ORL/HNS comprises many challenging areas and it is usual for
surgeons to subspecialise in one particular type of surgery (ear,
nose, voice, or head and neck), although outside major teaching
centres general ORL surgeons are the norm. There is a good
combination of outpatient consultation and surgical work. With the
exception of the head and neck cancer surgery, the majority of ORL
surgery involves younger patients undergoing ‘quality of life
surgery’ such as improving hearing, the airway, voice etc. This can
be quite rewarding for both the patient and the surgeon.
A high level manual dexterity is essential for ORL-HNS. You also
need to have binocular vision to use the microscope, and you must
have sound gentle tissue handling techniques. Good communication and
interpersonal skills are also essential.
Daily schedules vary according to the particular subspecialty. A
typical operating day for a head and neck surgeon would start with a
ward round at 7.30am and theatre commencing at 8.30am. There is
usually at least one complex case each week that requires two teams,
one ablative and the other reconstructive. In these instances one
case will take the entire operating day and last between five and 12
hours. Tumour ablation (for instance, in the throat) entails
resection of the primary tumour and neck dissection to excise nodes
that are (or may be) involved with the tumour. Reconstruction
usually involves transfer of a microvascular free flap. Once surgery
is completed the operating day finishes with a post-operative ward
round. Head and neck clinics are multidisciplinary and involve the
assessment of new patients and the monitoring and support of those
previously treated.
For an otologist, rhinologist or laryngologist the day would usually
start with a ward round, although there are far fewer inpatients for
these subspecialties. Clinics last for around three and a half hours
and are highly specialised. Laryngeal or voice clinics, for
instance, are usually run in conjunction with a speech therapist and
employ videoendoscopy and stroboscopy. Operating lists are usually
full day lists and surgery is performed in the main theatre or
day-stay unit. Most patients go home on the day of surgery, with the
remainder leaving the following morning. In regional hospitals with
a general ORL surgeon a mix of surgery would be performed with 4 – 6
cases on a list. Many ORL surgeons work in the private as well as
the public sector. A full time surgeon would expect 1 – 2 days
operating a week, 2 days of clinics, and 1 day of administration/CME.
Technological changes with image guidance systems, computing and
keeping up to date with changes in techniques pose the greatest
challenge. Funding will always be an issue with the cost of the
technology and surgery. Many ORL procedures are to improve the
quality of life (rather than save life) so funding constraints may
limit the availability of surgery.
Obtain exposure to the specialty by working as a house officer or
pre SET registrar. Once accepted on to the surgical
training programme you should ensure that appropriate rotations are
undertaken for the specialty. These include ORL, A&E, General
Surgery, Cardiothoracic, Plastics, Neurosurgery and ICU (some of these rotations are
compulsory as part of surgical training). You should check
with the Royal Australasian College of Surgeons (RACS) for an
up-to-date list of requirements for eligibility to apply for the
specialist training programme in ORL-HNS.
Most regions outside the main teaching centres throughout New
Zealand are experiencing a shortage of ORL-HNS surgeons and there is
a wide world shortage of surgeons.
Fellowships provide an excellent opportunity to live overseas and
CME affords extra travel opportunities. Having a family will always
add pressure when training, however most manage without significant
problems. Time out during the five year training programme is not
desirable but increased levels of female trainees make it inevitable
that some trainees need time out to have children. It is an
intensive training programme, so may result in additional training
time being necessary before being eligibly to sit exams or qualify
for accreditation depending on the duration of parental leave.
Overseas fellowship positions are usually taken up after completion
of training. The Surgeon/Scientist programme allows for integrating
1 – 2 years of research into the programme, prolonging training by
that amount of time. Working part time once a specialist is not a
problem.
In general ORL is an excellent surgical specialty for families, as
clinics and theatre sessions are predictable and controlled and most
cases are day-stay or short-stay. In all areas of the specialty the
after-hours call requirement is relatively light. However, the hours
of work entailed by HNS can be demanding. An understanding and
flexible partner or supportive extended family is always an
advantage.
Limited access to funding in the public sector will always be a
factor, otherwise there are no disadvantages when compared to other
surgical specialties.
The ORL-HNS training programme is currently 5 years. In New
Zealand you have to work in 2 (or more) centres to complete
training. Although preferences are considered, you may have to go to
a centre where a training post is available. It is not possible (or
advisable) to do all your training in one centre. The majority of
trainees should expect to do 1 – 2 years in a fellowship post
(usually overseas) after completion of training before taking up a
permanent consultant position. Pre SET requirements have to be fulfilled
to be eligible to apply to the advanced training programme.
