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ENT Otolaryngology vs Dermatology -> 20 yrs from now

Home General/Welcome ENT Otolaryngology vs Dermatology -> 20 yrs from now

  • Avatar Undifferentiated 
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    Joined: 06/09/2019

    Trying to decide between two great specialties.  Obvious considerations include career satisfaction, attending lifestyle (and resident, to a lesser extent), salary, career stability/safety, ability to make meaningful impact patient lives, and flexibility.  I love both medicine and quick surgeries.  I think as a dermatologist I would do general or procedural if I had the opportunity, whereas in otolaryngology I would do general or Facial plastics.

    I have rotated in both specialties but still having a hard time deciding.  Advisors in both have said I have a good chance of matching well.

    My biggest hesitations about dermatology are that the work in general is more prone to invasion by NP/PAs (in that a lot of pattern recognition can be learned on the job after 5-10 years and there are more graduating NPs wanting to derm than there are dermatologists each year), and the barriers to entry aren’t as high since people aren’t nearly as afraid of a solo NP doing a shave biopsy as they would be an NP taking out their child’s tonsils.  I also worry that while the work has a lot of huge improvements in many people’s quality of life, it also has very insignificant effects in others (ie. freezing AKs, removing tiny BCCs from 89 year olds). Big pros include the fact that it has a larger variety of medico/social issues that really matter to patients, the problems are relatively apparent, it allows for procedures/minor surgeries to be done without the huge logistical stresses of an operating room (staff I don’t hire, hospital credentialing, waiting for cases etc).

    My biggest hesitations about ENT are the work/life balance and stress about the fact it (albeit may be an incorrect perception) is really difficult and I worry that even if I obtain a residency spot, I would stress over each mistake and how negatively it could impact that patients life.  I also worry that the long term lifestyle would be far worse, due to the amount of call I would need to take if I am not in a large group.  That said, I think ENT has a lot to gain from the expansion of NPs/PAs that seems inevitable with the proliferation of online schools.  I also think that it has a lot to offer in terms of perfecting a craft that will be a lifelong venture.

    I would love to hear from Derms/ENTs and others on this.

    Edit: I do love surgery.  I also love most of the subjects I’ve had in med school and since I feel like I will be fulfilled in a lot of fields I am having a tougher time. That said, I don’t think I would do Head & Neck cancer after residency as I don’t think that in general I would love all of my patients being that high acuity.  Thyroids/parathyroids, parotids, lymph node biopsies sound like the length of surgery/acuity I would be most comfortable with.  I can tolerate the length just fine as a student, and hopefully as a resident but it is not my life goal. I like the surgical diversity in ENT (endoscopic sinus, microscopic ear, robotic/open thyroids, facial grafts/flaps) and just hope that after 5 years I would feel comfortable with moderate complexity cases in each sub specialty.  I know there will be call as an ENT but how burdensome does it tend to be once you are out of residency?

    #220444 Reply
    CordMcNally CordMcNally 
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    Status: Physician
    Posts: 2263
    Joined: 01/03/2017

    I’m not either but, in short, your guess will be as good as mine. I’ll let the ENT and Derm folks give a more detailed answer.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #220451 Reply
    Avatar bean25 
    Participant
    Status: Resident, Physician
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    Joined: 01/26/2016

    ENT is a surgical residency first and foremost. I’m an ENT resident currently on our cancer service and will be in at least three 8-9 hour surgeries doing complex resections and flaps this week. Plenty of rotations are not like that but nearly a quarter of your residency at most programs will be spent on the cancer service.

    If you want to do ENT because you think it is like Dermatology and a similar quality of life I don’t think you would be a good fit for our specialty.

    ENT can have a great quality of life after residency but you still take call for airway emergencies and other acute conditions. Not at all comparable to Dermatology in my opinion.

    #220475 Reply
    Liked by Vagabond MD
    Vagabond MD Vagabond MD 
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    Joined: 01/21/2016

    I always say that if you like surgery, all else equal, do ortho, and if you do not, do deem (assuming that you can match in either). ENT would be a worthy substitute for ortho. So we are back to the original question, do you like surgery or not?

    I do agree with your arguments in the OP. Can/will NPs or AI replace some of the functions of a Dermatologist (like semi-annual skin checks or rapid diagnosis of common skin lesions)? Yes. Can AI come in and do an emergency airway, take out a thyroid gland or parotid gland, or advise on aspirate a peritonsillar abscess? Probably not in my lifetime.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #220477 Reply
    Liked by bean25, okayplayer
    Avatar bean25 
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    Joined: 01/26/2016

    I agree that at the end of the day it boils down to whether you love surgery or not.

    Personally, I think ENT is a great field because there is so much variety in your practice. If you do Ortho, you are going to do a fellowship for most jobs. In ENT there is a great job market for general ENTs. Even in large metros, there is a role for non-fellowship trained ENTs, and if you are in a mid-sized city, it is even better. I like the idea of being able to do thyroids, parotids, small head and neck cancer cases, sinus surgery, ear surgery, and bread and butter peds. You don’t have to limited yourself to one thing, and your practice can evolve as you progress in your career. Plenty of young ENTs start their careers doing larger cases, and then have a more clinic/allergy based practice later in your career.

    All that said, ENTs in general do not operate as much as Ortho, Gen Surg, Neuro surg (1 to 1 1/2 days a week in many private practices). I think if you want a surgical specialty that has a similar lifestyle to Derm you are better off looking at Ophtho. I general I would think in terms of lifestyle Derm > Ophtho > Urology > ENT > Ortho/Gen Surg/Neurosurg. However, call varies widely based on your choice of practice- some office based ENTs take no ER call.

     

     

    #220491 Reply
    Avatar Undifferentiated 
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    Status: Student
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    Joined: 06/09/2019

    I would love to work in the suburbs, which is where I think a generalist ENT would have a good scope of practice.  If I am operating 1-2 days week, and my OR days are from 7-6pm, does the lifestyle really end up that bad?  Is it hard to work < 50 hours as an ENT? Obviously ENT residencies can have almost twice as many hours as a derm residency, but once you are out in practice is it that bad?  I love surgery, but also think I wouldn’t go crazy if I was stuck with more minor surgeries like wide excisions, lipomas, etc.  I just don’t think I could do hospitalist or peds where there really are almost no hands on procedures.

    #220530 Reply
    ENT Doc ENT Doc 
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    Joined: 01/14/2017

    The ENT residency will be longer and harder.  The lifestyle after will also likely be more grueling.  Derm is nice because it offers a high $/hr worked and doesn’t require long hours and call (typically).  ENT call could stink or be ok.  Ours is one out of every 7 weeks.  Others are Q2 or Q3.  You’ll suffer encroachment from NP/PAs/PCPs and technology more IMO as a Dermatologist, which may affect future income.  As bean said, you can be very diversified as a generalist, but you had inclinations towards facial plastics.  Being in FP may be a tough ramp up but in the end you might have more income protection from things like single payer, which may be the most significant threat to all our incomes.  Lots of ways you could go with this, but I think you really need to know if the 5 year ENT residency and long hours in the OR is what you want.  If you’re looking for quick little cases sure you’ll get that with tubes/tonsils and some nose/sinus.  But those cases are not as fun as the more involved cases where you’ll be in there dissecting over important nerves for hours.  Some of those cases are very stressful but also have been some of the most rewarding of my career.  You have to determine if that’s the kind of life you want as a physician IMO and where you see yourself in 10/20 years.  Hope this helps.

    #220532 Reply
    Liked by Zaphod, bean25
    ENT Doc ENT Doc 
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    Status: Physician
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    Joined: 01/14/2017

    I would love to work in the suburbs, which is where I think a generalist ENT would have a good scope of practice.  If I am operating 1-2 days week, and my OR days are from 7-6pm, does the lifestyle really end up that bad?  Is it hard to work < 50 hours as an ENT? Obviously ENT residencies can have almost twice as many hours as a derm residency, but once you are out in practice is it that bad?  I love surgery, but also think I wouldn’t go crazy if I was stuck with more minor surgeries like wide excisions, lipomas, etc.  I just don’t think I could do hospitalist or peds where there really are almost no hands on procedures.

    Click to expand…

    Depends on the practice you search out and what’s available when you go looking.  Wide variety of practices and expectations.

    #220533 Reply
    Avatar Undifferentiated 
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    Joined: 06/09/2019

    Do any of you guys in ENT or Derm regret it, or would you absolutely make the same choice?  I’m not afraid of hard work and honestly in a different world (ie. 30 years ago) I would do full-scope family medicine but I don’t think it makes sense nowadays with a future wife who probably won’t clear 6 figures and the expansion of midlevels and unreasonable amounts of paperwork in primary care.

    #220540 Reply
    Avatar nephron 
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    Status: Physician
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    Joined: 05/09/2019

    As a non-ENT/Derm guy, I would just point out that predicting 20 years into the future in medicine is impossible for anybody to do.   The medicare trust fund in projected to run out of money in ~ 10 years and with pressures on decreasing payments, it’s hard to see who will come out ahead or stable.   CMS does routinely propose draconian cuts for different procedures and while they usually do get some push back, I think that it is only a matter of time before more of them get through.    I think that derm has been great at using physician extenders, I don’t see them ever getting to the point where the extender does not require supervision though.   I say great because they can have some 40 office visits a day under one physician, it’s like a factory at some of their clinics.    They have been great at limiting the number of derm residencies, that is not going to change overnight, so I think that they will always be able to have some clout with their supply demand imbalance.   I think that they are one of the few specialties that could turn away medicare patients and do just cosmetics or just private insurances because there is such a shortage of them so I think that they will be safe for a while.

    #220541 Reply
    startupdoc startupdoc 
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    Status: Physician
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    Joined: 11/01/2017

    I’m an ENT. I also thought of doing derm (and even did some rotations as a med student).

    At the end of the day, I find the general day of an private practice ENT much more interesting than the general day of a private practice derm. ENTs see newborns to elderly. They do plenty of office based procedures. They do both outpatient and inpatient work. They operate in surgical centers. They operate in hospitals. I am never bored. Sometimes annoyed, but never bored.

    My private practice derm friends generally have much more monotonous schedules. They are seeing high volume patients in the office day in and day out. The advantage? They work less hours and no call. Obviously this doesn’t apply to all derm in all practice settings, but this is generally true.

    Though difficult to predict, I believe ENT is way more future proof than derm because they are more flexible in the stuff they can do. Also, there is less of a magnifying glass on ENT than derm since it is a smaller field and more under the radar (half of physicians have no idea what we do). I have seen virtually no encroachment from mid-levels, but I see PAs/NPs working largely independently within a dermatology practice.

     

    #220549 Reply
    ENT Doc ENT Doc 
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    Do any of you guys in ENT or Derm regret it, or would you absolutely make the same choice?  I’m not afraid of hard work and honestly in a different world (ie. 30 years ago) I would do full-scope family medicine but I don’t think it makes sense nowadays with a future wife who probably won’t clear 6 figures and the expansion of midlevels and unreasonable amounts of paperwork in primary care.

    Click to expand…

    I’d make the same choice, but I’d give Urology a harder look.  Just never something I thought I’d like and never pursued it, but was on a rotation later as an intern and really liked it.

    #220561 Reply

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