ENT subspecialties

[DocPRS]

So I am an MSII, and am interested in entering ENT. I've been wondering how many people end up sub-specializing in ENT, and what the more competitive fellowships are?

Also, I am curious, what are the salary difference between practicing general ENT vs tailoring your practice towards Facial plastics or neurotology? Basically I am trying to gauge whether it is worth it to spend an extra year doing a fellowship.

Thanks.

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[DrBodacious]

I am out of residency, in private practice for 2 years, so there may be new data. I recall people saying 25% of residents do a fellowship.

Plastics is probably the most competitive. Neurootology is really small (~13 spots?), so it can depend on how much interest there is.

Rhinology fellowship seems unnecessary if you just want to do sinus cases, because most residencies teach FESS well. But, could be good if you want to do academics and be involved in rhinology research or endoscopic skull base surgery. It would also help market yourself in an urban area, or if you just like doing sinus cases and not general ENT. It seems like many rhinology trained folks do some general, also, though.

Peds fellowship is kind of similar to Rhinology. Good for academics if you want to be the end of the line for rare and challenging cases, or research . Also a marketing tool /ploy, ie if you want to attract insured children in urban areas.

It seems like field - specific research is generally needed to show commitment for a fellowship, and faculty willing to make a phone call for you.

Monetary factors are not really worth considering as a MSII. The field could change in 7 yrs. It is complicated with regards to if a fellowship is a good financial decision or not. General ENT has a lot of potential for success. I started solo out of residency, merged with someone after a year. I am doing better than most salary offers. On top of that, I have complete control over my practice. I would hate being judged by a hospital system and reporting to the head of otolaryngology in the hospital system.

There seems to be a lot of people saying the shift to employment is going to continue. I would argue that in many if not most markets, private practice remains a much better option, financially.

 

[DrBodacious]

I guess I will refocus my answer to say that as a MSII, just learn about the clinical aspects of the various sub-fields, and see if you like them. I knew as a student that I liked many of the fields within ENT, and therefore it was great to have several options as I gained experience. I ended up continuing to like everything, so I do general.

And, maybe this answers your question, you definitely do not NEED a fellowship to do well, financially.

 

[DocPRS]

Wow thanks for the great response, this cleared up a lot of my questions.

 

[resiliens]

I am out of residency, in private practice for 2 years, so there may be new data. I recall people saying 25% of residents do a fellowship.

Plastics is probably the most competitive. Neurootology is really small (~13 spots?), so it can depend on how much interest there is.

Rhinology fellowship seems unnecessary if you just want to do sinus cases, because most residencies teach FESS well. But, could be good if you want to do academics and be involved in rhinology research or endoscopic skull base surgery. It would also help market yourself in an urban area, or if you just like doing sinus cases and not general ENT. It seems like many rhinology trained folks do some general, also, though.

Peds fellowship is kind of similar to Rhinology. Good for academics if you want to be the end of the line for rare and challenging cases, or research . Also a marketing tool /ploy, ie if you want to attract insured children in urban areas.

It seems like field - specific research is generally needed to show commitment for a fellowship, and faculty willing to make a phone call for you.

Monetary factors are not really worth considering as a MSII. The field could change in 7 yrs. It is complicated with regards to if a fellowship is a good financial decision or not. General ENT has a lot of potential for success. I started solo out of residency, merged with someone after a year. I am doing better than most salary offers. On top of that, I have complete control over my practice. I would hate being judged by a hospital system and reporting to the head of otolaryngology in the hospital system.

There seems to be a lot of people saying the shift to employment is going to continue. I would argue that in many if not most markets, private practice remains a much better option, financially.

Here's an interesting paper published in the AAO-HNS journal that touches on the financial aspects of pursuing a fellowship:
The Financial Value of Fellowship Training in Otolaryngology

I'm curious why facial plastics is the most competitive if it's not financially beneficial (as per the study's findings)..

 

[HighPriest]

Because financial reasons aren't the only reason to do a fellowship.

I've found that the most common reasons (in no particular order) are:

marketability (being able to add that fellowship training to your website and being able to tell all the primary docs in the neighborhood that you're fellowship trained)
comfort (a lot of people finish residency still not feeling comfortable operating and they need some extra time and training)
personal interest (you just like facial plastics and either you want more, or you want exposure to certain aspects of it that you didn't have much exposure to in residency...maybe you only did a couple of face lifts as a resident, or maybe you did more but you didn't really touch the patient),
Access to the complicated stuff - Yes you can do FESS and ear surgery coming out of residency, but that doesn't mean you're ready to do major skull base reconstruction or acoustics or free flaps, etc. In fact, credentialing will require that fellowship certification to do free flaps, and you can do that through a head and neck cancer pathway or through many facial plastics/reconstructive pathways.
competitiveness (You want to join that practice in downtown Boston? well, everyone else there did a fellowship, so you need a better resume)
avoiding the other stuff (maybe you hate ear surgery and want to avoid it at all cost. well, being the "rhinologist" is a good way to do that.)

And keep in mind that how much you're paid is more complicated than how much your net income is. It has a lot to do with location, types of procedures performed, billing, etc. etc. etc. Also, fellowship trained people go into academia more often, and the pay is lower.

But, generally, facial plastics is a short fellowship, it trains you to do some more valuable surgery, and it doesn't saddle you with being the head and neck guy, the otology guy, or the invasive fungal sinusitis guy. you can add a fellowship to your resume without really being potentially saddled with anything you don't want to do, and without taking 2 years to complete. Also, the fellowship schedule is probably a little better than some. Most of the facial plastics guys I know don't really do facial plastics as a significant portion of their practice.

 

[OtoHNS]

Agree with above.

Also, salary surveys for medical specialties are notoriously unreliable.

I remember writing a fairly in-depth post about the topic of earnings potential for various subspecialties within the past couple of years- you can probably search my post history to find it if you're interested.

 

[applicant0704]

Agree with above.

Also, salary surveys for medical specialties are notoriously unreliable.

I remember writing a fairly in-depth post about the topic of earnings potential for various subspecialties within the past couple of years- you can probably search my post history to find it if you're interested.

I was curious, if you subspecialize in head & neck oncology/microvascular reconstruction, how many of your attending cases are devoted towards procedures from your fellowship? Is it difficult to find a job out of fellowship where you actually get to do microvascular reconstruction/oncology and are then stuck with mostly general procedures?

I imagine it differs from institution to institution, but I was wondering what your experience has been like.

 

[HighPriest]

I was curious, if you subspecialize in head & neck oncology/microvascular reconstruction, how many of your attending cases are devoted towards procedures from your fellowship? Is it difficult to find a job out of fellowship where you actually get to do microvascular reconstruction/oncology and are then stuck with mostly general procedures?

I imagine it differs from institution to institution, but I was wondering what your experience has been like.

It isn’t that hard. It kind of depends upon what lifestyle you want and where you want to live. If you join a small community practice, you probably won’t do enough micro to even maintain your skill set. If you work for a hospital system in a large city, you should have no problem burning yourself out by doing 3-5 micro cases every week. Or more. If you’re insane.

The guys I know best are in a medium sized city with a ton of HN-micro competition and they do nothing but ablation and reconstruction for cancer.