You have probably heard of an ENT physician, but do you know the range of sub-specializations that actually exist within this career pathway? You can do surgery but you can also opt to stay office-based. Or, like this episode’s guest, you can find a narrow niche like rhinology and facial plastics. Whichever you choose, being an ENT physician can be a fulfilling career should you choose to get into it. In this two-part series, Dr. Richard Marn talks with Dr. Guy Lin, a partner at ENT and Allergy Associates, where he has been practicing for over a decade. In this episode, Dr. Guy talks about what his career looks like and how he impacts patients through his practice.

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To some degree, also, there are those moments that are extremely satisfying. If this is a problem, I can remove that problem that’s bothering that person with my expertise. Those are satisfying situations, but that’s not the majority of the time that I spend in clinical medicine. The majority of the time is much more complicated. They’re not reductionist problems.

That was Dr. Guy Lin, an ear, nose and throat doctor, otherwise known as an ENT physician. He’s a good friend. In this episode, he’s going to talk about his career, what it’s like. In the subsequent episode, he’s going to talk about how he became a surgeon and how he decided to become an ENT physician. Similar to my previous guest, Dr. Nathan Enoki, I will be splitting this guest interview into two separate episodes.

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We’re going to be talking with Dr. Guy Lin, an ENT surgeon, an ENT physician and hopefully, this will give you a better perspective and clear understanding of his specialty. Let me give a little background on Dr. Lin here. Dr. Guy Lin went to college at the University of Pennsylvania, where he majored in the Biological Basis of Behavior. He then went straight to medical school at the University of California, San Francisco or UCSF. After that, he went to the University of Pennsylvania where he did his internship in surgery and his residency training in Otolaryngology or ENT. He then went to Mount Sinai School of Medicine, where he did a clinical fellowship in Facial Plastic and Reconstructive Surgery. Since finishing his training, he’s been in a mix of academic and private practice, but mostly an emphasis on private practice. He is an assistant attending affiliated with Mount Sinai Medical System, but its main practice is with ENT and Allergy Associates where he is a partner and has been practicing there for well over a decade. I have Dr. Guy Lin. How are you doing?

I’m great, Rich. How are you?

I am doing well. It’s great that you’re here. We’ve known each other for many years now when we used to work at Mount Sinai. We were doing adult and pediatric ENT cases. To our readers, can you tell people what you do for a living, especially when someone asks you what you do and what your responsibilities are?

I am an ear, nose and throat specialist. My subspecialties are in rhinology and facial plastics. I’ll break that down into more simple layman terms. It’s a subspecialty within the surgical fields specializing in the head and neck area. Within that specialty, you can go on and further train and I did specialty fellowship training in facial plastics and rhinology, which is a combination of reconstructive cosmetic surgeries and specialty in the sinuses.

ENT is an abbreviation for Ear, Nose and Throat. Everybody that goes through this specialty, do they operate when they’re in private practice or start practicing?

No, not necessarily. The training is surgical, but a fair number of people may elect over time to exclusively devote their practices to office-based work so that may not necessarily involve going to the operating room for more complicated cases. The majority of your nose and throat surgeons generally do go to the operating room and do procedures. Keep in mind, just because you’re not going to the operating room, there are a fair number of procedures done that don’t require being placed under any type of general or local sedation.

What procedures are you doing that doesn’t require surgery?

You can deal with nosebleeds, ear procedures such as the puncture of an eardrum for drainage purposes of infection or fluid. You could do biopsies. You could do needle biopsies in the office. You can clean a person’s ear of foreign bodies or wax. You can remove foreign bodies from the nose and the throat. You can diagnose certain ailments with the use of an endoscope. Fiber optic endoscopes are used to look down into the throat and into the nasal walls. Microscopes are used to look closely at the eardrum. there’s a broad range of expertise that’s done on also an office-based setting.

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Guy, about your specific specialty, can you tell us about what you do, specifically what that entails or a more detailed basis?

It’s not a pure cosmetic practice. I deal with a lot of functional problems, people who can’t breathe, who have sinus issues. My bread and butter work is aiding patients in terms of helping them breathe better, whether it’s from an assortment of sino-nasal disorders or physical obstruction, maybe due to trauma in the past. A lot of patients will also seek out some form of aesthetic repair on their nose to give them a nicer appearance. A lot of times we’ll combine rhinoplasty with some form of functional work to give them some improvement in their breathing. That’s the bread and butter of what I do.

Is it often adult patients you’re dealing with, kids, or a combination?

I’ll see anybody from birth through end of life issues. I’ll operate on small children who have adenoid issues from a breathing perspective. They can range in age from approximately one year of age to as old as their 80s or 90s, although obviously the lower age and the higher up ages are falling right off that bell curve. The bell curve is right in the middle, anywhere between their 20s to their 50s. That’s the bulk of the practice.

Obviously, you can do an ENT residency and then start working. You went another year and did a fellowship. Why did you decide to do that?

If you’re practicing in a heavily populated, highly competitive urban setting, it is highly advantageous to have a unique and advantageous skillset to offer. First, it’s very intimidating to be within 10 to 20 blocks from numerous tertiary care centers where there’s heavy specialization, where people who are not only maybe your mentors, but well-established experts in their field are competing with you for the same patient population. If you’re practicing in an environment with low density, that’s a different situation. You have to determine for yourself what’s the environment that you’re going to settle upon for yourself. Beyond that, for personal gratification, it is nice to complete your training and then dive into something deep and see. Even though the training is a long and arduous process, to craft your trade and dive deep into an area of focus gives you a tremendous amount of confidence before you go into practice.

You finish up ENT residency and you can start working, but what subspecialties of ENT can you do a fellowship? What opportunities are there for an ENT doctor to subspecialize?

Interestingly, I don’t know exactly how many years ago but there were no fellowships. Fairly now, the generation above you and I, there’s a number of people who specialize, but they didn’t go through a fellowship process. That’s a relatively new thing that developed before our time, but the five major subspecialties of ENT include pediatrics. You can do all these areas of ENT that I’m about to mention, but you can further specialize, and those five areas include pediatrics neurotology, rhinology which is sinus, facial plastics and laryngology, which is expertise in voice and swallowing disorders.

Often these additional training are only about another year on top of the ENT residency?

The exception to that is neurotology, which I believe in some cases is two years.

 

For your work, for your career, what is your typical day like? When you come in, how many patients do you see? When you leave, who are you dealing with?

I usually operate once a week. Those days are a little different than the days that I don’t operate. The four days out of the week that I don’t operate, I’m usually starting in the office at around 8:00 in the morning. I’m wrapping up my day by about 5:30 to 6:00 in the evening. It’s a busy day. I’m usually seeing about 30 to 40 patients in a day, which was different during the first 5 to 10 years of my career. Now as you develop more and more of a reputation and your patients start spreading the word, you become busier and busier. That’s the thing about going into practice that you are never taught is the element of being patient and organically growing your business through the good care that you provide one by one, one patient at a time.

You didn’t learn that until you were working. You never learned how to cure patients or how to market yourself.

That was never part of the training. The training was developing the skillset so that you could come out of the training well qualified to deal with the issues that you were going to face. The realities of being in practice, that’s a whole other learning curve that begin day one when you go into practice for yourself.

Is that something do you think that you could better prepare for or is it something that you have to deal with it when you start working?

It’s like having a child. You’re never ready until it happens. I’m sure there are skills that you develop during the course of your lifetime that helps you in any situation. They’re translatable skills. It’s like your skill to network and your skill as a human connecting with other humans. The biggest mistake that I see a lot of new people make is that the amount of time that you spend outside of the practice, building your practice could be as consequential, if not more, in terms of being successful in practice. It’s important to build those relationships, whether it be the referring physicians or local urgent care. There are all kinds of new networks that are constantly building. When we started practice, social media wasn’t a thing. I’m definitely not somebody who partakes within social media at all. The reality is that the way people are finding doctors now is very different than the way they were looking into it when we went into practice. Everything evolves and you have to be malleable. I don’t want to equate it necessarily with a business. Being in practice, you’re running your own business essentially.

Do you think your colleagues feel the same way in terms of their preparation coming out? You come out and you have to learn about the business of medicine or do you think some of your colleagues are much more prepared in terms of getting ready and be able to get their name out there? If so, what were they doing to better prepare them?

There are different personalities. There are some personalities and from day one may intend to go out and work for an institution. They don’t want to have to go out and hustle for patients. They want to have the backing of the institution and to be it. Not everybody has the ambitions to necessarily be involved in the business of medicine necessarily. Some people would love to go and work for an employer and not necessarily be an employer themselves, even if they don’t go into academia.

There’s one particular resident senior to me that I recall and he had moved down south and he had this plan to start this huge operation. From what I heard of him not long after he had left residency is he had like a sleep center and maybe even an ambulatory center. He had very high ambitions and was ready to hit the ground and run. Not everybody necessarily is, to that degree, ambitious. If you’re practicing in a place like New York City versus a more suburban or rural setting, the capital costs to starting stuff are going to limit how quickly you can move like that as well. Every situation is unique unto itself.

What are the different venues that an ENT doctor can work in?

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The first distinction is the density of the population you want to be catering to. I don’t know the exact numbers but there are approximately 200 residents that graduate in the discipline of ENT per year. You spread 200 residents over and also understand that those graduates are going to concentrate in usually clusters within the country where there’s already a well-met demand for those specialists. That leaves a lot of the country with a huge demand for these specialists. The ethics of that is a separate conversation, but the beauty of being in a specialty with a constrained number of trained individuals is that there are plenty of jobs around the country. Maybe it’s going to be a little bit less favorable to work in a big city than an area where that demand is unmet. The second breakdown that I would say exists, like any physician making a decision, what setting to practice in is whether you go into academia or into private practice. Those are the two breakdowns. If you look at it that way, by geography, population density, academia versus private practice, that pretty much nails down your options and shows you the layout of the land.

Is there any particular moment or situation or patient encounter in your career where you believe your involvement affected a person’s outcome or even their life that you could share with us?

You asked me that right before we started. The first thing that comes to mind and you asked me that is a young woman that I cared for. My impact on her was short-lived because she was sick. She had a terminal case of lymphoma and was on heavy-duty chemotherapeutics. She essentially had an absent immune system because of the powerful nature of the treatment that was used to treat her cancer. The first time I met her, she presented to me with an invasive form of fungal disease within her sinuses. Generally, this type of presentation is deadly. I see her as an outpatient. She wasn’t sick enough at that point, but immediately I had to make a decision to take her to the operating room and remove a large portion of her support system that was holding up her nose. She came out of that essentially with a deformity, but she lived and she was in her 30s. She was married with three children. She was extremely grateful.

The situations are not always as dramatic as I’m describing to you that are memorable. You have an opportunity to help people even if it’s not a life or death situation. She made an impact on me because I remember not too long after that, maybe 2 or 3 years later, she started to get sent back to me by her oncologist. There were concerns again. She was pounded with more chemotherapeutics because she had gone into remission and then redeveloped a new and much more aggressive form of her disease. They were trying to throw things at her at all cost. At that point, it became more of a question why such heroic efforts were being made. Along the way, I got to know her and her family.

You never forget those situations where someone is so young. She was probably exactly the same age as I was at the time. It’s hard because you start to put yourself into that person’s shoes and you think about the consequences of leaving behind small kids and a young family. She was graceful, and I remember getting a card from her husband after she passed. They were very thankful about the way that I was able to be a part of her care. Even though I felt like I didn’t do much because you define your success by the ability to save someone. In this particular case, there was no saving her. She succumbed to her disease and in my opinion, probably was overtreated. You can’t criticize that. Sometimes the patient is willing to do whatever it takes at all costs to get another day, another week, another month. Until now, I keep that card in my desk. Every once in a while, I’ll open that drawer and see it. It’s a reminder of how lucky we are to have what we have and to be involved in her life. It was a real privilege.

What are some of the favorite parts about your typical day?

The thing about what I do is I like to be involved in a lot of different things. Even though I have the specialties that I have, a large amount of what I do spreads across the spectrum of what our specialty allows for. In other words, the limits of our scope are defined by the boundaries of the anatomy that we see. Having said that, I will most generously refer out complicated and surgical cases that I feel other people can manage better than me. That’s the privilege of being in a major urban area like New York City where there are many capable and excellent clinicians. I particularly love interactions where people are interested in bettering their life in terms of preventative health. Using something specific within our specialty to look at their overall health define for themselves goals in terms of helping better those specialty-specific items within the context of the overall health.

Looking at things not as a specialty but in the setting of a holistic sense, that’s a gratifying part of what I do. It’s something that has taken time to carve out because that wasn’t something that was necessarily trained in me. It’s not like the minute you graduate from your program, you’re etched in stone and that’s it, you practice what you were taught. There’s so much room for bettering yourself and those interactions have with others continues to teach you a lot about what it is you demand from yourself or what expectations you have. My patients are how I learned. What I accomplished and the satisfaction I get is completely bound by their experience and how they benefit from their interaction with me. It’s a two-way street. Obviously, you don’t want to paint an overly rosy picture. There is a huge burden placed on every clinician.

You’re in the grind. You’re seeing one and then another. As satisfying as a situation may be, the minute you’re done, it’s like the slate is blank and you start all over. It’s funny because now that we’re in this situation where there’s this shutdown, I crave those humans interactions again. When you’re in the grind, the thing that you want most is solitude within yourself because you don’t get a moment of quiet or peace necessarily when you’re busy. That’s interesting to look into. It’s like the grass being greener constantly. There is no perfection and things are constantly in flux.

It sounds like you, over the years, have evolved in terms of how you use your training as an ENT doctor and now provide more of a holistic overall approach as opposed to specifically focus on a body part. Do you find other physicians and doctors are like that?

 

No. There’s a growing interest, but I would say within specialty care, for sure, very few. There are a number of areas where people are carving out a growing interest in looking into these things like functional medicine. You don’t have to label yourself as a person who “performs functional medicine or primary care medicine,” to still interface with someone on a level of prevention. Let’s face it, the whole medical system is built on this concept of waiting at the bottom of the cliff. It’s all of our duties not to be there to help them when they’re in freefall and need that help, but also to use that as an opportunity to allow people to understand the bigger picture. No matter what your background, we all have the ability to have that influence.

Let me make sure we’re on the same page. What do you mean by holistic versus how you trained before when you first came out training?

Let’s put it in the perspective for instance of someone who’s an anesthesiologist. I want to speak your language a little bit. Let’s say you see a patient who’s having some form of elective procedure done. They come to you and they have the clearance from their primary care doctor, but they’re on heart medicines to help control their high blood pressure. They have diabetes and they have some weight issues. That may be a small 10 to 15-minute interface and you may not see yourself as playing a role in that patient’s care beyond the time the 10 to 15-minutes that you’re involved with them. I can assure you that patient when they see you have this supercharged impression of everything you say during those ten minutes and also the aftercare.

Your words and actions are powerful at that time. Let’s say you’re not, in that time, going to talk to the patient and tell them how to now newly manage their problems. A lot of times what I’ll see is I’ll take somebody through a procedure and the anesthesiologist will give me feedback that they had a hard time controlling their blood pressure. Maybe after the case, there’s a chance to coordinate back with that primary care provider or even talk to the patient about the fact that even though everything went fine, this is an opportunity to use this as a lesson. They look at it as an opportunity to improve on themselves. Too often, we provide ourselves with those boundaries. Things start and stop right here for my specialty in terms of how I’m involved in that person’s care. I see all of us as like a network, team players, building an understanding for patients as far as the bigger picture. Taking it back to my specialty, a lot of what I see integrates with a lot of their other problems. I see that as an opportunity to tie into those other problems and engage the other team members so that they don’t think of their problem as I take this pill and I fix it and that’s it.

I remove this one thing and I’m done with you.

The reductionist mentality. It’s this idea that I need to fix this and then it’s over. The beauty of my specialty, to some degree also, is there are those moments that are extremely satisfying. This is a problem, and I can remove that problem that’s bothering that person with my expertise. Those are satisfying situations. That’s not the majority of the time that I spend in clinical medicine. The majority of the time is much more complicated. They’re not reductionist problems.

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That was Dr. Guy Lin. This was the first half of the interview. In the second half of the interview, he talks more in-depth about how he got to become a physician, why he became an ENT doctor, who his mentors were and what he thought about mentorship and how important he believes in mentorship. Also, just a deeper perspective and discussion about how he made changes in his career to become a better physician. I hope you’ll be able to read that episode so you can get a full and complete picture of this interview with Dr. Guy Lin, which was wonderful. It’s very thought-provoking. Finally, thank you for joining in on this episode. I appreciate it. If it’s something that’s worthwhile to you, please hit that subscribe button. It helps elevate the attention to this show so that others can also benefit from it as well.

Important Links:

• Dr. Guy Lin
• Dr. Nathan Enoki – Previous episode
• ENT and Allergy Associates

About Dr. Guy Lin

Dr. Guy Lin received his Medical Degree from the University of California, San Francisco Medical School. He then went on to complete a General Surgery internship and an Otolaryngology-Head and Neck Surgery residency at the University of Pennsylvania. Dr. Lin also completed a clinical fellowship in Facial Plastics and Reconstructive Surgery through the American Academy of Facial Plastic and Reconstructive Surgery at Mount Sinai Medical Center in New York City. After entering private practice, Dr. Lin maintained a part-time academic position at Mount Sinai, teaching both residents and medical students at Elmhurst Hospital in Queens.

He has now devoted himself fully to private practice, maintaining close ties to Mount Sinai Hospital, as Associate Clinical Instructor, teaching both medical students and residents. Areas of special interest include sinus surgery and surgical treatments to improve nasal airflow. Dr. Lin’s extensive training provides him with unique expertise in rhinoplasty.  He is dual board certified by the American Board of Otolaryngology and the American Academy of Facial Plastic and Reconstructive Surgery.  Dr. Lin performs surgeries at Midtown Surgery Center and Mt. Sinai’s hospital and ambulatory centers.

Dr. Guy Lin also specializes in the nutritional management of common inflammatory ailments affecting the head and neck.  A major emphasis on whole foods that are plant-based will be used to help naturally treat chronic sinus, reflux, and other inflammatory disorders affecting the ear, nose and throat.  The goal will be to ultimately reduce the burden of antibiotics, reflux medications and other anti-inflammatory medications that provide a temporary fix to a problem.

For a more in-depth explanation and to view photos of the cosmetic options available, please refer to Dr. Lin’s facial plastics web page on the Advanced Facial Plastics website.

Please click here to read Dr. Guy Lins article on ‘How to Treat Silent Reflux Symptoms: Heatburn, Persistent Cough & Hoarsness’.