Differences in ENT Residencies in Canada and the US?

[Guest Roall]

Hello,

 

I was just curious if anyone knew about any significant differences between the ENT residency programs in Canada and those in the US? The reason I ask is that if a otolaryngologist trained in a Canadian residency program were to apply to a US school for a fellowship, would this be allowed, or are the programs' requirements/length/etc too different to allow for this to happen without additional training? I know Ian may well have some insight into this question, but I'm sure others out there are also well versed in this area. Any help you can offer would be appreciated. Thanks.

 

Jason

[Guest Roall]

Further to my last question (after reading an old post of Ian's), if you do an ENT residency in Canada at a school where they have a 1 year "gen surg" period and 4 years of ENT, would you still qualify to write the US exams? Also, I noticed (while looking at CaRMS) that many of the Canadian ENT programs have a 2 year "gen surg" period, but really, the total time doing non-ENT rotations is the equivalent of only 1 year. Would this imply that Canadian schools have altered their programs in order to allow graduates to write the US board exams? More questions for myself and others to think about...

 

Jason

[Guest Ian Wong]

As far as I am aware, the only Canadian school that had committed to altering its curriculum to the 1 GS + 4 ENT schedule seen in the US was Ottawa. The last I heard, many of the Canadian ENT programs were working on developing more fellowship opportunities for their graduates, in the potential event that their graduates were unable to go to the US for their fellowship training.

 

As far as the Canadian programs that are 2 "GS" + 3 ENT schedules, I'm not sure that they fit the requirements for the American Board of Otolaryngology, even if they have a total of 48 months of ENT training (ie. 12 months of ENT scattered within the 2 "GS" years).

 

Here's the information from the American Board of Otolaryngology:

 

www.aboto.org/docs/booklet_of_information.pdf

 

The revelant section is page 15/31 of the .pdf file (this is page 13 of the publication itself).

Individuals who entered otolaryngology-head and neck surgery training July 1, 2000 or thereafter must

satisfactorily complete a minimum of five years of training, as specified below, in an ACGME-approved

program(s):

• At least ONE YEAR of general surgical training. It is preferred that the general surgical residency

be taken prior to otolaryngologic training, but it may not be taken after otolaryngologic training.

• At least FOUR YEARS of residency training in otolaryngology-head and neck surgery. This

training must involve increasing responsibility each year and must include a final year of senior

experience. This final year must be spent within the accredited program in which the previous

year of training was spent, unless prior approval is obtained from the ABOto.

There's also this notation further down the page regarding foreign training:

FOREIGN TRAINING

[...]

Individuals who entered otolaryngologic training in Canadian programs prior to July 1, 2000 may be considered for examination.

Ian

[Guest Roall]

Thanks for the info, Ian. One additional question, relating to your response. If a Canadian-trained ENT resident were to do a fellowship in Canada, do you feel/think that such advanced training would give them sufficient education to fulfill the requirements of the ABOTO? And are American programs not accepting Canadian-trained graduates for fellowship positions (i.e. do they require ABOTO certification prior to acceptance into a fellowship program)? Thanks in advance for any more info you can offer.

 

Incidentally, where did you end up matching? (And was it ENT?)

 

Jason

[Guest Ian Wong]

I don't know if the extra training of a Canadian fellowship would allow you to write the ABO exam. It would be best to call them up directly and ask them. Part of the problem is that these decisions are often very political and arbitrary, and therefore subject to change at any time. Even if they tell you that the Canadian training could be valid doesn't necessarily mean it still will be some 6 years down the road after you've finished your 5 years of residency + 1 year of fellowship in Canada.

 

As far as I'm aware, no ABO certification makes it harder for the US programs to bill for work you've performed as a fellow (which is one of the incentives to have fellows, which is to pay them a small stipend relative to the work they are performing for you).

 

I don't even know if you'd be considered board-eligible after doing a Canadian residency (most practicing ENT's are board-certified, meaning they've written and passed the ABO exam; some ENT's are just board-eligible, meaning that they've finished their 5 year residency, and are eligible to sit for the exam, but have not passed the ABO exam either because they've never taken it, or have flunked it). Seeing as Canadian ENT training (assuming you started residency after 2000) doesn't qualify you to write the ABO exam, that would seem to me that you wouldn't even be considered board-eligible.

 

I interviewed in both ENT and Radiology, and ended up not ranking ENT and therefore matched into Radiology. I think I could have done a good job in ENT, but Radiology fits my interests in Anatomy and computer technology even better than ENT. I think I'll be happier longer-term as a radiologist than as a surgeon, and that's pretty much what sealed the deal for me.

 

Ian

[Guest Cowgirl Jenn]

Hello,

 

I'm a first year medical student from UofA, and "think" I may be interested in ENT and was just reading through these old posts. I'm curious if it is normal that a Canadian residency education would be so difficult to transfer to the US? Why is this such a concern? Is there a lack of ENT jobs in Canada?

 

Also, is it much easier/harder to get into an ENT residency in Canada versus the US (from Canada).

 

Thanks,

 

Jennifer

[Guest Cowgirl Jenn]

Hey,

 

Still waiting for a response to my above post, and thought I'd point it out with the hopes that someone would have some insight for me...

 

Thanks!

[Guest marbledust]

I don't know if you are going to get the response you are hoping for, only because we don't have any ENT residents who post here. You might get more information about the US side of things from SDN.

 

Good luck

[Guest UWOMED2005]

I'm NOT an expert on ENT nor a resident.

 

I think the issue is that OR time can be difficult to obtain in some centers if you're not an "academic ENT," and getting an academic appointment in Canada means doing a fellowship AND not necessarily getting your first choice for location. In the past, if this became a problem you could always go to the US if you couldn't get somewhere you wanted to work. If there's no US backup, you might find yourself stuck.

[Guest Cowgirl Jenn]

marbledust - what is SDN??

 

UWOMED2005 - thanks for the insight, I see what you mean. Is it hard/possible for Canadian trained ENTs to do their fellowship in the US? Even if they are not board certified in the US, could they not do their fellow there, and then come back? This way, they may not have a problem getting that academic position they want, to guarantee OR time.

 

Also, wouldn't Canadian ENTs have the option of setting up their own clinics/ORs if this really were a problem?

 

Thanks!

[Guest UWOMED2005]

You need an available operating room to to set up an OR. . . usually in a hospital.

 

And it's kind of hard to operate as an ENT. . . if you can't operate. Would you then refer operations to another ENT?

 

Can't really help you out more than this, but I do think Canadian ENTs can go to the US for fellowships still.

[Guest marbledust]

Hey Jennifer:

 

Sorry for just assuming you would know what SDN is. The last person I suggested the site to got insulted when I assumed they didn't know and typed out an explanation!

 

Anyways SDN is the "student doctor network" (http://www.sdn.net, I believe). It us a site similar to this one--many different forums to discuss admissions, med school, residency, etc.

 

You might want to try the surgery forums in the residency section. I "think" there is a separate ENT forum. There is also an international forum where you might get a response to your questions about US/Canadian similarities and differences.

 

It's a great site but sometimes things get downright wacky over there.

[Guest Cowgirl Jenn]

Thanks for the info guys!

 

Marbledust, I realise that an ENT without an OR/OR time isn't of much use, but I thought privately, they could set up their own OR? I mean, plastic surgeons do it don't they? Thats not a route I'm interested in, but IF you really couldn't get OR time at a hospital in Canada...

 

Thanks.

[Guest marbledust]

but I thought privately, they could set up their own OR? I mean, plastic surgeons do it don't they

 

To be honest this isn't an area I know a whole lot about--having less than zero interest in doing anything surgical with my career

 

My cautious guess would be that it would depend on what province you are in, as I believe the guidelines for private ORs vary from province to province. At least that is my understanding. Maybe somebody else might know?

[Guest Ian Wong]

Interestingly enough, I just swapped emails recently with a Canadian ENT residency graduate who is just starting a fellowship in the US. This individual graduated after the "grandfathering in" of the last class of Canadian ENT residents (in other words, didn't take the American Board of Otolaryngology board exam and is therefore not US board-certified), but was still able to obtain a fellowship in the US.

 

The implication here is that it is definitely possible to obtain US fellowships following a Canadian residency, even after this new decision by the ABO not to recognize Canadian residency training. That's pretty huge.

 

I don't know whether this individual will be eligible to work in the US afterwards (I think the major issue would be whether this fellowship makes you US board eligible or not, and if so, you'd still need to take and pass the US board exam). Without board certification (or at least, board eligibility as a minimum), it'd be very difficult to find US hospitals that would grant you priviledges, or different US insurers to get you both malpractice insurance as well as payment for the services you provide.

I realise that an ENT without an OR/OR time isn't of much use, but I thought privately, they could set up their own OR?

ENT is one of the surgical subspecialties that can be very conducive to outpatient surgery. This is a large component of why the ENT lifestyle can be so good relative to other fields; you are often operating on healthy people, and the surgeries themselves are often small and relatively delicate, meaning that post-operatively, many of these patients can go home the same day from surgery. Therefore, you don't keep many post-op patients in the hospital (unlike vascular surgery, general surgery, cardiac surgery, orthopedic surgery, etc), and your inpatient workload is MUCH better than many of those other specialties.

 

If you exclude head and neck cancer surgery (where patients can end up incredibly sick post-operatively), a lot of the other surgical procedure like ear tubes, septoplasty or rhinoplasty, endoscopic sinus surgery, lymph node biopsies, ENT facial plastics procedures, other otologic surgeries like tympanoplasty all can be done as an outpatient, which makes these cases well-suited for a private surgery center.

 

It's my belief that ENT is one of the surgical subspecialties (along with Ophthalmology and cosmetic Plastics) that would benefit the most from the widespread proliferation of private surgery centers. So much of the ENT surgical workload could be done as an outpatient, which also potentially relieves you from the call burden of a hospital contract. At least in BC, ENT OR time is incredibly scarce, so if you can set up a mechanism to do your procedures outside of a hospital OR, your increase in productivity could be huge.

 

Ian