ENT (Otolaryngology) Career Pros and Cons: Is It Right for You?

Are you considering a career in otolaryngology (ENT)? With so many specialties to choose from, how do you know which one is truly for you?

This guide will cover the pros and cons of becoming an ENT surgeon, from the diverse procedural variety and excellent compensation to the routine bread-and-butter cases and clinic-heavy schedule.

There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in residency, whether or not you want to focus on procedures, the level of patient interaction you’ll have, the setting you’ll practice in, the people you’ll work with, your work-life balance, your compensation, and more.

This series delves into the career of an ENT surgeon from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and explains why he ultimately chose not to pursue ENT as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in otolaryngology.

For a completely objective and unbiased look at ENT, including more details into the daily life of an ENT surgeon and the exact steps to take to become one, also check out our guide to How to Become an ENT Surgeon (So You Want to Be).

What I Liked About ENT

1 | Exceptional Procedural Variety

One of the most compelling aspects of ENT is the remarkable diversity of surgical procedures you’ll perform. In the last 5-10 years, more ENT surgeons have been performing their own microsurgery, including complex reconstructions with flaps harvested from other parts of the body, such as the forearm.

Previously, plastic surgeons would assist with flap mobilization, but ENTs have increasingly taken on this work independently. I find flaps and microsurgery to be among the most exciting and almost science-fiction-like aspects of surgery.

The procedural variety extends far beyond flaps. You’ll manage facial trauma (shared with plastic surgeons and oral maxillofacial surgeons who are also on call), restore patients’ hearing, voices, and airways, perform endoscopic sinus surgery, execute skull base approaches to set up neurosurgeons for brain tumor resections, and handle complex head and neck cancers with reconstruction.

ENT is one of the very few specialties where you can perform open, endoscopic, and microscopic cases, providing tremendous variety within a single field.

2 | Overlap with Plastic Surgery

The flap work I mentioned represents one of the most exciting aspects of surgery to me personally. Additionally, you can pursue a facial plastics fellowship and focus on facial aesthetics if that interests you.

While there are many differences between ENT and plastic surgery, there’s more overlap than you might expect. The shared focus on reconstruction, microsurgery, and facial aesthetics creates natural connections between these fields.

3 | Excellent Personalities

ENT attracts more laid-back, intellectually curious people relative to some other surgical specialties. They’re often considered the “nice” or “mostly normal” surgeons.

I rotated at Ohio State University in plastic surgery alongside an intern on the ENT track. He completely fit the profile—soft-spoken, kind, laid back, maybe slightly on the nerdier side. He was a fantastic colleague to work with.

Many other ENT surgeons I’ve encountered during medical school and residency were similarly chill. In my experience, ENTs have the most likable, easygoing personality types of any surgical specialty.

4 | Strong Compensation

ENT compensation ranks on the higher end, usually in the top five specialties. The current average is around $523,360, placing it just after plastic surgery, orthopedic surgery, cardiothoracic surgery, and neurosurgery, which range from the high $500,000s to over $760,000.

This level of compensation, combined with a reasonable lifestyle, makes ENT financially very attractive.

5 | Small Specialty Community

ENT offers around 350 residency spots per year, making it relatively small. For context, orthopedic surgery has 900 spots, neurosurgery has 240, plastic surgery has 190, vascular surgery categorical has 80, and thoracic surgery categorical has 50.

Surgical specialties are much smaller in terms of both residency positions and the total number of practicing attendings in the United States. I appreciate the smaller community aspect where you get to know colleagues in your field, see familiar faces at conferences, and feel connected rather than lost among thousands of other physicians.

This isn’t a strong preference, but it’s a modest advantage nonetheless.

6 | Lifestyle Flexibility

ENT offers flexibility and variety with procedure types. You can perform long, complex flap reconstructions alongside quick outpatient office procedures. Surgical specialties that include smaller, primarily outpatient procedures provide more lifestyle flexibility—you can maintain reasonable hours while still earning an excellent income.

There’s also a blend of surgical and medical management options, allowing you to tailor your practice to your preferences. When you’re younger, you might pursue more ambitious, complex surgeries. As you mature, you may prefer more straightforward procedures with increased clinic time and medical outpatient management.

7 | Immunity from Mid-Level Encroachment

This applies to just about every surgical subspecialty, but it’s worth mentioning. The technical complexity and specialized training required for ENT procedures provide substantial protection from mid-level scope creep.

8 | Complex and Intricate Anatomy

I’m somewhat torn about the anatomy aspect, but it leans positive overall. Head and neck anatomy is incredibly complex and intricate. It’s beautiful how much functionality and structure exist in such a compact space.

In the first-year anatomy lab, working on the head and neck was one of my favorite regions because there was so much happening in that area. Even memorizing the external carotid artery branches requires elaborate mnemonics, such as “Some Anatomists Love Freaking, Others Prefer S&M.”

I’ll admit a large part of my fascination stemmed from the neurology and neurosurgery aspects of the head and neck—learning about ipsilateral and contralateral innervation patterns, and how deficits in specific brain regions or nerves would manifest clinically.

What I Didn’t Like About ENT

1 | Limited Anatomical Region

While I appreciate how nuanced head and neck anatomy is, it’s somewhat limited. You’re constrained to working on one particular region of the body, which can feel restrictive if you value broader anatomical variety.

The region can also be somewhat unpleasant due to the various glands, secretions, and fluids in the head and neck. When evaluating anatomic areas of surgery, you need to consider both what you think of that body region’s anatomy at baseline when it’s clean and what you think of it when dealing with secretions and body fluids.

For me, blood was never a problem. Mucous and respiratory secretions are more bothersome. Pus, stool, and GI secretions fall somewhere in the middle. Of the various subspecialization areas within plastic surgery, craniofacial was actually one of my least favorite for this reason.

2 | Routine Bread and Butter Cases

Whenever you consider a specialty, don’t become too enamored with the rare, exciting zebra cases. Focus on what you’ll encounter day in and day out.

In ENT, that means tonsillectomies, tube placements, dizziness workups, chronic sinusitis, allergic rhinitis, ear infections, and sleep apnea. This bread-and-butter caseload doesn’t particularly excite me. While you can’t expect routine cases to be thrilling by definition, you should at least not dread them.

3 | Less Variety Compared to Some Specialties

While ENT still offers a substantial variety, it’s less than, say, plastic surgery. Plastic surgery is truly head-to-toe, working on both soft tissue and bony structures throughout the body.

ENT encompasses many different procedures, but apart from harvesting flaps, you’re excluding everything below the neck. Despite what my mother says, I value variety, and there’s no shame in that preference.

4 | Significant Clinic Responsibilities

ENT involves more clinic time than some other surgical specialties. On the OR-versus-clinic balance spectrum, ENT is more similar to ophthalmology and urology, and less similar to trauma surgery.

If you’re someone who wants to maximize OR time and minimize clinic obligations, ENT may require more outpatient management than you’d prefer.

If You’re Considering ENT

Should you become an ENT surgeon?

The answer depends on your priorities and what aspects of medicine genuinely resonate with you. ENT occupies a unique space in surgery—offering impressive procedural diversity, excellent lifestyle flexibility, and strong compensation, while maintaining a collegial community of surgeons.

Consider whether the head and neck region provides enough anatomical variety to sustain your interest throughout a career. Can you find fulfillment in the bread-and-butter cases that will dominate your practice—tonsillectomies, tube placements, and chronic sinusitis management—alongside the occasional complex reconstruction or skull base approach?

If you appreciate intricate anatomy, enjoy both microscopic and endoscopic techniques, want to restore critical functions like hearing and speech, value work-life balance with strong earnings, and prefer working with more laid-back surgical personalities, ENT could be an excellent match.

However, you must accept working exclusively on the head and neck region, managing substantial clinic responsibilities, and that routine cases will comprise the majority of your practice, despite the exciting, complex surgeries.

ENT attracts surgeons who value technical precision, appreciate the anatomical complexity of a focused region, and seek lifestyle flexibility within a surgical career. The specialty offers one of the best combinations of compensation, procedural variety, and work-life balance among surgical fields.

If you’re considering ENT, ensure you experience both the exciting reconstructive cases and the routine outpatient work to understand the full scope of the specialty.

ENT is an excellent specialty for those who find fulfillment in restoring critical functions like hearing, breathing, and speech, enjoy the technical challenge of working in a compact anatomical space, and want substantial compensation without sacrificing their personal life.

If you want to learn more about ENT, check out So You Want to Be an ENT Surgeon.