ENT

[Guest DancingDoc]

I couldn't find the information I wanted in any of the older posts so hopefully someone can help me out here. I curious as to what an ENT actually does. I know they see a wide variety of cases, but what are some examples. And what is the lifestyle like because I heard both that it is a really busy specialty and that it is one of the btter ones, which is it or does it depend? Also, is there a difference between ENT, otolaryngology and head and neck surgeons.... my impression is that they are all the same, but maybe focus on various areas more than others???? Anyway, just curious because it sounds like a really interesting specialty and I'm hoping that if I get in this year it's one type of shadowing I might aim to fit in somewhere.

[Guest Kirsteen]

Hey there,

 

We had a number of lectures from the ENT docs during our Neuro unit. You're right, it does seem like a pretty cool specialty, and those ENT docs whom I spoke with afterwards were pretty happy with their lifestyles and incomes.

 

In terms of case types, many ENT docs in the bigger centres are specialized in some of the areas that cover their gamut: head & neck oncology, hearing disorders, e.g., cochlear implants, dysphonia due to vocal cord abnormalities, structural abnormality corrections. They do quite a bit.

 

Lastly, generally, ENT=otolaryngology, and although they are considered head and neck surgeons, there are also other types of surgeons who may be classified in this category, e.g., Endocrine, who also do a lot of work in those areas.

 

Cheers,

Kirsteen

[Guest DancingDoc]

Thanks Kirsteen. It really does sound like an awesome specialty, hopefully I can try it out this year for an observership if I get in!! :b

 

so do endocrinologists also do surgery? I thought they were more internal medicine....

[Guest medicator007]

Endocrinology (& Metabolism) is a sub-specialty of Internal Medicine, two years after the core Internal Medicine period. Having spent some time in this discipline I don't know any that do surgery themselves. They work quite closely with ENT Surgeons, particularly in the management of thyroid neoplasms. The only "Surgical" Procedure I have ever seen an endocrinologist do is FNAC of thyroid nodules, and not everyone does them and at that, only in the most appreciable nodules.

 

I think what Kirsteen may have been alluding to is there are quite a few "General Surgeons" who work in the same region, mostly the neck, as ENT surgeons. I've seen quite a few General Surgeons do thyroidectomies for a variety of indications, though more often benign than malignant and this division of roles would depend on whether you were in an academic center or not and also on the availability of an ENT surgeon.

 

Hope that helps,

Medicator

[Guest Steve MD09]

We had a week on otolaryngology back in January here at UWO, and I also attended a seminar on what ENT is like as a specialty. In addition to the areas Kirsteen mentioned, otolaryngologists can also do some plastics type surgery, such as repair of cleft lip and/or palate (edit: I just noticed she already mentioned "structural abnormality corrections", which covers this). Apparently some otolaryngologists take this a bit farther and do face lifts, rhinoplasty, and botox injections. The surgeon doing the presentation even showed us an advertisement by one of his former colleagues who does breast enlargements, although he noted that the vast majority of ENT surgeons stay above the clavicles.

[Guest DancingDoc]

Thanks guys that info definitely helps

Makes it seem even more like specialty I woud like to try out/learn more about

Has anyone here actually done any rotations in ENT?

[Guest Kirsteen]

Hey there,

 

Just to add, it was the General Surgery to Endocrine Surgery path that I was thinking of earlier. There are a couple of big guys in Toronto who tackle Endocrine Surgery almost exclusively and I know one current General Surgery resident who went to work with them for a month to see if he would fancy that career path for himself. In itself, Endocrine Surgery as a branch from General might be interesting too, given that you can viably venture below the clavicles as well as above.

 

I haven't done a rotation or any shadowing in ENT, although I've talked with a number of ENT surgeons here. They all seem to adore their work and have mentioned numerous times how it's quite lifestyle friendly, that they can tailor their practices as they see fit, and that, the way the billing codes are currently assigned, they make a handy income. It'd be a great field in which to do training, but the competitiveness of the residency programs can be a bit of a turn off (for me, at least).

 

Cheers,

Kirsteen

[Guest Blake128]

Hmm, I had a chat with a 4th year student here who just matched in ENT at Montreal. She didn't do any elective rotations in ENT, except 1 mandatory week. She's a pretty good student, but I don't think ''top of the class'' good. Anyway, she got me interested in knowing more about this field (in her opinion, it's a bit close to neurosurgery (acoustic neuromas, skull-base surgeries, neurotology, etc), with less crazy hours, more diversity of cases and some cool and technically difficult surgeries).

[Guest DancingDoc]

Wow, this is sounding exciting! I really hope I can get in so I try ENT (however endocrine specific surgery sounds interesting too...). I've done some observerships (not med school ones) with neurosurgeons and loved it but I wouldn't want the lifestyle nor do I have the right personality for it based on most neurosurgeons I know. But ENT is sounding pretty good. It is really that competitive to match? Blake, do you know what your friend might have had that stood out (interviewing abilities maybe?). Thanks guys, this is really informative for me!!

[Guest Blake128]

I'm not sure what made her an outstanding candidate for the job, but I'll keep you updated next time I see her.

[Guest noncestvrai]

Out of all the surgical specialties, to me it is the most appealing. There is great diversity in the nature of the work, you do 12/13 cases that are medical though, according to a chief resident at my university. I am still debating whether I should go all out for this...I need to be exposed a bit more, yet it's part of my top 5.

 

However, you are still a surgeon, meaning very early mornings when going to the OR.

 

noncestvrai

[Guest DancingDoc]

Noncestvrai,

what do you mean by 12/13 are medical..... (aren't they all, ? Sorry if this is a really naive question)

[Guest noncestvrai]

medical vs surgical

 

Albeit, to my knowledge, these overlap to a great deal! So I'm not sure what that really meant. You have the possibility to do both surgeries and see patients at the clinic, which is appealing, at least to me.

 

noncestvrai

[Guest Kirsteen]

Hey there dancingdoc,

 

What was probably meant, above, when they said "medical" was the treatment approach (as opposed to surgical). That is, the first line treatment for Meniere's disease (a disorder that is often tackled by an ENT doctor) is often medical, (normally some sort of diuretic to decrease the amount of endolymph in the ear) as opposed to surgical (opening up the cavity surgically and draining the endolymph), for example.

 

Cheers,

Kirsteen

[Guest physiology]

Hello,

 

Just to get you guys thinking - MOST ENTs who work in large academic centres (such as Vancouver) are quite bitter over the lack of OR time. As you can imagine, most ENT surgeries (sinus surgeries, throat ones) don't carry as much "clout' as let's say a hip/knee surgery or are as pressing as let's say an expanding brain tumour that needs to be resected by a neurosurgeon. It's unfortunate that hospital administrators are the ones that determine who gets a piece of the pie called the "operating room."

 

Most large centres (including the suburbs) have enough ENTs and if you want to work in a big city, it may be difficult. The situation is of course different for smaller communities.

 

For those who say - "Well, why can't I just open up my practice right after I finish residency?" Well, the answer to that is you need to get the trust and respect of your medical colleagues first (ie. family physicians), and often you do that by working in an academic centre first to build up your reputation. Also - you need to practice your surgical skills on frequently. If you don't have OR access, you end up losing your surgical skills. And the OR is where you make money.

 

This is a similar problem for ophtho and urology.

 

Anyway - sorry to rain on the parade, but I think this is something that should be brought to light. Getting into a residency is fine - but what about translating that into a job when it's all said and done?

 

Physio

[Guest DancingDoc]

What about "not large" academic centres......

[Guest physiology]

It varies from center to center - from what I've seen in CMAJ - they seem to want ENTs in more rural parts of AB.

 

This is a very difficult question to answer. Medicine is VERY political and it depends what the situation is once you've finished residnecy.

[Guest cracked30]

Who said this,

 

 

 

"I've dedicated my life to diseases of the head-holes."

[Guest walton1]

... as Dr. Tad Winslow?

[Guest DancingDoc]

What about head and neck oncological surgeries (if that is what they are called...?). Do ENTs that focus in this area also have a hard time getting OR time? And does anyone know if you can do a subspecialty in head and neck surgery specific to oncology through ENT?

Thanks

[Guest Kirsteen]

Hi there,

 

I know a couple of head & neck oncologists and they took this route via a post-General Surgery fellowship. The folks that I know in one of the big cities are in the OR 2 days per week (sometimes more if slots open up due to cancellations).

 

Cheers,

Kirsteen

[Guest Cowgirl Jenn]

Haha, I have to admit, I find this quote rather intriguing and am curious where it is from? Movie/book?

 

Also, many Canadian otolaryngology programs do offer head & neck fellowships which are mainly focused on oncological H&N surgery - so you can do H&N oncology via either ENT or Gen Surg.

 

Thanks!

Jenn

[stepstofollow]

Hi there:

 

I thought I 'd throw in my two cents -- I have *some* knowledge about this -- my husband is a subspecialized ENT (not in H & N though) and I know a large number of otolaryngologists, and am pretty familar with some of the Canadian programs.

 

While H and N oncology surgeries can be done by either appropriately trained general surgeons OR otolaryngologists -- there is an increasing trend for H & N to be subspecialty of ENT. Otolaryngology "Head and Neck" fellowships focus on -- are dominated by specialized training in the surgical treatment of all extracranial head and neck cancers -- mostly squamous cell carcinomas ( of the aerodigestive tract). Over 90% of all extracranial H & N Ca's are squamous cell cancers. Of note, ENT's generally have a quite a large exposure to this H & N ca sx's even in their residencies, much more so than in general surgery (at least at the Canadian Centres we are more familar with -- may not be the case in all centres , as it depends on traditional roles )(Note: thyroid and parathyroid cancer is probably the one surgery more dominated by general surgeons)

 

A "Head and Neck" fellowship is one of the most common fellowship ENT surgeons pursue after residency and the demands of the fellowship have grown.... For example, many ENT surgeons are also doing their own reconstructive surgeries for head & neck cancers including free tissue transfers, which were traditionally done by plastic surgeons.

 

In terms of the comments about OR time -- OR time is probably at premium for all surgical specialities types -- and is a complaint of ALL the specialities!!! It largely depends on individual centres. Some have more, some have less, but if you ask most surgeons it's never enough! (b/c they like to do surgery). OR time at the academic centre where hubby works (ranges from slightly less than 1 day a week for most ENT surgeons, but 1.5 -2 for others like H & N Cancer surgeons. My husband gets 1.5 OR days per week, with 2 full days of clinic per week, and 1.5 for teaching, research and administration. Call is 1week in 3(Mon.-Thurs), and 1 in 6 w/e's. Not bad -- and call is from home.

 

Other ENT fellowships (subspecializations) include pediatric airway and pediatric otolaryngology, otology/neuro-otology, laryngology/voice, sino-nasal sx, sleep medicine, as well as facial reconstruction & cosmetic sx. Lots of interesting options, and most general practice ENT's really like the variety in what they see, too.

 

Some disorders, problems or surgeries commonly see by ENTs ranging from generalists to specialist include (not a full list!):

• Acute Sinusitis
  
• Chronic Sinsitis
  
• Adenoidectomy
  
• Allergies
  
• Breathing Problems in Children
  
• Endoscopic Sinus Surgery
  
• Rhinoplasty
  
• Cosmetic Surgery of the Ears
  
• Myringotomy and Tubes
  
• Cochlear Implants
  
• Advise/investigate/tx hearing losses
  
• Disorders of the Salivary Glands
  
• Snoring
  
• Tonsilitis/Tonsillectomy
  
• Disorders of the Thyroid and Parathyroid Glands
  
• Face and Neck Trauma
  
• Head and Neck Cancer
  
• Masses and Cysts of the Neck
  
• TMJ
  
• Dysphagia and voice disorders
  
• Vertigo
  

 

Anyway, as with most surgical specialities, ENT is competitive. In recent matches, there were often twice as many applicants as available spots -- but important to remember that many of these are ALSO applying to other surgical specialities and many of these folks may not have ENT as their first choice. It is by no means the MOST competitive speciality, but it is popular.

 

Cheers

Steps

[Ian Wong]

Hey,

 

Thanks for the informative post!

 

Ian

[stepstofollow]

Hey Ian,

 

Long time no chat. Hope residency is going well.... Just starting Med II with only a few more grey hairs relative to rest of class......

I figured I'd stop lurking and post something....Hey, I love ENT. It pays the bills! (have no plans myself to do sx though....)

Steps