Applying for OMFS ~6 years after graduating

[DivaDent]

Hi All!

I am a public health dentist, who graduated dental school in 2013. Every year since then, I've spent months contemplating whether or not I should apply. I truly enjoy doing oral surgery and I have spent the years since graduation improving my skills, but I am well aware of my limitations. I have spent the last three years working in a public health clinic in a rural area, where access to care is a major issue. If there is a surgical procedure beyond my comfort level or clinic accommodations, patients have to drive hours, find a way to pay a local oral surgeon, or in most cases let it be.

I am guessing I am a nontraditional applicant at this point. I have been so far removed from dental school in this time that I am almost clueless about what to do. Due to being a Full-Time state employee, going away for an externship would be extremely difficult. I see that I would have to take the CBSE and honestly I rejoiced in 2013 when I was done taking tests, but that's ok.

With all that being said, does anyone have advice for someone like me? Any experience with similar applicants or situations?

For a bit more information: I was not top 10% in my class, but I believe I was in the top 1/3. GPA was good. Lots of extracurriculars, mostly public health and community service related. Current public health dentist. Volunteer at local dental clinic and RAM clinics. 34 year old, single, AA woman with no children so relocation is not a problem.

Thank you!

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[Downfracture1]

I know someone who practiced for almost ten years as a GP in community health and now is an OMFS. There's an exam in about one week which is likely too late to sign up for, would have been a good dry run for you.

There is an exam mid-August this year I believe. I suggest you try and get into an intern/ non-cat year (a lot of programs are still looking for July), study as much as you can right now for the August exam, crush that exam, apply this summer. Do well your intern year and you'll match.

Goodluck!

 

[sgv]

It generally isn't looked favorably upon to have practiced GP for however many years.

You will likely have to do a non-categorical intern year.

An adverse view of studying for the CBSE doesn't exactly paint a picture of someone with the best insight into OMFS because you will be reading and studying every day during residency to keep up with your responsibilities and be a useful member of a team.

Your mentioning of literally just teeth removal as having piqued your interest may not paint you as someone with the best insight regarding the scope of OMFS. Generally, the primary interest that solidified applicants decision to pursue OMFS extends far beyond teeth. At least one externship might prove useful not only to your application but yourself as well.

With that said, if I were in your position, I would recommend using vacation time to do 3 externships, using every free minute to study for the CBSE, and then look into a preliminary non-categorical internship or just giving it a shot and applying.

Good luck!

 

[DivaDent]

It generally isn't looked favorably upon to have practiced GP for however many years.

You will likely have to do a non-categorical intern year at the very least.

An adverse view of studying for the CBSE doesn't exactly paint a picture of someone with the best insight into OMFS because you will be reading and studying every day during residency to keep up with your responsibilities and be a useful member of a team.

Your mentioning of literally just teeth removal as having piqued your interest may not paint you as someone with the best insight regarding the scope of OMFS. Generally, the primary interest that solidified applicants decision to pursue OMFS extends far beyond teeth. At least one externship might prove useful not only to your application but yourself as well.

With that said, if I were in your position or as someone who has some part of evaluating potential residents, I would recommend using vacation time to do 3 externships, using every free minute to study for the CBSE, and then look into a preliminary non-categorical internship or just giving it a shot and applying.

Good luck!

Thank you for your input. I would like to point out a couple things that may help clarify for you or anyone else replying. I'm not averse to studying or specifically studying for the CBSE. My point was that I had previously enjoyed being done taking tests, which is a realistic feeling that I had . Also, I didn't mention just "literally teeth removal" as what piqued my interest. I didn't actually state what piqued my interest at all or when it occurred. Thank you for your advice regarding externships/internships.

 

[KinKs]

I graduated in 2012 and I am about to begin the journey of becoming an oral surgeon. I am taking the test in August and started studying 2 days ago. You still have 6.5 months before the exam.

My path will be
A. Murder the CBSE
If unable to match:
B. Complete a non-cat internship
If unable to match
C. Rinse and repeat B

 

[Downfracture1]

I graduated in 2012 and I am about to begin the journey of becoming an oral surgeon. I am taking the test in August and started studying 2 days ago. You still have 6.5 months before the exam.

My path will be
A. Murder the CBSE
If unable to match:
B. Complete a non-cat internship
If unable to match
C. Rinse and repeat B

My only recommendation would be to start an internship in July as well. Goodluck

 

[nsx2omfs]

Can someone explain why is being a GP prior to OMFS residency is frowned upon?

I would think it’s the other way around. Being more mature and being able to complete a rigorous OMFS residency?

 

[deleted659902]

Can someone explain why is being a GP prior to OMFS residency is frowned upon?

I would think it’s the other way around. Being more mature and being able to complete a rigorous OMFS residency?

you've already tasted what making good money is like, and there's a good chance you might drop out of residency to go back being a GP with cush lifestyle. also, "you can't teach an old dog a new trick."

 

[Dwight K. Schrute]

There’a no such thing as a cush lifestyle for new grads. with half a mil in debt and being worked like a dog in a corp.

Working like a “dog” in a Corp is still cush compared to an oral surgery residency and making less than half of what even a new grad would make in that relatively cush corporate job. I don’t know if it is frowned upon but why go into gp when you would have shown more dedication by being an intern somewhere? I understand everyone’s situation is different but just because you were a gp somewhere for a year does not make you more mature than another person. It just gives you different experiences.

 

[321931]

I sorta posted this in another thread but I will edit as needed.

Is there a reason why you want to do omfs? You do know by the time you come out if you achieve it... a lot of your friends who just did a normal 8-5 4 day week practice will have their loans paid off, prob their practice paid off, net worth to their name etc etc. For example, I graduated 2014 with you...by the time you actually get finish OMFS, I will actually be done with my practice loan, done with student loans, and halfway done with house mortgage.

If residency is the way to go... that’s fine but you are going to be a decade behind your peers in terms of net worth, time spent with kids/family/ stocks, House, practice, student loan debt etc.

It would be like running a marathon with everyone else but you are running backwards for the first 13 miles.

What’s the point? Why do you want this so bad? If it’s for the money and security... then wrong choice. Prestige? Wrong choice. True love for it? Then sure I guess I can go with it.

If you want to practice and challenge yourself- then open your practice. Take CE, learn, grow, and reap the rewards. You can easily do OMFS as a GP and do IV sedation and the likes. Refer out the hard ones, and keep the easy ones for yourself. Do everything and do it for yourself.

 

[GimmeTheScalpel]

I sorta posted this in another thread but I will edit as needed.

Is there a reason why you want to do omfs? You do know by the time you come out if you achieve it... a lot of your friends who just did a normal 8-5 4 day week practice will have their loans paid off, prob their practice paid off, net worth to their name etc etc. For example, I graduated 2014 with you...by the time you actually get finish OMFS, I will actually be done with my practice loan, done with student loans, and halfway done with house mortgage.

If residency is the way to go... that’s fine but you are going to be a decade behind your peers in terms of net worth, time spent with kids/family/ stocks, House, practice, student loan debt etc.

It would be like running a marathon with everyone else but you are running backwards for the first 13 miles.

What’s the point? Why do you want this so bad? If it’s for the money and security... then wrong choice. Prestige? Wrong choice. True love for it? Then sure I guess I can go with it.

If you want to practice and challenge yourself- then open your practice. Take CE, learn, grow, and reap the rewards. You can easily do OMFS as a GP and do IV sedation and the likes. Refer out the hard ones, and keep the easy ones for yourself. Do everything and do it for yourself.

Why should OP care so much about how their peers are doing financially or what this person or that person is doing? They shouldn’t be comparing anything to a marathon with others. It’s their own life.

@DivaDent if it’s a well thought out decision that you and your family can stand behind then go for it. Do what’s best for you. Good luck!

 

[321931]

Why should OP care so much about how their peers are doing financially or what this person or that person is doing? They shouldn’t be comparing anything to a marathon with others. It’s their own life.

@DivaDent if it’s a well thought out decision that you and your family can stand behind then go for it. Do what’s best for you. Good luck!

Fair enough. The only reason I post contra opinions is to make other people think. Cheerleading is good but so are opposing views.

My main point is doing it for the right reason. What’s the OP reason? It wasn’t really that apparent. Many times I’ve talked to grads my classmates that are burned out from corporate and or Fqhc. Either by the amount of patients or inadequate pay or respect and they think that going back to school to specialize is their out. Some do it plainly because they want a bigger paycheck which ironically sets them so far back a decades worth. But as stated if done for the love or true joy or whatever then yeah no problem what so ever. Sometimes you just gotta be that voice that says are you sure you want to do this?

 

[AKtoTXstudent]

@Rainee was hoping to PM a question about this topic. I am in dental school currently and wondering about the opportunity costs of specializing

 

[BlackThought]

You can easily do OMFS as a GP and do IV sedation and the likes. Refer out the hard ones, and keep the easy ones for yourself.

Just semantics but just to clarify:

A GP can not "easily do OMFS" . They can try to incorporate some surgical dentoalveolar procedures into their practice, and I think that's what you meant.

The field of OMFS incorporates more than just dentoalveolar, regardless of what most private practice OMFS is.

 

[321931]

Just semantics but just to clarify:

A GP can not "easily do OMFS" . They can try to incorporate some surgical dentoalveolar procedures into their practice, and I think that's what you meant.

The field of OMFS incorporates more than just dentoalveolar, regardless of what most private practice OMFS is.

Semantics aside. Majority of oral surgeons that I refer to...just do IV sedation, wisdoms, surgicals, and implants.

A GP can easily do the above if they do CE and are confident in their abilities. Personally, I do not do any of the above aside from surgicals. However, I have GP friends that have no problems doing IV sedations, wisdoms, surgicals, implants, sinus bumps, bone grafts and the likes. Therefore, yes I stand by the comment that a GP can "easily" do the basics of OMFS entails.

I only know of one oral surgeon in the area that if a patient needed to have their face put back together will do it. However, he says that working with the hospitals and the compensation is a nightmare and so even he will just refer to a teaching institution with medical/omfs residents to take care of the situation.

So back to the topic at hand, if one truly hungers to just take teeth out all day...can do it with just some extra CE, marketing for it, and opening a practice in an area of need for that. Look up Murphs extraction courses. He can make you oral surgery proficient in a jiffy. Really good Doc.

 

[321931]

If an OMFS is sitting before you making expert testimony, do you really wanna say your credential is some weekend warrior courses taken here and there?

So if the case for going into speciality school for that case, I can go with that. With the reasons such as I want to be more involved in the community, I LOVE it, it's great amazing keeps me wanting more. Sure go for it.

My opposing view is for students that think "this is for money" "this is because I'm not happy with my current situation- not because they love OMFS, but rather they want to get out of their predicament." - You tend to see this alot with jaded dentists that are out 1-5 years that see 40+ patients a day making really crummy money in some dental mill being told by an office manager to do prophies and working 5 days a week with alternating saturdays with 8 PM end times. I've seen it alot amongst my dental friends. They just think if I go back to school all this nightmare will disappear. But in reality that's really setting yourself back. When you have loans that don't even have a dent accumulating 6% interest- putting that on hold and going back to school for 3-6 years... you are going to be in a world of hurt. There maybe some that say who cares about finances- sure. Most of the time these are individuals that are still single, or maybe have no debt or whatever. That's fine, but things change when you settle down with kids, family, plan out retirement...and then you see this big burden of student debt that will effect your life. It will change.

Going out and buying a practice/starting a practice will get you that dental lifestyle that alot of dentists associate with. That's why I present the opposing view. Nothing wrong with that.

 

[2TH MVR]

I agree with most of @Rainee points. Going into OMFS or any other specialty does not mean that your life automatically becomes better. There are plenty of GPs that make more money than specialists and vice versa. Also .... everyone here forgets that being a specialist (esp: OMFS) means you need to beg for GP referrals. Begging sucks. Trust me. One of the main reasons I left private practice for the Corp job was because I was getting tired of the referral (begging) game. OMFS get patients from essentially 2 sources: GPs/other referrals and being a provider on insurance plans. The one thing that OMFS has on other specialists (i.e Ortho) is that they are fewer in numbers. But that will change since EVERYONE here on SDN wants to be an OMFS lol. Also .... in the real world .... most OMFS do not do orthognathic surgery. With insurance ... it doesn't pay as well. The reimbursement is not worth the hassle of dealing with the orthodontist and the liability itself. I know of only ONE OMFS in Phoenix who does orthognathic surgery. I'm sure there are others, but it's not a large number .... by choice.

OP. If you truly love the field of OMFS ... then go for it. Just realize that you will have spent a large part of your life to achieve this goal and will have less time on the tail side to enjoy your decision.

 

[Likkriue]

The one thing that OMFS has on other specialists (i.e Ortho) is that they are fewer in numbers. But that will change since EVERYONE here on SDN wants to be an OMFS lol.

Why would that matter if the amount of OMFS graduates are capped by the limited amount of seats and length of program not by the amount of interest. Been a consistent 200 or so graduates every 4 years at the minimum. Very different from short specialties where they graduate 500 a program every 2 years.

Let’s say 20% of dental school students want to do omfs (1/5 of the class, well truthfully it’s like 1/2 of the class at the beginning lol), and there’s 230 positions, they can’t accomodate 1k students even if they wanted to.

 

[2TH MVR]

Why would that matter if the amount of OMFS graduates are capped by the limited amount of seats and length of program not by the amount of interest. Been a consistent 200 or so graduates every 4 years at the minimum. Very different from short specialties where they graduate 500 a program every 2 years.

Let’s say 20% of dental school students want to do omfs (1/5 of the class, well truthfully it’s like 1/2 of the class at the beginning lol), and there’s 230 positions, they can’t accomodate 1k students even if they wanted to.

Any new OMFS residencies open in the last decade or planned for the future? If no ..... You are correct and OMFS has done an excellent job at limiting their numbers. Seems like new ortho programs popped up to meet a "supposed" demand.

 

[Likkriue]

Any new OMFS residencies open in the last decade or planned for the future? If no ..... You are correct and OMFS has done an excellent job at limiting their numbers. Seems like new ortho programs popped up to meet a "supposed" demand.

Looked at match statistics and since 2015 there’s been 12 additional spots.

In comparison orthodontics added 49 spots within that same time period and peds added 43.

 

[DDS9994]

Any new OMFS residencies open in the last decade or planned for the future? If no ..... You are correct and OMFS has done an excellent job at limiting their numbers. Seems like new ortho programs popped up to meet a "supposed" demand.

Keep in mind most OS programs have 2 slots only, next OS programs tend to be neither family friendly nor female friendly, also most OS programs have to be afflilited with a hospital of some sort for the training. In contrast ortho can have what up to ten residents in a program, good work life balance for the female population, and last you can pop up an ortho program or Pedo wherever you want as long there is the money and backing. So I dont see the numbers varying too much in the future.

 

[2TH MVR]

Regardless of why.... OMFS have done a good job of limiting or maintaining their numbers. Capitalism (new for-profit DS mass producing other specialists) hasn't brought saturation in the OMFS field. Within my narrow scope of OMFS in my ortho field .... they extract wisdom teeth, place implants, expose impacted cuspids, etc. etc. Is there a concern in the OMFS field that other dentists/specialists want to do more implants?

 

[DDS9994]

Probably averages put to 3ish, this but it ranges from 1 to 5+.


This is changing very fast. Yes, while it's still predominately male, I would not use the blanket statement and say that all OMFS programs are "not female friendly". Tons of females are matching into OMFS in recent years. I don't have a family of my own but many residents do indeed have families and do just fine. But I do see where you are coming from.


Not "most". They all do. It's not "OMFS" is there is not a hospital affiliation. There are a fair number that are not affiliated with a dental school.

Bottom line: Comparing work/life balance, and the number of residency spots is not the way to decide between OMFS and Ortho. They are two very different fields. Shadowing residents and attendings is required to be able to distinguish which type of procedures you prefer.

Its good to hear that is changing in regards to females, back in DS I externed at a few programs, and during my GPR did a month OS rotation thru Cook County/Stroger OS. Those guys were very adamant about females in the program, the director point blank said " I get 2 residents a year, if one of them gets pregnant everyone has to pick up the slack and we dont like that, guess what you see anyone here that can get preganant?" Yes that was a direct quote. And the other programs had no females, now this was back in 2002-2004, a lot may have changed since then.

 

[DDS9994]

Probably averages put to 3ish, this but it ranges from 1 to 5+.


This is changing very fast. Yes, while it's still predominately male, I would not use the blanket statement and say that all OMFS programs are "not female friendly". Tons of females are matching into OMFS in recent years. I don't have a family of my own but many residents do indeed have families and do just fine. But I do see where you are coming from.


Not "most". They all do. It's not "OMFS" is there is not a hospital affiliation. There are a fair number that are not affiliated with a dental school.

Bottom line: Comparing work/life balance, and the number of residency spots is not the way to decide between OMFS and Ortho. They are two very different fields. Shadowing residents and attendings is required to be able to distinguish which type of procedures you prefer.

I agree, but I was just commenting on why the numbers are pretty consistent unlike how other specialities are able to crank up the number of slots.

 

[DDS9994]

Regardless of why.... OMFS have done a good job of limiting or maintaining their numbers. Capitalism (new for-profit DS mass producing other specialists) hasn't brought saturation in the OMFS field. Within my narrow scope of OMFS in my ortho field .... they extract wisdom teeth, place implants, expose impacted cuspids, etc. etc. Is there a concern in the OMFS field that other dentists/specialists want to do more implants?

Regardless of why.... OMFS have done a good job of limiting or maintaining their numbers. Capitalism (new for-profit DS mass producing other specialists) hasn't brought saturation in the OMFS field. Within my narrow scope of OMFS in my ortho field .... they extract wisdom teeth, place implants, expose impacted cuspids, etc. etc. Is there a concern in the OMFS field that other dentists/specialists want to do more implants?

I imagine as implant companies tout how " easy" placing implants is there will still be more demand for OS,, back when rotary endo started in the early 2000, late 90's everyone predicted the endo of endodontics, well that never happened, just all of a sudden they are doing a lot of retreats.

 

[DDS9994]

you mean perio will be more in demand...doubt oral surgeons know how to properly manage peri implantitis, let alone soft tissue management

Depends, I have refered to both OS and Perio for implants in the esthetic zone, and both have done excellent jobs.

 

[2TH MVR]

Depends, I have refered to both OS and Perio for implants in the esthetic zone, and both have done excellent jobs.

I'm curious. If after an anterior implant with restoration is placed and the patient develops a black triangle at the implant site. Who (perio or Omfs) is more equipped to restore a Papilla?

 

[DDS9994]

I'm curious. If after an anterior implant with restoration is placed and the patient develops a black triangle at the implant site. Who (perio or Omfs) is more equipped to restore a Papilla?

I a have yet to have that happen to me (knock on wood), I would give the nod to Perio, but this is where you get to know your specialists and what they can and cannot do. I have had perio in my area who are old timers and sadly there implant placing skills I was not happy with and vice versa with OS.

 

[Mr.Scalpel]

I'm curious. If after an anterior implant with restoration is placed and the patient develops a black triangle at the implant site. Who (perio or Omfs) is more equipped to restore a Papilla?

The gum surgeons, hands down 😉.

 

[321931]

you mean perio will be more in demand...doubt oral surgeons know how to properly manage peri implantitis, let alone soft tissue management

Doubt it. Just use screw retained for everything. I never refer to my periodontist. In my opinion, and I know it will ruffle feathers, its a specialty that is dying compared to OMFS.

The patients that are aesthetically conscious about their looks and whatnot- you learn to be very well aware of these cases and it would be in your best interest to refer to a prosthodontist. Most of the time you will lose money on these cases if its a PPO fee due to pickiness of the patient. After a couple of retries, a few headaches and ultimately they want to do something else...you end up eating the lab case cost and the fees redoing it.

You learn to foresee this in private practice. Luckily its very rare you have patients complain about an implant black triangle after they have been living with a flipper for the past 8 months.

 

[DDS9994]

Doubt it. Just use screw retained for everything. I never refer to my periodontist. In my opinion, and I know it will ruffle feathers, its a specialty that is dying compared to OMFS.

The patients that are aesthetically conscious about their looks and whatnot- you learn to be very well aware of these cases and it would be in your best interest to refer to a prosthodontist. Most of the time you will lose money on these cases if its a PPO fee due to pickiness of the patient. After a couple of retries, a few headaches and ultimately they want to do something else...you end up eating the lab case cost and the fees redoing it.

You learn to foresee this in private practice. Luckily its very rare you have patients complain about an implant black triangle after they have been living with a flipper for the past 8 months.

Its funny you mentioned this, I just got thru doing an anterior case for a great patient of mine who is on PPO fees, the. lab cost made the case a wash, not really worth my time, its more profitable to do 2 regular crowns. The patient was great but with the lab cost going up I also will boot any its for anterior crowns to Pros or local cosmetic guru. I place my own implants in the posterior on straight forward cases and refer to OS or Perio both are great for anything complicated. For the big cases All on Fours, black triangles don't matter so OS gets those.

 

[GimmeTheScalpel]

I think OP’s questions have been answered. Can you guys continue your dragged out discussion via DM

 

[surgmagee]

Hi All!

I am a public health dentist, who graduated dental school in 2013. Every year since then, I've spent months contemplating whether or not I should apply. I truly enjoy doing oral surgery and I have spent the years since graduation improving my skills, but I am well aware of my limitations. I have spent the last three years working in a public health clinic in a rural area, where access to care is a major issue. If there is a surgical procedure beyond my comfort level or clinic accommodations, patients have to drive hours, find a way to pay a local oral surgeon, or in most cases let it be.

I am guessing I am a nontraditional applicant at this point. I have been so far removed from dental school in this time that I am almost clueless about what to do. Due to being a Full-Time state employee, going away for an externship would be extremely difficult. I see that I would have to take the CBSE and honestly I rejoiced in 2013 when I was done taking tests, but that's ok.

With all that being said, does anyone have advice for someone like me? Any experience with similar applicants or situations?

For a bit more information: I was not top 10% in my class, but I believe I was in the top 1/3. GPA was good. Lots of extracurriculars, mostly public health and community service related. Current public health dentist. Volunteer at local dental clinic and RAM clinics. 34 year old, single, AA woman with no children so relocation is not a problem.

Thank you!

There’s a lot of good info on here and also a lot of nonsense! If this is your dream go for it. I would definitely recommend externships at least 3 before making this decision. Taking out surgical extractions on low income and sick patients is not OS. Get an idea of full scope. I did several years of public health and Matched into a 6yr w/NO non-cat intern yr. This was my first time applying. CBSE are important but these externships are equally important or plan on not matching. You can do this!!! And the “cush” money comments are usually made by people who haven’t made money.... it’s not as satisfying or as “cush” as a dream fulfilled.

 

[vellnueve]

lol

 

[321931]

Perio sx will always be in demand and in higher fees than traditional bread and butter GP procedures. Crown lengthening, tissue/bone regeneration, and Chao pinhole are all both aesthetic-based and pathology-corrective procedures. Unlike most of the GP cases, perio procedures are more lucrative and are conducive to smaller patient volume. Further, ongoing clinical research in perio, which is a research powerhouse specialty compared to OMFS, will pave ways for innovative perio sx including more predictable vertical ridge augmentation and tissue/bone regeneration. This, combined with perio's stronghold in the implant realm, will reaffirm the specialty's importance in dentistry, both in academia and in industry. It's the specialty of the near future.

Perio sx will always be in demand and in higher fees than traditional bread and butter GP procedures. Crown lengthening, tissue/bone regeneration, and Chao pinhole are all both aesthetic-based and pathology-corrective procedures. Unlike most of the GP cases, perio procedures are more lucrative and are conducive to smaller patient volume. Further, ongoing clinical research in perio, which is a research powerhouse specialty compared to OMFS, will pave ways for innovative perio sx including more predictable vertical ridge augmentation and tissue/bone regeneration. This, combined with perio's stronghold in the implant realm, will reaffirm the specialty's importance in dentistry, both in academia and in industry. It's the specialty of the near future.

Alrighty, I will give some input on the real world dentistry... and anyone can chime in of course:

1) Perio treatment will always be higher fees as they are charging out specialist fees. Yes that's true.

2) Crown lengthening is pretty rare. Most GP's can do it. It's not very hard at all. To date for 2018, I only referred out one case crown lengthening because it was in a distal third molar area. To hard to fix on my own. In addition, when a patient needs crown lengthening...that usually means the decay is pretty extensive with a possible root canal. What a patient is told they need to go through crown lengthening, possible root canal with a guarded prognosis... with three different doctors...that will cost them easily 3-5,000$, patients usually op for extraction with bridge/implant.

3) Grafting, tissue bone regen, and chao pinhole? Most patients just want to have their teeth cleaned and move on with their life. Even in areas of recession, we inform but they say doc just clean my teeth I'm fine the way I am. I personally have recession on my posteriors, but I don't do anything about it. Unless, it truely hurts from sensitivity or gum problems where patients will lose the tooth...not many patients will pay over 1000$ for perio grafting. Most of the time, they opt for a buccal filling that costs 20$ and some desensitizer that does the job.

4) My omfs can do all the predictable vertical ridge augmentation and implants and research you are citing. In addition to this, OMFS put people to sleep all the time. Many periodontists do not do IV sedation or they choose not to as they aren't as well versed as an OMFS. They will never be on that same level as an oral surgeon, and for that reason- for patient's comfort- perio has a tougher time competing for oral surgery/implant treatments.

5) Finally, You forget one thing why alot of GP's do not refer to perio for the most part. Because Perio has their own hygiene program. Sometimes you refer to perio for an implant and all of sudden your patient doesn't want to come back for cleanings because the periodontist has convinced them that their hygienist can clean better and that they are the "gum" doctor. Then you look at the chart and they all probings of all 3/4.... which does not need a periodontist cleaning. That's why for implants, I mainly refer to OMFS

Welcome to the world of PPO dentistry. In terms of me pulling out my referal pad:
1) OMFS every other day wisdoms/exts/implants
2) Endo every other day
3) Pedo once every 2-3 weeks or so
4) Ortho once every 2-3 weeks or so (pedo and ortho I don't get many younger patients)
5) Perio/Prostho extremely rare. Maybe once every few months or so.

This is just from a 5 year out practicing GP that owns his own practice. It sounds like you might be set on Perio, which is totally fine....but just throwing out some real world experience that I've seen and heard.