Ear, Nose and Throat Surgeon

What ENT (ear, nose and throat) surgeons make

Net income after overhead. Most bill the province per operation and clinic visit. A large office practice means higher overhead. Pay varies by province and billing model. CIHI (Canadian Institute for Health Information) reports average gross payments of about $552,000 for otolaryngology in 2023 to 2024, before overhead, and Job Bank puts the median for all surgeons at about $419,000.

During residency

Residents are paid employees. Quebec pays the least. Call covers airway emergencies, nosebleeds that will not stop and facial trauma.

Office procedures add up

Unlike many surgeons, ENT (ear, nose and throat) doctors earn a big share of their income outside the operating room. That makes the job less dependent on scarce hospital operating time.

What it costs to get there

Undergrad degree (3 to 4 years)

$7,000 to $10,000 a year

Medical school (3 to 4 years)

$15,000 to $28,000 a year

MCAT (medical school admission test), applications, interviews

$2,000 to $5,000

MCCQE (the national medical exam) plus the Royal College exam

$1,500 for the MCCQE, plus several thousand more for the Royal College exam

Office scopes and equipment once practising

Tens of thousands of dollars or more

Roughly, all in

$74,500 to $167,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is a three year undergraduate degree at cheaper tuition, a medical school at the low end of Canadian fees, and the national medical exam plus the specialty exam. The high end is four years of undergraduate study, an expensive medical school, and the top of every exam fee. The five year surgical residency is paid, and a fellowship adds one or two more years at roughly resident pay, so the long training is income rather than cost. Office scopes and equipment are left out here because they are the cost of running a practice later, not of qualifying, and they run into tens of thousands of dollars.

Typical debt at the end of medical school is $80,000 to $150,000. Fellowships add 1 to 2 years at roughly resident pay.

What comes with the job

• No employer pension

  Most surgeons are self-employed and save through a professional corporation.

• Private-pay options

  Cosmetic nose surgery and some sleep and allergy work are paid by the patient.

• On-call stipends

  Extra pay for covering airway emergencies overnight.

• Malpractice coverage

  Through the CMPA (Canadian Medical Protective Association), partly reimbursed by provinces.

The path

Same road as every surgeon. The official name is otolaryngology, head and neck surgery.

1. 1

   High school

   Grades 11 and 12

   Top marks in biology, chemistry, math and English. A very high average is the entry ticket.

2. 2

   Bachelor's degree

   3 to 4 years

   Any major, usually life sciences. High GPA, research, volunteering. Write the MCAT (medical school admission test).

3. 3

   Medical school, the MD (doctor of medicine)

   3 to 4 years

   Acceptance rates are 5 to 15%. Electives in ear, nose and throat surgery plus research in your final year decide the match.

4. 4

   Otolaryngology residency

   5 years

   Matched through CaRMS (the residency matching service). Paid, supervised. Ear surgery under a microscope, sinus surgery through a camera, cancer surgery of the neck, kids' tonsils and ear tubes.

5. 5

   Royal College exam, licence, often a fellowship

   1 to 2 years

   Pass the Royal College of Physicians and Surgeons of Canada exam, register with your provincial College of Physicians and Surgeons. Many add a 1 to 2 year fellowship.

High school courses that help

• Biology and chemistry

  Required for nearly every pre-med path.

• Physics

  Sound, hearing and airflow are physics. Also on the MCAT (medical school admission test).

• Calculus and functions

• English

  You will explain voice, hearing and cancer to patients of every age.

Time and money, at a glance

Years after high school

12 to 15

Med school acceptance rate

Roughly 5% to 15%

Otolaryngology residency spots in Canada

About 35 a year

Total tuition

$90,000 to $150,000

Paid while training?

Only from residency on

Heavily regulated

You need a licence from your provincial College of Physicians and Surgeons to practise, and specialist certification in otolaryngology from the Royal College of Physicians and Surgeons of Canada to work as an ENT (ear, nose and throat) surgeon. Hospitals grant operating privileges only with both. Licences transfer between provinces with paperwork and fees.

Fellowships that shape the job

• Head and neck cancer

  Big operations removing tumours of the mouth, throat and neck, often rebuilding with tissue from elsewhere.

• Ear and hearing (otology)

  Cochlear implants and microscopic ear surgery.

• Sinus (rhinology)

  Camera-guided sinus surgery, some skull base work with neurosurgeons.

• Pediatric

  Airway problems, tonsils, ear tubes and hearing in children.

• Facial plastics

  Nose reshaping and facial reconstruction, partly private-pay.

• Voice (laryngology)

  Singers, teachers and anyone whose voice has failed.

Nice-to-haves

• Electives and research in ear, nose and throat surgery

  Reference letters from the specialty decide the match.

• Fine motor skills

  Ear surgery works on bones the size of a grain of rice.

• Comfort with kids

  A large share of patients are children.

• Comfort with cameras and scopes

  Much of the specialty is done through an endoscope on a screen.

Community versus academic

A community ENT (ear, nose and throat) surgeon does tonsils, sinuses, ear tubes, nasal surgery and office scopes, with decent hours and light call. An academic head and neck cancer surgeon at a teaching hospital does 10-hour operations and heavier call for lower pay per hour. Most residents pick a lane by their final year.

A typical day

Surgery days: 8:00 a.m. in the operating room (OR) for a run of short cases, tonsils, ear tubes, a sinus surgery through the nose, or one long neck cancer case. Clinic days: 30 to 50 patients, scopes through the nose to look at the throat, ear cleaning under a microscope, hearing results. Call is a few nights a month: a blocked airway, a deep neck infection, a nosebleed that will not stop.

The honest trade-offs

Work life

Typical hours

50 to 60 a week, moderate call

Remote work

None

Physical demand

Moderate to high, microscope and scope work

Unionized

Residents yes, staff surgeons no

Similar paths

• AudiologistTest hearing and balance, fit hearing aids, and help people hear again. A master's degree and only six schools in Canada.
• Speech-Language PathologistHelp people speak, understand and swallow safely. A master's degree, then schools, hospitals or your own clinic.
• Plastic SurgeonRebuild what injury, cancer and birth defects take away, and reshape what patients pay to change. Far more reconstruction than Hollywood.

The most common surgeries in kids

Ear tubes and tonsil removal are among the most common operations performed on Canadian children. An ENT (ear, nose and throat) surgeon may do several before lunch, each in under half an hour.

The smallest bones in the body

The three bones of the middle ear are smaller than a grain of rice. Ear surgeons repair and replace them under a microscope, and a cochlear implant bypasses them entirely to restore hearing.

The doctor of last resort for singers

Voice specialists in otolaryngology treat professional singers, actors and teachers. They look at the vocal cords with a strobe light to see them vibrate hundreds of times a second.

Nobody can say the real name

Otolaryngology, head and neck surgery is the official title. Even doctors say ENT (ear, nose and throat). It comes from the Greek words for ear and larynx, the voice box.