Otolaryngologist Ear Nose and Throat Doctor, Otorhinolaryngologist, and ENTs - The Similarities and Differences

Otolaryngologists, ENT's, Rhinologists, Otologists, and Ear Nose and Throat Doctors

Otolaryngology also known as ENT, Ear Nose and Throat doctors, and Head and Neck Surgeons, focus on medical and surgical disorders of the ears, nose, throat and basically anything above the clavicles except eyes and brain. This medical specialty gives a really nice mix of clinical medicine in the office and surgical procedures. The majority of an ENT's day focuses on kind of more common things such as a lot of kids with ear issues on a simple stuff like that, might require your tubes and tonsil issues and snoring, and things like that. Many adults get seen for issues that include chronic sore throats, a lot of which end up being acid reflux, a lot of allergy and sinus disorders, ear problems and then other generalized issues in the head and neck. A lot of the surgical portion focuses on a really broad stretch of things, so an average surgery day might include fixing a hole in somebody's ear drum and then maybe moving on to a sinus operation and then moving on and taking out a thyroid gland.

So being an Otolaryngologist is very very diverse and there are some crossovers between ENT and other specialties. For instance, endocrine surgery, a general surgeon, might take out thyroids and other glands, but as a head and neck surgeon will take out thyroid and other glands in this region of the body.

https://www.umhs-sk.org/blog/otolaryngologists-ents-rhinologists-and-otologists

Now, what time you usually come into, what time do you usually leave, and what kind of does that vary from day to day? Yes, absolutely um, one of the nice things about the environment that I work in is the organization allows us to be very flexible about our schedules. It actually encourages us to have kind of alternative hours like earlier hours or later hours to accommodate people with with jobs.

So usually, I come in anywhere between 7 & 8, depending on the day and I'm almost always home by 4:00 or 5:00, depending on what happens during the day and that's a lot of my design and my choice. If I wanted to, I could certainly work 6:00 to 6:00 every day and probably more than that, but I find it very healthy to kind of strike a work-life balance and it's 8 to 5 7 to 4. Something of that nature.

There are long articles where I have a lot of surgeries and I won't get home until 6 or 7, and sometimes I get lucky and I take a short day like today, I'm leaving in two. Would you say that unity is very conducive to work-life balance and also maybe scheduling flexibility so that you could do like administrative work or mentoring or other things like that? You know what there's I know: there's a lot of stereotypes around certain specialties having more of a work-life balance and not, and I think a lot of that relies on the person and also the work environment.

So, if you want to in any specialty, you can run yourself into the ground, you can spend all day everyday at a hospital or in an office, and you know really really go go for it. I think that EMT is a specialty that allows you to strike a better work/life balance, but also where I work allows us to strike a better work-life balance, because we know that it's very important to be healthy as a physician in order to provide better care for Your patients, so yeah EMTs classically one of those things where you can say yeah.

I have a pretty good work-life balance, so it seems like most specialties are moving towards like bigger groups, and things like that. I'r not sure if this is part of a bigger group, and we just say that bigger groups allow you to do that more or like, if you're being a feel like an independent. I don't share their independent soul. Oh yeah, um again. That really depends so I trained in Philadelphia and almost everybody I worked with was private practice or kind of loosely affiliated with an academic center, and then we had one larger group that was like absorbed and just integral with the University and the way that they ran Their lives was just completely different and out here in Northern California.

This is like this is the land of large health systems. There are several big-name large health systems in the Sacramento area and there's very few honest-to-god independent physicians left that have you know, hung up a shingle and are running their own practice. So, even if somebody has their own practice, oftentimes they're sort of contracted on the back with one of the larger systems to provide like EHR, support or billing support, or something like that to help reduce their overhead and that's just the practice climate in Northern California.

So out here there are very few ents that are independent and those that are I'm sure, they're doing fine, but there's mainly large groups and one very large private group. But they have, you know a lot of collective bargaining power because they've been here forever and it's a large ent group. I have a friend that works in rural Oklahoma and he and I trained together and he went right back home and you know, put his name up on the wall and bought an office and open to practice.

And he is completely thriving. But he's the only game. In town it works really well for him there in that environment, so it really depends on where you're going to go, but you're right in general, there has been a trend over the last, probably 15 years or so a lot of specialties kind of consolidating into a Larger health system - and you see that with primary care, what's the most challenging and rewarding aspects of ent, there are always those patients in those cases that can be very challenging either from a diagnostic standpoint like what is going on here, challenging procedures, surgeries.

What you know, there's always always technical challenges there, and sometimes it's challenging to deal with its strong personality of a patient where you think that there's something going on and there's having a little bit of difficulty like getting people on the same page. So I'd say that probably working on very challenging diagnostic things. This isn't it most because it really keeps your mind pushed us to like you, can't get complacent and you know doing the same things all day because you go, you might be working through your whole day and say the same things ten times and see the certain Things that is very common and then out of the blue and get something really weird, and you just have to stop and go give you just one second sort of dig back to first year of medical school and think about that thing that you think you heard Of that, you can't quite remember, and maybe step out and jump on up-to-date for a second.

What is that or reach out to a colleague or talk to somebody to figure out what Mac you're doing and then bring it all back together to try and help that person and the most rewarding on this Lee's comes from patients? You know when somebody comes back and they feel better and they're doing better and they look better and they say thank you. It's really nice to hear - and it's really nice to see and it sort of helps me kind of tuck that aside, so that if I do have a really challenging patient, I'm like you know what overall we're doing great going to do the best for every patient.

But it's nice to be able to actually help people and see improvement in change and what other certain personality types that do best in ent. Oh gosh, I'm true somebody's done. Research on this I'm sure, there's a myers-briggs that fits the best, but my experience with it always been that ents in general are usually pretty laid-back and are usually pretty nice. There's always exceptions to that, and training on the East Coast was I'm from the West Coast.

Like that's, why I'm back here I was like get me out of here as soon as I was done with training, but you know: there's a northeast mentality, that's a little bit more sort of like angry in a certain way. No, I love my East Coast friends, but uh by and large EMTs, usually one of the more relaxed specialties are usually super easy to deal with. You know pretty happy to handle almost anything in our in our wheelhouse so and my partner's here really chill super relaxed.

Like it's a good environment to work in okay and since NT 8 seems to be a pretty competitive specialty. What tips would you give medical students to match into? Well, unity is a is it a subspecialty of the general surgery or no it's a it's a lavinia. Okay, how would you recommend we match it to that or do things to mention to that? So, let's see I graduated from medical school in 2009. That's 2018! Now so my residency was 2010 to 14, so you're getting old advice, but I know when I was going through and I'm even in residency when I was interviewing students and things like that.

Boards go through very important: hey, that's a total cliche, but it was one of the specialties where board scores are very important to kind of get your application to the top of the pile. But, above and beyond that, as both an interviewer while I was in residency and a previous interviewee, I think personality has a lot to do with it. Do you want somebody who is intelligent? Obviously I mean its medical school.

You've got intelligence to some degree, but you know somebody who knows their stuff and that's always very important. Somebody was interested in the field, there's actually a ton of ENT history. That's fascinating and most ents would be happy to sit down and probably walk you through some esoteric story about some doctor. They knew whose name is on some device or whatever, because there's all kinds of stuff like that.

But I think you end up becoming really interested and passionate about the specialty, because it's so unique amongst medicine and so focus so definitely a drive in an interest. Most programs want to see a lot of research in T research. You know general research is fine, but most want to see some interests in the UT research and then, as with many things, many academic programs want to see somebody that wants to be academic.

Whether or not that's a reality or not, but to get personality is important. I know when we were interviewing residents for our program. We look at somebody and go. Can I work with this person? You know when you've got 20 people that look great on paper and somebody rotates. Third, you think I could work with that person that person this one, maybe not for us - that's really important. I know ent had done fill the spots I think clutter so you're going to hear before for one of the first time.

So the Academy is like a lineup for like let me make it too competitive, so there's there's actually like articles published in our journals about like what are we going to do about that? You know that might be a good time, so I noticed you're an osteopathic physician. I was wondering since ent is so competitive. Do you find it more challenging, or do you think it's more challenging coming from the osteopathic side and also kind of a related term, you use like OMM with your patients? Personally, I don't.

I do have a couple of friends who are nemt that do and I think more commonly people probably don't and whether that's a good thing that is a totally different discussion. Is it more difficult to come into ent as a deal? I think so, absolutely especially on the west coast. There was a bit of do bias in the ENT programs that I rotated without your trying to kind of like get my foot in the door. My board scores were awesome into the USMLE.

I had everything on paper and then got really positive, feedbacks and rotations out here, but was actually told you know point-blank. We don't take deals another later Thanks. So the program that I ended up with in Philadelphia was actually one of the do. Programs and the interesting part about being in Philadelphia was that there were four ent residences in the metropolitan area, and so we had a lot of interaction with the other ent programs and the other ent residents and hospitals and facilities and things.

And I think that by and large we all had very comparable training, so the program that I ended up through I thought was fantastic, but it did I I had to go all the way to Philadelphia to do this, but it was the best program for me. It was an excellent training um, and I think that it was very much parallel with any program in the country, but yeah it was. It was a couple of extra steps, manure, and do you think, that's still the case or cuz like I heard, they're merging that residency programs and things in 20, 20 years? There's a lot happening with that.

So the program that I went to in Philadelphia did get dual accreditation through ACGME and thank God they started that process. When I was there - and it was actually granted this year - which was a big deal - so that's great for them - it sort of gives them a lot of survivorship there and the ability to keep taking osteopathic students if they choose to, but what it means that they Can stand on their home, which is great for them, and I don't know that ent actually is merging.

I know a few of the specialties, I think, opted to maintain an independent and he was one of them. So the programs that are the strongest amongst the osteopathic community, like the one that I came from, are now getting that dual accreditation so that they can stand on both sides of the line. Regardless of what happens so lots of change on the horizon at all, but yeah, I know that some of the osteopathic programs have stepped up to that dual accreditation.

How has medicine changed as you started practicing and what future changes do seem like in the Rison sounds a change um. There is so much more to do with the computer. When I was in residency I mean I'm not that old, but you know, while he's got a internship and residency in 2009, I think one of our hospitals was on an EMR system and of all the hospitals we covered. I think I've been through five or six EHR transitions through residency just going from paper to computer, so that was like super painful to go through every time.

So that's been one of my biggest observations is the change in the way the health information and and workflow happens. So I think that that transition into information availability is huge is a big difference. What I've noticed since starting with my current organization, is that the availability of information is like boundless. The systems that we use are integrated with almost everybody in Northern California and there's a huge network in this particular EHR across the country.

So I can pull records from somebody in North Carolina like like that without worrying about it, and I can see clinic and chart notes from anybody in Northern California. So it makes it so much easier to manage a patient that may come in and you say well what can I do for you, so you can kind of dig around a little bit. It doesn't take long at all and find out why they were sitting there who sent them what's been done.

You know to see the maybe they've been for the same thing ten years ago at Stanford, no less you have this ten years ago. So that's been excellent. I think that's actually a good push towards like elimination of redundancies and cost reductions overall, but um since I started. I've also seen a lot more focus on quality outcomes, and you know I think, of the word quality as a positive thing. But when you get a new practice, it may not actually turn out to be a positive word at all, because some of the ways that these programs coming down the pipeline from Medicare and Medicaid Services and things like that are - are designed or not.

The most realistic. In my opinion, and so when we're told hey, this is a quality measure and you look at it feeling that nothing to do it the way they practice medicine. I don't quite understand that. Why am I being judged on it? Sometimes it takes a little bit to kind of integrate that into your day and figure out what to do with it, but again, there's a strength of numbers idea there that when you have a large Health System, there's people and consultants and physicians within the group that Are responsible for managing all of that information and disseminating it down and then coming to you and saying here's what I need you to do a lot of times, it's much more simple than kind of looking at this huge federal report and trying to figure out how To not get money taken away from you, how well are UT visitors, khamseh generly and how I'd recommend maximizing kind of like that's low.

So I think ent in general, community and T in particular, outside of a major academic center, is very high volume and that sets it apart from a lot of other specialties. You know here I see about 30 people a day and that's pretty difficult for my day and it's fine. You know I'm still within those hours we talked about earlier, I'm in and out and turning sufficient and that's a lot because of what I've done with it.

But also because it's it's just the way, ent flows, it's very heavier heavily procedural. So we do a lot of procedures here in the office as well as surgeries in the surgery center in the hospital, and that allows for more. I guess billable items if you want to put it that way and think about it that way, but I think it's a whole um Tisa very well compensated. Okay and again, this is a practice model thing.

The way that we're reimbursed here is very different from the folks that I work with in Philadelphia and, of course, they keep in touch with a lot of people and talk about reimbursement models of my residency, friends and stuff, and a lot of them are in systems. Very similar to the one that we're in here, but by and large it's it's very comfortable lets me do what I want to do, which is come to work, see a lot of patients in a really efficient manner, helped a lot of people and then go and Relax and so what history give us to become good doctors, listen to your patients, absolutely listen to your patients.

That's number one! I was at some seminar a few months ago about patient experience and you know how patients experience their medical care, and things like that, and one of the points that was put out right up front was that I think an average phys. I don't recall where this number came from, but an average physician gave a patient something like 17 seconds to talk before cutting them off, and sometimes that's really hard to do, because you can look at what the nurse gives you when they put a patient in the Room or within two seconds of looking at them, talk to them.

You're like right. I know, what's wrong with you, can you get up? Let's go, go, let's! Go because we're trains to be so like vignette answers and get an answer and you're like I know. I know I don't pick me pick me, but you have to let them tell you and a lot of times when you just listen. Not only do they tell you exactly what's wrong with them half the time they already know how to fix it. You just need to kind of like nudge them, a direction to come to their own realization and people really appreciate it.

When you listen, really appreciate it, it doesn't mean you have to spend 45 minutes like you're well as a third-year student in the room. Getting absolutely no useful information, that's fine you'll get there, but especially when you're out on your own, listen to the patients, they will tell you what's wrong with them and it will make your life so much easier in the long run and they will be so much Happier with the care that you're delivering great so make sure you're listening yeah well, thank you, dr.

Centric, for being brothers interviewer. Thank you guys for reading. If you have any questions for dr. Centric, leave them in a comment below and I'll ask them in realer than answer back to you guys. You guys are reading and have a great day.