Any ENT/Plastics people out there? What chance do I have?

[Moola]

I'm applying for ENT now and hope to go to a respected, reknowned institution. At the end of five years in ENT, I hope to apply for General Plastics residency in hopes of having the expertise and skill to do perform the reconstruction after performing composite resection of head and neck tumors. I hope to also get into cleft palate and facial cosmetic work as well. I know that facial plastics fellowships exist for ENT people but the focus is too focused on the cosmetic aspect of plastic surgery rather than the reconstruction. I wish to be a good reconstructive surgeon basically specializing on the head/neck, and through general plastics I can do it.

My question is this. I understand entering the process that a GS resident will have a better shot than I would for the spot. I accept this. But, is there anyone out there who is ENT trained who made it into Plastics. I am desperate to find out. At this juncture, I will do what I can to be competitive. I will hopefully have 2-4 pubs by the end of this year. For residency, I hope to attend a place that is both well respected and has its own plastics program. I will work like a dog to ace my inservice exams, be an excellent ENT resident, and do research with the plastics department for as long as I am a resident-5 yrs. Hopefully, I can secure a good rec from the plastics guys there. After all is said and done, will this render me as being COMPETITIVE overall? Will I have a good chance? Should I give up my dreams of matching through ENT? If I don't match the first attempt, would doing a head/neck fellowship better my odds on teh 2nd time around?

I dont expect anyone to answer all my questions but just shed some light on the issue. In the end, I want to learn the essential reconstruction and be a moola surgeon.

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[gary_ruska]

I'm applying for ENT now and hope to go to a respected, reknowned institution. At the end of five years in ENT, I hope to apply for General Plastics residency in hopes of having the expertise and skill to do perform the reconstruction after performing composite resection of head and neck tumors. I hope to also get into cleft palate and facial cosmetic work as well. I know that facial plastics fellowships exist for ENT people but the focus is too focused on the cosmetic aspect of plastic surgery rather than the reconstruction. I wish to be a good reconstructive surgeon basically specializing on the head/neck, and through general plastics I can do it.

My question is this. I understand entering the process that a GS resident will have a better shot than I would for the spot. I accept this. But, is there anyone out there who is ENT trained who made it into Plastics. I am desperate to find out. At this juncture, I will do what I can to be competitive. I will hopefully have 2-4 pubs by the end of this year. For residency, I hope to attend a place that is both well respected and has its own plastics program. I will work like a dog to ace my inservice exams, be an excellent ENT resident, and do research with the plastics department for as long as I am a resident-5 yrs. Hopefully, I can secure a good rec from the plastics guys there. After all is said and done, will this render me as being COMPETITIVE overall? Will I have a good chance? Should I give up my dreams of matching through ENT? If I don't match the first attempt, would doing a head/neck fellowship better my odds on teh 2nd time around?

I dont expect anyone to answer all my questions but just shed some light on the issue. In the end, I want to learn the essential reconstruction and be a moola surgeon.

Gary Ruska here,
There are a number of well-known PRS who went the ENT route. Two that immediately come to mind are Thomas Mustoe (chief of PRS at Northwestern) and John Meara (chief of PRS at Boston Children's Hospital).

The ENT folks would be better equipped to answer your specific questions, but it is strictly GR's impression that ENT training and a head and neck surgery fellowship will allow you to accomplish most head and neck reconstructive work (with the possible exception of cleft lip/palate work) and, depending on your ENT program, qualify you to do various kinds of cosmetic work.

A question you should be asking yourself is why bother applying to ENT if you just want to end up doing plastics? Both fields are competitive to get into, and given the unpredictability of the fellowship plastics option (who knows if it will still be around when you're doing with ENT training), why not try for an integrated plastics spot?

GR would also recommend that you be extremely careful on the interview circuit about discussing these specific goals. There aren't too many ENT PDs who would like to hear that you plan on using ENT as a stepping-stone into plastics.

 

[Moola]

Hey Gary, thanks for your reply. The answer to your question is that I am not applying to integrated plastics because I like ENT a lot, but I like Plastics as well. By doing integrated plastics, i would really missing out as well. Also, I really am not particularly interested in doing colon/abdomen work during the first few years of an integrated residency. I would rather being doing ENT-Head and Neck stuff in that time. I'm definitely not using ENT to step into Plastics but I would like to customize my practice to afford the flexibility of ENT and Plastics practice and learn how to rebuild a face/head that I took apart during a resection. With that said, can anyone answer the rest of my question?

Moola

 

[alexroet]

Just a few words- first of all, you have everything planned out quite specifically- where you will do residency, how you will do on your inservice, who will write your letters, etc. Yes it's great to have a dream, and a plan to get there. But just don't put all your eggs in one basket.

And next- lose the whole "moola" thing. You seem to at least be able to talk the talk, and sound like you're in it for the surgery, not the money. Whether or not that is the truth, or an act, who knows. But I have to say your username and avatar cost you some credibility, and frankly I think are offensive.

 

[Moola]

Alex, thanks for your post and I know when i'm right and when i'm wrong. Yes, I am planning things out too far in advance. I realized that just now. But, as for your commments about the avatar/username in relation to their credibility...YEAH, MONEY IS IMPORTANT. I hate when these yuppie medical students come up to me and say "OH, I DONT CARE ABOUT MONEY...I JUST WANT TO LIVE IN THE BACKWOODS, MAKE JACK $HIT AND HELP THE PEOPLE." Such comments are offensive to people like me, the GENUINE POOR. While you were baking brownies for your biology professor for extra credit, I was struggling to keep my head over water playing college football for a scholarship while working nights and weekends at some of the worst jobs. In my whole academic career, I had to constantly give up going to some of the best schools because of financial hardships, being forced to go to places that offered reasonable financial aid. The reason my name is MOOLA is because I understand how hard it is to be a true SELF MADE MAN and how hard making an honest buck is. I'm just putting a humorous spin on my difficult circumstances and apparently u dont have humor. I have told all my interviewers thus far that yeah, financial security is important to me. This does not mean making $1 mil a year but at least having a realistic and tangible idea that as doctor, I'll make sure my kids won't have to make the same sacrifices and actually enjoy their college and grad school experiences. They all said that they agreed with me and appreciated my honesty in light of my circumstances.

In retrospect, these yuppie, liberal med students with their I HATE MONEY, DOCTORS WHO GO INTO MEDICINE FOR MONEY ARE EVIL will soon learn the reality. People like this either are lying about their money motives or have their head up their a$$. Life is tough and having a decent amount of money facilitates life. I'm honest with my intentions with money. My cards are on the table. I know I'm playing the world's smallest violin, but alex, YOU are the one who is offensive. Now...you can take your foot out of your mouth.

 

[cdql]

ouch

 

[alexroet]

No, no "ouch", and I do not need to take my foot out of my mouth, since I will stand by what I say.

The general public already thinks that we (doctors) are just money-grubbing bastards who sit on our asses, play golf all day, and make millions. Posts like yours don't help, regardless of the intent.

I don't know you, you don't know me- our backgrounds really don't matter. Yes, money is a factor. I am not that naive. As much as I love what I do, I don't think I'd be willing to put up with all this **** if I didn't know it would pay off someday. That said, if all I cared about were money, there are other, easier, ways to do it.

The thing is, doctors make good money. Regardless. Even the most basic primary care doc probably makes >100K. And that is plenty of money to live comfortably on and raise a family without having to make crazy sacrifices.

Yes, I look forward to the day that I'm not living on a resident's salary. I've worked my ass off (as we all have), and I think I (and all of us) absolutely deserve it.

Yes, the fact that plastics tends to be on the higher end of the spectrum appeals to me. But it is not my main motivation.

As I said- I don't blame you for wanting to make a good living someday. Especially if you came from a tough background. And I commend you for being honest about it- but I still think it's tacky to call yourself "moola" and talk about which residency will make the MOST money.

No matter what, you'll make money as a doc. Do what makes you happy and what you love.

 

[Tristero]

alex shut the **** up you tool. Moola is right about everything he said, and it's liberal asssholes like you who are the reason why the govt feels its ok to cut Medicare by anotehr 60% by 2015.

Enough is enough, stop with the altruistic self destruction. You need to work with some Family Docs ands see how they are struggling to pay their overheads.

Get off your high horse...yes >100k is a decent salary but any MBA or law partner and recently real estate brokers would laugh at that, and they have half our education. I'm not saying we all need to be millionaires, but between loans and the years we lose on residency, there needs to be some thign as just compensation...and with some primary care docs making less per hjour than PLUMBERS, this **** has gone too far...we are some of the best and brightest and we could have gone into any field and been successful, but we all went into medicine because at the end of the day we want to help people

you want to help out? when you're a plastic surgeon, how about you make 100k and everythign else you do past that is pro bono? put you money where your mouth is

and gary ruska, if you want to start **** with me because of the OMFS thread go ahead, because I was dead wrong...but I know i'm right about this. and you're still a loser for referring to yourself in third person. have a nice day.

 

[Fah-Q]

I'm applying for ENT now and hope to go to a respected, reknowned institution. At the end of five years in ENT, I hope to apply for General Plastics residency in hopes of having the expertise and skill to do perform the reconstruction after performing composite resection of head and neck tumors. I hope to also get into cleft palate and facial cosmetic work as well. I know that facial plastics fellowships exist for ENT people but the focus is too focused on the cosmetic aspect of plastic surgery rather than the reconstruction. I wish to be a good reconstructive surgeon basically specializing on the head/neck, and through general plastics I can do it.

My question is this. I understand entering the process that a GS resident will have a better shot than I would for the spot. I accept this. But, is there anyone out there who is ENT trained who made it into Plastics. I am desperate to find out. At this juncture, I will do what I can to be competitive. I will hopefully have 2-4 pubs by the end of this year. For residency, I hope to attend a place that is both well respected and has its own plastics program. I will work like a dog to ace my inservice exams, be an excellent ENT resident, and do research with the plastics department for as long as I am a resident-5 yrs. Hopefully, I can secure a good rec from the plastics guys there. After all is said and done, will this render me as being COMPETITIVE overall? Will I have a good chance? Should I give up my dreams of matching through ENT? If I don't match the first attempt, would doing a head/neck fellowship better my odds on teh 2nd time around?

I dont expect anyone to answer all my questions but just shed some light on the issue. In the end, I want to learn the essential reconstruction and be a moola surgeon.

The best head/neck fellowships offer microvscular recon training. General plastics are doing fewer H&N flaps and ENT's are doing more. If you really know you want to do H&N cancer and recon then a general plastics fellowship won't offer any advantage over an ENT H&N fellowship.

Cleft lip/palate is still mainly general plastics territory but there are ENT residencies and fellowships that offer training in this as well. I think you will find it difficult to do major H&N cancer/recon AND clefts in your practice. They are completely different in terms of training and patient population.

 

[gary_ruska]

and gary ruska, if you want to start **** with me because of the OMFS thread go ahead, because I was dead wrong...but I know i'm right about this. and you're still a loser for referring to yourself in third person. have a nice day.

GR here,
Please reread what GR wrote - none of what was written is attacking you in any way, tristero. Nothing GR has written on this thread is attacking anyone.

 

[toofache32]

Simma down now!

 

[alexroet]

me? liberal? Ha.

Tristero I felt bad when you deleted your posts in the OMFS thread, b/c I thought you were right on. I would have gone back to re-read to see if I missed something, but, well, they were deleted.

Whatever. I think it's obnoxious for someone to call himself "moola". That's it. And I will think that no matter how much you all swear at me.

I am done with this thread. Have fun.

 

[Tristero]

lol sorry man i didnt mean to be such a dick...its just important we stay unified at a time in which 3rd parties are trying to destroy the profession of medicine.

its important for doctors to be humble, but we all must also realize that we possess/will possess skills that very, very few people have, yet for for some reason we have no control over our profession..which is different from every other professional occupation i can think of

anyways...best of luck to you alex!

 

[donkeypunch]

its just important we stay unified at a time in which 3rd parties are trying to destroy the profession of medicine.

Trying to destroy? Its already destroyed. The time for unification was 25 years ago but the baby boomers decided to take while the taking was good instead of doing something to save it.

Also the deck is stacked against unification. Do you think it isn't intentional that a general surgeon is paid $1200 for a whipple when an ophtho doc can get the same for a 20 minute outpatient cataract? I think the fee structure is set up to keep doctors pissed at each other so that they don't cooperate.

its important for doctors to be humble, but we all must also realize that we possess/will possess skills that very, very few people have, yet for for some reason we have no control over our profession..which is different from every other professional occupation i can think of

You may be incredibly skilled. It doesn't matter. 70% of people in the US think healthcare is a right and every other industrialized country has socialized medicine. Eventually that is what will happen in the US. If you are comfortable with that then by all means do family practice or anesthesia or radiology. If you don't want to work in a socialized system for pennies on the dollar of what you are worth then you better not provide a service that people need. Need constitutes right in the minds of 70% of US people. Education is also a right in the US. How much do they pay teachers. Teachers have to have 4 year degrees and many of them have training beyond like masters degrees. Even with a masters degree (and of course this will vary a little bit by district) teachers typically top out at around 50K. My guess is that doctors won't get a whole lot more than that.

 

[toofache32]

Also the deck is stacked against unification. Do you think it isn't intentional that a general surgeon is paid $1200 for a whipple when an ophtho doc can get the same for a 20 minute outpatient cataract?

....and a dentist can get $2000 for a 15-minute set of wisdom teeth.

 

[droliver]

The best head/neck fellowships offer microvscular recon training. General plastics are doing fewer H&N flaps and ENT's are doing more.

I'd argue that you're 100% wrong outside of some (but not all) tertiary teaching hospitals. In the three states I've practiced and trained in , there is no reconstructive microsurgery being done by ENT's except at 2 (of 5) training programs that were in those areas. Also keep in mind that the # of patients truly requiring microsurgery is very small.

For that matter, I don't know any ENT's who would have a remote interest in this to a large degree. The reconstruction is usually more tedious & less financially rewarding then the resection. My medical students going into ENT used to tell me that heavy micro exposure was a huge negative in the way they evaluated programs (kind of like plastic surgery programs that run the burn unit)

 

[Fah-Q]

I'd argue that you're 100% wrong outside of some (but not all) tertiary teaching hospitals. In the three states I've practiced and trained in , there is no reconstructive microsurgery being done by ENT's except at 2 (of 5) training programs that were in those areas. Also keep in mind that the # of patients truly requiring microsurgery is very small.

For that matter, I don't know any ENT's who would have a remote interest in this to a large degree. The reconstruction is usually more tedious & less financially rewarding then the resection. My medical students going into ENT used to tell me that heavy micro exposure was a huge negative in the way they evaluated programs (kind of like plastic surgery programs that run the burn unit)

Tertiary teaching hospitals is what I am talking about because private guys just don't do these cases. But I appreciate the 100% wrong comment...that's always helpful in determining who is clueless.

The top ENT programs all do their own recon and most have fellowships. Resident exposure to micro is limited (fellows do this at most places) and any student deciding on ENT programs based on how many flaps they do is horribly misguided.

I wouldn't call the number of patients requiring free flaps small...at least not in tertiary care centers. The number of flaps being done is increasing, not decreasing. The demand for free flap surgeons in ENT programs is high and is going to increase.

Also, the reimbursement for resections and recons is actually increasing. It is still not a financially viable option for a private guy, but again I'm only speaking about tertiary academic centers.

 

[eclcell]

The top ENT programs all do their own recon and most have fellowships. Resident exposure to micro is limited (fellows do this at most places) and any student deciding on ENT programs based on how many flaps they do is horribly misguided.

At the institution I work with the ENT's do most all their own free flaps and reconstructions. In fact the plastic surgery residents struggle to get enough of these cases, and this is a top plastic surgery program.

As far as Moola's plan to do head and neck cancer surgery and reconstruction I would say this is feasible though the ENT path alone. For the cleft lip/palate goal, however, I think you'll have to decide what you want to do most. It would be very difficult to have a career doing head and neck cancer surgery and craniofacial plastics in kids. They don't overlap very well as far as career paths. Most of the people in my experience doing cleft lips/palates are craniofacial trained plastic surgeons. There are more of them wanting to do it than there are patients that need it. Being a head and neck cancer specialist trying to swallow up some cool pediatric craniofacial too might not go over well.

 

[Leforte]

Where I am at, we do ~75+ free flaps a year, with no fellow. Residents are involved on them all, but usually the attendings do the micro anastamoses. Residents can perform the anastamoses as chiefs if they have an interest (read: will be doing a H&N fellowship) = it takes far to long to teach someone micro if they're going into private practice or Peds ENT, etc... Plastics is not involved in any of our reconstructions. Call is Q4 from home, so its actually not too bad - plus the operative exposure can't be beat.

There are a few ENT residencies that do clefts - UC Davis, Arkansas, Minnesota (if memory serves me right) - Davis has a fellow, not sure about the others.

Getting into Clefts in practice is tough - and just because one completes a General Plastics Fellowship doesn't mean they've had adequate exposure, either. I'd agree with the need for advanced training if this wasn't a strong area in residency/fellowship.

BTW Head and Neck reconstruction sounds cool as a medical student. But there is a reason that only ~1/3 of all H&N fellowship positions fill.

You'll find out in residency.

Leforte

 

[alexroet]

Where I am at,

care to say where that is?

 

[resxn]

I trained at Colorado and one of our 6 Peds ENT guys, Greg Allen, does about 3 cleft surgeries a week. I left my program having done 22 palates and 11 lips. Now they're doing even more and there is no fellow.

I know 6 plastic surgeons in Denver who did ENT residencies and then the plastics fellowship. It's very common to go from ENT to plastics. I'd rather die than do it, but some do.

As far as recon goes. MD Anderson H&N oncology fellowship does one year of extirpation and one year micovascular recon. Several oncology fellowships are like that. Many other places, the plastics department is the one that does the recon. In CO, the ENT program did removal and recon entirely on our own. We NEVER used plastics. The cases could take forever because of that (7AM-1AM was not uncommon for the big ones) but we did it all and had great experience with it.

Many places the ENT does the removal and someone else, either plastics or another ENT, does the recon. The reason is because the extirpative guy shouldn't be biased regarding his margins and thinking how hard something will be to close. That and it allows one surgeon to not have to do a 14 hour case--most go only 6 or so anyway when done in a tandem--trust me at 1AM it's not fun doing a microvascular anastomosis when you've been in the OR all day.

 

[MDstudent79]

Alex, thanks for your post and I know when i'm right and when i'm wrong. Yes, I am planning things out too far in advance. I realized that just now. But, as for your commments about the avatar/username in relation to their credibility...YEAH, MONEY IS IMPORTANT. I hate when these yuppie medical students come up to me and say "OH, I DONT CARE ABOUT MONEY...I JUST WANT TO LIVE IN THE BACKWOODS, MAKE JACK $HIT AND HELP THE PEOPLE." Such comments are offensive to people like me, the GENUINE POOR. While you were baking brownies for your biology professor for extra credit, I was struggling to keep my head over water playing college football for a scholarship while working nights and weekends at some of the worst jobs. In my whole academic career, I had to constantly give up going to some of the best schools because of financial hardships, being forced to go to places that offered reasonable financial aid. The reason my name is MOOLA is because I understand how hard it is to be a true SELF MADE MAN and how hard making an honest buck is. I'm just putting a humorous spin on my difficult circumstances and apparently u dont have humor. I have told all my interviewers thus far that yeah, financial security is important to me. This does not mean making $1 mil a year but at least having a realistic and tangible idea that as doctor, I'll make sure my kids won't have to make the same sacrifices and actually enjoy their college and grad school experiences. They all said that they agreed with me and appreciated my honesty in light of my circumstances.

In retrospect, these yuppie, liberal med students with their I HATE MONEY, DOCTORS WHO GO INTO MEDICINE FOR MONEY ARE EVIL will soon learn the reality. People like this either are lying about their money motives or have their head up their a$$. Life is tough and having a decent amount of money facilitates life. I'm honest with my intentions with money. My cards are on the table. I know I'm playing the world's smallest violin, but alex, YOU are the one who is offensive. Now...you can take your foot out of your mouth.

I'm only an MS1, and I've already observed some of what you're talking about. We recently had a lecture with Dr. Paul Farmer (of "Mountains Beyond Mountains" fame)--who, if you don't know, has made huge sacrifices in his own life as an infectious disease doc setting up clinics in Haiti, Russia, and elsewhere throughout the world.

The point is that after the lecture--and reading the book, as was asigned to us all--many students were saying that Dr. Farmer was an inspiration to them and that that's exactly what they wanted to do with their careers and so forth.

Obviosuly something happens between MS1 and MS4, as the stats show pretty plainly that the most competitive fields in medicine all boast either a better-than-average (for an MD) lifestyle or better-than-average salaries. It would seem family practice, ID, and public health stuff would all be at the top of the list if money and lifestyle were truly at the bottom of every MD's priority list.

That said, in response to the posts that went back and forth here, I would say that EVEN the average general internist who's been working a few years is in the top 1% of income earners in the country and lives a very nice lifestyle. No, not like a rock star or Bill Gates. You're going to have to generally open up clinics, invent something, or make some good investments to do that sort of thing.

But it really doesn't take *that* much money to have the nice house in the prestigious neighborhood, send your kids to good schools, have a fancy car and a boat, etc. My father was an airline pilot and never made over about $250k, and we had all of those things growing up and then some, and all of my education (including college) was paid for with family cash easily.

The lesson isn't so much that doctors get paid so handsomely, but rather that there are a LOT of people barely making ends meet in this country. Until you're at the level where you can go to lunch with Steve Jobs or buy a professional ball team, there's really not a huge difference between the lifestyle of somebody making $200k a year and someone making $600k. Except that the latter is probably working more and pays more taxes.

 

[uziel]

But it really doesn't take *that* much money to have the nice house in the prestigious neighborhood, send your kids to good schools, have a fancy car and a boat, etc. My father was an airline pilot and never made over about $250k, and we had all of those things growing up and then some, and all of my education (including college) was paid for with family cash easily.

Please, you sound like those bright-eyed bushy tailed ppl who are just as idealist as the next. I'd take Tristero's advice, why don't you try making 100K and come back and tell us you're "just fine". Well, aren't you lucky your paps paid for your freakin schooling, you pompous no-debt crap-head. I'm sure you represent the whole lot of us. How could you even know what you're talking about? I bet you're not married you don't own a house or have kids to pay for (much less their college) or a boat. You all just pull it out of your ass. If I make $1 mil a year and decided to give half of it to the poor, or to playboy, that's my perrogative. We all make decisions for OURSELVES, regarding OUR lives, and OUR money. Everyone stop trying to guilt future docs into feeding the facade.

 

[Tired]

But it really doesn't take *that* much money to have the nice house in the prestigious neighborhood, send your kids to good schools, have a fancy car and a boat, etc. My father was an airline pilot and never made over about $250k, and we had all of those things growing up and then some, and all of my education (including college) was paid for with family cash easily.

Wow, only 250k and your family still managed to squeak by?

Here, let me predict your next three posts:

"There were some days when the maid was off, and I had to make my own breakfast."

"I've never understood why people take out loans. Don't they have Daddies who can pay for it?"

"I don't understand why doctors don't do more pro bono work. Their trust fund should cover their overhead."

 

[donkeypunch]

Wow, only 250k and your family still managed to squeak by?

Here, let me predict your next three posts:

"There were some days when the maid was off, and I had to make my own breakfast."

"I've never understood why people take out loans. Don't they have Daddies who can pay for it?"

"I don't understand why doctors don't do more pro bono work. Their trust fund should cover their overhead."

It always amazes me the amount of people who are in medicine that come from money, or have parents who are willing to give them cash for expenses. My wife and I are the only people we know - in or out of medicine - our age who don't have parents sending money. Go to any major city and see the 24 year olds living in million dollar apartments in the trendiest areas of the city and try to convince yourself that they are somehow generating the income necessary to support the lifestyle. Puh Leeze.

Like you, I stare in disbelief when people who have everything handed to them start lecturing me about how I shouldn't worry about making money. Lemosine Liberalism at its best.