Choosing a surgical subspecialty: My path to Otolaryngology

Shabnam-G-bannerChoosing a career in medicine was one of the easiest decisions I ever made. Although I was the first out of a family of engineers to go into medicine, it was a natural choice for me. I loved interacting with people and thinking critically about the applications of science to the human body. My passion for medicine was clear. But, choosing a medical specialty was unexpectedly difficult.

During the first two years of medical school, students around the country are taught the foundations of clinical medicine. While there is some exposure to the various specialties, the focus of these years is to act as an introduction to medicine through lectures, textbooks and exams. In contrast, the third year of medical school transitions students out of the classroom to the bedside. Students rotate through clerkships in various specialties learning how to apply their knowledge to patient care. In this year, students begin to learn how medical teams function as well as understand the roles of the different specialties and how they work together. While some students enter these third-year clerkships already confident about their specialty choice, many students maintain an open mind.

In the fall of the fourth year of medical school, students then apply to residency programs in a chosen specialty. It happens very quickly. One minute you are being told, “You have lots of time, don’t worry about choosing a specialty yet.” The next minute you realize that you are the last one to decide and you should have been publishing research papers in the field since before medical school even started. Across the board, applying to residency has become increasingly competitive and showing commitment to the chosen field through research and letters of recommendation from faculty is important.

Halfway through my third year of medical school I remember starting to feel a little discouraged. I watched as my classmates decisively pursued their chosen specialties and met with faculty mentors to plan for residency applications. Meanwhile I continued to be undecided. I had enjoyed all of my third year clerkships so far. As I rotated through, I would try to convince myself that certain fields met some of my interests. But I was never able to wholeheartedly commit to a specialty. I had mentors in fields of pediatrics, family medicine, general surgery and radiology. None of which I wanted to pursue for the rest of my career.

One day during my psychiatry rotation at the VA Medical Center, one patient-encounter changed everything. I was observing as a fellow medical student evaluated a patient for possible dementia. She was leaning close to him, asking questions in a high-pitched voice. His responses were inconsistent and unreliable, indicating advanced dementia. For some reason however, he reminded me of my grandfather and I got an idea. From years of experience, I knew that people with hearing loss due to aging typically have difficulty with high-pitched sounds. I told the medical student to try repeating the questions in a deeper, lower-pitched voice. Voilà! He didn’t have dementia, he was hard-of-hearing. As I walked out of that room, I realized that communication disorders have implications in patient care across all specialties. Given my experience with my grandfather and interest in language barriers in medicine, this was particularly meaningful for me. Although I had never worked with an otolaryngologist, aka “Ear-nose-throat doctor” (ENT), I thought of one memorable faculty member who had lectured to our class during first year. I emailed him that day.

Little did I know, ENT was more than hearing aids and communication disorders. Otolaryngology-Head and Neck Surgery, as it is called, is one of the most diverse specialties I have ever experienced. It encompasses anything and everything you can think of from the collarbones up. Every ENT is trained as a surgeon performing procedures in the fields of oncology, neurotology, facial plastic surgery, microvascular surgery, endocrine surgery and sinus surgery. They are experts in voice disorders and airway management. The scope of the field is incredible and encompasses principles of various specialties including primary care, pediatrics, vascular surgery, orthopedics, trauma surgery, neurosurgery and anesthesiology. It may be one of the best-kept secrets in medicine.

Last year, no OHSU graduates applied for an otolaryngology residency. This year, I am the only female applying from my class. My path to ENT has been filled with self-reflection and active engagement. Less than a year after discovering this specialty, I have submitted my applications for residency in otolaryngology. The residency will add a minimum of 5 more years of training after completing 4 years of medical school. Now, I am being asked what fellowship I plan to pursue after residency. A subspecialty within a subspecialty. This sounds familiar. There is always more to learn…what is a few more years?

To the next wave of students, I would like to say: be patient. Take an active role in your education and seek out experiences that will help you understand your passions. You will hear about physician burn-out and the impossible commitment that certain specialties require. Try not to let that influence your decisions. Choosing a shorter residency or a less time-intensive specialty will not make 30 years of practice more enjoyable. From what I have seen, the overall experience is built on daily interactions, one patient at a time. Find a specialty that has a deep layer of meaning for you. It will continue to excite and inspire you in the long run.

Remember, a career is a marathon, not a sprint.