Urology vs ENT.... Or Plastics

[British_IMG]

Medical Student here. I started medical school thinking i wanted to be a cardiac surgeon after doing a year of research in cardiology prior to medschool. Unfortunately, after watching 20 odd CABG I’ve realised cardiac surgery isn’t for me, I want a speciality that is a little broader.

So as an overview I would like to be in a surgical speciality which offers:
- Diversity both in patient population and procedures
- A medical and diagnostic element
- Reconstructive in nature
- A bonus would be complex pathophysiology

I considered ortho and went to see a few surgeries but I felt although there is nice diversity, there is a lack of diagnostic medicine and a lot of the surgeries are somewhat crude (Other than hand which i loved).

A couple of friend suggested i look into urology and ENT.

I first went to see an ENT surgeon and watched a few surgeries. The surgeries seem very complex, especially head and neck, as well as skull base which i found extremely interesting. However, I was drawn more to the reconstruction element following removal of the cancers.

In terms of urology, I enjoyed the andrology aspect of endocrinology and really enjoyed the complexity of renal physiology. Unfortunately, I haven’t had the opportunity to see any surgeries as of yet, due to the current climate of the medical world with covid. However, I have been doing a lot of reading around the speciality and it seems to tick most boxes. Once again, in terms of surgery, the reconstructive element within paediatrics, phalloplasty and gender confirmation interested me the most.

Knowing I enjoyed reconstructive urology and the craniofacial reconstruction aspect of ent should I give up on the “medical” aspect of a surgical speciality and aim for plastics?

If there is any Urologists, ENT, Plastic surgeons or anyone other surgeons who feel their speciality may appeal to me please give could you give me an insight into your speciality and why you chose it over the others fore-mentioned. I know there are several posts around similar topics, however I would like people opinions the differences of these specialities and the pros and cons of each.

Thanks.

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[ThoracicGuy]

Medical Student here. I started medical school thinking i wanted to be a cardiac surgeon after doing a year of research in cardiology prior to medschool. Unfortunately, after watching 20 odd CABG I’ve realised cardiac surgery isn’t for me, I want a speciality that is a little broader.

So as an overview I would like to be in a surgical speciality which offers:
- Diversity both in patient population and procedures
- A medical and diagnostic element
- Reconstructive in nature
- A bonus would be complex pathophysiology

I considered ortho and went to see a few surgeries but I felt although there is nice diversity, there is a lack of diagnostic medicine and a lot of the surgeries are somewhat crude (Other than hand which i loved).

A couple of friend suggested i look into urology and ENT.

I first went to see an ENT surgeon and watched a few surgeries. The surgeries seem very complex, especially head and neck, as well as skull base which i found extremely interesting. However, I was drawn more to the reconstruction element following removal of the cancers.

In terms of urology, I enjoyed the andrology aspect of endocrinology and really enjoyed the complexity of renal physiology. Unfortunately, I haven’t had the opportunity to see any surgeries as of yet, due to the current climate of the medical world with covid. However, I have been doing a lot of reading around the speciality and it seems to tick most boxes. Once again, in terms of surgery, the reconstructive element within paediatrics, phalloplasty and gender confirmation interested me the most.

Knowing I enjoyed reconstructive urology and the craniofacial reconstruction aspect of ent should I give up on the “medical” aspect of a surgical speciality and aim for plastics?

If there is any Urologists, ENT, Plastic surgeons or anyone other surgeons who feel their speciality may appeal to me please give could you give me an insight into your speciality and why you chose it over the others fore-mentioned. I know there are several posts around similar topics, however I would like people opinions the differences of these specialities and the pros and cons of each.

Thanks.

ReplyForward

You are not going to find that Urology or ENT is going to be giving you all that much variety much like CT Surgery. You will have you bread and butter cases that you will do most of your work with. With ENT, you're not likely to be doing complex reconstruction as a community surgeon, but definitely can as a specialist in an academic or large hospital group practice. With Urology, you'll be doing much the same kind of thing.

With Urology and ENT, you'll be doing a bunch more clinic visits compared to CT Surgery and other surgical fields.

 

[British_IMG]

Thanks for the reply ThoracicGuy. I think i would prefer to work within academics, I enjoy research and teaching. Do you have any suggestions of a surgical speciality that ticks my boxes?

 

[ThoracicGuy]

Thanks for the reply ThoracicGuy. I think i would prefer to work within academics, I enjoy research and teaching. Do you have any suggestions of a surgical speciality that ticks my boxes?

You can get some of those in most specialties.

General surgery - You can do hepatobiliary for the complex cases.
Pediatric surgery - Wide variety of cases, though just with kids. Mostly academic jobs.
Urology - Clinic/surgery mix. Can have complex cases.
ENT - Clinic/surgery mix. Can have complex cases.
CT Surgery - Can have some complex cardiac cases, particularly minimally invasive techniques.
Plastics - Can treat kids and adults in many cases, though it seems most surgeons tend to skew one way or another.
Vascular - Variety of cases, generally the same demographic. Can be complex.

I'm not sure there's one that absolutely matches everything in general, but you can find a subspecialist type of job in most any field that probably matches most. The biggest question is going to be matching. I'm assuming you are wanting to come to the US for training. Are you a UK national that is at a medical school geared towards UK students or are you a US/Canadian national at a European school? That can have a difference on matching potentials. Sometimes, you may just not be competitive for some fields which can help narrow it down. The good thing about general surgery is that it still gives you a path to plastics and CT surgery along with other fields as well.

 

[British_IMG]

You can get some of those in most specialties.

General surgery - You can do hepatobiliary for the complex cases.
Pediatric surgery - Wide variety of cases, though just with kids. Mostly academic jobs.
Urology - Clinic/surgery mix. Can have complex cases.
ENT - Clinic/surgery mix. Can have complex cases.
CT Surgery - Can have some complex cardiac cases, particularly minimally invasive techniques.
Plastics - Can treat kids and adults in many cases, though it seems most surgeons tend to skew one way or another.
Vascular - Variety of cases, generally the same demographic. Can be complex.

I'm not sure there's one that absolutely matches everything in general, but you can find a subspecialist type of job in most any field that probably matches most. The biggest question is going to be matching. I'm assuming you are wanting to come to the US for training. Are you a UK national that is at a medical school geared towards UK students or are you a US/Canadian national at a European school? That can have a difference on matching potentials. Sometimes, you may just not be competitive for some fields which can help narrow it down. The good thing about general surgery is that it still gives you a path to plastics and CT surgery along with other fields as well.

Yes, Im a UK student, I have a masters from King's College London and am now at a well known Scottish medical School. I have some contacts in the US already. With that said I aim to complete a research fellowship before even considering applying. I know the outcome of my Step scores will dictate whether it is feasable to apply to some of the subspecialities. I'm happy taking extra years reapplying and continuing research or returning to the UK as our training pathway is minimum 10 years post graduate training in comparison to US which tends to be 3-5 years shorter

 

[ThoracicGuy]

Yes, Im a UK student, I have a masters from King's College London and am now at a well known Scottish medical School. I have some contacts in the US already. With that said I aim to complete a research fellowship before even considering applying. I know the outcome of my Step scores will dictate whether it is feasable to apply to some of the subspecialities. I'm happy taking extra years reapplying and continuing research or returning to the UK as our training pathway is minimum 10 years post graduate training in comparison to US which tends to be 3-5 years shorter

Matching as an FMG can be difficult for certain programs, though having top level Step scores can go a long way to helping with that. Certainly do your best to get those scores to help open more doors. Research is useful, but if there is any way to have a rotation in the US as a student, getting that experience and letter would really help as well.

 

[British_IMG]

Matching as an FMG can be difficult for certain programs, though having top level Step scores can go a long way to helping with that. Certainly do your best to get those scores to help open more doors. Research is useful, but if there is any way to have a rotation in the US as a student, getting that experience and letter would really help as well.

We're allowed one away rotation in our final year so I hope to get some US clinical experience at that point in time. It is hard to know whether to attempt to gain US clinical experience in a particular subspeciality or general surgery, as well as doing research in a particular area say reconstructive urology or craniofacial surgery or keep it more general. To date my research is cardiology based and I have a paper on the history of Gender affirming surgery that is yet to be published.

I do have some contacts at UCSF benioff and when I have done observeships there before they are very friendly and encouraging, the first surgery i ever witnessed was a Norwood which pulled me into cardiac originally. However, within the rules I am not allowed to complete clinical experience there, only research and observeships.

 

[ThoracicGuy]

We're allowed one away rotation in our final year so I hope to get some US clinical experience at that point in time. It is hard to know whether to attempt to gain US clinical experience in a particular subspeciality or general surgery, as well as doing research in a particular area say reconstructive urology or craniofacial surgery or keep it more general. To date my research is cardiology based and I have a paper on the history of Gender affirming surgery that is yet to be published.

I do have some contacts at UCSF benioff and when I have done observeships there before they are very friendly and encouraging, the first surgery i ever witnessed was a Norwood which pulled me into cardiac originally. However, within the rules I am not allowed to complete clinical experience there, only research and observeships.

It would be better if you can find a place that allows clinical experience as well. It may take contacting a bunch of places, but there has to be something out there. As for what rotation to do, you would really need to get your Step 1 and ideally Step 2 scores done first to be able to tailor towards the best rotation. If you are wanting Urology or ENT and are competitive, then you would need to do one of those rotations. You really want to get some letters from US based physicians for your application. General Surgery is probably a better option than Cardiac or Vascular I6 programs.

 

[British_IMG]

It would be better if you can find a place that allows clinical experience as well. It may take contacting a bunch of places, but there has to be something out there. As for what rotation to do, you would really need to get your Step 1 and ideally Step 2 scores done first to be able to tailor towards the best rotation. If you are wanting Urology or ENT and are competitive, then you would need to do one of those rotations. You really want to get some letters from US based physicians for your application. General Surgery is probably a better option than Cardiac or Vascular I6 programs.

Thank you for all of this advice. Out of interest what made you choose thoracic surgery and did you ever consider any other speciality?

 

[ThoracicGuy]

Thank you for all of this advice. Out of interest what made you choose thoracic surgery and did you ever consider any other speciality?

I originally went in thinking about pediatric surgery. After I did two rotations, I did not want that lifestyle. I then looked at colorectal, but I wasn't really excited after I did a rotation. When I looked back at all the rotations that I did, general thoracic surgery was the one that I liked the most, so, that's what I decided to go into.

In my med school, we didn't have many of the specialty services, so I had no exposure to ENT, plastics, Urology, Vascular, or others. We basically had General Surgery and Ortho available as rotations. Might I have picked one of the other fields if I had exposure? Maybe, but I'm ok with where I am now, so it all worked out.

 

[British_IMG]

I originally went in thinking about pediatric surgery. After I did two rotations, I did not want that lifestyle. I then looked at colorectal, but I wasn't really excited after I did a rotation. When I looked back at all the rotations that I did, general thoracic surgery was the one that I liked the most, so, that's what I decided to go into.

In my med school, we didn't have many of the specialty services, so I had no exposure to ENT, plastics, Urology, Vascular, or others. We basically had General Surgery and Ortho available as rotations. Might I have picked one of the other fields if I had exposure? Maybe, but I'm ok with where I am now, so it all worked out.

Its good to hear you're happy! It's funny you mention lifestyle as I always thought thoracic was at the latter end for lifestyle in terms of surgical specialities?

 

[ThoracicGuy]

Its good to hear you're happy! It's funny you mention lifestyle as I always thought thoracic was at the latter end for lifestyle in terms of surgical specialities?

Well, with general thoracic there aren't that many emergencies, particularly at night. If I did cardiac, that's totally different. I have good hours and get to spend time with my kids.

 

[British_IMG]

Well, with general thoracic there aren't that many emergencies, particularly at night. If I did cardiac, that's totally different. I have good hours and get to spend time with my kids.

Thats good to know! Do you take general surgery call or only thoracic? What sort of surgeries do you tend to see? Is there an option to go into paediatrics or is that in the realm of the general paediatric surgeon? Lastly, is your compensation similar to cardiac, although compensation isn't a groundbreaker for me, its an added bonus.

 

[ThoracicGuy]

Thats good to know! Do you take general surgery call or only thoracic? What sort of surgeries do you tend to see? Is there an option to go into paediatrics or is that in the realm of the general paediatric surgeon? Lastly, is your compensation similar to cardiac, although compensation isn't a groundbreaker for me, its an added bonus.

I do thoracic and vascular call. I do not take any general surgery call. I see a mix of surgeries, but no cardiac surgery. Pediatrics is something I don't deal with. That would be a congenital cardiac guy or the pediatric surgeon who would do those.

As for compensation, the cardiac guys seem to have higher salaries overall, but they also have that emergency call for things like ascending aortic dissections that could lead to a 6 or 8 hour surgery at 2 am.

 

[HighPriest]

I’m an ENT. Agree that clinic plays a big role for most general ENT docs, compared to a general surgeon for example. We also will usually have fewer inpatient responsibilities. The exceptions would be mostly head and neck oncology or reconstructive surgeons at larger institutions. You’ll still do clinic of course, but surgery is proportionally a larger part of your practice compared to general ENT.
You can do reconstructive surgery as a head and neck oncologist, or through a facial plastics route. It really depends upon what you’re talking about when you say reconstructive. Presumably you want to put Humpty Dumpty back together again after someone whacked a 10cm hole out of his pharynx. But there are smaller reconstructive procedures as well, whether it’s otologic procedures to rebuild the inner ear or just functional rhinoplasty. They’re not as glamorous, or as large, but your quality of life will be better than the free flap guy.
So far as breadth of cases: most ENT docs treat pediatric to elderly patients. I personally always feel like our case types are very broad-ranging, because I feel like a sinus case is nothing like an ear case is nothing like a cancer case. But I suppose if I did a colectomy followed by a pilonidal cyst I might think otherwise.
If you specialize into something like head and neck oncology, of course, you lose some of that variability: fewer kids, and for the most part you’re doing cancer and recon.

The lifestyle for a general ENT is pretty good. For a HN oncologist, it can be pretty brutal. If you have residents, it’s a bit better of course.

I think most fields are going to have some complex and some simple pathophysiology.

 

[HighPriest]

The other benefit of smaller recon procedures:

When I rebuild an ear, more often than not the patient hears better afterwards.

When I rebuild a nose, more often than not the patient looks better and breathes better than before.

When you rebuild a mandible, you’re happy if they look more or less symmetric, and their speech is intelligible.

When you reconstruct after a total laryngectomy, you’re just happy the fistula heals and you’re hoping the patient doesn’t get suicidal.

Food for thought. But, of course, someone has to do the big stuff too. Otherwise I would have to do it.

 

[British_IMG]

The other benefit of smaller recon procedures:

When I rebuild an ear, more often than not the patient hears better afterwards.

When I rebuild a nose, more often than not the patient looks better and breathes better than before.

When you rebuild a mandible, you’re happy if they look more or less symmetric, and their speech is intelligible.

When you reconstruct after a total laryngectomy, you’re just happy the fistula heals and you’re hoping the patient doesn’t get suicidal.

Food for thought. But, of course, someone has to do the big stuff too. Otherwise I would have to do it.

HighPriest thank you for your insight. I am very much someone who want to put humpty dumpty back together again as you said ha. Whilst i am still young I think I would prefer to do the large free flap procedures, but as I get older transition to smaller surgeries and eventually as an old man clinic based procedures. This is why ENT and Urology appealed to me as well. People talk about ENT being heavily medical based by this do they mean the allergy and immunology aspect of ENT? I have a skewed image of the speciality as I have mostly seem Head and neck cases.

Thanks again.

 

[HighPriest]

HighPriest thank you for your insight. I am very much someone who want to put humpty dumpty back together again as you said ha. Whilst i am still young I think I would prefer to do the large free flap procedures, but as I get older transition to smaller surgeries and eventually as an old man clinic based procedures. This is why ENT and Urology appealed to me as well. People talk about ENT being heavily medical based by this do they mean the allergy and immunology aspect of ENT? I have a skewed image of the speciality as I have mostly seem Head and neck cases.

Thanks again.

Lots of general ENT is clinic based. Sinus patients need medical treatment or an in office procedure more often than they need surgery. Patients with vertigo almost never need surgery. Patients with hearing loss rarely need surgery. Patients with dysphagia rarely need surgery. And then, of course and as you say, allergy patients are clinic-based. Additionally, in my clinic at least, about 10% of what I see really shouldn’t have been referred to ENT anyway. (They’re having a neurological issue or TMJ or they need a GI).

How much time you spend in the OR really depends upon your practice and if you sub-specialize. So, as I mentioned, if you really go for head and neck oncology, almost everyone you see as a new patient needs surgery. This is of course because most of the referrals you’re getting are from oncologists or from other ENT docs who have hopefully made the determination that the patient not only has cancer, but that they need more than just chemo radiation. Even then, you may have clinic follow up patients for five years (patients who are disease free but not necessarily cured) or your rad-onc colleagues might do that. Or you might get patients from less-savvy local ENT docs who aren’t sure if a patient needs just chemorads (which is what most oropharyngeal cancers get nowadays instead of surgery) or if they need surgery, in which case it may be you referring to the radiation oncologist. It depends upon how your practice is structured. So, in a University system perhaps you only see patients with a diagnosis of cancer who actually need surgery or st least a biopsy, in which case you generate a case with each new patient. In a mid-sized city, you may be working for a hospital system with fewer surrounding ENT docs, and you might have to weed through cases a bit.
General ENT is similar, but with more new patients who will not generate a surgical case be default. I have ENT friends who operate 2-3 days per week, and I know some older guys who operate 1 full day every other week even though they see clinic 4 days each week. I operate usually 2 days/week, although there are slow times where I miss a day per month. The busiest I’ve been surgically was in the military, where I operated at least 2 and usually 3 days per week. But in that case it was all bread-and-butter (tubes, tonsils, etc.) and I had a PA who I had trained to recognize what needed basic surgery, what needed to see me, and what needed to go somewhere else, and she saw clinic 5 days/week. So she kept coal in the engine. And that’s something you can do as a general ENT.
Finally, keep in mind that case length means a lot. So when I do a full day or OR, that’s usually 9-12 cases and the only reason it isn’t more is turnover time. And I’m done by 3. I’m not doing three big cases and leaving at 6pm. If I have a cancer case, then I may do that in the morning and then 3 cases to follow. The guys I know who are HN trained operate 2-3 days/week and may do 2-3 big cases each day.

 

[DoctwoB]

Can only speak for the urology side here but if you’re interested in variety and reconstruction then urology is a great field. In a typical week a urologist could perform endoscopic procedures like transurethral resection of the prostate or bladder tumors or laser lithotripsy of kidney stones, relatively minor open surgery (eg hydroceles or orchiectomies), vaginal surgery (e.g slings or prolapse repair), or major open or lap/robotic abdominal and pelvic surgery; like prostatectomies, partial or radical nephrectomies, etc). All of that falls into “bread and butter” urology.

If you’re interested in recon you can further sub specialize in reconstructive or pediatric urology. Reconstructive urology can range from urethroplasty (urethral reconstruction, often with flaps or grafts), urinary tract reconstruction like bladder augmentation,more external surgery like buried penis repair/skingrafting, or gender affirming surgery. Pediatrics also involves a lot of reconstruction like with hypospadias repair, management of ambiguous genitalia, more rare reconstructive cases like bladder exstrophy or epispadias repair, and so on.

The above posters are right in that there is a big clinic component, most urologists will be split 2/2 or 3/2 or even 3/1 in clinic vs OR days. Clinic also involves a lot of procedures like prostate biopsies, cystos copies, and vasectomies. Overall it’s a great field with good post residency quality of life (for a surgical field), great cases/variety, great pay/job market, and patients that tend to do very well and appreciate our efforts.

 

[British_IMG]

Thank you, thats the most in depth analysis I've had from and EN

Lots of general ENT is clinic based. Sinus patients need medical treatment or an in office procedure more often than they need surgery. Patients with vertigo almost never need surgery. Patients with hearing loss rarely need surgery. Patients with dysphagia rarely need surgery. And then, of course and as you say, allergy patients are clinic-based. Additionally, in my clinic at least, about 10% of what I see really shouldn’t have been referred to ENT anyway. (They’re having a neurological issue or TMJ or they need a GI).

How much time you spend in the OR really depends upon your practice and if you sub-specialize. So, as I mentioned, if you really go for head and neck oncology, almost everyone you see as a new patient needs surgery. This is of course because most of the referrals you’re getting are from oncologists or from other ENT docs who have hopefully made the determination that the patient not only has cancer, but that they need more than just chemo radiation. Even then, you may have clinic follow up patients for five years (patients who are disease free but not necessarily cured) or your rad-onc colleagues might do that. Or you might get patients from less-savvy local ENT docs who aren’t sure if a patient needs just chemorads (which is what most oropharyngeal cancers get nowadays instead of surgery) or if they need surgery, in which case it may be you referring to the radiation oncologist. It depends upon how your practice is structured. So, in a University system perhaps you only see patients with a diagnosis of cancer who actually need surgery or st least a biopsy, in which case you generate a case with each new patient. In a mid-sized city, you may be working for a hospital system with fewer surrounding ENT docs, and you might have to weed through cases a bit.
General ENT is similar, but with more new patients who will not generate a surgical case be default. I have ENT friends who operate 2-3 days per week, and I know some older guys who operate 1 full day every other week even though they see clinic 4 days each week. I operate usually 2 days/week, although there are slow times where I miss a day per month. The busiest I’ve been surgically was in the military, where I operated at least 2 and usually 3 days per week. But in that case it was all bread-and-butter (tubes, tonsils, etc.) and I had a PA who I had trained to recognize what needed basic surgery, what needed to see me, and what needed to go somewhere else, and she saw clinic 5 days/week. So she kept coal in the engine. And that’s something you can do as a general ENT.
Finally, keep in mind that case length means a lot. So when I do a full day or OR, that’s usually 9-12 cases and the only reason it isn’t more is turnover time. And I’m done by 3. I’m not doing three big cases and leaving at 6pm. If I have a cancer case, then I may do that in the morning and then 3 cases to follow. The guys I know who are HN trained operate 2-3 days/week and may do 2-3 big cases each day.

Thank you, thats the most in depth analysis I've had from and ENT surgeon so far including consultants i have been in the OR with.

 

[British_IMG]

Can only speak for the urology side here but if you’re interested in variety and reconstruction then urology is a great field. In a typical week a urologist could perform endoscopic procedures like transurethral resection of the prostate or bladder tumors or laser lithotripsy of kidney stones, relatively minor open surgery (eg hydroceles or orchiectomies), vaginal surgery (e.g slings or prolapse repair), or major open or lap/robotic abdominal and pelvic surgery; like prostatectomies, partial or radical nephrectomies, etc). All of that falls into “bread and butter” urology.

If you’re interested in recon you can further sub specialize in reconstructive or pediatric urology. Reconstructive urology can range from urethroplasty (urethral reconstruction, often with flaps or grafts), urinary tract reconstruction like bladder augmentation,more external surgery like buried penis repair/skingrafting, or gender affirming surgery. Pediatrics also involves a lot of reconstruction like with hypospadias repair, management of ambiguous genitalia, more rare reconstructive cases like bladder exstrophy or epispadias repair, and so on.

The above posters are right in that there is a big clinic component, most urologists will be split 2/2 or 3/2 or even 3/1 in clinic vs OR days. Clinic also involves a lot of procedures like prostate biopsies, cystos copies, and vasectomies. Overall it’s a great field with good post residency quality of life (for a surgical field), great cases/variety, great pay/job market, and patients that tend to do very well and appreciate our efforts.

Thank you for your reply! The bread and butter that you described sounds interesting! In terms of academics, will an individual focus on one area or is there a lot of cross over, for example could a paediatric urologist also do reconstructive work and reproduction clinics within the adult population or do you find Urologist focus on either adult or paeds as Thoracic Guy mentioned plastics do. In terms of IMGs gaining a residency position in the US, is it highly unlikely or with research and good-->strong academics is it possible?

 

[DoctwoB]

Typically in academics one will be fellowship trained and focus on one area, like pediatrics, adult reconstruction, oncology, stones, etc though may still cover some of the other areas when on call or to fill out their practice. There is the emerging field of transitional urology, which involves managing pediatric problems in patients as they age, eg post hypospadias repair strictures, adult spina bifida patients who need or have had bladder reconstruction, etc but it’s still pretty niche. A nice thing about urology though is that outside of academia fellowships are definitely not necessary and one can still have a very broad scope of practice.

For IMGs, urology is definitely tough to match in, though I expect a British IMG would be in better shape then most. It is a separate match so hard to compare directly but probably similarly competitive to the other surgical subspecialties like ENT, plastics, etc. Having connections will be key as an IMG, whether that means doing research with a UK urologist who is well known in the US or (even better) doing a research year/away rotation in the US to get some faculty behind your application.

 

[British_IMG]

Typically in academics one will be fellowship trained and focus on one area, like pediatrics, adult reconstruction, oncology, stones, etc though may still cover some of the other areas when on call or to fill out their practice. There is the emerging field of transitional urology, which involves managing pediatric problems in patients as they age, eg post hypospadias repair strictures, adult spina bifida patients who need or have had bladder reconstruction, etc but it’s still pretty niche. A nice thing about urology though is that outside of academia fellowships are definitely not necessary and one can still have a very broad scope of practice.

For IMGs, urology is definitely tough to match in, though I expect a British IMG would be in better shape then most. It is a separate match so hard to compare directly but probably similarly competitive to the other surgical subspecialties like ENT, plastics, etc. Having connections will be key as an IMG, whether that means doing research with a UK urologist who is well known in the US or (even better) doing a research year/away rotation in the US to get some faculty behind your application.

Im hoping to get some research with Professor James N'Dow who is affiliated with my university once the situation with Covid-19 begins to calm down. Im also trying to get into contact Mr Dan Wood and hopefully get some exposure to gender affirming surgery. Unfortunately Mr Wood is based in London, a fair way from Scotland. I was also considering doing a research fellowship between my 4th and 5th year (medicine is a 5 year program in the UK), do you recommend any institutions? I know the University of Utah has a good reconstructive department and have already spoke to them. Ive contacted University of Colorado, Denver but they do not accept IMGs at the present moment in time.

 

[deleted547339]

Medical Student here. I started medical school thinking i wanted to be a cardiac surgeon after doing a year of research in cardiology prior to medschool. Unfortunately, after watching 20 odd CABG I’ve realised cardiac surgery isn’t for me, I want a speciality that is a little broader.

So as an overview I would like to be in a surgical speciality which offers:
- Diversity both in patient population and procedures
- A medical and diagnostic element
- Reconstructive in nature
- A bonus would be complex pathophysiology

I considered ortho and went to see a few surgeries but I felt although there is nice diversity, there is a lack of diagnostic medicine and a lot of the surgeries are somewhat crude (Other than hand which i loved).

A couple of friend suggested i look into urology and ENT.

I first went to see an ENT surgeon and watched a few surgeries. The surgeries seem very complex, especially head and neck, as well as skull base which i found extremely interesting. However, I was drawn more to the reconstruction element following removal of the cancers.

In terms of urology, I enjoyed the andrology aspect of endocrinology and really enjoyed the complexity of renal physiology. Unfortunately, I haven’t had the opportunity to see any surgeries as of yet, due to the current climate of the medical world with covid. However, I have been doing a lot of reading around the speciality and it seems to tick most boxes. Once again, in terms of surgery, the reconstructive element within paediatrics, phalloplasty and gender confirmation interested me the most.

Knowing I enjoyed reconstructive urology and the craniofacial reconstruction aspect of ent should I give up on the “medical” aspect of a surgical speciality and aim for plastics?

If there is any Urologists, ENT, Plastic surgeons or anyone other surgeons who feel their speciality may appeal to me please give could you give me an insight into your speciality and why you chose it over the others fore-mentioned. I know there are several posts around similar topics, however I would like people opinions the differences of these specialities and the pros and cons of each.

Thanks.

ReplyForward

Let me start by saying that I’m not a surgeon. But what you’ve come to realize is a bit ahead of where most of your peers are. There was a thread on here recently discussing medicine as a job vs a calling. I can’t speak to the inteacices or surgery, but I can tell you that what I’ve learned as an attending is that my job is not often “challenging.” I think most specialties are the same way - they seem complex and interesting, but are fairly rote once you’ve achieved mastery. I don’t want my surgeon getting creative when they take out my appendix, I want someone to put in a couple ports, pull out my appendix and sew me up. I want that to be boring.

 

[Flodaddy]

One of the reasons a lot of us go into uro is how much variety there is. It’s one of the most varied fields in practice without even needing to do fellowship

British_IMG none of those fields would be a bad choice. They would check all your boxes. Uro doesn’t deal much with complex renal physiology though; that is nephrology. Uro recon is an interesting field and the increasing use of the robot in recon and uro involvement in gender affirmation surgery is exciting.

Decide based on how likely you are to match as an IMG, the anatomy, and types of surgeries/surgical techniques.

 

[Dr.JMoon]

Hey @HighPriest looking back now would you say you are happy you chose ent? What other specialties did you consider? I am interested in a specialty that blends medicine and surgery, I know ENT checks this box but I was wondering how diverse and complex would you say ENT cases are? Are you happy with the ENT lifestyle and pay/job market? Thanks a lot, your posts have given me a better understanding of ENT.

 

[HighPriest]

Hey @HighPriest looking back now would you say you are happy you chose ent? What other specialties did you consider? I am interested in a specialty that blends medicine and surgery, I know ENT checks this box but I was wondering how diverse and complex would you say ENT cases are? Are you happy with the ENT lifestyle and pay/job market? Thanks a lot, your posts have given me a better understanding of ENT.

I’m very happy with ENT. I went through a spectrum of choices before ENT like most med students. I thought about EM, Ortho, Gen Surg. I think ENT is very diverse. Otology blends a lot of very detailed microsurgery as well as a good deal of neurology, oncology for the head and neck is pretty variable from thyroid to throat cancer to salivary cancers and skin cancers, none of which are treated in the same way. We do facial cosmetics. Reconstructive surgery of the face and skull. Reconstructive surgery of the facial bones. Rhinology and allergy blends a lot of immunology along with sinus surgery, which is fairly anatomically driven and where technique is very important. And as I mentioned, treating kids to adults, congenital neck masses to vertigo and cancer. It’s pretty broad ranged. And yet the patient population is as complicated as you want it to be. If you want lots of inpatients, do head and neck. If you don’t, that’s ok too. I rarely have to go round. Lifestyle is good. Call sucks, but only because being on call sucks no matter what. nowhere near as bad as my general surgery colleagues. I probably have to go in less than once/month, and I don’t even get called every night. If I worked at a trauma center, I’d be busier on call.
Pay is very reasonable, especially considering the level of risk, the amount of work, and the lifestyle. No complaints there. Job market is great - far too few ENT docs out there.

 

[The wise one]

lol, this sounded like an interview.

 

[cpants]

Urologist here. Great field that would tick most of your boxes. Most urologists do a lot of endoscopic surgery, so make sure that is something you would like.

I will caution you that it is very difficult to match urology as an IMG. Only 32% of IMG applicants matched last year, and that is a very self-selected group (ie. they probably all had strong applications to even consider applying). AUA Match data can be found here.

Sounds like you are most interested in the reconstruction aspect of things. The path of least resistance for you might be trying to get a good general surgery spot and then working toward a plastics fellowship. It would be easier to get a GS residency spot, and you could still end up focusing on reconstruction or even gender-affirming surgery.

 

[British_IMG]

Urologist here. Great field that would tick most of your boxes. Most urologists do a lot of endoscopic surgery, so make sure that is something you would like.

I will caution you that it is very difficult to match urology as an IMG. Only 32% of IMG applicants matched last year, and that is a very self-selected group (ie. they probably all had strong applications to even consider applying). AUA Match data can be found here.

Sounds like you are most interested in the reconstruction aspect of things. The path of least resistance for you might be trying to get a good general surgery spot and then working toward a plastics fellowship. It would be easier to get a GS residency spot, and you could still end up focusing on reconstruction or even gender-affirming surgery.

Thank you, I know it's going to an uphill battle to match. By the sounds of things it looks like i will have to wait and see what my step scores are and then decide from there, would you agree?

 

[cpants]

Thank you, I know it's going to an uphill battle to match. By the sounds of things it looks like i will have to wait and see what my step scores are and then decide from there, would you agree?

Yes. Without outstanding step 1 score and great research, it's probably a no go.

 

[British_IMG]

Yes. Without outstanding step 1 score and great research, it's probably a no go.

Better get back to anki then haha

 

[akwho]

An ENT once told me to chose your surgical specialty, based on what you think the least gross bodily fluid to work with is. I didn't take his advice, but I did think it was a funny tiebreaker.

Urology - urine/semen
ENT - phlegm/cerumen
PRS - pus/burns

 

[TraumaLlamaMD]

An ENT once told me to chose your surgical specialty, based on what you think the least gross bodily fluid to work with is. I didn't take his advice, but I did think it was a funny tiebreaker.

Urology - urine/semen
ENT - phlegm/cerumen
PRS - pus/burns

I had a friend come into Med school dead set on ENT. One day into his rotation he already knew he hated it because he couldn’t stand all the secretions! He’s now happy as a cardiologist.

 

[VisionaryTics]

An ENT once told me to chose your surgical specialty, based on what you think the least gross bodily fluid to work with is. I didn't take his advice, but I did think it was a funny tiebreaker.

Urology - urine/semen
ENT - phlegm/cerumen
PRS - pus/burns

I really, really hated stool and urine. Guess that's why I ended up as a snot sucker.

 

[Jenghiz_Khaan]

Plastics hands down. Most interesting cases and not NEARLY as nasty as the other two.

 

[DoctwoB]

An ENT once told me to chose your surgical specialty, based on what you think the least gross bodily fluid to work with is. I didn't take his advice, but I did think it was a funny tiebreaker.

Urology - urine/semen
ENT - phlegm/cerumen
PRS - pus/burns

As a urologist you won’t actually work with semen, except aspirating it with a needle in infertility work for seeing some secretions on the screen on a TURP or if you get into the seminal vesicles on a prostatectomy.

Urine on the other hand Is a different story.

 

[HighPriest]

As a urologist you won’t actually work with semen, except aspirating it with a needle in infertility work for seeing some secretions on the screen on a TURP or if you get into the seminal vesicles on a prostatectomy.

Urine on the other hand Is a different story.

Pfft. If my copay is $50, I expect a -little- semen during my visit.

 

[LucidSplash]

Pfft. If my copay is $50, I expect a -little- semen during my visit.

I paid a $50 copay today and all I got was a bandaid from having a mole shaved off. I’ll tell my dermatologist to step up her game.

 

[DoctwoB]

Pfft. If my copay is $50, I expect a -little- semen during my visit.

There was a patient on my clinic schedule with the chief complaint “needs prostate massage”. I’m pretty sure that’s not covered in a level 3 new patient visit.

 

[HighPriest]

There was a patient on my clinic schedule with the chief complaint “needs prostate massage”. I’m pretty sure that’s not covered in a level 3 new patient visit.

I mean, not by Medicare. Unless you have a supplemental.

When you do that, do the CPTs change depending upon how many fingers you use?

 

[DoctwoB]

I mean, not by Medicare. Unless you have a supplemental.

When you do that, do the CPTs change depending upon how many fingers you use?

Anything over two Is a 55700

 

[Dr G Oogle]

If you like putting things together again, one field that hasn’t been mentioned is female recon which you can do through urology or gyn and can practice this exclusively in either private practice. Obviously the downside to doing it through OBGyn is all the downsides of doing OBGyn made worse by the fact that you only want to do recon but it is a very satisfying job and OBG is easier to match than urology. I did it through gyn but busy doing this. It’s a field completely rooted in restoring normal function and is experiencing a huge growth spurt due to increasing demand, aging population and a skill set that’s becoming increasingly limited to fellowship trained people, especially for complex pelvic organ prolapse.