If practicing fellowship scope is even in your thoughts, you should pursue an MD. I think there is a huge misconception among applicants and residents. Fellowships are in general not very competitive to obtain which is why a 4 year and 6 year program does not matter and there are 4 year people that do them. But what people do not tell you is that you can do the fellowship as a 4 year, but obtaining a GOOD job afterwards is near impossible. For jobs for head and neck, a lot of them you have to interview with the ENT chair and so OMFS programs wouldn't even dare trying to bring a 4 year in front of them. The best jobs are the private hospital jobs for fellowship jobs and those mostly will not hire a 4 year - they can't have a PA or NP which is needed to generate production (These people are breaking 7 figures). Also, it's a disadvantage in the hospital not to have a PA or NP that the hospital pays for. Furthermore, look at the number of 4 year vs 6 year practitioners doing head and neck or cleft/cranio. It's pretty much 6 year dominated - almost 90%+. Yes, there's a handful for 4 years doing it. Cosmetics is hard as a 4 year. There's unicorns doing it but it's mostly MD dominated. Also look at the fellowship directors, there's a reason why everyone is a 6 year and at the job they're at. (They're good jobs because they have a fellow doing their scutwork)
