Any last minute ranking advise from the senior members?
excuse the mis-spell in the topice line: ranking advice is what I am looking for
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excuse the mis-spell in the topice line: ranking advice is what I am looking for
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Ranking Advise
- Thread starter ent
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I just made a similar post on otomatch.com under the "should i go to a program that does free flaps" (or whatever).
Ranking is difficult. This is basically going to seal a lot of your options in the future. It really does. I never realized how uninformed I was about programs in general until I was well into residency and you learn about other programs and your colleagues who go through residency with you and in parallel to you. Some of your reasoning will be sound; some of it will be ill-informed.
You can't be miserable at a program. However, you can't expect to be walking on sunshine either.
You want a program that gives you all the experience you need in your career; however, you don't want to be operating to 2 am every other night or be murdered on call.
If I could give you my advice, it would be this.
1) Location is really unimportant. It's five years. If you're single, bite the bullet. If you're married, convince your spouse to move. If you have a family, find a way to make it work. It may suck to be in a place like Iowa (no offense, Throat) or whatever, but if the training is good, you won't regret it.
2) Seek a balance, but some things are more important than other. Things I consider important are in the following order: 1) Head and Neck, 2) Rhinology, 3) Otology, 4) laryngology, 6) plastics, and 5) peds. Why? Here's why. If you go to a program that is head and neck strong, you pretty much can learn a lot of skills. Programs strong in H&N will get you your cancer cases, thyroid cases, flaps, pituitaries, and the like. You may never touch another cancer case, but you'll have mad skills in the OR. If you are private practice bound, sinus is going to be your bread and butter. That brings in a lot of dough. So do septoplasties. Outpatient turbinate surgery, sinuplasty. Highly profitable stuff. Better know how to do tehm well. Again, if you're going into private practice, you're not going to be doing acoustic neuromas, lateral TB resections, labyrinthectomies, or cochlear implants. But, you will do tubes, tympanoplasties, mastoidectomies, and potentially stapedectomies. For laryngology, if you can do strobes, do microlaryngoscopies, microflaps, vocal cord injections, thyroplasties, and BoTox, you've got a good laryngology practice. Beyond that, it's going to a laryngologist in your area. Plastics is highly specialized and if it's purely cosmetic, you might not want to mess with it. However, doing blephs, rhinoplasties, and mandible fractures (insurance, yes) are good money. Lastly, people often lament that a program has no pediatric otolaryngologist. So what? I bet you this: if you go into private practice, you ain't doing a pediatric neck mass, cochlear implant, cleft lip, or tracheoplasty. Tubes. Tonsils. Thyroglossal duct cysts.
3) Rank a program that works you, but make sure this program strikes a balance. If it's all OR, that ain't right. If it's all clinic, that ain't right either. If you're up all night on call typically, don't worry about this. You'll go home the next morning. Don't worry about minor violations of the 80 hour work week; you'll live.
4) Rank a program that has a clear didactic schedule run by attendings and/or fellows, not one that is run by residents. Rank a program that considers the didactics mandatory and excuses residents from clinical duties, not one that lets you go if clinic is "light" or if the case is "almost done" or whatever.
5) If you get a bad vibe from one attending, see how strong the others are. You can work with one bad apple. More than that, think twice. Remember: balance.
6) Don't rank a program just because of its name. What they are now doesn't necessarily live up to its name.
7) Do look at where graduating residents go. If they are going into fellowships, look at what types and where they go. This is tough. Some fellowships aren't accredited, but that doesn't mean anything. However, some fellowships, although not accredited, are pretty shady. For example, head and neck fellowships aren't accredited. Obviously going to Sloan would be great. Going to the Alaskan Head and Neck Institute for fellowship may not be so great.
8) Your gut isn't always right; don't forget that you occasionally have gas pains.
Ranking is difficult. This is basically going to seal a lot of your options in the future. It really does. I never realized how uninformed I was about programs in general until I was well into residency and you learn about other programs and your colleagues who go through residency with you and in parallel to you. Some of your reasoning will be sound; some of it will be ill-informed.
You can't be miserable at a program. However, you can't expect to be walking on sunshine either.
You want a program that gives you all the experience you need in your career; however, you don't want to be operating to 2 am every other night or be murdered on call.
If I could give you my advice, it would be this.
1) Location is really unimportant. It's five years. If you're single, bite the bullet. If you're married, convince your spouse to move. If you have a family, find a way to make it work. It may suck to be in a place like Iowa (no offense, Throat) or whatever, but if the training is good, you won't regret it.
2) Seek a balance, but some things are more important than other. Things I consider important are in the following order: 1) Head and Neck, 2) Rhinology, 3) Otology, 4) laryngology, 6) plastics, and 5) peds. Why? Here's why. If you go to a program that is head and neck strong, you pretty much can learn a lot of skills. Programs strong in H&N will get you your cancer cases, thyroid cases, flaps, pituitaries, and the like. You may never touch another cancer case, but you'll have mad skills in the OR. If you are private practice bound, sinus is going to be your bread and butter. That brings in a lot of dough. So do septoplasties. Outpatient turbinate surgery, sinuplasty. Highly profitable stuff. Better know how to do tehm well. Again, if you're going into private practice, you're not going to be doing acoustic neuromas, lateral TB resections, labyrinthectomies, or cochlear implants. But, you will do tubes, tympanoplasties, mastoidectomies, and potentially stapedectomies. For laryngology, if you can do strobes, do microlaryngoscopies, microflaps, vocal cord injections, thyroplasties, and BoTox, you've got a good laryngology practice. Beyond that, it's going to a laryngologist in your area. Plastics is highly specialized and if it's purely cosmetic, you might not want to mess with it. However, doing blephs, rhinoplasties, and mandible fractures (insurance, yes) are good money. Lastly, people often lament that a program has no pediatric otolaryngologist. So what? I bet you this: if you go into private practice, you ain't doing a pediatric neck mass, cochlear implant, cleft lip, or tracheoplasty. Tubes. Tonsils. Thyroglossal duct cysts.
3) Rank a program that works you, but make sure this program strikes a balance. If it's all OR, that ain't right. If it's all clinic, that ain't right either. If you're up all night on call typically, don't worry about this. You'll go home the next morning. Don't worry about minor violations of the 80 hour work week; you'll live.
4) Rank a program that has a clear didactic schedule run by attendings and/or fellows, not one that is run by residents. Rank a program that considers the didactics mandatory and excuses residents from clinical duties, not one that lets you go if clinic is "light" or if the case is "almost done" or whatever.
5) If you get a bad vibe from one attending, see how strong the others are. You can work with one bad apple. More than that, think twice. Remember: balance.
6) Don't rank a program just because of its name. What they are now doesn't necessarily live up to its name.
7) Do look at where graduating residents go. If they are going into fellowships, look at what types and where they go. This is tough. Some fellowships aren't accredited, but that doesn't mean anything. However, some fellowships, although not accredited, are pretty shady. For example, head and neck fellowships aren't accredited. Obviously going to Sloan would be great. Going to the Alaskan Head and Neck Institute for fellowship may not be so great.
8) Your gut isn't always right; don't forget that you occasionally have gas pains.
- Joined
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I agree with a lot of what NB posted. I completely agree with the location factor. You will never get another chance to train as a resident. You only get 5 years to form a foundation for the rest of your career. The best training should be top priority. It would be nice if the best training was also in a sweet city, but in ENT this is rare. Desirable cities tend to have 2-3 programs that compete with each other for the same patients. Ultimately this leads to 2-3 average programs in a great city. On the other hand, less desirable locations usually only have one program, no competition and better resident training overall. This is why places like Iowa, Wash U and Michigan have highly regarded programs.
As for free flaps, the day is coming when this will be part of the standard otolaryngology training. Programs that offer free flap training to residents are ahead of the curve in my opinion.
Don't sell yourself short. Go for the best possible training available to you.
As for free flaps, the day is coming when this will be part of the standard otolaryngology training. Programs that offer free flap training to residents are ahead of the curve in my opinion.
Don't sell yourself short. Go for the best possible training available to you.
- Joined
- Jan 18, 2001
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I would say that knowing whether you are heading toward private practice or academics really helps knowing where to go. There are very few programs that will not prepare you to be a good private practice doc, AND if you apply yourself, you can get into most fellowships from pretty much any program. BUT, the more "academic" programs can make it easier to get the big fellowships (a few examples: otology at House, voice with Ossoff, etc)
Regarding location, if you KNOW that you want to practice in area X, it can be helpful to establish connections in that area. For example if you just had to practice in Florida, going to one of the Florida residencies could be helpful. That said, I pretty much knew that I would be practicing in Texas, but going to Iowa didn't really stop me from doing that.
Beyond that, NP has some really great points, in theory. You have to live for 5 years of your life with the residents that were there and different programs definitely had a different "vibe". For example, I knew that I wanted to start a family while in residency and pretty much decided against going to some programs that I didn't feel were family-friendly. I also really wanted to be at a place where I felt that I could enjoy my life and if I felt that the residents where unhappy at a program, it got a lower ranking.
SO, if you want to be at a family friendly place, Iowa is not a bad choice. Besides making babies, there's not too much to do in Iowa!
Regarding location, if you KNOW that you want to practice in area X, it can be helpful to establish connections in that area. For example if you just had to practice in Florida, going to one of the Florida residencies could be helpful. That said, I pretty much knew that I would be practicing in Texas, but going to Iowa didn't really stop me from doing that.
Beyond that, NP has some really great points, in theory. You have to live for 5 years of your life with the residents that were there and different programs definitely had a different "vibe". For example, I knew that I wanted to start a family while in residency and pretty much decided against going to some programs that I didn't feel were family-friendly. I also really wanted to be at a place where I felt that I could enjoy my life and if I felt that the residents where unhappy at a program, it got a lower ranking.
SO, if you want to be at a family friendly place, Iowa is not a bad choice. Besides making babies, there's not too much to do in Iowa!
