The Reasons We Keep Going

Phoenix in April is relentless in the most beautiful way — sunlight all day, mountains at every horizon, the kind of clarity in the air that lets you see all the way to the edges of things. I arrived at the Combined Otolaryngology Spring Meetings (COSM) 2026 tired on a Wednesday evening, carrying the weight of a division that is still growing, changing, and demanding more from me than I often feel I have left to give. But something happened over those days that always happens, the thing I forget until I am deeply immersed in our meetings: The young people reminded me why I am here.

This happens every year—not only at COSM. For over 20 years, whether it’s at meetings for the Society for Ear, Nose and Throat Advances in Children (SENTAC), American Society of Pediatric Otolaryngology (ASPO), American Academy of Otolaryngology–Head and Neck Surgery (AAOHNS), or the Triological Society sections, or when privileged to be invited as a visiting professor or speaker, being inspired, humbled, and re-energized is what drives my commitment to mentorship, clinical research, and discretionary effort. We attend these conferences for the science—great podium and poster presentations, panels on complex subspecialty topics, and increasingly rich career development and leadership programming. But what I carry home is the energy of the residents, fellows, and early-career surgeons doing this work with a freshness and hunger that inspires me. They refuel me. They always have.

I share with students and trainees that the most unexpected gift of my career has been the countless friendships and networks of support I never anticipated when I was in training. The chance conversations about work, family, and personal challenges that occur with ease only a few times a year have become among the most cherished parts of my life.

The Letters

Every cycle, I prepare for fellowship interviews by reviewing each application and reading each of the three or four letters of recommendation carefully. These letters shouldn’t be treated as a perfunctory exercise. Each one represents a very busy faculty member who took time to write something true about an applicant with a long track record of giving everything—in academics, athletics, community service, and life—to reach this point in their training.

The best letters do more than check the boxes of strong technical skills, intellectual curiosity, excellent communication, and high emotional intelligence. They summarize character strengths and dependable actions observed over months and years of research projects, clinical mentorship, and countless small moments of accountability. I can feel the weight of the relationship in them—the mentor who stayed late to give feedback, the trainee who welcomed it and showed up every day with self-awareness and dedication. When I read one of those letters, I am not just evaluating a candidate; I am witnessing a lineage. I am seeing the way the best parts of our specialty pass from one generation to the next.

Having been on both ends of this journey, I remember with crystalline clarity what it felt like to be the applicant—the specific anxiety of not knowing whether what I wanted to pursue was something those who had already mastered their careers would find worthy. Now, many years later, I am the one writing the letters. I understand something I did not then: A truly good letter costs something. It requires the mentor to have invested deeply—in time, energy, and attention—so that they have something worth saying.

The best letters I read are not about credentials. They are about character witnessed under pressure. That is what we are really selecting for.

Fellowship Interviews and What They Reveal

The fellowship match cycle for pediatric otolaryngology comes with unspoken pressure. In a compressed span of time, programs and candidates try to see each other clearly enough to make a decision that will shape, in no small way, the trajectory of a career. For over six consecutive years, the number of applicants to pediatric otolaryngology has decreased until this year. As Al Merati, MD, articulated pointedly during the Accreditation Council for Graduate Medical Education (ACGME) graduate education panel, each year a trainee hasn’t graduated, hundreds of thousands of patients have one fewer practicing otolaryngologist providing access to care. That truth lands differently when you are sitting across from a PGY-4 who has sacrificed years and incurred real financial cost to be in the room with you.

What I have come to understand is that the interview reveals less about what candidates say and more about how they think. The most memorable applicants are not the most polished. They are the ones who pause, who acknowledge complexity, who say “I hadn’t thought about it that way”—and mean it. Curious rather than merely confident.

This year, I was blown away by the caliber, poise, and depth of this applicant pool—PGY-4s with research publications, unique hobbies, and some who are already parents. When do they sleep? We continue to see highly accomplished international medical graduates navigating enormous logistical and cultural hurdles to train here. Candidates from underrepresented backgrounds—in race, ethnicity, and from programs without home otolaryngology faculty—spoke honestly about the real cost of reaching an in-person interview. This year’s cohort called themselves the “pandemic class.” None had visited any programs for residency interviews in person, so visiting Cincinnati Children’s and meeting faculty and trainees face to face carried a meaning that was palpable.

Phoenix Showed Us Where We Are Going

This year’s ASPO program Bluestone Lecture was given by Robin Cotton, MD, whose talk was titled “Bridging the Past to the Future (No AI Slop).” Dr. Cotton’s name alone carries the weight of a whole era, spanning more than four decades in pediatric airway surgery, his legacy lived daily through dozens of division directors and faculty, former Cincinnati fellows, across the U.S. and the world. When he took the stage, the room went still in the way that only happens when someone walks in who has been the room’s reason for existing, in some important sense, for decades. He did not perform. He reflected on the birth of ASPO, the history of our subspecialty, the patients who shaped his understanding of the work, and what it means to build something that outlasts you.

I looked out at the hundreds in the audience and thought about continuity. What does it mean for a specialty to have lineage—not just surgical techniques passed down and built upon, but values, commitments, and a shared understanding of what excellence looks like when it is pointed at a sick child and a family enduring suffering while holding onto hope?

My dear friend Dana Thompson, MD, delivered the Kerschner, Derkay, and Cunningham Lecture, “Leading Change.” As always, she spoke with conviction and clarity about what is required to shift our culture in healthcare—not merely to innovate technically, but to change how we think about who belongs here, how we train, and what we owe those who come after us. Dr. Thompson has given oxygen to that conversation across the Triological Society, the American Broncho-Esophagological Association, the ASPO, and the American Laryngological Association for years.

So many incredible panels on the program for every society at COSM! They span areas ranging from clinical expertise to disparities and equity, or lack of, in healthcare delivery, to leadership. The ASPO panel “Career Paths to Hospital Leadership for Pediatric Otolaryngology,” featured Drs. Steven Goudy, Joshua Bedwell, and Daniela Carvalho—three surgeons who took different routes into leadership and spoke honestly about what those paths cost and what they gave. The panel on “Expanding Our Surgical Identity: Building the Future of Pediatric Head and Neck Surgery” opened a necessary conversation about what our subspecialty needs to claim and grow into. ASPO has now officially rebranded as ASPO-HNS—a signal that the panelists, many of them mid-career, were not the most senior names in the room by design. We have brilliant young surgeons in every subspecialty who will challenge the past, push boundaries, and create better paths for the trainees who follow.

What I witnessed in Phoenix was a specialty in the middle of becoming something. Not finished—that is never the point—but actively, intentionally growing toward its best version of itself.

The Triological Society: A Legacy That Keeps Living

On Thursday morning, I attended the Triological Society’s New Fellows Induction Ceremony. Thirty-two new fellows were inducted at the 128th Annual Meeting—each having completed a mentored thesis accepted by peers and joining a society that has, since 1895, asked its members to prove not just clinical competence but commitment to scholarship. I will never forget my own induction in 2012. Greeting each new member in the long procession is not nostalgic so much as clarifying: This tradition has been cherished and protected for a very long time, and each generation that commits to rigor and mentorship adds to something that will outlast us all.

The third annual Gerald B. Healy Panel on the current state of graduate medical education, moderated by Triological Society president Alan Micco, MD, addressed changes and challenges affecting programs and trainees today. The gift of these conversations is not in their resolution—it is in the stillness they require. A few days each year, when we are not racing between patients and inboxes, we get the gift of being still together, listening to new perspectives, and continuing our own learning.

What the Young Keep Teaching Me

On Friday afternoon, the session featuring the gene therapy panel and otology podium presentations was astounding. Presenter after presenter—residents, fellows, early-career faculty—walked to the microphone to share work built over years. Cochlear implant equity. Genomic newborn hearing screening. Gene therapy for otoferlin-mediated hearing loss is becoming, for the first time, a clinical reality. The following morning, I turned on the news at 6 a.m., and gene therapy as a novel treatment for pediatric sensorineural hearing loss (SNHL) was the national story. What we had heard from the podium was already the world.

Over the years, more presenters are medical students, residents, and fellows rather than attendings. Fearless, rehearsed, giving everything to a six-minute window—these presentations show us that the specialty’s future is being actively secured, not waited for.

I am genuinely energized by young trainees and faculty. This is not a senior physician’s performance of generosity. It is a physiological response to being in the presence of people still discovering what they are capable of. Their drive reaches me. Their questions reach me. And this year, something new: From being eagerly greeted by fellowship applicants I had met just weeks before, to research fellows from the Medical University of South Carolina (MUSC), to medical students from my new affiliation at Northeast Ohio Medical University, to hugging University of Central Florida students I once mentored who are now attendings with spouses and children and gorgeous photos to show me—this COSM was beyond memorable.

The most incredible experience at this COSM was having our daughter Claire with me in Phoenix. As a college sophomore, Claire had the opportunity to present a poster on the impact of cochlear implantation on neurocognitive development and outcomes for pediatric SNHL—work made possible by the mentorship of David White, MD, Shaun Nguyen, MD, and the MUSC otolaryngology research fellows who gave her that experience. Claire was nervous. I watched her present to many of my dearest friends and colleagues, who came to her poster in support. I stood nearby and felt something I have no clean word for—pride and gratitude and the strange, full feeling of watching someone you love step into a world you have loved for decades.

The future of our specialty is not something we watch happen. It is something we make—one letter, one interview, one honest panel conversation at a time.

We Are the Ones Who Pass It On

A career, if you are lucky and intentional, becomes a kind of gift—accumulated experience, judgment, and hard-won wisdom offered to the people who come after you, alongside hundreds of colleagues and friends you cherish along the way.

We know the burdens of training well: the time it takes, the documentation it requires, the emotional labor of guiding someone through their most vulnerable clinical moments and trying to teach them not just the next surgical maneuver but how to navigate this life. All of that is real. But there is also this: We get to be part of why the next generation of otolaryngologists becomes who they are. That is not a small thing. That is, on the best days, the whole thing.

To every fellow applicant who sat across from me in Cincinnati or on Zoom this cycle and trusted me with the story of why you want this—thank you. I read everything. I see your passion and your future, no matter where you end up training. Congratulations to all who matched and all who are graduating. I am rooting for every one of you.

Our specialty is in good hands. I saw it in Phoenix. I see it every time I read a letter that makes me put it down and take a breath. That is enough to keep going. It is more than enough.   

Dr. Wei is the division director of pediatric otolaryngology at Akron Children’s Hospital, where she holds the Alfred J. Magoline Endowed Chair. She is a professor at the University of Cincinnati College of Medicine and NEOMED, past president of ASPO and SENTAC, and associate editor for ENTtoday. She attended COSM 2026 in Phoenix, where she served as session proctor and participated in the ASPO Annual Meeting.