Otolaryngology – The Long Haul

Explore a Career in Otolaryngology

Otolaryngology–Head and Neck Surgery, commonly called ENT, is one of the most diverse surgical specialties in medicine. ENT physicians diagnose and treat diseases involving much of the head and neck, combining medical management, office-based care, and surgery within a single specialty. As Dr. Peter DZ describes it, otolaryngologists are the medical and surgical specialists for essentially “everything above the collarbone except for the brain and eyes.” They also care for patients across the lifespan, from newborns through older adulthood.

Meet Dr. Peter DZ

Peter T. Dziegielewski, MD, FACS — Board-Certified Otolaryngologist, UF Health

Board-Certified Otolaryngologist | UF Health Director of Head & Neck Surgical Oncology and Microvascular Reconstructive Surgery Fellowship Director, Advanced Head & Neck Oncologic Surgery

Dr. DZ earned his medical degree from the University of Alberta in Canada, where he also completed residency training in Otolaryngology.

He subsequently completed fellowship training in Advanced Head & Neck Oncologic Surgery at The Ohio State University.

His career represents one of the most complex surgical ends of the ENT spectrum: removing head and neck cancers and reconstructing the resulting defects while attempting to preserve critical functions such as speech and swallowing.

What Is Otolaryngology?

Otolaryngology is both a medical and surgical specialty focused on diseases of the ear, nose, throat, and related structures of the head and neck. The specialty is unusual because the same physician may diagnose a disease, medically manage it, operate when necessary, and continue following the patient afterward.

Hearing

Balance

Sinuses

Nasal breathing

Voice

Swallowing

Sleep

Allergies

Facial trauma

Facial appearance & reconstruction

Head & neck tumors

Thyroid & salivary glands

Pediatric ENT

Is ENT Medical or Surgical?

Both. This is an important point for students exploring the specialty. ENT residency is fundamentally surgical training, but that doesn’t mean an ENT physician spends every day in the operating room — that flexibility is one of ENT’s defining features.

More Medical

Clinic-Focused Practice

More Surgical

Operating-Room-Focused Practice

What Are the Subspecialties of ENT?

ENT encompasses an unusually broad collection of subspecialties.

01

Pediatric Otolaryngology

Focuses on ENT conditions affecting infants and children.

02

Otology & Neurotology

Focuses on diseases of the ear, hearing, balance, and related structures.

03

Rhinology

Focuses on disorders of the nose and sinuses.

04

Endoscopic Skull Base Surgery

Minimally invasive approaches through the nose to access difficult areas near the skull base — often called "brain surgery through the nose."

05

Facial Plastic & Reconstructive Surgery

Cosmetic and reconstructive procedures involving the face and neck.

06

Sleep Surgery

Surgically treats selected causes of sleep-disordered breathing and obstructive sleep apnea.

07

Trauma / Facial Reconstruction

Focuses on injuries affecting the face and related structures.

08

Head & Neck Surgical Oncology

Focuses on cancers involving the head and neck.

09

Microvascular Reconstructive Surgery

Uses tissue from another area of the body to reconstruct complex defects after cancer surgery or trauma.

10

Comprehensive / General Otolaryngology

Broad ENT care across multiple areas — particularly common in community and private-practice settings.

How Do You Become an ENT Physician?

ENT is its own residency. You do not complete General Surgery residency first and then specialize in ENT — medical students apply directly into Otolaryngology–Head & Neck Surgery.

4 Years

Medical School

5 Years

Otolaryngology–Head & Neck Surgery Residency

Optional Fellowship

Usually 1–2+ years depending on subspecialty and research — allows physicians to develop advanced expertise within one area of ENT.

What Is ENT Residency Like?

ENT residency is heavily surgical — and there is a simple reason: you cannot learn surgery from a textbook. Early training incorporates broader rotations and foundational clinical management before residents advance into increasingly complex ENT operations.

General Surgery

Emergency Medicine

Neurosurgery

Vascular Surgery

Thoracic Surgery

General Medicine

What Kinds of Surgery Do ENT Physicians Perform?

This should be one of the major visual sections of the page, because the sheer range of ENT surgery is difficult to appreciate until you see the examples side-by-side.

An ENT operation can be as small as: Placing an ear tube in a child Potentially taking only minutes.

Removing a major portion of someone’s face because of cancer and reconstructing it using tissue and bone from another part of the body.

Dr. Zygolowski describes ENT procedures ranging from approximately five-minute ear tube operations to all-day reconstructive cancer surgeries.

Few specialties offer this much procedural variety within one field.

Why Choose ENT?

Dr. DZ did not enter medical school already knowing he wanted to become an ENT surgeon.

In fact, he says he didn’t even know ENT existed.

He explored different surgical specialties through shadowing and discovered ENT during head and neck anatomy.

Then he watched a major head and neck cancer resection with free-flap reconstruction.

That changed everything.

“I loved the intricate anatomy. I loved the combination of science and art in the surgery.”

— Dr. Peter DZ

What Is Head & Neck Surgical Oncology?

Head & Neck Surgical Oncology focuses on cancers involving structures of the head and neck.

Depending on the disease, surgery may affect structures responsible for fundamental human functions such as:

Speaking

Swallowing

Breathing

Eating

Appearance

Facial movement

Saving a Life Worth Living

Removing cancer is obviously critical. But in head and neck cancer surgery, survival is not the only outcome that matters. Patients may also need to:

Speak. Swallow. Eat. Breathe. Communicate. Interact socially.

The most rewarding aspect of his work as treating life-threatening disease while preserving excellent function afterward—particularly speech, swallowing, and quality of life.

That changed everything.

“To save them a life that's worth living.”

— Dr. Peter DZ

What Is Rewarding About ENT?

For a head and neck oncologic surgeon, one of the greatest rewards is seeing patients years after treatment — cancer-free. Academic medicine adds another dimension: training residents and watching physicians he taught eventually enter their own practices and care for their own patients. The impact extends beyond one patient — treat a patient, train a physician, affect the patients that physician will treat for decades.

What Is Challenging About ENT?

At the complex surgical end of ENT, operations can be extraordinarily demanding — patients who have already undergone surgery, previously received radiation, have recurrent cancer, significant scar tissue, or major reconstructive needs. The surgeon must simultaneously determine how to remove the cancer and how to reconstruct what remains. Some of these operations can last approximately 12–16 hours.

How Much Does an ENT Physician Operate?

Head & Neck Surgical Oncology focuses on cancers involving structures of the head and neck.

Depending on the disease, surgery may affect structures responsible for fundamental human functions such as:

Rather than thinking “ENT = surgeon,” it may be more accurate to think: ENT = a spectrum of medical and surgical practice. That flexibility allows physicians to shape their careers around their interests.

What Is the Lifestyle Like in ENT?

These are examples from the interview — not universal ENT schedules.

30–40 hrs/wk

Medical ENT

A predominantly medical practice could work fairly traditional office hours with limited or even no operative call.

~40–50 hrs/wk

General ENT

A general schedule might begin around 7–8 AM, with OR days starting earlier than clinic days, ending roughly 3–6 PM. Call frequency depends heavily on group size.

60–80 hrs/wk

Head & Neck Surgical Oncology

Longer operative days, more complex patients, greater call responsibilities, smaller specialized call pools, and more after-hours work.

Academic ENT vs. Private Practice

The practice environment can dramatically change the types of patients and cases a surgeon encounters.

Private Practice

The interview describes private-practice cases as often being:

Academic Medicine

Academic referral centers may receive:

More medically complex patients
Revision surgeries
Previously irradiated tissue
Failed previous operations
More advanced disease
Significant health disparities
Unusual or difficult cases

What Is It Like to Teach Surgery?

Teaching surgery is different from simply giving a lecture. The attending physician must allow a resident to develop surgical independence while simultaneously ensuring the patient’s safety — teaching residents to perform operations while ensuring the outcome remains as good as if he had performed the entire operation himself. That creates a difficult balance between education, independence, supervision, and patient safety.

How Competitive Is ENT?

ENT has historically been considered a highly competitive residency specialty. Applicants as having very strong academic profiles and notes the importance of:

How Much Do ENT Physicians Make?

At the time of the interview, Dr. DZ discussed starting compensation around 250,000–350,000 in some settings, with much greater earning potential in certain private-practice, underserved, senior, or practice-ownership situations.

Academic vs. private practice
Geographic location
General vs. subspecialty practice
Surgical volume
Experience
Practice ownership
Productivity
Local demand

Is ENT Really “Ears, Nose & Throat”?

Yes—but that nickname dramatically understates the specialty. A physician may be performing an ear tube procedure on a child in one setting while another ENT surgeon is performing a 16-hour cancer resection and microvascular reconstruction. That’s why the formal name — Otolaryngology–Head and Neck Surgery — better communicates the breadth of the specialty.

Ear

Nose

Sinuses

Throat

Voice

Airway

Thyroid

Salivary Glands

Skull Base

Face

Neck

Reconstruction

Cancer

What Are Common Misconceptions About ENT?

"ENT is a small, easy surgical specialty."

Not necessarily. Dr. DZ discusses the old characterization of ENT as "easy nights and tennis" and strongly pushes back on the idea that surgery should ever be treated casually — every operation introduces risk and responsibility.

"ENT doctors only treat ear infections and sinus problems."

No. ENT includes everything from pediatric ear disease to skull-base surgery, facial plastics, sleep surgery, cancer surgery, and microvascular reconstruction.

"ENT is basically General Surgery for the head."

No. ENT is its own five-year residency, and medical students apply directly into it.

"All ENT physicians operate constantly."

No. Many ENT physicians have significant medical practices, and some can shape their careers toward predominantly non-operative care.

"ENT is only about improving symptoms."

Not always. Head and neck surgeons may treat life-threatening cancer while simultaneously reconstructing structures necessary for speech, swallowing, breathing, and appearance.

Can an ENT Physician Stop Operating?

Interestingly, yes. Because ENT contains both medical and surgical practice, a surgeon who eventually wants — or needs — to stop operating may potentially transition toward more non-operative ENT care. An ENT surgeon approaching retirement could potentially stop operating while continuing to see patients medically. That’s a relatively unusual degree of career flexibility for a surgical specialty.

Who Is a Good Fit for ENT?

What Advice Is There for Future Physicians?

Dr. DZ’s major advice is particularly relevant for pre-medical students: know what you’re getting yourself into. The idea of being a physician and the reality of practicing medicine aren’t necessarily the same. Students should obtain meaningful clinical exposure before committing to the career — shadowing, talking with physicians, asking about training and lifestyle, seeing actual clinical practice, and exploring multiple specialties. He emphasizes making that decision before investing years into training, because medicine requires substantial sacrifice, effort, and motivation.

Frequently Asked Questions About ENT

What does ENT stand for?

ENT stands for Ear, Nose and Throat, although the formal specialty is called Otolaryngology–Head and Neck Surgery.

How long is ENT residency?

ENT residency is generally five years.

Do you complete General Surgery before ENT?

No. Medical students apply directly to Otolaryngology residency.

Is ENT a surgical specialty?

Yes. Residency is heavily surgical, although practicing ENT physicians also provide substantial medical management.

Do all ENT physicians perform surgery?

ENT physicians receive surgical training, but the amount they ultimately operate can vary dramatically.

Do ENT physicians perform plastic surgery?

Facial Plastic and Reconstructive Surgery is a recognized area within Otolaryngology.

Do ENT physicians treat cancer?

Head & Neck Surgical Oncologists specialize in cancers affecting the head and neck.

Do ENT physicians perform brain surgery?

ENT physicians don’t generally operate on the brain itself, but specialized rhinologists and skull-base surgeons may use endoscopic approaches through the nose to access areas at the skull base, often working collaboratively with Neurosurgery. The interview specifically discusses endoscopic skull-base surgery.

Can ENT be mostly outpatient?

Yes. The balance between outpatient medicine and surgery varies according to the physician’s practice.

Can ENT be mostly outpatient?

Yes. The balance between outpatient medicine and surgery varies according to the physician’s practice.

Is ENT competitive?

Historically, yes. Current competitiveness should be evaluated using the latest NRMP data rather than historical interview numbers.

Is ENT a good lifestyle specialty?

It can be, but this varies enormously. A medical ENT practice may look completely different from a Head & Neck Surgical Oncology practice.

Can ENT surgeons have long-term patient relationships?

Absolutely. Head and neck cancer physicians, for example, may follow patients for years after treatment.

Hear It From an ENT Surgeon

One physician may spend most of the week treating sinus and allergy problems in clinic. Another may restore hearing, perform facial cosmetic surgery, operate through the nose at the base of the skull, or spend an entire day removing a life-threatening cancer and rebuilding the patient’s face using tissue from elsewhere in the body. Hear directly from Dr. Peter DZ about Otolaryngology, surgical training, Head & Neck Oncology, reconstructive surgery, lifestyle, residency competitiveness, academic medicine, and what makes the specialty rewarding.