Academic vs. Private Practice OMFS [current residents]

[piko00]

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Who's planning on staying in academic omfs and who's going to private practice. Most importantly please explain why.

It seems that most omfs graduates take the private practice route for financial reasons and because of the low stress involved (or rather no stress involved). What's the deal? I might have misunderstood, but it sort of sounded as if academic omfs's don't make as much money. Was that a misunderstanding on my part, or is it just that their lifestyle is more stressful. If I'm interested in academic omfs, should I expect to be poor or something in return for having the guts and the desire to stick to the real meat and the complicated procedures of omfs and the associated stress, as opposed to jumping ship to do 3rd molars and implants in private practice?

Please vote and discuss what you're up to. For those planning to stay in academic omfs, please share your thoughts. For those taking the private practice route, share your thoughts also and explain the reasons why you're leaving. Is it the stress that you'd prefer to live without, or is the cash (if I'm not misunderstanding the situation) that you're going for?

 

[oms fan]

As it stands right now (I don't start my res until July), I plan on an academic career. I already am a faculty member and there are so many things that I like about working in academia versus my thoughts about what private practice might be like.
I think it is without doubt that you can make significantly more money in private practice. However, that doesn't mean that you're going to be in the poor house if you go into academics. You will have your base salary...but you can, and are usually expected, to work in the faculty practice. This can supplement you income tremendously, and make it a comfortable living.
Money is certainly important. I am going to be 36 when I'm done, so I am getting a late start on my retirement. However, if I only wanted to make money, I could be doing that right now in private practice as a GP.
I can't stop thinking "Why would anyone spend 4-6 more years of there life learning such complex (and really cool) procedures just to go into private practice and take out thirds and place implants." It seems unfulfilling to me. That isn't to disparage anyone else's choice. We all do what we have to do. I just think academic OMS would be way more fun.
Obviously, you can be in private practice and supplement your practice with more hospital procedure. You can take call at your local trauma unit, get on a head and neck team and do some craniofacial stuff. I just don't see many of them doing that. In Vegas, there are maybe 15 OMS. A few of them take trauma call, not all. Most of them do very little orthognathic etc...
One guy in town is a superstar...he is the one we all look up to. He does a lot. But I think he is by far the exception.

So, long response.
I will qualify everything I just said with this...six years is a freakin' long time. A lot may change in that time. Who knows, I may forsake the academic route for more cash. I know my wife would like me to make good money after all this. 🙂

 

[OMFSCardsFan]

I will qualify everything I just said with this...six years is a freakin' long time. A lot may change in that time. Who knows, I may forsake the academic route for more cash. I know my wife would like me to make good money after all this. 🙂

It would be interesting to follow the preference over the six years. I know several residents who were gung-ho academics which have changed their minds...I was private practice from the get-go. And I didn't hide that fact during my interviews. I would like to be in a private, broad-scope group practice. We'll see if I find one...

 

[piko00]

That's very tricky, because after spending 8-10 years in dental training alone, one would expect to afford the nicest things to his family.

How much different is the gap between academic and private practice omfs in terms of pay?

Is there a way to compromise such that one is making private practice pay while still working on complex cases such as Trauma, etc. like oms fan was saying above.

Is it possible to start your own broad-scope practice if you couldn't find a broad-scope group?

Please discuss over and above these questions if you can.

Thanks for everybody's input.

 

[oms fan]

I'm surprised more guys aren't posting any comments...😕

 

[EuroOMFS]

I'm surprised more guys aren't posting any comments...😕

OK. I'm not in the US, but things aren't that different over here when it comes to academics vs. private practice.

I was dead sure when I entered into OMS that I would go into private practice, probably retaining some ties to hospital (trauma call, orthognathics etc). Then, as I saw more, and did more "real" OMS procedures, I became less focused on private practice, and wanted to stay in academics/hospital service.

Now my chief resident year is coming up. I've done four years of residency, with an income that sucks, and I'm pining for greener pastures I'm really very undecided. On the one hand, I see my GP buddies who by now live a very comfortable life, with nice houses and cars, go on vacation twice a year etc. On the other hand I see a carreer in academics doing incredibly cool and fun surgery, making an OK living, but probably taking forever to get rid of my debt 😱 .

I'll probably end up doing 60/40, private/academic.

 

[UNLV OMS GUNNABE]

I'm surprised more guys aren't posting any comments...😕

There's nothing like 9 months of being an intern to really turn you on to private practice. Who knows, maybe I'll still want to do academics in 4 years.

 

[Stanford Fencer]

Unless you are on tenure track with need to become an independent investigator (i.e., R01 funded), you can still make a very attractive salary in the academia. Except, you aren't really in the academia, but more like a community surgeon who happens to work at an university setting. Ultimately, besides some teaching duties, life can still be like the private practice guys, perhaps doing more interesting procedures, with reduced income.

So really, I think either go all out private practice, or enter the tenure track which is really a monastic process. One can count all academic oral surgeons with R01 funding on one hand.

 

[mayo]

So lets say you decide to go into academic OMFS cos you love it to no end, how much can you reasonably expect to earn per year?

No pipe dreams of owning a personal Gulfstream V here, just enough to pay off the darned school loans, take 1 vacation a year with the wife and kids and have a modest but comfortable life with a house in the suburbs.🙄

 

[esclavo]

I'm surprised more guys aren't posting any comments...😕

I am going to repay a 3 year military commitment in Texas (where the bible belt and tornado alley cross). Then I want to enter private practice. Academics would be fun but I hate big beaurocratic things. The drawback to academia as I have known it is that it can be a huge beaurocratic/political jugernaut! The income is fine, it is the other BS that I couldn't handle. I would end up going postal on some of the crap I've seen happen in the hospital.... I plan on going into private practice in a smaller community that has NEED. I want to have a broad scope practice so I'll go somewhere that has legit need. I don't want to constantly be in urinating contests about my broad scope or privileges. Besides, I hate the city with a passion. Just give me decent hospital and a smaller community and some pent up demand and I'll be happy....

 

[IcedOMFS]

Academics would be fun but I hate big beaurocratic things. The drawback to academia as I have known it is that it can be a huge beaurocratic/political jugernaut! The income is fine, it is the other BS that I couldn't handle. I would end up going postal on some of the crap I've seen happen in the hospital.... ..

I agree with this. I hate beaurocracy, both in hospitals and dental schools... Just a bunch of people making arbitrary rules and regulations to serve their own convenience rather than in the interests of patient care and getting actual work done...

When I am done residency, I think I am going to branch out and diversify a little. See if I can't leverage my earnings as an OMFS into ownership of some other businesses. Namely Stripper Joints... That's where the real money is.

 

[eliteOMFS]

Don't take offense, but if your strictly limiting yourself to a private practice scope of OMFS chucking thirds and placing implants why didn't you chose perio?

 

[scalpel2008]

in addition to academics and private practice there's a third option now that seems to be quite tempting and that's "hospital OMS". Basically you work at a level 2 or a tertiary referral center and cover OMS issues and face trauma (sparse call)while they provide you with a clinic, equipment, and staff to set up your own clinic where you can even bring in your private patients. To me this is the best of both worlds, ie, you get to do bread and butter OMS yet you get to keep your fingers wet with some trauma, pathology, etc and although you do have to deal with some of the beaurocracy of the hospital, you have less of it (it seems) compared to academics. The pay is actually pretty damn good (some start at 300K+benefits and then whatever you want to bring in during your clinic hours). I think this trend will increase over the next few years as hospitals realize it's becoming more challenging to violate EMTALA laws and constantly turf patients.

 

[piko00]

I think this trend will increase over the next few years as hospitals realize it's becoming more challenging to violate EMTALA laws and constantly turf patients.

I looked up EMLATA and apparently it stands for Federal Emergency Medical Treatment and Active Labor Act, also known as COBRA or the Patient Anti-Dumping Law.

Didn't look up more detail about it though. Scalpel, can you explain what you meant about it becoming "more challenging to violate EMTALA laws and constantly turf patients."? I don't know anything about this EMLATA beyond what it stands for.

 

[esclavo]

in addition to academics and private practice there's a third option now that seems to be quite tempting and that's "hospital OMS". Basically you work at a level 2 or a tertiary referral center and cover OMS issues and face trauma (sparse call)while they provide you with a clinic, equipment, and staff to set up your own clinic where you can even bring in your private patients. To me this is the best of both worlds, ie, you get to do bread and butter OMS yet you get to keep your fingers wet with some trauma, pathology, etc and although you do have to deal with some of the beaurocracy of the hospital, you have less of it (it seems) compared to academics. The pay is actually pretty damn good (some start at 300K+benefits and then whatever you want to bring in during your clinic hours). I think this trend will increase over the next few years as hospitals realize it's becoming more challenging to violate EMTALA laws and constantly turf patients.

these new "situations" that scalpel is talking about do sound attractive.... it reminds me a little of where I am training. I think it is a good option. Besides, bringing in a private OMFS component to a hospital/clinic is a great cash cow.... should be a win win for a guy who still wants to do some extended scope stuff like path/cleft/cosmetics/bigger recon stuff etcetera....

 

[toofache32]

I looked up EMLATA and apparently it stands for Federal Emergency Medical Treatment and Active Labor Act, also known as COBRA or the Patient Anti-Dumping Law.

Didn't look up more detail about it though. Scalpel, can you explain what you meant about it becoming "more challenging to violate EMTALA laws and constantly turf patients."? I don't know anything about this EMLATA beyond what it stands for.

EMTALA is the reason ER's can't turn away patients who can't pay. It was a good idea, but it was mandated as a rule without any funding or recommendations on how the hospitals would deal with uninsured patients. Prior to EMTALA, the ER would perform a "wallet biopsy" on each patient. If the biopsy was negative then the patient got shipped to some county hospital, sometimes an 8-12 hour drive away.

Those hospitals still do this, but now they transfer so the patient can "receive a higher level of care." Yeah, whatever. I love getting called from the community hospital just outside of town here where 2 of our recent grads are practicing together. The ER doc always says "we don't have any oral surgeons here" and I always say "yeah you do....Dr. So-and-so....you want his number?"

The real tragedy is those private hospitals will do a CT scan on the patient just so they can bill Medicaid for a real ER visit. Then they ship the patient to us with the worst CTs you've ever seen. We have to repeat the CT just to get something usable, but Medicaid won't pay for it because they've already paid for the same CT at another hospital.

 

[Mask80]

I think it would be interesting to compare the willingness of interns Vs. that of chief residents to go to academia. I would bet there's a trend. I think you can make a decent living doing academia (depends also on where you live). But in general I would say you'd be making about half of what you make outside, only if you are pretty successful in academia. That requires a different set of skills.

 

[PM16]

Hello there,

This might be a naive question, but what does the option of working at a hospital (the third option mentioned aside from private practice and academia) actually entail?

So you have your own clinic and they assign you patients? You can bring your own in? The hospital sets the prices for the procedures?

What about regarding procedures that require actual OR time. How often is that? Do you have to be on-call, if so, how long? What type of procedures can one do in this position?

How are the hours? Are there any other benefits?

Thank you.

 

[sarah_bellum]

Excellent idea for a thread. I'd be interested in spanning this across all specialties. I'd really be interested in seeing a typical package offered to someone coming fresh out of residency, as I have no idea what kinds of compensation we're talking about.

I don't need to be rich - I need to payoff my loans and be able to pay a reasonable mortgage. I'm seriously interested in academia, but the financial pit I'll be in (even attending my state school) is pretty serious. I'm in dentistry as a career change, and more than anything else, I want to love my job. I think I can do that in academia at least as well as I can in private practice.

 

[DrReo]

Excellent idea for a thread. I'd be interested in spanning this across all specialties. I'd really be interested in seeing a typical package offered to someone coming fresh out of residency, as I have no idea what kinds of compensation we're talking about.

I don't need to be rich - I need to payoff my loans and be able to pay a reasonable mortgage. I'm seriously interested in academia, but the financial pit I'll be in (even attending my state school) is pretty serious. I'm in dentistry as a career change, and more than anything else, I want to love my job. I think I can do that in academia at least as well as I can in private practice.

I also attend a state school. The prosthodontist who have earned their certificate about 2-3 years ago are making 115k. The one has a master degree in education, pros and foreign dental is 125k. However, there are some DDS, PhD who are associate professors are at about 120k with research with teaching positions.

 

[toofache32]

Academic oral surgery positions are out there with a base starting salary as low as 120G and as high as 400G from what I've seen. Private practice usually starts in this range also, but the difference is that an exponential increase is seen in private practice while academic salaries increase very slowly.

 

[jk5177]

I plan on going into private practice in a smaller community that has NEED. I want to have a broad scope practice so I'll go somewhere that has legit need. I don't want to constantly be in urinating contests about my broad scope or privileges. Besides, I hate the city with a passion. Just give me decent hospital and a smaller community and some pent up demand and I'll be happy....

You read my mind.

 

[akog]

I'm going to necro this thread because it seems like the place to ask...

I'll be a D1 this fall, but I work at a coffee shop currently. I have this older, gray-haired gentlemen in scrubs come in most weekday mornings. He always seems really happy and has something snappy ready to say like, "TGIM. TGIM. Thank god it's monday. Hair looks good *brushes hair with hand* I smell good *sniffs*." One of the other baristas asked him what he did one day, and it turns out he's a private practice oral surgeon. (I remember her telling me he was an oral surgeon one day, and I looked down at the pitcher of milk I was steaming and mumbled, 'I ****ing hate that guy.')

So, this whole dilemma between academic and private practice is predicated, I take it, on the axiom that private practice is boring. And that seems like a reasonable assertion to me. Granted, I've only shadowed academic OMS, so I wouldn't really know. Which is why I'll ask: are there really surgeons out there who *only* do third molars and implants for decades of their lives? And... is that actually a boring thing? Or is there something desirable there... a "no two wisdom teeth are alike" kinda thing... or maybe getting so facile at it that it becomes a some sort of elegant, zen thing (which incidentally is what my 'boring' coffee job has become in a good way)...

Basically what I'm asking is: is private practice OMS really actually mind-numbingly boring?

(Obviously there's one objective truth between private/academic in that most private offices will be less socially interesting than hospitals, which is no small consideration.)

 

[vellnueve]

I'm going to live and work in an 1100ft floating steel box/international airport for several years and will initially make less than I will in residency.

After that? Hopefully hospital staff.

 

[armorshell]

I'm going to necro this thread because it seems like the place to ask...

I'll be a D1 this fall, but I work at a coffee shop currently. I have this older, gray-haired gentlemen in scrubs come in most weekday mornings. He always seems really happy and has something snappy ready to say like, "TGIM. TGIM. Thank god it's monday. Hair looks good *brushes hair with hand* I smell good *sniffs*." One of the other baristas asked him what he did one day, and it turns out he's a private practice oral surgeon. (I remember her telling me he was an oral surgeon one day, and I looked down at the pitcher of milk I was steaming and mumbled, 'I ****ing hate that guy.')

So, this whole dilemma between academic and private practice is predicated, I take it, on the axiom that private practice is boring. And that seems like a reasonable assertion to me. Granted, I've only shadowed academic OMS, so I wouldn't really know. Which is why I'll ask: are there really surgeons out there who *only* do third molars and implants for decades of their lives? And... is that actually a boring thing? Or is there something desirable there... a "no two wisdom teeth are alike" kinda thing... or maybe getting so facile at it that it becomes a some sort of elegant, zen thing (which incidentally is what my 'boring' coffee job has become in a good way)...

Basically what I'm asking is: is private practice OMS really actually mind-numbingly boring?

(Obviously there's one objective truth between private/academic in that most private offices will be less socially interesting than hospitals, which is no small consideration.)

I'll chip in with my beliefs on this since I've been mulling over these ideas the last two years,and I originally voted *undecided* in this poll when I was a first year resident.

I think there are a lot of private practitioners out there that do quite a bit more than just T&T, even more than reflected on SDN-type websites. Two of our recent grads are in private practice doing full scope craniofacial and microvascular oncology. There's a number of private practice guy in the DFW area doing full scope, including multiple guys doing microvascular (Kang/Williams), craniofacial (Sinn), cosmetics (McBride/Epker), trauma (Simpson/Michaels). There's the huge group in NC doing tons of orthognathics. McCain in Florida and Wolford in Dallas doing TMJ. Big groups in Virginia/Nebraska doing full scope. Legacy in Portland. Trippel in Seattle does a ton of stuff. Those are just the ones I'm naming off the top of my head from people I've either met or have some connection to my program. I think the "trap", if you can even call it that, that people fall in to is their T&T practice gets so busy that it becomes hard to justify angering your big money producing T&T referrals by booking wisdom tooth cases 2 months out so that you can fit in all the trauma and orthognathic patients that you have to let the time-sink OR cases fall by the wayside.

OMFS is a fantastic specialty, and you can make whatever you want out of it. For me personally, I'm continuing on in academics because I'm particularly interested in improving the way we educate residents and furthering the clinical science of our specialty. I like working in a large academic medical center, and as you alluded to, I think I'll thrive in that social dynamic over the classic "private practice." The fact that it allows for a full scope practice is almost ancillary, I believe if that's all you want you can probably accomplish that through either route.

 

[armorshell]

I'm going to live and work in an 1100ft floating steel box/international airport for several years and will initially make less than I will in residency.

After that? Hopefully hospital staff.

Is it true OMS on the big boat get an officers berth and get to do all the cool officer things like take helicopter rides and shoot bouys with the rail gun?

 

[vellnueve]

Is it true OMS on the big boat get an officers berth and get to do all the cool officer things like take helicopter rides and shoot bouys with the rail gun?

All dentists are officers and get officer's berthing (which is very spacious compared to, say, a Smart Car). The other stuff depends on who you make friends with.

 

[osteotomy01]

in addition to academics and private practice there's a third option now that seems to be quite tempting and that's "hospital OMS". Basically you work at a level 2 or a tertiary referral center and cover OMS issues and face trauma (sparse call)while they provide you with a clinic, equipment, and staff to set up your own clinic where you can even bring in your private patients. To me this is the best of both worlds, ie, you get to do bread and butter OMS yet you get to keep your fingers wet with some trauma, pathology, etc and although you do have to deal with some of the beaurocracy of the hospital, you have less of it (it seems) compared to academics. The pay is actually pretty damn good (some start at 300K+benefits and then whatever you want to bring in during your clinic hours). I think this trend will increase over the next few years as hospitals realize it's becoming more challenging to violate EMTALA laws and constantly turf patients.

This is my plan as I am about finish up. I know of several doing this successfully and making comfortable livings with loans paid back after a couple years. I think many guys underestimate this and automatically assume no such thing is possible. After so many years of straight T&T, I think I would get burnt out. I love the full scope and think it only serves our speciality more to practice everything.