Otolaryngology & Plastics

[tbo]

Hi all, so I'm mired in the 'what do you want to be when you grow up'-fun of MS1 and have limited exposure to specialities so far. I have seen some microvasculature done by an H&N Otolaryngologist and have no exposure Plastics. Both seem to do similar reconstructive procedures. I was curious if any of you more senior folks can provide some insight into the similarities and differences between the two and how to better explore these specialties. Thanks.

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[Pir8DeacDoc]

Hi all, so I'm mired in the 'what do you want to be when you grow up'-fun of MS1 and have limited exposure to specialities so far. I have seen some microvasculature done by an H&N Otolaryngologist and have no exposure Plastics. Both seem to do similar reconstructive procedures. I was curious if any of you more senior folks can provide some insight into the similarities and differences between the two and how to better explore these specialties. Thanks.

Right now you better just worry about having a strong application. Both are competitive. IMHO you aren't really at a stage in your career where the differences matter much. So keep working hard in your Biochem class and things will begin to fall into place when the third year starts. If you have some time here or there, then shadown a PRS guy and see more about what they do.

 

[Wardens]

Hi all, so I'm mired in the 'what do you want to be when you grow up'-fun of MS1 and have limited exposure to specialities so far. I have seen some microvasculature done by an H&N Otolaryngologist and have no exposure Plastics. Both seem to do similar reconstructive procedures. I was curious if any of you more senior folks can provide some insight into the similarities and differences between the two and how to better explore these specialties. Thanks.

I can comment a bit about the ENT side of things, but realized that I've only just matched. If you go to plastics via ENT you do a subspecialty in facial plastics and/or microvascular reconstruction after an ENT residency (currently the most competetive ENT subspecialty). You'll obiously be limiting yourself to head and neck aesthetics and local reconstruction. Plastics may or may not be 2 years shorter depending on the way you go through plastics (integrated or not).

As an MS-I, you can start expressing interest in the department. Start shadowing an ENT in clinic, offer to work on a summer research project, write a case report, etc. As you get a bit further along (late second-mid-third year) schedule a meeting with the chair and start going to grand rounds as often as possible. Take an ENT month early if you're still unsure at this point. Some of the other folks can help you out with learning more about plastics.

 

[225557]

As an MS-1 your only real job at this point is to study your butt off and focus on doing well on Step 1 and doing well as a 3rd year. You need to put yourself at the top or near the top of your class and try your best to get AOA. You have no idea how insanely competitive it is as I just matched this year into an integrated spot. If your school has a plastics department then you should try to get involved in some research and if you do not have a program like I did not, try to get involved with gen surg in research.
The only real way to see what the fields are really like is to do a rotation in each. I did an away at a big name and it was eye opening and awesome. You will have some time during your 4th year to do a rotation in each before applying and you may have an opportunity to spend time with each 3rd year.
But, if you have to get the grades, letters of rec, and Step 1 score first to have a shot at either so work hard now to give yourself all the options possible.

 

[tbo]

First of all, I appreciate all the advice and candor for an MS1. This is particularly valuable since as you all know, MS1 is a bit of a tunnel and context is hard to come by.

But I will respectfully disagree that the only responsibility during MS1 is to do well in classes. Why not gain a focus as early as possible? Having such a focus or resolution early on can bolster one's ability to do well - you can find a direction, and move towards it.

In any case, prepping for ENT or plastics (or anything else competitive for that matter) doesn't exclude me from any career options going forward. I suspect everyone here would agree that establishing a path early on helps.

Anyhow, thanks for the insight. I still would appreciate a plastics perspective to supplement Warden's comments (thanks). Good luck to all transitioning this year.

 

[dilated]

Hi all, so I'm mired in the 'what do you want to be when you grow up'-fun of MS1 and have limited exposure to specialities so far. I have seen some microvasculature done by an H&N Otolaryngologist and have no exposure Plastics. Both seem to do similar reconstructive procedures.

They're not THAT similar. They do overlap somewhat in the area of post-cancer head and neck recon. Who does what is institution dependent, there are places where ENT does all of their own recon including free flaps and places where they do basically none. But either way, not that many plastic surgeons OR ENTs are doing post-mandibulectomy free fibs because those cases tend to be done at high volume academic places by specialized fellowship-trained micro guys.

If you really want to figure out which field you're better off seeing which one's bread and butter appeals to you more than whether you prefer skull base tumor resections to fronto-orbital advancements.

 

[Pir8DeacDoc]

But I will respectfully disagree that the only responsibility during MS1 is to do well in classes. Why not gain a focus as early as possible? Having such a focus or resolution early on can bolster one's ability to do well - you can find a direction, and move towards it.

Interesting that you ask for advice and receive it from a plastics resident and an ENT resident and you (an MS-1) disagree.

 

[jejudo]

Interesting that you ask for advice and receive it from a plastics resident and an ENT resident and you (an MS-1) disagree.

He simply phrased it incorrectly. All of us MS1s know that good grades, high Step 1, and AOA are important. The question is what else should we do to get a better feel for ENT and plastics, and more importantly, to become more competitive for these specialties?

Wardens, you say that ENT limits you to facial plastic surgery. Do plastics guys (via integrated or combined) do many facial reconstructions? Or is this field dominated by 'ENT Plastic Surgeons'? Is it fair to say that regular plastics focuses on below body reconstructions (breast, hand, etc.)? If I were to open up shop as an integrated-trained plastics guy, could I have reasonable success (i.e. referrals) for facial reconstructions?

As for being competitive, does basic science research help out in either of these specialties? Would a year off as an HHMI med scholar (doing research on, say, regenerative medicine) make an applicant stand out significantly?

Many thanks in advance.

 

[Pir8DeacDoc]

There are two misconceptions that are going on in this thread that need to be addressed.

1. A PRS trained physician can operate on any part of the body. This includes reconstruction/cosmetic procedures of the face. Certainly the market can get a little tighter in the face as there might be ENT and OMFS competing for that market. But overall if you wanted to do facial recon (not cosmetic) doubtful anyone will be trying to take that business from you.

2. An ENT physician isn't limited to only facial plastics. It is a one year option that many ENTs find more palatable than a 3 year PRS fellowship, but ENT is an approved pathway for PRS fellowship. In fact, at my hospital currently one of the plastics fellows is fully trained in ENT. Honestly it makes more sense to come to PRS from ENT than from general surgery (at least to me, but I'm biased)

 

[maxheadroom]

I'm a chief in an integrated PRS program. At our place, ENT does most of their own Head & Neck Recon. They'll do Radial Forearms (without bone) and occasionally they'll do a Fibula. They won't do a Scapula or a Radial Forearm with bone. They are very aggressive with preop Chemo/Rads, so their resections aren't as big as ones that I saw in medschool.

We do almost all of the post-MOHS recon. We get a lot more of the facial lesions. We split facial trauma with them, but they hand off some of the more difficult mandibles to one of our attendings.

In summary, most PRS programs should give you plenty of training in facial recon. If your program doesn't do as much H&N free flaps, you might want some additional training if that's something that you really want to do (which is only done in major academic centers). I'm happy not doing much in the realm of H&N free flaps, but I have friends who are academics who focus their practice on that area.

I have a friend who is a ENT-Facial Plastics guy. He does a fair amount of post-MOHS work. He doesn't do micro.

 

[PAJain]

As an OMFS resident I've worked with both PRS and ENT on facial recon cases. Personally I've found the PRS residents to have more knowledge and surgical experience with reconstructing the face, especially when it came to trauma cases. I also found the PRS residents to be more informed of all the aspects of facial cosmetic surgery. If someone was interested in doing facial reconstruction I think PRS is the way to go. The facial plastics/ent surgeons are extremely skilled when it comes to rhinoplasties, but aside from that I haven't seen an advantage of doing ENT over plastics.

"Max" I think its interesting that ENT defers to your service with the complex mandibles. In my experience usually both ENT and PRS defer to OMFS with their complex mandible fractures.

 

[maxheadroom]

Believe me, I'd be happy to hand off the condylar fractures to OMFS, but our OMFS guys are private practice and don't really want any trauma at all. They'll take the occasional fracture, but most of them get split between ENT & PRS.

 

[Leforte]

It all depends on where you train as to what abilities you will have when you finish. Every program is different for both ENT and PRS. We do our own trauma and plastics does their own. We have never asked the other to assist or help out. We (that is, my ENT department) do our own free-flaps, mainly RFFF (with and without bone) and the occasional fibula, scapula and even rectus (if a second tissue flap is needed for BIG holes). PRS does all the clefts and reconstructions in any place other than the H&N. Both of us do cosmetics, but the vast majority in my city of >2 million go to the non-academic private practice guys in the community so our ENT and PRS experience is limited. Most people interested in this pursue additional training in a cosmetic fellowship.

I agree with what is said before, PRS and ENT are very different fields. It would be like say GS and ENT are similar fields because we both take out thyroids and do neck dissections. Look at each fields bread and butter. If you like basic ENT, focus there. If you like basic PRS, focus in that department. Both are competitive, but I'd say PRS>ENT due to the small number of slots and high caliber of MS IVs interested in the specialty. Yes getting your foot in the door can help, but most students I have seen start this process at the end of their MSI year when looking for summer research opportunities. As a new MSI, you'll quickly learn that you are surrounded by very smart people and it takes a ton of effort to do well in your basic courses, much less focus a significant amount of time with a clinical department. First things first.

 

[MadDoc124]

I'm a third year considering both plastics and ENT at the moment .. I found the discussion quite helpful. just wondering if you can comment on whether one is better for women or if they are pretty much the same in terms of time outside of work (for having a family)? I would appreciate any advice/ thoughts. Thanks.

 

[Leforte]

For women in any surgical field, as for men in any surgical field, the time commitment required after residency is determined by you. You can work long hours if you want to get into big surgeries with complex patients or make money - you can work shorter hours and be home, too, but usually sacrifice case complexity that you will be comfortable with as well as income. The dynamics of the group you join when you finish training will also dictate what is required, too. If everyone is hard-core and working long hours, they may not be willing to accept you as a partner if you want to home each night by 5 pm and pass off work to them. Both PRS and ENT are considered more lifestyle oriented surgical specialties, but in both of our fields, there are surgeons who work 80+ hrs per week and surgeons who are <50. Call in both is relatively light. Financially, we do similarly, too. Look at the bread and butter of each field, and see which you prefer. Some people prefer to not deal with snot and ear wax, others aren't into breast reductions and ulcers. You can't go wrong with either field, and I would say that both PRS and ENT attendings are quite happy with their chosen fields.

I can tell you, that in ENT, we have seen a dramatic increase in the number of female applicants and residents, but I would guess that this is representative more of the medical student population since I see far more female residents in all surgical fields.