I become

EXPLAIN YOURSELF.

 

[Catalyst]

EXPLAIN YOURSELF.

Wow.

 

[dilated]

And then I did ENT and fell in love with procedures. More importantly, it was the only clinic I did that I actually enjoyed as a student.

What clinic, though? Part of the reason I have a hard time knowing if I'd like ENT or not is that (at least at my institution) everybody is super-specialized. Peds clinic is pretty boring, but H&N clinic is cool, laryngology clinic is neat but balance/vestibular clinic isn't. There's no 'general ENT' here so how do you combine these completely different experiences - neuro-otology vs peds are like two different professions.

The diversity of ENT is one of its best aspects but it makes it hard to know if you really "belong" or not.

 

[Leforte]

Although a broad generalization, take the bread and butter of each sub-specialty and that is what you'd do as a generalist ENT. Some do more or less depending on their residency experience -

Peds: Tubes, tonsils, LN Biosies, occasional thyroglossal duct cysts, etc
Neuro-otology: Tympanoplasty, tympmastoids, BAHA, Basic OCR, tc
H&N: thyroids, parotids, anterior floor of mouth CA, neck dissections, etc
Laryngology: vocal cord medialization, VC microflaps, subglottic stenosis, etc
Facial plastics: Trauma, gold weights, skin lesions, septums, rhinoplasty

Plus a ton of others.

As far as a generalist in academics - that all depends on the place. Many people who choose general would rather make higher pay in PP. Those in subspecialties can find it hard to have an exclusive practice unless in academics, although many do quite well in PP, too.

Personally, I would like the idea of being a generalist in an academic setting provided that I could get as advanced as you want, with good peer support (which is not always the case).

 

[Pir8DeacDoc]

Personally, I would like the idea of being a generalist in an academic setting provided that I could get as advanced as you want, with good peer support (which is not always the case).

I'm told that as a generalist in a speciality dominated academic practice that you're likely to get the dump cases that no one else wants while the specialists take all the good stuff. Is this what you're referring to in terms of "peer support" ? Thanks

 

[resxn]

LeForte took the words right out of my mouth.

And yes, peer support is sometimes tough as a general ENT in an academic practice. I nearly took a full-time faculty position, but would have been relegated to very few thyroids, very few sinus cases, and stuck with doing a lot of trauma and sleep apnea. Not exactly what I was looking for.

If your subspecialist peers would "allow" you to have a true general ENT practice it would be a great way to practice. That's hard to do these days.

From most of the positions I've seen at least as well-stocked departments, the general guy does mostly trauma, H&N infections, and OSA, a few tonsils and tubes, and tympanoplasties here and there. Doesn't do much oncology, otology, rhinology, or pediatrics. That's a big chunk of change to miss out on.

 

[driedcaribou]

And yes, peer support is sometimes tough as a general ENT in an academic practice. I nearly took a full-time faculty position, but would have been relegated to very few thyroids, very few sinus cases, and stuck with doing a lot of trauma and sleep apnea. Not exactly what I was looking for.

That's very insightful. Thanks!

It's funny how the world after residency usually is a blackbox to those prior to entering a field.

 

[beastmaster]

Peds: Tubes, tonsils, LN Biosies, occasional thyroglossal duct cysts, etc
Neuro-otology: Tympanoplasty, tympmastoids, BAHA, Basic OCR, tc
H&N: thyroids, parotids, anterior floor of mouth CA, neck dissections, etc
Laryngology: vocal cord medialization, VC microflaps, subglottic stenosis, etc
Facial plastics: Trauma, gold weights, skin lesions, septums, rhinoplasty

How do new ENTs streamline into one of these areas? Is it because they've completed a fellowship, or are these straight-from-residency graduates who themselves decided to focus on say H&N or facial plastics? I guess what I'm asking - do you have to be fellowship trained to subspecialize in academia? What about in PP?

 

[resxn]

How do new ENTs streamline into one of these areas? Is it because they've completed a fellowship, or are these straight-from-residency graduates who themselves decided to focus on say H&N or facial plastics? I guess what I'm asking - do you have to be fellowship trained to subspecialize in academia? What about in PP?

The short and less-accurate answer is yes, you need a fellowship to guarantee your ability to do that specific type of work.

The longer, better answer is it depends on your location. If you're in private practice where there are very few fellowship-trained physicians (typically this wouldn't be the case in a major metro) you could put yourself into a niche quite easily and do well. You couldn't do this in a fellowship-rich location, however. Well, at least not easily and without lots of time to build your practice. You will not garner the support or trust as easily in that setting. Having said that, I know of a handful of docs who have done just that but all of them have said it took a ton of work to be able to do so--more than they wanted oftentimes.

In the academic setting it totally depends on the department and what they're looking for. Some departments will hire a general ENT for a peds position and you could do that well. However, in a place that does not support the general ENT doing niche work, you would not be even a candidate for some of those positions. It's fairly transparent, though, since most universities are required to advertise nationally for their open spots. Most of those ads state quite clearly whether fellowship training is necessary.

 

[THE armada]

Are there a multitude of vocal cord pathologies or is there one very common pathology? What size market is needed to have a successful laryngology clinic?

 

[resxn]

Are there a multitude of vocal cord pathologies or is there one very common pathology? What size market is needed to have a successful laryngology clinic?

That's a pretty generic question for a highly specialized field which makes me wonder why you'd be asking it.

However, I guess the best answer is to say there is enough vocal fold (do not call it a cord if you're going into ENT) pathologies out there to have the demand for a subspecialty.

The size of the community? I'm not sure if there are true stats on that. The current thinking is that you need 1 general ENT per 35K people. So I'm going to guess that the "need" for a laryngologist (in order to remain busy) at the minimum is more on the order of 1 Laryngologist for every 5-7 general ENT's or in other words for every 175K-245K people. Certainly, if the laryngologist wants to focus on laryngology alone, he's going to need to be in a bigger population.

I have a good friend in a town of 220K in the midwest. He's a general ENT but focuses mostly on laryngology. Probably tries to keep 75%+ of his practice in laryngology alone. He can with that population. Another colleague about 40 miles north of him in a town of 400K is also a general ENT but tries to remain exclusively laryngology. He estimates about 90% of his practice is that way.

In general, you need a good referral system with lots of general ENT's to keep you busy if you want to exclusively do your subspecialty.

 

[THE armada]

That's a pretty generic question for a highly specialized field which makes me wonder why you'd be asking it.

However, I guess the best answer is to say there is enough vocal fold (do not call it a cord if you're going into ENT) pathologies out there to have the demand for a subspecialty.

The size of the community? I'm not sure if there are true stats on that. The current thinking is that you need 1 general ENT per 35K people. So I'm going to guess that the "need" for a laryngologist (in order to remain busy) at the minimum is more on the order of 1 Laryngologist for every 5-7 general ENT's or in other words for every 175K-245K people. Certainly, if the laryngologist wants to focus on laryngology alone, he's going to need to be in a bigger population.

I have a good friend in a town of 220K in the midwest. He's a general ENT but focuses mostly on laryngology. Probably tries to keep 75%+ of his practice in laryngology alone. He can with that population. Another colleague about 40 miles north of him in a town of 400K is also a general ENT but tries to remain exclusively laryngology. He estimates about 90% of his practice is that way.

In general, you need a good referral system with lots of general ENT's to keep you busy if you want to exclusively do your subspecialty.

The reason I ask is because I've always been involved in vocal performance and just wanted some general information about the subspecialty. Sorry bout the terminology, I'm a first year who hasn't had head and neck anatomy yet. I appreciate the help resxn.

 

[TheThroat]

The reason I ask is because I've always been involved in vocal performance and just wanted some general information about the subspecialty. Sorry bout the terminology, I'm a first year who hasn't had head and neck anatomy yet. I appreciate the help resxn.

Ahh, tomatoe tomatah....lets call the whole thing off. I know tons of folks who call it the TVC (true vocal cord), but some guys just have to call a centimeter a "sontometer". Its not like you're calling it the lair-nix.

There are still some places that would LOVE to have a fellowship trained laryngologist around (DFW, for one).

 

[5150]

Seems like there's a lot of pet peeves in oto, huh. I've been told never to call an otolaryngologist an ENT, never to use the word "injected' when describing TMs, and now I know some people get pissed if you say "cord" instead of "fold"... All very interesting.

Someone should make a thread titled "How to fail your oto rotation in 10 days," and then you guys can list all the things that med students say that really, really annoy you.

👍 or 👎?

 

[Catalyst]

Hahahaha

 

[Pir8DeacDoc]

Seems like there's a lot of pet peeves in oto, huh. I've been told never to call an otolaryngologist an ENT, never to use the word "injected' when describing TMs, and now I know some people get pissed if you say "cord" instead of "fold"... All very interesting.

Someone should make a thread titled "How to fail your oto rotation in 10 days," and then you guys can list all the things that med students say that really, really annoy you.

👍 or 👎?

Well, at least here we call them true vocal cords (TVC) and there's no problem with calling us ENT's. I guess the preferred nomenclature is Otolaryngology, Head and Neck Surgery, or calling them by their fellowship training --> "Neurotologist". Either way, I don't think it's such a big deal.

 

[resxn]

For the record, I have no problem being called ENT, and to be honest, although I've heard that rumor, I have yet to meet someone who does have a problem with it. I also don't really have a problem with TVC, but you just won't hear that from the laryngologists these days, and I've been told they will correct you if you submit any papers with TVC instead of TVF.

 

[Leforte]

It's not a big deal to call an ENT an ENT -far easier than otolaryngologist, head and neck surgeon. Some may have an issue with it, but I have yet to meet or work with one. I do agree that once you get into the subspecialties, people are usually referred to by their subspecialty (neurotologist, laryngologist, facial plastic surgeon) more because they really are not into, nor practicing, the whole field of ENT,

As far as TVF vs TVC - to my ENT peers, I say TVF - to peers from other specialties or patients, I usually just say "vocal cords" because I am lazy and really don't want to explain why we say fold instead of cord.

 

[exmike]

during interviews, I was asked "Why ENT" far more than "Why otolaryngology" by attendings

 

[5150]

That's actually refreshing to hear. I'm almost deathly afraid to utter those 3 letters these days in front of actual ENTs. Even the ENT Secrets book advises students against calling any otolaryngologist an "ENT." It's not something I've ever understood.