Category Archive: Choosing a Specialty

How to Match into a Great Emergency Medicine Residency

Emergency_room

An Emergency Medicine Attending Physician's Perspective:

From an interview with an Emergency Medicine physician in Colorado. Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

How competitive is the Emergency Medicine match?

Emergency Medicine has increased in competitiveness over the last 5-7 years, and seems to fluctuate somewhat in competitiveness. I personally think that competitiveness will maintain or increase as graduates are more attracted to specialties that compensate well while maintaining a good lifestyle (with minimal call), but that remains to be seen.

 

What must a student do to match into a great Emergency Medicine residency?

As with all specialties in the match, a good score on Step 1 is a must, but additionally a good Step 2 score is also important. EM program directors value this clinical-based test and your ability to perform in a clinical environment. Some say that this score is even more important than Step 1.

More important than either of those is your performance on clinical rotations, shelf exams, and letters of recommendation.  Emergency Physicians greatly value working with partners and colleagues who push themselves to be not only be great physicians, but team players who give the effort to help their fellow physicians. You have to go above and beyond with a solid knowledge base, evidence-based practice, and great interpersonal skills. 

The core 3rd year rotations are especially important (in addition to a sub-internship in EM) as our scope of practice really does encompass a significant portion of every other specialty.

 

What are residencies looking for in an Emergency Medicine applicant?

See the above – work ethic, integrity, clinical acumen, decisiveness, procedural competence, and being a team player.

 

What should students look for in an Emergency Medicine residency?

This will vary; you have to prioritize what is most important to you. Important considerations include location, reputation, research and leadership capability / opportunities, faculty, etc. Compensation is a consideration, but I think you (like me) will find that the variability is slight. Some programs offer coverage of meals while working, and some offer full health insurance benefits including dependents.  You will find a litany of differences – some of which may be deal breakers, some of which will only be perks – it's up to you to decide what's important.

Most programs have some subtle differences in their rotation schedule, which may make or break the decision for some, but I find that the differences are small, and many programs will provide excellent training. There are some programs which rise above the others for one reason or the other, but these reasons may be different for each applicant.  I found that focusing on subtle schedule differences created frustration, and got away from the more important consideration, which was fit.

In my opinion, the most important consideration is how you feel you fit with the program. Does your personality mesh well with your fellow residents and those of the faculty? If you have a family, will they be welcomed at events, or is every out-of-work gathering going to be held at a bar? What is your overall impression of the program, and how does that fit with your goals?

 

Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

With regards to ranking programs, most of that in my opinion is answered above. It's important to make a list of priorities and stick to it. As for the application, LORs, and personal statement: LORs should be obtained from practicing Emergency Physicians who know you and can speak to your clinical skills as well as personal attributes. Having an impersonal letter from a "big name" in Emergency Medicine is not nearly as important as one from someone who can write a strong letter touting your abilities as a provider as well as a person.

Your personal statement should be concise (no more than a page) and clearly demonstrate WHY you are going to be a rock star EP. However, you should not explicitly write all that out. Find a case that will grab the attention of the reader, demonstrates why you think EM is a no-brainer choice and why you are committed to it, and also showcasing your talents and skills.  This is your chance to express how you stand out from your peers, so you need to do that without sounding egotistical.  This is not a time for straight humility, but you must represent yourself with quiet confidence.

 

What do you wish you knew before application/interview season?  

Be familiar with the results of the match from recent years, and discuss with your faculty mentors how many programs you need to apply to / interview with.  Currently, 9-12 interviews is likely sufficient for the average applicant, but that may vary in coming years, and depending on the applicant. Interviews can be expensive, so consider your top picks ahead of time, but don't be afraid to adjust that list as you visit programs and formulate your impressions. You will likely be surprised about which programs stand out, or which will fall in their rank (I know I was…).

 

What other advice do you have for students applying for Emergency Medicine residency?  

This is a great specialty and profession. While we tout fun procedures, fast-paced shifts, and a great lifestyle, you should make no mistake and know that we work hard. Very hard. We do work that no one else does, and that many shy away from. We are not experts in every field of medicine, but we are masters of resuscitation, emergent airway management, trauma, and critical care. You will hear some people bash Emergency Medicine for not being "experts" in their specific area of expertise – that's by design! I was never trained to be an OB/GYN, but I am trained to recognize and treat OB and GYN related emergencies, referring those non-emergent cases for outpatient follow-up.  This does not give us room to slack and provide substandard care, but rather excellent care of urgent and emergent problems, leaving more obscure and less urgent problems to the specialist. Emergency medicine is awesome, enjoy it!

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Why did you go into Emergency Medicine?

Glidescope_02

An Emergency Medicine Attending Physician's Perspective:

From an interview with an Emergency Medicine physician in Colorado. Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

What attracted you to Emergency Medicine?

Emergency Medicine is the perfect combination of acuity and generality. I'd like to say that every patient I treat has an emergent reason to be in the ED, but unfortunately, that's not the case.  However, many do.  We evaluate, stabilize, and initiate treatment for critically ill patients every day. We hold difficult discussions with families, provide reassurance to parents, and address a large spectrum of medical illnesses. We are specially-trained to address any potential problem that could walk through the door, be it trauma-related, pediatric, geriatric, or anything in between. 

 

Describe an emergency department physician's typical work day?

The typical day is quite variable, depending on the day of the week and time of day that you are working.  As emergency physicians, we work in shifts. This means that our work days have predetermined start and end points. While those end points may flex slightly depending on the flow of the department on any given day, and you may be required to stay an hour or so late, when you leave you are done and no longer have to worry yourself about patient care responsibilities. 

I usually arrive 10-15 minutes early for a shift to provide the off-going doctor with a few extra minutes of relief, knowing just how busy his or her day could have been. After signing PA charts and verbal orders from the day before, I get right to seeing patients, or asking around to see if there's anything pending that my partners might need assistance with.  From that point, it's moving from room to room, patient to patient, providing counsel, instruction, reassurance, and at times, bad news. The number of patients seen in a typical shift will vary from day to day, and depending on where you work whether it be a busy urban / suburban ED or a more rural setting, but even in the rural setting any given shift can become incredibly busy; it all depends on the day. 

The hallmark of the emergency physician is the disposition.  At the end of every patient encounter, the patient will either be discharged home, admitted, or transferred.  There are typically no loose ends to worry about or results that will be pending for tomorrow that require attention. Each day brings a new census of patients that will come and go according to their respective disposition, and the cycle repeats itself. 

 

What type of lifestyle can an Emergency Physician expect?  

As a result of "shift work", the lifestyle of an emergency physician is largely customizable by the individual.  In my group, it's fairly easy to request certain days off for sporting events, school performances, or other special occasions. When those come up unexpectedly, fellow physicians are very accommodating of shift trades. This allows me to be present for my family when I want / need to be. When I'm off during the day, I have time with my wife and young child, and I am home to help with school-aged children, homework, as well as afternoon trips to the park and bike rides, etc. 

Saying that an emergency physician never takes call is a bit of a misnomer; our group does have a back-up call system for unexpected illness, emergency, or even a horrendously busy day in the department when we need an extra person to decompress the waiting room.  I take one 24-hr period of call each month, and find that I very rarely get called in.  Specifically, in the last year I cannot remember being called in, and have only seen 1 or 2 of my partners called in. 

Our group is very equitable about how we disperse shifts.  We do have several dedicated night-docs who take the majority of our night shifts, and the rest are dispersed equally among the rest of us. I work a mixture of shifts, and find that I work on average 14-15 shifts a month (mostly 9 hour shifts), with 4-5 of those being overnights or late evening shifts. This varies by month of course, but on average my number of night shifts is very manageable. 

There will be times when you will have to work nights, weekends, and holidays, but the trade off is time off on weekdays 

 

What is the potential salary of an Emergency Physician?

Specialty-specific salary information is available from many sources, and this varies by region as well as the collecting agency. The most current numbers from Medscape (http://www.medscape.com/features/slideshow/compensation/2014/emergencymedicine) show a competitive salary averaging at $272,000. It is not unheard of for a partner in a private group to exceed that, but that's the posted average.

 

What is the job market like for Emergency Medicine?

Honestly, it's great.  You can literally get a job anywhere in the country.  Having said that, not all jobs in EM (or medicine in general) are created equal.  There are certain markets that are more difficult to break into because of a given reason (i.e. mountains, beach, prestigious academic institutions, etc.) but those doors can open by pursuing fellowship training, other post-graduate experience, networking, and sometimes just persistence and demonstrating proficiency above that of your competitors. 

 

What can you tell us about Emergency Medicine subspecialties?

Post-graduate fellowship training is currently available for Critical Care, EMS, Ultrasound, Administration, Research, Toxicology, Pediatric Emergency Medicine, Disaster medicine, Simulation and Education, Sports Medicine, Health Policy, Emergency Cardiology, International Emergency Medicine and Global Health, Hyperbarics, Legal Medicine, Emergency Neurology, and Wilderness Medicine. 

Most of these are 1 year, some are 2 (CCM, Peds). Salary numbers will vary greatly depending on your chose practice site (private vs Academic, geographic location), and as you subspecialize, your job market narrows significantly (i.e. if you train in Peds and need to work at least part of your shifts in a large children's ED, that limits you geographically), but at the same time some of this post-graduate training can give you quite the edge over other applicants to help you break into more difficult markets. It's all about what you want to build your practice into. For example, if you want to be a toxicology or legal expert, you can likely work in either an academic or private group while still taking call at the poison center / consulting with a malpractice firm. 

 

What are the potential downsides of Emergency Medicine that students should be aware of?

Every specialty and every job will have some downsides. There are times when dealing with consultants can be challenging, or when patients come to the ED with a chronic problem, sometimes having had a thorough workup, expecting you to be able to solve their problem in an hour or two. You have to be able to take these experiences with a grain of salt, knowing that they will come occasionally, but are greatly outweighed by the opportunity to positively impact both the critical and not-critical (but still ill) patients.

Most people also quote chronic narcotic-seeking patients as a downside. These patients can be challenging as well, but in all reality many emergency departments have policies in place that make this much easier, and you have the backing of your administration and the nurses in the department, making disposition without narcotics on these patients easier.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: How to Match in Physical Medicine and Rehabilitation

PM&R Vintage

 

A Physical Medicine and Rehabilitation (PM&R) Resident’s Perspective:  From an interview with a PM&R resident from Ohio.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the PM&R match?

Matching in PM&R is not as competitive as some fields, such as radiology, neurosurgery, dermatology, etc. However, it also used to be a relatively unknown specialty. Medical student exposure to PM&R has improved and the number of applicants seems to be steadily increasing, so it is becoming more competitive.

 

  •  What must a student do to match well in PM&R?

A student looking to match well in PM&R should focus on the same things students would pursuing other specialties. Like any specialty, doing well on boards is important. Most programs have now instituted board score cut-offs for applicants, which are around 200-220 for USMLE Step 1. In general, students should perform well on their clinical clerkships throughout medical school, and a rotation is PM&R is preferred. Strong supportive letters of recommendation, including one from someone in PM&R, is preferred. At least some exposure to or participation in research is also a plus.

 

  • What are residencies looking for in a PM&R applicant?
PM&R residencies look for all the usual strengths in an applicant like good board scores and academic performance, good clinical performance on your clerkships, research exposure, etc. In my experience, PM&R residencies also tend to appreciate individuals with additional interests like sports and music. There are many in PM&R who followed non-traditional paths to medicine and may have had other careers first. Personality is also very important, as it takes pretty caring and compassionate people to be providers for individuals with disabilities as well as an ability to work with a multi-disciplinary team. In addition to a student's application, their interview day with a residency program will be very important

 

  • What should students look for in a PM&R residency?

If you are pursuing PM&R but not yet sure whether you want to do a fellowship, look for a well-rounded PM&R program with opportunities for exposure to the subspecialties. I looked for a program with a good balance of inpatient and outpatient clinical duties and wanted exposure to all the major areas: Sports/MSK, stroke, TBI (traumatic brain injury), SCI (spinal cord injury), amputation and pediatric rehab. I also looked for programs that had an ultrasound curriculum, as well as plenty of exposure to procedures including electrodiagnosis (EMG), botox, interventional spine and baclofen pumps. Beyond curriculum, the deciding factor in residency programs for me was finding a good “fit.” I paid close attention to interactions with residents, students, fellows and faculty on interview days to try and get a feel for whether this was a place I would like to train or not. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Like any other specialty, having a well-rounded application is important. Although board scores are important and used as a screening tool, residencies want to see much more than that. Do at least one rotation in PM&R, even if you have to arrange an away rotation. Also try and have at least one Letter of Recommendation from someone in PM&R. I looked for well-rounded programs to rank, but ultimately my rank list came down to finding a good fit on my interview day. Pick a program where you can see yourself being both well trained and happy for 4 years

 

  • What do you wish you knew before application/interview season?  

Although I did a lot of practice interview questions before my interviews, one question I didn’t have a great answer for was “So what is a Physiatrist?” I struggled with this question because the scope of our field is pretty broad, but having a decent answer will help guide your personal statement and save you the embarrassment if asked on the interview trail

 
  • What other advice do you have for students applying for PM&R residency?  

People like to say “plenty of money and relaxation,” and although the lifestyle is good there are long days and hard days. We take care of very sick patients, many of which have experienced something catastrophic, and as their physiatrist we can be their greatest advocate or on some days just their cheerleader. In PM&R, you have to be willing to wear many different hats. Also, make sure you write “PM&R” NOT “PMNR,” and know how to pronounce “Physiatrist.”  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Spotlight Interview: Why Did You Choose Physical Medicine and Rehabilitation (PM&R)?

 
EMG2

 

 

A Physical Medicine and Rehabilitation PM&R) Resident’s Perspective: From an interview with a PM&R resident from Ohio.. 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to physical medicine and rehabilitation (PM&R)?

I initially explored PM&R because I always had an interest in neurophysiology and neuroanatomy, and I knew that physiatrists took care of patients with stroke, traumatic brain injury, spinal cord injury, and other disorders of the nervous and musculoskeletal systems. During my first rotation in PM&R was when I learned that physiatrists primary focus in helping their patients is by improving function. This focus on function is ultimately what attracted me to PM&R, because enabling patients with different abilities to function can substantially affect quality of life. Another aspect of PM&R that attracted me to the specialty was working with a multidisciplinary team to provide care. 

 

  • Describe a physiatrist's typical work day?

The workday of a typical physiatrist is quite regular, usually from about 8am to 5pm, but this can vary somewhat depending on your type of practice. There are many physiatrists who only do outpatient clinic, while others do both inpatient and outpatient. 

 

  • What type of lifestyle can a physiatrist expect?  

Lifestyle of a physiatrist can be somewhat variable depending on practice setup and location, but overall is considered to be well balanced relative to other specialties in medicine. We also have a high job satisfaction. PM&R is a very family friendly field, with plenty of free time and family time. Most physiatrists do not work nights, but there is some call coverage for those with inpatient duties. On average, call is usually about one week and one weekend per month, but can be less frequent depending on size of the department. Primary (first) call at large hospitals is most often covered by residents and fellows, and the attending is only called when needed. Call does usually include rounding on the weekend, which is usually brief.

 

  • What is the potential salary of a physiatrist?

The average salary of a physiatrist is around $180,000-190,000. 

 

  • What is the job market like for PM&R?

The job market for physiatrists is excellent both immediately following completion of residency as well as after advanced fellowship training

 

  • What can you tell us about PM&R subspecialties?

Another advantage to training in PM&R is that there are many options for subspecialty training. PM&R residents can pursue fellowship in many areas including the following: Interventional Pain/Spine, Sports Medicine, Cancer Rehabilitation, Stroke Rehabilitation, Traumatic Brain Injury, Spinal Cord Injury, Pediatric Rehabilitation Medicine, Neuromuscular Medicine/EMG, Informatics and Research. Most of the clinical fellowships are 1 year of additional training, and Pediatric Rehabilitation Medicine can be 1 year for those who completed a combined residency and 2 years for those who completed a general PM&R residency 

 

  • What are the potential downsides of PM&R that students should be aware of?

Although I did not consider salary when making my career decisions, it is an important consideration for students to think about as many of us have student loan debt and families to provide for. One potential downside of PM&R that students should be aware of is reimbursement changes for procedures, particularly electrodiagnostic testing. The salary I mentioned earlier is at or just below the average for all physicians.

 

  • What else would you tell medical students who are considering PM&R?

I highly recommend considering a career in PM&R. It is a fairly small field of medicine but it is growing and evolving, with so many exciting possibilities particularly with advances in technology. Being a physiatrist is incredibly rewarding. It is difficult to describe what it feels like when you see someone who had a stroke, spinal cord injury, or amputation walk again, but it’s pretty awesome to be a part of the team making that happen 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: How to match in neurosurgery

Recklinghausen neurosurgery

 

A Neurosurgery Resident’s Perspective:  From an interview with a neurosurgery resident from a top program in the Midwest.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the neurosurgery match?

Neurosurgery is among the very competitive specialties. Still though, I think that 80% of U.S. grads match somewhere.

 

 

  •  What must a student do to match well in neurosurgery?

All students should rotate at their home institution as well as at least one away rotation (almost everyone in my medical school class did at least two away rotations).  Boards are important.  Research and publications are very well looked on, as is performance on the sub-internship.  Being a good sub-intern is not about how much you know, but rather how hard you work, how willing you are to be at the hospital constantly, and how easy to get along with you are.

 

  • What are residencies looking for in a neurosurgery applicant?
The answers are the same as what I mentioned earlier. As a resident, I want someone who’s going to work their tail off on service and not let down the rest of the team.  

 

  • What should students look for in a neurosurgery residency?

Make sure the fit of your personality matches the department.  Seven years is a long time to be miserable if you don’t like the people, no matter how prestigious the place. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from neurosurgeons (it’s a very small world), or research mentors. Perhaps other types of surgeons can write your letter of recommendation if you’ve worked with them a lot.   Other letters really won’t count for anything.  You should get one from the chair at the places where you rotate.  It doesn’t matter if you didn’t really work with them at all; they will solicit feedback from the residents and staff you did work with and their letter serves as a summary of your time there.  

 

  • What do you wish you knew before application/interview season?  

It’s well worth it to interview at a lot of places and get a “tour” of neurosurgery.  It really is a small world and you’ll run into people over and over.  

 
  • What other advice do you have for students applying for neurosurgery residency?  

It’s an awesome privilege to be able to do this stuff. Good luck!  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Spotlight Interview: Why did you choose neurosurgery?

vintage neurosurgery
 

A Neurosurgery Resident’s Perspective: From an interview with a neurosurgical resident from a top program in the Midwest. 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to neurosurgery?

I knew pretty early on that I enjoyed surgery.  I liked surgery rotations, liked the satisfaction of work that was both mental and physical, liked that there is a lot of instant gratification in surgery, being able to (sometimes) fix something in a very immediate way.  Within surgery I think I could have liked a lot of rotations, but I ultimately gravitated to neurosurgery because I liked seeing people who came in pretty dramatically ill, and sometimes we were able to help, or at least mitigate the badness.  I liked the intensity of it, as well as the variety; there’s everything from tedious microsurgery for brain aneurysms to giant spine cases where you’re using big power tools.  The common denominator is that most of it is pretty high stakes.  

 

  • Describe a neurosurgeon's typical work day?

In general, days start early and end late.  As a resident I usually get in around 5:30, and the day ends when the cases are over and evening rounds are done.  Sometimes I’m out by 6, but more often substantially later.

 

  • What type of lifestyle can a neurosurgeon expect?  

Many neurosurgical problems (trauma, ruptured aneurysms, cranial or spine infections) need to be dealt with right away, whether it’s the middle of the night or the weekend.  There are some neurosurgeons that have more regular schedules than others, but most have a substantial amount of call.

 

  • What is the potential salary of a neurosurgeon?

I honestly don’t know exact numbers, but I do know it is generally high, even for surgical specialties.  I think that shouldn’t factor too much into your decision to go into it though- It’s nice to know you’re going to be well compensated, but I’ve got to think a lot of the long, off-hour, painful cases would be utter misery if your only motivation is that it pays a lot.   

 

  • What is the job market like for neurosurgery?

I don’t know- I’ll tell you when I’m closer to completing residency!  One thing to be aware of is that in general, private practice docs do more spine surgery, and more of the cranial work is done at Academic Institutions. 

 

  • What can you tell us about neurosurgery subspecialties?

Subspecialty training after residency can be in pediatrics (1 year fellowship), endovascular or open vascular (1-2 year fellowship), spine (1 year), tumor (1 year), functional (1 year), peripheral nerve (1 year).  

 

  • What are the potential downsides of neurosurgery that students should be aware of?

A large part of neurosurgery can be trying to help people with chronic pain, and they can be a challenging population.  Neurosurgeons suffer from some of the highest malpractice rates in the country.  There is much discussion in neurosurgical circles about the decreasing reimbursement for our procedures.  Much of patient volume in private practice is spine.  

 

  • What else would you tell medical students who are considering neurosurgery?

A lot of people say “only do neurosurgery if you couldn’t do anything else.”  I’m not that dogmatic, but you need to realize it’s a pretty heavy lifestyle commitment  

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: Why Did You Choose ENT?

Neck Dissection
 

An Otolaryngology (ENT) Resident’s Perspective: From an interview with an ENT resident at from the Midwest.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to ENT?

I was attracted to surgery initially.  After shadowing in ENT I realize that I really enjoyed the anatomy, I enjoyed the personalities that I encountered in the specialty and I thought that the idea of treating deafness with cochlear implants and the idea of helping kids with cleft lip really exciting.

 

  • Describe a otolaryngologist’s typical work day?

Work is usually in the office or in the operating room.  Some ENTs split their day between both, but most have "clinic days" and "OR days".  A resident will round in the morning (early like surgery) and either go to the assigned OR or go to the assigned clinic.  Rarely do residents have days to just do floor work after internship.  After the day's work is done residents will finish any consults from the day, round on the patients in the evening and sign out to the covering resident.  

Attendings will typically come in to start their OR or clinic in the morning, check on their patients during the day, and head home when the work is done.

 

  • What type of lifestyle can a otolaryngologist expect?  

ENT lifestyle is good.  Most ENTs have predictable hours and flexibility to arrange their schedule to avoid working late into the night.  In private practice, ENTs finish by 5 o'clock and their family can count on them to be home.  In academic practice, there can be more evening meetings or emergent consults; and family flexibility is important.  Many ENTs are in academic medicine or practice in private groups and divide call across the group. 

 

  • What is the potential salary of a otolaryngologist?

$200-300k for someone starting academic job, 400-600k+ for private (Midwest estimates)

 

  • What is the job market like for otolaryngology?

There seems to be a shortage of ENTs currently and private groups are recruiting heavily across the country.  Academic jobs are available, but may require flexibility on location to get exactly what you are looking for.  Fellowships are generally available, although trends seem to ebb and flow & are unpredictable.  (i.e. recently facial plastics fellowships were very popular: twice as many applicants as positions, but not the case this year (2015))

  • What can you tell us about otolaryngology subspecialties?

Options for otolaryngologists include General ENT, Head and Neck Oncology, Facial Plastics and Reconstructive surgery, Advanced Pediatric Otolaryngology, Laryngology, Rhinology/Allergy, Otology/Neurotology, Skull Base, Surgery, Sleep Medicine.  All differences in salary are mainly determined by private vs. academic setting.

+General ENT- no extra training, most are in private practice with great salary and wide open job market

+Head and Neck oncology- 1-2 year fellowship required, almost all are associated with academic department, most likely type of ENT to have long hours- because surgeries are complex and urgent due to cancer treatment.  Airway and bleeding emergencies happen in the patient population, so call can include overnight emergencies requiring surgery.

+Facial plastics and reconstructive surgery: 1-year fellowship, there is variability within this subspecialty from purely cosmetic facial plastic practice to free flap reconstruction after major cancer surgery.  The lifestyle of the cosmetic surgeon in private practice can be as glamorous as it sounds.  The free flap surgeon lifestyle resembles the head and neck-oncologist.

+Advanced pediatric otolaryngology- 1-2 year fellowship, generally associated with tertiary referral hospital and/or academic center.  Lifestyle is a bit busier because they are more likely to have ICU patients than General ENT counterparts.  Kids are frequently getting things stuck in their trachea at night so call often involves surgery.  

+Laryngology- 1 year fellowship: voice surgery, again typically associated with academic center/tertiary hospital.  Some of these ENTs treat professional vocalists and their practice may resemble the cosmetic (posh) clinic.  Most laryngologists have consistent hours but airway emergencies can be quite stressful.  

+Rhinology/Allergy- 1 year fellowship. Generally specialize in sinus surgery and there is a trend to managing allergy.  May be in private or academic setting.  Lifestyle is good because emergencies are rare- consults can generally wait until office hours.  Somehow billing has been very favorable for rhinology and they are in demand because their practice is lucrative.  

+Otology/Neurotology- 2 year fellowship. Focus on treating ear disease and ear surgery including operations on the internal auditory canal (between the brainstem and the inner ear.)  They are associated with tertiary referral centers/academic centers and have a good lifestyle- consults can generally wait for business hours.  

 

  • What are the potential downsides of otolaryngology that students should be aware of?

The residency is a surgical residency and that comes with the long hours, pimping, and no service cap.  ENT does not have strong history of research and there are many aspects of treatment which are based on expert opinion as the best evidence.  If you want evidence like cardiology has- it just isn't there yet.  You will encounter snot, ear wax, tracheostomy secretions, pus from neck infections.  If this is unacceptable- stay away.  

 

  • What else would you tell medical students who are considering otolaryngology?

Many ENT's enjoy all of the gizmos.  Our academic meetings feature many companies coming up with gadgets, scopes and tools for work in the ear/nose/throat.  Robotic surgeries are becoming common in ENT practice.  Minimally invasive surgery is progressing rapidly.  Some of the first applications of 3D printing in medicine have occurred in ENT.  If  you love innovation, look into this specialty.  We have been curing deafness with cochlear implants for decades.  There are many more examples.

There is a big variety within the field and you can perform simple procedures like ear tubes or tonsillectomies- all the way to reconstructing a baby's trachea or removing the voicebox for cancer treatment.  We frequently work alongside other specialities; neurosurgery has overlaps, endocrine surgery with the thyroid and parathyroid glands, oral surgery, ophthalmology, plastic surgery, pediatric surgery, cardiothoracic surgery etc.   

Another strength of the specialty, in my opinion, is that there is no direct medical counterpart (for example neurosurgery and neurology).  Which means that we treat head and neck diseases and we decide when to treat medically and when to treat surgically.  

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: How to Match in ENT

Ear Exam

 

An Otolaryngology Resident’s Perspective:  From an interview with an ENT resident from the Midwest

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the Otolaryngology match?

The match is very competitive, recently it has been otolaryngology matched applicants with the highest average Step 1 score.   

 

  •  What must a student do to match well in Otolaryngology ?

Generally applicants need to have good test scores, and strong research and extracurricular features in their CV to be ensured an interview.  However, the programs are small- and personality conflicts are hard to avoid, so the interview becomes crucial to actually matching.  Programs have many qualified applicants and interviews are important for finding people who will be a good fit.  Also, the field is small, a well-connected chairman seems to know all the ENT's in the country, so your letters of recommendation (specifically who wrote them) is vitally important to where you match.  

 

  • What are residencies looking for in a Otolaryngology applicant?
Residencies are looking for someone who they get along with, someone they can trust to tell them the truth when staffing a consult in the middle of the night (not just what they want to hear).  Big academic centers are looking for hard-working and successful researchers with a record of being able to get a project to publication as a student.  Of course, any concerns that the resident will have professionalism or personal coping issues during training will flag them to fall way down the rank list.  (Programs are generally 2-3 people per year/ 5 year program, losing one resident means losing 10% of the residency).

 

  • What should students look for in a Otolaryngology residency?

Students should pay attention to what graduates  have been doing.  If everyone is going into fellowship and becoming chairman somewhere- you can be sure that there is some unstated expectation that matched applicants will continue that trend.  On the flip-side, if everybody goes into general practice and you want an academic job, there may not be mentors or support for you to get there.  Think honestly about what you ultimately desire- then come up with a politically correct way to convey those career goals to discuss in interviews.  

Another thing to look for is representation of all the subspecialties.  It can be hard for academic programs to retain facial plastic surgeons. If you hope to treat cleft lips, make sure there is someone to learn it from.  

Observe the general happiness of the residents.  If you match, you will join that small cohort of people and spend more time with them than your spouse.  Watch for anything that might be intolerable.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

It is a competitive match so seek a mentor who is well-connected in the field.  They will help you with curating experiences to put on your CV and where to get letters of recommendation.  This may mean looking outside your institution.  Successful research is sought and will be discussed at all interviews.   Letters of recommendation are almost all positive, so it becomes important WHO wrote the letter.  If you have your heart set on a specific program, make sure your letter writers know the chair/program director.  Be proactive without being annoying in the process.  One of my co-residents was not offered an interview here, but she called and politely discussed her situation with the coordinator and program director.  She got an interview and ended up matching.  The corollary is that if you are rude to the secratary managing interviews, they can mention it to the committee and get you off the rank list.  Be professional!  Rank lists are deeply personal and involve many factors- but basically rank where you WANT to go. 

 

  • What do you wish you knew before application/interview season?  

I wish I knew how small the field is.  Fortunately my letter writers were well known- to my benefit.  In a competitive specialty like this one, small things matter- if you are professional and hard-working it will show. 

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Which Residents Work the Hardest?

No one will ever agree on which residency is the hardest, or which residents work the most. However, with some new data from the FREIDA website, we get a better idea than ever before.  (For more information about the FREIDA website, read my previous article) FREIDA reports diverse variables about each specialty including the average of numbers worked per week, the average number of days off per week, and the average vacation time of each specialty.  I have compiled these into one database so that for THE FIRST TIME EVER you can compare objectively which residencies work the hardest.  (Well, at least you can compare which work the longest).

The first figure demonstrates the average number of hours worked by each specialty. As expected, the surgical sub-specialties work the longest hours with neurosurgery leading the pack and general surgery following closely in second.  Of the medical specialties, suprisingly, neurology works the most hours, with pediatrics and internal medicine following close behind. And at the bottom of the list… you guessed it, Dermatology. I wish I loved skin!

The results of the average number of days off per week and the average vacation time during residency follows closely with the trend seen in the graph above. For your viewing pleasure I have the entire compiled dataset posted below.  

 

 

 

 

 

Hours worked per week

Days off per week

Vacation weeks per year

Dermatology

45.0

1.9

3.3

Nuclear Medicine

47.4

1.8

3.5

Medical Genetics

48.2

1.7

3.4

Radiation Oncology

50.0

1.9

3.4

Pathology

51.4

1.8

3.3

Ophthalmology

51.8

1.6

3.3

Radiology

51.8

1.7

3.5

PM&R

54.2

1.6

3.4

Psychiatry

55.7

1.5

3.3

Emergency Medicine

56.6

1.6

3.3

Transitional Year

60.5

1.3

3.1

Colon and Rectal Surgery

61.3

1.4

3.3

Anesthesiology

61.5

1.6

3.4

Family Medicine

62.8

1.3

3.1

Internal Medicine

63.7

1.2

3.4

Pediatrics

64.2

1.3

3.4

Neurology

64.6

1.3

3.4

Urology

66.0

1.3

3.4

Otolaryngology

67.7

1.2

3.1

Orthopaedic Surgery

69.6

1.3

3.1

Obstetrics and Gynecology

70.8

1.3

3.2

Plastic Surgery

71.2

1.2

3.0

Vascular Surgery

72.0

1.2

3.1

Thoracic Surgery

73.0

1.1

3.2

General Surgery

75.1

1.1

3.1

Neurological Surgery

75.6

1.2

3.1

 

 

FREIDA: Also a Great Resource to Compare Specialties

FREIDA Online is a fantastic resource for any medical student. I recently wrote about how students can compare individual residency programs using FREIDA's various different variables.  The database is not limited to comparing individual training programs; it also allows students to compare different specialties.  

The "Specialty Training Statistics" section provides basic statistics about training in each specialty. Variables presented for each specialty include:

  1. Number of residency programs in the US
  2. Length of training programs
  3. Average number of interviews performed by each residency program
  4. Total number of residents
  5. Gender Gap for each specialty
  6. Average number of faculty per resident
  7. Average number of work hours per week for each specialty
  8. Average number of days off per week  (THESE LAST TWO ARE VERY IMPORTANT!  COMPARE SPECIALTIES!)

LINK HERE

 

The "Graduate Career Plans" section of FREIDA provides information about the careers plans of each of the medical specialties.  Variables presented for each specialty include:

  1. Percentage of residency graduates pursuing further training
  2. Percentage of last year's graduates who are in private practice
  3. Percentage of last year's graduates who are employed in academic settings
  4. Percentage in the military
  5. Percentage employed as basic scientists
  6. Percentage who are unemployed

In each case, the statistics are taken from the most recent graduating class and the database is updated each year. 

LINK HERE

 

Read these data carefully.  I found that the "Hours Per Week" section was very useful and very realistic!

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