why otolaryngology?
Rahul Shah MDIf I was to create the ideal medical specialty it would be as such: a diverse patient population, varying degrees of pathology, anatomical and intellectually challenging, the ability to medically and surgically ameliorate diseases, well respected and having the potential for growth. Fortunately for me, I did not have to create this field as it already exists. Otolaryngology – Head and Neck Surgery is the best specialty in medicine. Obviously, I am a biased as I am finishing my post-graduate year four in the Otolaryngology – Head and Neck Surgery residency program here at Tufts – New England Medical Center. Though I guarantee if you ask any of the other approximately 7500 practicing Otolaryngologists around the country, they would strongly concur about the virtues of our specialty.
Many of my co-residents often joke that I knew I wanted to be an Otolaryngologist
as a kindergartner. Little do they know that this cannot be further from
the truth - I knew in the 6th grade that this was my dream. Actually it
was in medical school, after an exhaustive search for a career that would
encompass all that I wanted from medicine that I came to realize that Otolaryngology
was for me. Many medical students have had interesting paths to medical
school. Mine was boring. I was in the seven-year medical program at Boston
University. I really enjoyed the program and the ability that we were provided
to develop independent outside interests. My outside interest (my wife calls
it an obsession) is research. I have been active in research since I was
an undergraduate, first working in the Otolaryngology Research Center at
this medical school in the Ziskind building. The exposure to the field at
an early, formative stage in my career allowed me to see the diversity of
the specialty. But I reserved my commitment to the field until the end of
third year, when I was certain that Otolaryngology had all the attributes
that I was looking for in a career.
An Otolaryngologist takes care of the medical and surgical diseases of the
head and neck. This includes myriad diseases ranging from airway reconstruction
in neonates to major extirpative and reconstructive surgery of head and
neck neoplasms. In addition to the surgical amelioration of disease, Otolaryngologists
spend a great deal of their practice in an out-patient setting, managing
medical problems such as sinusitis, the professional voice, hearing disorders,
etc.
The vast opportunities available to Otolaryngologists becomes clear when
you examine the fellowships offered in our specialty. Fellowships are one
to two years of training that residents embark upon after finishing residency.
A fellowship enables a physician to gain further experience and proficiency
in a sub-specialty, also potentially facilitating the development of an
academic career. In Otolaryngology, fellowship opportunities include: head
and neck cancer, microvascular reconstruction, facial plastics, neurotology,
pediatric otolaryngology, allergy, rhinology, and laryngology. Of the over
7500 Otolaryngologists in practice, almost 85% are in private practice,
the remainder in academic settings.
Another aspect of the field, which probably will only interest a small part
of you, is the vast amount of research opportunities available. As our field
is very diverse, there is a great deal of variety in research that goes
on with regards to bench, translational, and clinical work. Some basic science
researchers are examining the molecular basis of head and neck cancer with
hopes of developing immunotherapy regimens, while others assess the ability
of the inner ear hair cells to regenerate (reversing deafness). Translational
research projects involve creating more sophisticated cochlear implants
to increase speech discrimination in implant users or the development of
biomaterials to implant in the larynx for restoration and preservation of
the professional voice. Finally, some clinical research projects exam the
outcomes of children that have had tubes placed and the quality of life
impact of patients that have had surgery for the treatment of their sleep
apnea.
As you are still in medical school, the furthest thing from your mind is
your professional career (after training). Otolaryngology remains a very
physician friendly specialty. In addition to the various fellowships available,
there are a great amount of job opportunities available in academic and
private practice settings. It is really true that most graduating residents
can choose where and what type of practice setting they wish to practice.
In early March I was fortunate to be awarded a grant from the American Academy
of Otolaryngology - Head and Neck Surgery to attend Washington Advocacy
Week. Over 250 Otolaryngologists from around the country "went to Washington"
to lobby Congress about issues pertinent to our specialty and scope of practice.
I mention this trip as it epitomizes the dedication of our specialty towards
the next generation of Otolaryngologists. The Academy is supportive of and
enables resident educational opportunities – from advocacy issues
to an extensive research grant program.
A career in Otolaryngology is exciting and limitless. Unfortunately, medical
school curriculums do not provide many opportunities for students to be
exposed to this field. There are many avenues for students to understand
precisely what we do and why we love our jobs. Students can speak with the
Department Chair, Dr. Elie E. Rebeiz (6-1664), and schedule a one to four
week rotation on the Otolaryngology service. Students can also use the internet
to read some more about our field. Some excellent sites are www.entnet.org
(our Academy's official website), www.sfmatch.org (the official match site
for Otolaryngology residency applicants), and www.laryngoscope.com (an excellent
journal that provides a broad exposure to our specialty). The last way that
I encourage you to learn about our field is to simply page one of the residents
on service and chat with one of us.
Finally, good luck with your class work and scheduling issues. The end of
the academic year is always an exciting and somewhat intimidating time of
year. The fourth years will be leaving to start intern year (one of the
best years of my professional life - seriously), the third years will soon
be enjoying the last year of medical school, the second years are nervously
awaiting ward rotations and the first years cannot wait to enjoy their summer.
Best wishes to you all and after working with many of you on service, I
know that TUSM does an excellent job of preparing students for the practice
of medicine.