Deciding between otology and rhinology

[afozengaron]

About to finish residency (not in the US), Im not American but my wife is so I'll get a green card no problem...
I want to do fellowship in the US and trying to decide between otology and rhinology.
Can someone provide and input comparing these 2 fields in terms of:
1. Availability of fellowship programs for those who did not complete an ENT residency in the US
2. Market prospects in the present and near future
Thanks!

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[javksmith93]

I’m not sure even if you do a fellowship here if you could practice in the US without having to match into ent residency and then completing that you won’t be board eligible otherwise. At least that’s my understanding this doesn’t have to do with green card or no green card but that does make matching into residency slightly easier but as an img would still be a big up hill battle

 

[operaman]

Yeah the licensure thing is going to be key. Not sure how the rules work from your country.

Rhinology fellowships aren’t ACGME which means you’re usually hired as an attending and have to be fully licensed. I’ve seen some foreign grads around over the years but not sure what paths they took or what the terms of their fellowship were.

Otology is ACGME but is by far the most competitive fellowship in ENT and that still doesn’t solve your employability problem after finishing.

If your hope is to go back and practice in your home country, there may be arrangements you can make. If you’ve got a strong cv and internationally known mentors who will vouch for you with US programs, you might be able to find something.

Hopefully someone else knows more about the nuts and bolts of making this work.

 

[Wordead]

There is zero chance of getting an otology spot in the US without some nuclear-powered connections and probably a ton of research. You could do years of research at a program for a hope of matching but (in my opinion) not worth it.

Rhinology programs are plentiful and you might be able to get one, but getting a job might still be a problem as mentioned above. Rhinology fellowship is pretty much useless for getting a job - way more rhino grads than academic jobs, and every generalist does sinus surgery so you're limited.

 

[afozengaron]

For some reason the perception that Americans have on the difficulty of getting a fellowship spot as a foreigner is quite distant from reality and I don't mean it in a confrontational way 🤣🤣
Seriously EVERY US resident/attending share the idea that is (almost) impossible to get a spot on certain US fellowships and Im telling you from personal experience that I met a few, and a few doesn't mean those 2 guys lol... I've met a few people from my home country that matched into US otology fellowships, I just don't know what they did to get in and Im sure its hard.
Im not gonna lie, getting a spot in the US is waaaay harder than Canada, England, Australia, etc
And I've even met a ridiculously small number (that guy and the other one) that actually got to stay working in academia in the US after completing their fellowship, without doing residency in the US... I have no idea how that happened 🤷🏻‍♂️

 

[Wordead]

Well sounds like you know better than us so good luck

 

[operaman]

For some reason the perception that Americans have on the difficulty of getting a fellowship spot as a foreigner is quite distant from reality and I don't mean it in a confrontational way 🤣🤣
Seriously EVERY US resident/attending share the idea that is (almost) impossible to get a spot on certain US fellowships and Im telling you from personal experience that I met a few, and a few doesn't mean those 2 guys lol... I've met a few people from my home country that matched into US otology fellowships, I just don't know what they did to get in and Im sure its hard.
Im not gonna lie, getting a spot in the US is waaaay harder than Canada, England, Australia, etc
And I've even met a ridiculously small number (that guy and the other one) that actually got to stay working in academia in the US after completing their fellowship, without doing residency in the US... I have no idea how that happened 🤷🏻‍♂️

Ok I think we probably need to clarify a bit here.

For most US based docs, when we say otology fellowship what we actually mean is a neuro otology fellowship. It’s a 2 year acgme program leading to a subspecialty board cert in neurotology. These are the highly competitive very academic programs. Otology fellows have written more papers about acoustic neuromas than there are patients who have had acoustic neuromas.

There are other non acgme 1 year otology fellowships. These do not lead to any special certification and are much less competitive. My guess is that this is what your compatriots did, and they are correct that it’s pretty easy to get one. You’d still have all the same licensing issues, but these fellowships would likely be attainable if you had that sorted out.

Working in an academic US position after one of these is exceptionally rare. I know of only one - quite possibly the same one you know. If it is, he’s an exceptionally brilliant and personable man and I remember him having to deal with a lot of red tape to get where he is now. But he has landed a wonderful job and ironically his new chairman is the only other US academic otologist I know who never did an otology fellowship at all! Both awesome and accomplished surgeons though.

 

[afozengaron]

Ok I think we probably need to clarify a bit here.

For most US based docs, when we say otology fellowship what we actually mean is a neuro otology fellowship. It’s a 2 year acgme program leading to a subspecialty board cert in neurotology. These are the highly competitive very academic programs. Otology fellows have written more papers about acoustic neuromas than there are patients who have had acoustic neuromas.

There are other non acgme 1 year otology fellowships. These do not lead to any special certification and are much less competitive. My guess is that this is what your compatriots did, and they are correct that it’s pretty easy to get one. You’d still have all the same licensing issues, but these fellowships would likely be attainable if you had that sorted out.

Working in an academic US position after one of these is exceptionally rare. I know of only one - quite possibly the same one you know. If it is, he’s an exceptionally brilliant and personable man and I remember him having to deal with a lot of red tape to get where he is now. But he has landed a wonderful job and ironically his new chairman is the only other US academic otologist I know who never did an otology fellowship at all! Both awesome and accomplished surgeons though.

Mmm yeah its possible that we're talking about non accredited fellowships... Just out of curiosity, who are you talking about??

Well sounds like you know better than us so good luck

I didn't mean to offend anyone with my comment... It was just an observation... Like I always hear about how impossible it is (not just from you) and yet, the cases are there, not many though... And I don't really know HOW to become one of those cases... Peace

 

[Slack3r]

Why is otology so competitive? Few spots?

 

[Wordead]

Why is otology so competitive? Few spots?

Very few spots, somewhere between 12-14 depending on the year (though I believe a couple new programs have started up in the last couple years though I dont keep abreast of it anymore). I think you dont need that many positions because there's only so many skull base cases to go around.

Mmm yeah its possible that we're talking about non accredited fellowships... Just out of curiosity, who are you talking about??

I didn't mean to offend anyone with my comment... It was just an observation... Like I always hear about how impossible it is (not just from you) and yet, the cases are there, not many though... And I don't really know HOW to become one of those cases... Peace

I know 3 foreign grads that did neuro-otology fellowships. All of them did 3-5 years of research at an institution that was impressed with them and took them in and the attendings spoke up on their behalf. I gave you the answer in my initial post. Apply to do research at one of the programs with a strong otology presence, be productive and impressive, and hope they support you.

 

[afozengaron]

What's the situation of peds fellowship programs in the US?
Might be totally worth it since you get to do a lot of otology in children anyways