Choose Your Passion
Once you’ve decided to pursue a fellowship, decisions should fundamentally be about your passion for learning. The topic of your fellowship should be something that resonates deeply. “Pick something you’re truly passionate about,” said Rakesh Chandra, MD, MMHC, professor of otolaryngology–head and neck surgery, Endowed Directorship for Leadership and Educational Development, Vanderbilt University Medical Center, Nashville. “Whether you serve in that capacity in your academic department and/or your community, that’s what matters the most.”
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February 2021Dr. Le advises residents that a genuine interest in a particular subspecialty is the most important consideration when pursuing a fellowship. “I always ask my residents whether they would be happy practicing general otolaryngology for their entire career or if there’s a subspecialty area they really gravitate toward,” he said.
Although some subspecialties in otolaryngology are more conducive to academic medicine, others may flourish in private practices, said Dr. Le. For example, fellowship training in head and neck oncology/microvascular reconstructive surgery would more likely lead to practicing in an academic setting that would offer more career support, including access to clinical trials and collaboration with other fellowship-trained colleagues and residents. Other subspecialties requiring fellowship training, such as facial plastics reconstructive surgery, may be more conducive to private practice, given the freedom a private practice allows for more control over advertising, purchasing and distribution of cosmetic products, and reimbursement for cash pay procedures and surgeries without the academic medicine’s arduous approval process.
According to Dr. Le, one subspecialty that’s always in demand in both private practice and academic medicine is neurotology. “The high demand might be due to a combination of limited fellowship positions and graduates each year and decreasing exposure or comfort of graduating residents with otologic surgery compared to past generations of graduating residents,” he said.
Perspective from a New Fellow
Lauren Cass, MD, MPH, an otolaryngologist with Kaiser Permanente in Clackamas, Ore., who graduated in 2020 with a fellowship in rhinology, sinus, and skull base surgery and now practices in a large physician-owned multispecialty group setting, said her first priority when considering a fellowship was asking herself what she wanted to get out of it.
I always ask my residents whether they would be happy practicing general otolaryngology for their entire career or if there’s a subspecialty area they really gravitate toward. —Christopher Le, MD
“My primary motivator for doing a fellowship was that I really liked rhinology and that by completing a fellowship I could hopefully narrow my future practice, to some degree, whether that be in private practice or academics,” she said.
Dr. Cass cited additional benefits to pursuing a fellowship. “Perhaps you feel like you didn’t get enough exposure or practice in a certain area of the specialty but know that the specialty will make up a big part of your practice,” she noted. In addition, a physician fellow can offer expertise in a specialty area that a private practice group may be lacking. “Some groups may be looking for a competitive advantage and want to advertise fellowship-trained physicians,” she said.
Dr. Cass, who also has an interest in clinical research and a background in public health, emphasized that pursuing a fellowship gave her additional time and access to clinician-researchers so she could gain more robust experience in clinical research. Although she considered some academic jobs following her fellowship, she chose to practice with Kaiser Permanente, specifically Northwest Permanente, because it offered her a position that fulfilled her goals to practice more rhinology in a preferred geographical location. She also underscored the fact that Kaiser Permanente, although not academic based, is more similar to a health or hospital system-based practice than a traditional private practice group.
Dr. Cass also noted some of the disadvantages of a fellowship, including not being able to practice in your trained subspecialty if you choose to practice in a small group or in a major metropolitan area where the market for specific subspecialists is saturated. “In underserved areas, there may be more of a need or opportunity for your subspecialty, but you may also find yourself doing a lot of non-subspecialty work because there are fewer otolaryngologists in general to meet the general needs of the community,” she said.
She also pointed to the economic disadvantage, saying that fellows give up a year or two of significantly more pay than a starting salary for a practicing physician, and, like Glazer, noted that many residents are ready to settle down and begin working after long years of medical and residency training.
Overall, said Dr. Cass, residents need to be honest with themselves about what kind of career they want to pursue and what will really make them happy. “Ultimately, the needs of the group you join will largely dictate the type of practice you have regardless of what you see as your ideal practice, at least when you’re starting off,” she said, adding that the needs of the group will be dictated by its type, geographic location, and the particular landscape of the workforce at the time.
Whether or not to pursue a fellowship in otolaryngology is a choice made based on careful considerations of your personal and professional aspirations. Fundamentally, the choice to pursue a fellowship should be made on the strength of the passion you have for the subspecialty, taking into account the time it will take to become an expert in a subspecialty you may or may not use in your future career. Physician-owned group practices may offer a fellow-trained otolaryngologist a niche in their practice for taking on cases in their trained subspecialty, but it may take years to develop a subspecialty practice within the group.