Switching to ENT; a few Q's

[twofeetwhoops]

Hello everyone- I am currently in the match within another surgical subspecialty field and considering taking a year off and applying for ENT next year. I have a few questions about ENT, however:

-Is clinic ever boring, or at least is this a common complaint amongst residents at all? One of the reasons I am considering leaving my current field of choice is that it has become heavily clinic based, and I absolutely love the OR. Additionally, the clinic is, in my opinion horribly boring for my current specialty. Part of me worries allergy clinic would be horribly boring, and this is a big fear for me when thinking of my future career.

-What is the scope of practice like for general ENT?
Again, in my current field, a generalist is VERY limited in his/her scope- and I would LOVE the idea of being able to do some plastics, some small tumor stuff, tonsils, tubes etc all in the same practice setting. Or, is ENT going towards surgical subspecialization with generalists being stripped of more and more cool stuff.

-Finally, is there a good resource for a prospective ENT-er? I've found otomatch.com, but that's about it.

Thank you all so very much for your time!

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[JekyllandHyde]

Just a student here but after a few months of Sub-Is and Aways... heres what Ive noticed

1) Yes clinic can be boring and lots of attendings schedule will be more like 1-1.5 days OR and 3.5-4 days clinic. I think as a student we dont see that, but as an attending its a necessity to see enough patients to find those who are surgical candidates.

2) Ive seen generalists who were limited to tubes/tonsils and other bread and butter cases. I seen others doing smaller parotids/thyroids, revisions sinus, upper blephs etc. Depends heavily on the practice and location I think. From conversations with some attendings Ive had, they see it moving more towards large practices with more fellowship trained guys taking those types of cases FWIW.

3) Otomatch is kinda insane, Ive made the mistake of checking it during application/interview season and am kicking myself for it. This is also good, there are some attendings on here who have been great for getting advice. Dont forget to look at back posts for info too.

Hope this helped, and hopefully I havent mislead you. Those of you out there who know more, please feel free to correct me.

 

[resxn]

I am only going to respond to your first question because the other 2 have been addressed ad nauseum on this board.

Anyone who is a proceduralist will tell you that clinic is boring. Whether they are GI docs, ophthos, orthos, or whatever. However, ENT clinic was the least boring clinic of any I went to as a student (and as a resident in my PGY-1 year). That is one of the major reasons I chose ENT. There were so many procedures in clinic that it was far less boring. In fact, I'd say that there is a CPT code on over 50% of my clinic visits. Often those are routine wax removals, but that alone is better than just a 99213 medicine visit. That allows ENT clinic to actually be more lucrative than our non-procedure heavy colleagues and often more than the OR on many days. 25 patients in a clinic day will earn me more money than the day I do 8 surgical cases (unless they're all septo/FESS stuff).

 

[remote]

I am only going to respond to your first question because the other 2 have been addressed ad nauseum on this board.

Anyone who is a proceduralist will tell you that clinic is boring. Whether they are GI docs, ophthos, orthos, or whatever. However, ENT clinic was the least boring clinic of any I went to as a student (and as a resident in my PGY-1 year). That is one of the major reasons I chose ENT. There were so many procedures in clinic that it was far less boring. In fact, I'd say that there is a CPT code on over 50% of my clinic visits. Often those are routine wax removals, but that alone is better than just a 99213 medicine visit. That allows ENT clinic to actually be more lucrative than our non-procedure heavy colleagues and often more than the OR on many days. 25 patients in a clinic day will earn me more money than the day I do 8 surgical cases (unless they're all septo/FESS stuff).

totally agree. having clinic is just part of being almost any type of surgeon. you need to find patients to take to the OR. but as mentioned above, the nice thing about certain surgical fields like ophtho, ENT, urology, is that these fields offer you the opportunity to do a bunch of different procedures in the office setting which help decrease the monotony and boredom of clinic while at the same time allow you to make more money....just out of curiosity, what surgical field r u trying to switch out of?

 

[neutropeniaboy]

In fact, I'd say that there is a CPT code on over 50% of my clinic visits.

Technically speaking, there should be a CPT code for 100% of your visits...

 

[neutropeniaboy]

In my opinion, clinic sucks. I have never liked it, and I never will. Listening to people talk about their dizziness and their headaches makes me want to shoot myself. But, for every 5 patients I see, I usually schedule a procedure. And for every 15 patients, I usually schedule a big procedure. So, from all evil arises the goodness. It's the only way it can happen.

 

[resxn]

Technically speaking, there should be a CPT code for 100% of your visits...

Touche. But, if insurance doesn't consider E&M codes CPT's, neither do I.

 

[neutropeniaboy]

Touche. But, if insurance doesn't consider E&M codes CPT's, neither do I.

Intrigued. Explain, por favor.

 

[resxn]

Intrigued. Explain, por favor.

semantics. Technically, E&M are CPT codes, but insurances treat them very differently, from the copay for them to the deductible or co-insurance. For example, you might collect a $25 copay for your 99213, but if you also do a 31575 on that pt and you don't let them know in your financial policy that it is a separate charge and may be handled differently by their insurance (i.e. applies to their deductible) they have successfully sued ENT's (and other specialties) for unfair billing practices. I just don't treat them like CPT's even though they officially are just a subcategory of CPT's.

 

[neutropeniaboy]

Thanks, man.

I am sheltered from the "collecting" part of my practice much less so than the "billing" aspect of my practice. A benefit (and drawback) of being in academics.