I am totally biased towards a GPR, so take the following comments with that in mind. I did a 2 year GPR, and frankly couldn't imagine practicing without having done it. Some of that I will admit was finding the right GPR for me, I know of many folks who hated their GPR, and all that I heard was comments like... "They had awful facilities/staff" "I barely did and (insert your favorite discipline other than restorative here)" "the attendings never did any teaching" etc, etc, etc.
In mine, St. Francis Hospital in Hartford, CT it was a nothing held back kind of approach. If the patient needed some implants, you did them, if they needed a 12 unit bridge, you did it, if they needed 8 endos you did them. I was suturing complex facial lacerations in the OR from trauma patients at 3 in the morning, I was going to the OR with the oral surgery fellow (at the time St Francis wasn't affiliated with the UCONN OMFS program as it is now) to help assist on both open and closed reductions. We regularly (2 days a week) took both pedo and special needs patients to the OR for full mouth dental care. We sedated patients for sets of wisdom teeth/endos/implants. The only thing that we didn't do alot of was ortho. Once again alot of this oportunity was set up by and outstanding group of attendings who not only were excellent clinicians, but also excellent and enthusiastic teachers.
As for what skills I picked up, number one speed/ confidence in treatment planning abilities and clinical skills. Number 2 experience, alot of potentially missed subtle diagnostic clues that will make for a superior result can be learned when you are working day in and day out with attendings who had combined close to 100 years of practice experience. Number 3, the ability to manage multiple patients/hygenists in multiple rooms at once. Number 4 management skills, especially during my 2nd year when I was chief resident and had 7 1st year residents to help train and make schedules for. Basically the core skills that I use every day in practice.
Conscious sedation, I'm qualified to take the exam, but I haven't and don't want to. First off in the last 3 years in private practice I've only wished that I had a sedation license 3 times, and all those times I've ended up calling in my local dental anesthiologist to sedate my patients. True, I'm not taking out nearly as many sets of wizzys as I did in my GPR, but to be honest with you the major oral surgical procedures are where you're most likely to have the post op complications where you get called at 2AM or over the weekend, and that doesn't interest me as much now as it did in my GPR (afterall we're all entitled to a life outside of dentistry, aren't we
) Also, if you have patients coming to you just because you have IV sedation, chances are that they are the dental phobics that really won't do alot of dentistry other than emergency stuff. Third, the malpractice insurance premiums are outrageous. You'd literally have to be sedating atleast a person a day to make it a financially reasonable thing to do in most general practices. Other cost issues associated with it, you need to tie up an extra room and have an extra person monitoring the patient as they are recovering before you can discharge them, and when the patient is sedated you have to be there the entire time so you can't be floating around checking your hygenists who are (hopefully) helping to find new areas of decay/ problems for you to correct on other patients.
Hospital vs non hospital programs. I loved the hospital environment, the nights on call, the rush I got when the trauma team was called to the trauma room to receive an incoming life flight(in a weird sort of way hoping there would be facial injuries so I'd called to the traume room also). I'm a bit of an adrenaline junky, and the challenge of the hospital environment really appealed to me. Non hospital programs, can easily give you an excellent residency training experience, it in many cases is also a similiar lifestyle to private practice, you just need to see which one really catches your interests/ excitement.
On last thing that I told all the perspective candiates that I interviewed for GPR positions during my chief year. Choose a program where you're a little nervous about being able to handle the work load/experiences that the program offers. That way you'll be pushed a bit which will ultimately make you a better clinician
