H&N practice for General Surgeons?

[Atton]

Hello,

I'm a MS4 currently on the interview trail for Gen Surg. Every program has shown their fellowship match list and I noticed several people going into "Head and Neck" over the past few years (at least in 5+ programs I have visited so far).

I'm wondering what is the scope of practice for those GS-trained surgeons who do a H&N fellowship (no ENT background)? Are they basically just doing thyroids and parathyroids? If so, why wouldn't they do an endocrine fellowship instead (classically a more GS fellowship)?

I can't even imagine how GS-trained people can even do a H&N fellowship, compared to an ENT person who has spent 5 years working above the clavicle. I have seen some H&N surgeons (ENT) at my home institution and they are doing crazy complex tumor ablations and recons. I don't know how a GS could do those, with just 1 year fellowship.

Also, what does it look like in terms of employment (since they can't take ENT calls)?

Thanks!

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[OtoHNS]

There was a surgical oncologist at the institution where I did my residency who did some H+N cases. He was in his late 50s to early 60s (and this was 8-10 years ago now). I'm not sure what training he had, but he did the occasional laryngectomy, neck dissection, parotidectomy, etc. He had the reputation for turning the bovie up to 80 and blasting the specimen out as fast as possible, cranial nerves be damned. I'm not sure how true the legends were since I never scrubbed with him during my month of surg onc as an intern.

Otherwise, I'm not personally familiar with any more recently trained general surgeons who have trained in head and neck. For ENTs, the main purpose of a head and neck fellowship is to learn how to do free flaps, with a secondary purpose learning very advanced and unusual ablative procedures. A graduating chief resident in ENT ought to be able to perform the vast majority of head and neck ablative procedures.

A general surgeon going into head and neck would be very far behind, not just in the open surgical aspect, but in the ability to evaluate the pharynx and larynx, both in the office with the fiberoptic scope as well as directly under anesthesia.

A general surgeon building a practice in H+N could probably be done in certain circumstances, but it would be a significant uphill battle to do so.

I guess if you are really interested, you could try and find out names of people who matched into head and neck fellowships and see what they are doing now.

 

[WinslowPringle]

There are/have been two surgeons at UNMC who did GS residencies then HN fellowships now doing HN surg onc and reconstructive work.

 

[drdoctor]

I don't think this is a good route. A lot of complex head and neck surgery requires ENT skill set - knowing endoscopic sinus surgery for anterior craniofacial resections. Even simple stuff like a myringotomy is necessary to know for patients with nasopharyngeal tumors. I think thyroid and parathyroid surgery, parotid, neck surgeries can be done with training, but not complex resection/recon. Scoping is a whole new skill set that takes ENTs an entire pgy-2 year to really learn.

 

[nacholibre]

Agree completely with Drdoctor. There are two very different cultures and ways of thinking about the H&N between ENTs and General Surgeons in my experience. The ENT surgeon spends 5 years of training learning about the complex interrelationships of structures, organs, nerves, and functions of the various head and neck systems. The ENT understands the complex physiologic consequences of damaging one of these structures or systems. For example a resident will invariably encounter a patient with a recurrent laryngeal nerve injury in each of the following settings: H&N oncology, laryngology, speech pathology and pulmonology. The patient with a large parotid cancer will be seen in H&N oncology, neurootolgy and facial plastics. The list goes on. Furthermore in each of these settings, a resident masters different methods, tools and techniques to evaluate these systems and their pathologies. This just isn't the case for general surgeons. They too, often have a mastery of the anatomy, but cranial nerves, accessory swallowing muscles, extra mucosa, salivary ducts, redundant venous drainage pathways, etc become much less sacred to them (in my limited experience).