Finding Your Happy Place in Otolaryngology

If you’re an otolaryngology resident in 2024, there are several different paths to achieving your personal and professional goals, depending on what those goals are. From private to hospital-based practice to academic research and teaching, every path in otolaryngology has its high points.

The new AAO-HNS Otolaryngology Private Practice Section (OPPS) sponsored a live webinar, “Finding Your Happy Place,” on February 20 to provide insight into the variety of practice opportunities and employment models currently available to otolaryngologists.

Melanie Seybt, MD, chair of the OPPS Resident and Fellow Outreach Committee introduced moderator Greg Davis, MD, a physician educator and co-director of the world’s largest sinus surgery education course (the American Rhinologic Society’s Summer Sinus Symposium) along with an esteemed panel of otolaryngologists with rich experience in different models of practice.

For Stacey T. Gray, MD, academia has been her professional home for around two decades. After training at Massachusetts Eye and Ear for residency and fellowship, Dr. Gray decided to stay, realizing that an institution where she could teach is the ideal place for her. Dr. Gray is now vice chair of education for the Department of Otolaryngology–Head and Neck Surgery and the residency program director. “Teaching is a huge part of my professional identity and something that I really love. That is, I think, what has probably kept me at the same institution is my ability to do that,” Dr. Gray shared.

Craig Miller, MD, works for a large community hospital in Seattle, Washington, called Virginia Mason Franciscan Health. The hospital setting appeals to Dr. Miller because it has an, “Emphasis on being able to be clinically busy and clinically productive, with a strong goal of also doing things with an academic perspective,” he said. Along with strong support for academic work, there is also plenty of interaction with residents; both help establish the foundation for a high-level practice.

Both academic institutions and large hospital systems come with tradeoffs, though. Dr. Gray noted that not having control over your own practice and certain decisions can be difficult at times. Dr. Miller echoed those sentiments, noting that, “You have to figure out how to work in that model.” But neither would change their current circumstances.

“I have nine of the best partners and friends that I could hope for, and that goes beyond just my section. I think the whole hospital system is filled with people that I enjoy being with on a daily basis,” Dr. Miller said. Noting her close relationship with her colleagues as well, Dr. Gray added, “I think that’s a huge part of my happiness at work—my close relationships with people.”

Private practice, in contrast, can offer a completely different scope of work to academic practice and large hospital systems. After completing his residency, Andrew K. Johnson, MD, joined a private practice in Miami and was an associate there for a year and a half before the practice was purchased by a private equity group. Dr. Johnson left the practice and joined Annapolis ENT under Chesapeake Specialty Care in Annapolis, Maryland. There, he gets to be a “true generalist,” which is exactly what he was looking for at this point in his career. “What makes me happy on a daily basis is my scope of cases,” Dr. Johnson said, adding that he’s not restricted to just one niche.

Like Dr. Johnson, Nora W. Perkins, MD, also wanted to be a comprehensive otolaryngologist. She wanted to have a say in running the business and helping mold the direction of the practice, making Albany ENT & Allergy Services in Albany, New York, the perfect fit for her. Dr. Perkins has found happiness in the independence that comes with being in private practice, and she also loves the work-life balance that the private practice sector offers her.

“Having control over your schedule is something that makes me very happy,” Dr. Perkins said, adding that she can pretty much develop her schedule as she wants as long as it doesn’t negatively affect anyone else that works in the office.

One of the main differences associated with private practice is that physicians also have to be concerned with the business side of medicine. Dr. Johnson noted that his practice has weekly office meetings where they don't talk about medicine at all. Instead, they focus on the challenges facing the office, and not everyone is as interested in that side of the work.

Private practices were also affected differently to large institutions when the COVID-19 pandemic hit. Staffing has always been an issue, but it was greatly exacerbated by the pandemic, noted Dr. Perkins. Deciding the best way to proceed for the business, whether that be having some people working remotely or potentially furloughing employees, are always difficult decisions to make. “You're not under the umbrella of a large institution [that makes those decisions for you],” Dr. Perkins said.

Like Dr. Gray and Dr. Miller, though, neither Dr. Johnson nor Dr. Perkins would change their circumstances. “I've been very happy with finally becoming a partner and having a seat at the table where the decisions are made,” Dr. Johnson said.

“One of the things that makes me the happiest about the private practice I’m in is the speed of change. It is really nice to be able to identify a problem and work on it with a bunch of people who are colleagues and friends. You can identify some solutions, implement them, and then reevaluate and change course if need be. That can happen so quickly because there isn't an oversight committee or a group that has to approve it...That's one thing that I really enjoy about being in private practice,” shared Dr. Johnson.

If you think private practice might be your happy place, too, check out the Otolaryngology Private Practice Section (OPPS), newly established in 2023 to serve the unique needs of private practice physicians.