Switching out of ENT residency into a different specialty

[OTOSwap]

I am an ENT resident with a family. However, I realize this field is not for me and my interests and personality lie elsewhere.

Has anyone made the switch from a competitive surgical specialty? My concern is the impact this may have on my wife and our kids.

My interest lies in dermatology. I have publications in this field and looked at both ENT and Derm as a med student. Dermatology is the most competitive specialty in medicine though. I am hoping there is someone that has been through this process. It is late in the year and I am trying to find research fellowships. It is quite scary to leave a guaranteed specialty for nothing though.

Any attendings out there that have been through this process or willing to help? I am all ears.... (no pun intended)

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[ThoracicGuy]

I am an ENT resident with a family. However, I realize this field is not for me and my interests and personality lie elsewhere.

Has anyone made the switch from a competitive surgical specialty? My concern is the impact this may have on my wife and our kids.

My interest lies in dermatology. I have publications in this field and looked at both ENT and Derm as a med student. Dermatology is the most competitive specialty in medicine though. I am hoping there is someone that has been through this process. It is late in the year and I am trying to find research fellowships. It is quite scary to leave a guaranteed specialty for nothing though.

Any attendings out there that have been through this process or willing to help? I am all ears.... (no pun intended)

Your chances of leaving ent and moving to derm are slim to none. What is it about ent that you don't like?

 

[Winged Scapula]

TG had a good question above.

If it's the more aesthetic component have you considered a facial plastics fellowship after ENT?

Give us a little bit more info about what the issue is please.

 

[educ8r]

What year are you in residency?

 

[Naijaba]

I have to echo WingedScapula's question. ENT is known to be a relatively lifestyle friendly specialty after residency. Of course, Derm is the best lifestyle-wise, but I don't think much more so than ENT. If you prefer clinic-life more than the OR, then that seems like a good reason to switch.

 

[doctalaughs]

It can be done but even moving from one competitive specialty to another is far from guaranteed even with a stellar CV, scores and interviewing skills. So the real question is why do you want to do it? What draws you to dermatology? How many years do you have left? With wife/kids are you willing to take a chance of not successfully switching? Could you be happy after finishing ENT?

Need more information to give you advice.


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[OTOSwap]

I have to echo WingedScapula's question. ENT is known to be a relatively lifestyle friendly specialty after residency. Of course, Derm is the best lifestyle-wise, but I don't think much more so than ENT. If you prefer clinic-life more than the OR, then that seems like a good reason to switch.

I don't want to post too much personal info on an open forum, for obvious reasons.

Office versus Operating Room
However, I 100% prefer being in the office seeing patients than in the operating room. The OR was fun as a medical student because it was so new. However, medical dermatology is much more interesting to me. I do not want to be the guy just cutting things out. People who do surgery absolutely love being in the OR and hate the office. As an attending in ENT, there is no way to be strictly outpatient and have no ties to the hospital. I do not want to be involved in hospital medicine. I prefer all outpatient. With the limitations of medical management in ENT, I find myself looking at the specialty consisting of 90% of not what I want to do when I am completed. At times, I considered family medicine due to the outpatient component, but I know I do not enjoy family medicine as a career.

I am the opposite, I much rather drive to the office and have all my patients in one place.

Subject Matter
ENT does not have a lot of medical management. I found myself really interested in different pathology and I love how in dermatology I can see things visually in front of me. Dermatology medical treatment is so different and has lots of research opportunities. All the new immunologic medications and the different It is a subject I can read about daily. I have done rotations in dermatology as a medical student. I really enjoyed those interactions and felt gratification there.

Physical aspects
In ENT, I feel my neck and back having issues and most ENT I know have cervical problems. I have some baseline back issues from playing football in high school and college.

 

[ThoracicGuy]

I don't want to post too much personal info on an open forum, for obvious reasons.

Office versus Operating Room
However, I 100% prefer being in the office seeing patients than in the operating room. The OR was fun as a medical student because it was so new. However, medical dermatology is much more interesting to me. I do not want to be the guy just cutting things out. People who do surgery absolutely love being in the OR and hate the office. As an attending in ENT, there is no way to be strictly outpatient and have no ties to the hospital. I do not want to be involved in hospital medicine. I prefer all outpatient. With the limitations of medical management in ENT, I find myself looking at the specialty consisting of 90% of not what I want to do when I am completed. At times, I considered family medicine due to the outpatient component, but I know I do not enjoy family medicine as a career.

I am the opposite, I much rather drive to the office and have all my patients in one place.

Subject Matter
ENT does not have a lot of medical management. I found myself really interested in different pathology and I love how in dermatology I can see things visually in front of me. Dermatology medical treatment is so different and has lots of research opportunities. All the new immunologic medications and the different It is a subject I can read about daily. I have done rotations in dermatology as a medical student. I really enjoyed those interactions and felt gratification there.

Physical aspects
In ENT, I feel my neck and back having issues and most ENT I know have cervical problems. I have some baseline back issues from playing football in high school and college.

Do you have a local Derm department? If so, have you approached the PD to discuss your competitiveness in finding a Derm spot? Does your own PD know about your unhappiness? How far along are you into ENT?

 

[Wordead]

I don't want to post too much personal info on an open forum, for obvious reasons.

Office versus Operating Room
However, I 100% prefer being in the office seeing patients than in the operating room. The OR was fun as a medical student because it was so new. However, medical dermatology is much more interesting to me. I do not want to be the guy just cutting things out. People who do surgery absolutely love being in the OR and hate the office. As an attending in ENT, there is no way to be strictly outpatient and have no ties to the hospital. I do not want to be involved in hospital medicine. I prefer all outpatient. With the limitations of medical management in ENT, I find myself looking at the specialty consisting of 90% of not what I want to do when I am completed. At times, I considered family medicine due to the outpatient component, but I know I do not enjoy family medicine as a career.

It actually is possible to be outpatient only with no inpatient duties. I know an attending like this. I hope to have a couple partners like this that will feed me cases.

 

[bannie22]

I have no input nor experience but I wish you best of luck. I hope some of the others will be able to help you instead of just asking questions and derailing OP.

 

[anonperson]

I have no input nor experience but I wish you best of luck. I hope some of the others will be able to help you instead of just asking questions and derailing OP.

No one's derailing anything.

OP posted a vague ass description of their situation. It's like pulling teeth to get pertinent information to offer any meaningful advice.

At the end of the day, switching from ENT into one of the most competitive specialties is the question at hand.

Is it possible? Yes.
Is it probable?
Probably not but unless we know board scores, AOA status, etc its all conjecture . Best chance is going to be matching into home program but again that is tough to say.

If the OP truly hates ENT and wants to switch at all costs to a clinic based specialty, then he can do IM,FP, PM&R, Psych without worrying about matching. I have a hunch these other specialties aren't going to appeal though (cough $$ cough $$).

His best bet is to stick to ENT and just don't operate much.

 

[educ8r]

OP, you say you like the immunologic aspects of Dermatology. I'm sure you've thought about this, but why not set up an allergy practice (from ENT)? Is it a matter of getting through the rest of a surgery-heavy residency? FWIW, I love clinic too- one of the things that drew me to ENT is the potential of setting up a clinic only practice especially later in one's career. But there's nothing to prevent you from doing that sooner if it appeals.
Some of the answer to your original question is likely dependent on what year you are in training. For example, I am not sure but based on reading other threads about residency switches it seems like a resident is funded for the number of years of his initial training. So if you are PGY2 now, you'd still have 3 years of funding left.

 

[NotAProgDirector]

As the OP is currently in an ENT residency, it seems likely that they are a US grad, have great USMLE scores, and did well in medical school. Without that, it's unlikely that they would have ended up in ENT in the first place. As the averages for USMLE's etc for ENT are similar to derm, chances are that, on paper, they are competitive for derm.

So the question likely comes down to whether a derm program will be interested in someone who has already trained partially in ENT. The answer is "probably". I agree the OP's first step is to talk to the local derm PD. With a family, it's likely the OP would rather not move, hence getting into a local derm program might be the best option. As the match is over, the OP would be looking for a derm spot that is 2 years away -- July 2019 to start -- unless there's an unexpected opening. Like any field switch request, talking to your own PD is recommended -- you want them to hear this from you. If you don't get a derm spot, do you want to continue in ENT? Would you finish ENT by July 2019 anyway?

 

[ThoracicGuy]

I have no input nor experience but I wish you best of luck. I hope some of the others will be able to help you instead of just asking questions and derailing OP.

Do you think these questions being asked are not pertinent to the issues at hand? Maybe they don't matter in the pre-podiatry world...

 

[tux4]

Derm isn't interesting.


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[OTOSwap]

As the OP is currently in an ENT residency, it seems likely that they are a US grad, have great USMLE scores, and did well in medical school. Without that, it's unlikely that they would have ended up in ENT in the first place. As the averages for USMLE's etc for ENT are similar to derm, chances are that, on paper, they are competitive for derm.

So the question likely comes down to whether a derm program will be interested in someone who has already trained partially in ENT. The answer is "probably". I agree the OP's first step is to talk to the local derm PD. With a family, it's likely the OP would rather not move, hence getting into a local derm program might be the best option. As the match is over, the OP would be looking for a derm spot that is 2 years away -- July 2019 to start -- unless there's an unexpected opening. Like any field switch request, talking to your own PD is recommended -- you want them to hear this from you. If you don't get a derm spot, do you want to continue in ENT? Would you finish ENT by July 2019 anyway?

I do not have a home dermatology program. I have been in touch with some people I know that switched from ENT to dermatology and attendings that went back to do a 2nd residency in dermatology. I am willing to go to Alaska if need be. However, I do not want to blindly enter a dead-end research gig without having a solid plan. I have found a number of people get burned by this.

I do not think I would be happy doing ENT long-term. You have to absolutely love being in the OR more than anything else. I am not very interested in the surgeries as much as I had exposure to as a student. I enjoyed the clinic component then. I recently used a week of vacation to spend a week in a dermatology clinic (a break to do more work). I can say I was honestly really happy and excited with the day to day. I will be honest with you, I am very scared to leave a competitive high paying specialty without something in hand. I know people would kill to have an ENT spot. However, if I remain, I will burn my funding up. It is hard to get advice from a dermatology PD without having a home program.

 

[ThoracicGuy]

I do not have a home dermatology program. I have been in touch with some people I know that switched from ENT to dermatology and attendings that went back to do a 2nd residency in dermatology. I am willing to go to Alaska if need be. However, I do not want to blindly enter a dead-end research gig without having a solid plan. I have found a number of people get burned by this.

I do not think I would be happy doing ENT long-term. You have to absolutely love being in the OR more than anything else. I am not very interested in the surgeries as much as I had exposure to as a student. I enjoyed the clinic component then. I recently used a week of vacation to spend a week in a dermatology clinic (a break to do more work). I can say I was honestly really happy and excited with the day to day. I will be honest with you, I am very scared to leave a competitive high paying specialty without something in hand. I know people would kill to have an ENT spot. However, if I remain, I will burn my funding up. It is hard to get advice from a dermatology PD without having a home program.

I wouldn't use the funding issue as a driving factor here. While you'll have the 5 years of 100% funding, you'll still get about 75% funding if I remember correctly for the other years. This wouldn't be a reason a program wouldn't choose you.

As for a derm PD, does your med school have a derm program? Maybe you can talk to them? If not, what about just cold-calling/emailing various programs and getting input?

Also, I would consider doing this via next year's match if you are really interested. Talk with your own PD first, though, because they will want a LOR from your PD. I wouldn't leave your program without something in the works.

 

[OTOSwap]

I wouldn't use the funding issue as a driving factor here. While you'll have the 5 years of 100% funding, you'll still get about 75% funding if I remember correctly for the other years. This wouldn't be a reason a program wouldn't choose you.

As for a derm PD, does your med school have a derm program? Maybe you can talk to them? If not, what about just cold-calling/emailing various programs and getting input?

Also, I would consider doing this via next year's match if you are really interested. Talk with your own PD first, though, because they will want a LOR from your PD. I wouldn't leave your program without something in the works.

Thank you for the advice. I am trying to find quality research/clinical dermatology fellowships. Is there a good resource to use to find these?

My PD and Department Chair have both given me their full support and will write me strong letters and offered to call any program. I am leaving with no red flags in good standing. We have no institutional dermatology program nor did my medical school.

 

[Moose A Moose]

Do you think these questions being asked are not pertinent to the issues at hand? Maybe they don't matter in the pre-podiatry world...

Ohhhhhhhhhhhhhhh SNAP

 

[OtoHNS]

I'm an ENT attending in private practice. I spend 4.5 days/week in clinic and 0.5 in the OR. I do exclusively outpatient surgeries- this includes stuff like total thyroids, superficial parotidectomies because I like doing them. I could easily eliminate those cases if I wanted. I don't take any call for the ER or inpatient consults (though I do take call for the practice, and this rarely requires me to go in after hours for tonsil bleeds and the like).

To the OP, what you are looking for is entirely possible if you continue with ENT. You could probably even swing a clinic-only practice if you wanted- this would be particularly possible in a larger group where you could feed your partners the "interesting" surgical patients.

Another path to consider (mentioned above) would be to go the cosmetic/facial plastics route. You could incorporate a lot of cosmetic derm stuff like fillers, skin peels, and laser treatments, and you would never need to go near a hospital. Many cosmetic surgeons do all their procedures in an office-based OR as well. A caveat with this pathway is that you have to be willing to learn how to market yourself and aggressively do so to succeed.

What you see in the academic world is not all there is to ENT. Once you are out in the real world, there are many ways to structure your career, not just grinding away doing 12+ hour free flap cases all day.