As an otolaryngologist, I can tell you that the specialty is becoming increasingly subspecialized. If you're seriously considering this path, be prepared to do a fellowship. You should understand what you're getting yourself into—not just the clinical aspects, but the long-term realities of the field.
Right now, salaries appear high, but this is partly a distortion. We're in a post-COVID market correction. Approximately 14,000 ENTs are practicing in the U.S., with about 750 retiring each year—a sharp increase from 350 in 2014. Meanwhile, training programs are producing only around 333 new ENTs annually. Even if that number increases to 380, as planned, we'll still see a net decline in workforce. While that may sound like good news for job security and salary, I believe it could actually signal instability. Once the market fully resets, salaries may fall dramatically.
If you're going into ENT purely for financial reasons, you may find yourself disappointed. This career can—and often must—be a labor of love. It's a phenomenal specialty with a lot to offer, but it may not be what you imagined when you started residency.
The obvious advice is to do as many away rotations in ENT as possible to gain exposure. But also, talk to practicing physicians—not just the ones posting highlight reels online. The truth is, nearly every doctor I know is actively planning or at least dreaming about doing less clinical work in the future. Very few expect to retire doing the same job they started with.
Technology is evolving rapidly across all of medicine, and that's exciting. But the broader medical landscape—bureaucracy, reimbursement pressures, administrative burdens—is getting tougher. Ask yourself: What do I want my life to look like 15 years from now?
It's easy to fall in love with a subspecialty during training, only to wake up one day and realize that being in the trenches indefinitely is not what you signed up for. Many physicians eventually shift into administrative roles to escape that grind.
So my advice is to proceed cautiously—and think like an entrepreneur. Have a long-term vision. There is more to life than your career, and if you weigh all the factors upfront, you'll make better decisions. I'm glad I chose ENT—it truly is the best of the worst—but if I had to do it all over again, I'm not sure I would, not because of the specialty itself, but because of the bureaucracy that now defines so much of medicine.
DD