why otolaryngology

[surgery2121]

Why is it super competitive? Can some one list the pros and cons and the future of this field.

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[ensuii]

Have you tried reading their forum?

http://forums.studentdoctor.net/forumdisplay.php?f=143

 

[Droopy Snoopy]

Why is it super competitive? Can some one list the pros and cons and the future of this field.

Bottom line is ENTs in general make bank, are home for dinner, and get an uninterrupted night's sleep.

They say everything between dura and pleura which covers a lot of intricate anatomy, the challenge of which really appeals to that subgroup of surgically-minded people who desire a better lifestyle than what gensurg/ortho/neuro offers. Parotid tumors, craniofacial trauma, thyroid, helping deaf kids hear, etc. The daily routine is a nice mix of medsurg without being too broad, and they're big on academic research which appeals to a lot of people. But it really comes down to the money. Picture a family doc with 30 relatively simple office visits per day, the ENT by comparison has 20 relatively minor surgical procedures in the same day and is reimbursed x10.

Medicine is really going to be going through changes in the next 10 years or so, both in terms of technology and actual delivery. Some specialties will find a way to benefit, some will be harmed. 40 years ago radiology for example was the field that all the 'questionable admissions' sought out, but with the advent of advanced imaging modalities and later interventional technique it really took off. We could get a single payer system that up and decides to pay $30 for a T&A instead of $300 and makes FM where the money's at. Nobody really knows, so you just have to pick work that you love and can see yourself being happy with regardless of tax bracket.

 

[surgery2121]

those are some really good pros but I also want to hear some cons. What are some things ENTs aren't happy about.

 

[BOOURNS]

But it really comes down to the money.

Really? Based on what I've seen, ENT salaries are about the same as Gsurg (albeit working less hours), and significantly less than ortho, uro, etc.

Anyway, I didn't pick for the money.

 

[Pir8DeacDoc]

Salaries vary from region to region and type of job. Generally speaking ENT's will be compensated on par with urologists, which tends to be more than G surg but less than ortho and Nsurg. If you want to make a fortune in any of the above, you can do it, just depends on where you are willing to live.

 

[BOOURNS]

I was speaking strictly based on published mean and median salaries. There are always outliers. And I think some of those in ENT are those doing lots of facial plastics.

 

[surgery2121]

you guys think ent is safe from socialized medicine because its sort of elective.

 

[Pir8DeacDoc]

The largest chunk of what we do is not elective. As others have noted above, if all of a sudden someone decides to change re-imbursement for ear tubes, tonsills/adenoids, and sinus surgery, then compensation for ENT's would drop like a rock.



At the end of the day you do what seems to fit you the best. If you are paid well for it, then even better.

 

[resxn]

The largest chunk of what we do is not elective.

I'd have to completely disagree with this. The vast majority of what we do is elective. Although there are absolute indications for tubes and tonsils, there are a significant number who get them for relative indications. Thyroid surgery is often elective (benign FNA on a sub 3cm nodule). FESS is nearly universally elective except in the case of noted malignancy. OSA surgery is universally elective. Laryngeal surgery usually is elective. Most ear surgeries are elective whether mastoid, tympanoplasties, acoustics, etc.

Cancer surgery, airway emergencies, and trauma are pretty much the only guaranteed non-electives.

As far as salaries go, if you look at a general ENT with the latest MGMA salary surveys, we make slightly more than general slavery, slightly less than urology, but have better lifestyles than both. We make far less than ortho and neurosurg. We make more than general ophtho. But seriously, you won't last a decade in practice if you're picking your specialty based on money and lifestyle. You'd better like it. And you'd better find it rewarding or you'll burn out, regardless of the field. If you don't burn out and quit, your referring docs will see that you don't love it and you'll lose your referral base. I see it far too often in far too many specialties including ENT. Pick what you love, not what you can tolerate.

 

[Pir8DeacDoc]

Point well taken.

 

[sansibar]

Hi!
I am a trauma resident and tired of emergency operations. I want to switch to ENT not only because its more elective.
But my biggest concerns is about the training. It is a very difficult anatomic area to learn to operate
Are my concerns legitimate?

 

[resxn]

Hi!
I am a trauma resident and tired of emergency operations. I want to switch to ENT not only because its more elective.
But my biggest concerns is about the training. It is a very difficult anatomic area to learn to operate
Are my concerns legitimate?

I think that's what appeals to the majority of ENT residents. Personally, I think if you're not completely baffled by how the hell you do a neck dissection before your R3 year, something is wrong. Also, I don't think you'll find harder anatomy to learn and conceptualize than the skull base and temporal bone. But that's the fun part of it all.

The biggest difference from what you're doing is that other than cancer whacks, you're doing small hole surgery in complex 3-D anatomy. It's the BEST!

 

[radslooking]

I think that's what appeals to the majority of ENT residents. Personally, I think if you're not completely baffled by how the hell you do a neck dissection before your R3 year, something is wrong. Also, I don't think you'll find harder anatomy to learn and conceptualize than the skull base and temporal bone. But that's the fun part of it all.

The biggest difference from what you're doing is that other than cancer whacks, you're doing small hole surgery in complex 3-D anatomy. It's the BEST!

that's what i liked best about ENT. working in relatively small spaces with complex anatomy. if that turns your crank that would help. Not an ENT surgeon, but did contemplate the career at one time.

 

[TubesNTonsils]

I think many people who choose Oto are those who decided they wanted to be surgeons then looked at the various options.

The pros include:
- being specialized enough that you don't share a ton of turf with other specialties (notable exceptions include thyroid and facial plastics)
- great lifestyle compared to other surgeons
- excellent population control such that the job market is always pretty good whether you want to do academics or private practice
- balance between medical and surgical practice (though for some this may be considered a negative)
- lots of variety - there's a big difference between doing ears, sinus and skull base, and head and neck stuff that keeps things interesting
- your colleagues will generally be happy, nice people

Cons:
- you could make more money doing radiology or some of the other surgical subs if you're into that
- as long as you take patients who have health insurance, you are somewhat at the mercy of their reimbursement rates; the only people immune to this are those who do cosmetic procedures (keep in mind that these have plummeted during the recession) and those who have a boutique cash-only practice which is basically impossible if you intend to do much operating
- some people hate "small hole surgery" and prefer to have all of the anatomy splayed out in front of them and wield large saws and chisels

 

[sansibar]

@ TubesNTonsils
First of all; I like that kind of breakdown into pros and cons. It helps me to make my decision. Please more of that
But
concerning "lots of variety"
I dont think thats like that. In my hospital (I did a rotation in ENT when I studied) the ear guy just did ears, the nose guy just did nosejobs etc. Dont get me wrong, I mean as a patient i would rather prefer a guy who did 500 nosejobs instead of 100. But as a surgeon it seems boring doing repetitive procedures. Thats not just an ENT problem, I mean we have one guy who is specialized in hip-trauma, the other does all the joint traumas. But they all can do each operation some better some worse.

Its that sub sub-specialization what bothers me to change into ENT.
Because it is already a small field, splitting it again in organ parts makes more mini.

 

[TubesNTonsils]

Sansibar, you point out a fact that is true at academic institutions. In order to be viable in academics, you need a niche. Most faculty are fellowship-trained (except for the older ones perhaps), and this sort of super-specialization is a good thing for residency training. You want to learn from the experts in each respective sub-specialty. There are general otolaryngologists in academics, but they're usually the minority.

In private practice, however, you really can do a bit of everything. You'll end up referring the most complex stuff to tertiary centers, but you will have first crack at anything that walks in your door. Every field has it's own version of "bread and butter" - the routine things that pay the bills. My mentor told me that if you don't like the bread and butter of a given specialty (whether ortho or gen surg or oto), you won't be happy. The private practice guys I've talked to say that their bread and butter includes T+A, BMT, FESS (minus major frontal sinus work), T plasty, DLs, and basic neck masses. If you ask me, that's a pretty good variety!

 

[sansibar]

Thanx for the suggestion. The notation about breadNbutter is genuine!
Respective variety, I think you are right if you mention the pretty good variety in Oto. In comparative to trauma at all events!
For the U.S. its even more diverse, because here in Germany, ENTs dont do Thyreoids and few plastics (in academics).

I had the best time during ENT rotation. The patients, the staff, the OR, the manageable emergency (but I hated vertigo!) etc.

I should do it in the first place. Anyway, I think I will try it

 

[drivesmecraazee]

How is the varitety of ENT compared to urology? Which one has more variety of procedures and clinic?