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aren't you a dental student?This guy is a realist
aren't you a dental student?This guy is a realist
I was very disappointed to hear that Clear Choice is only open Monday-Thursday. I imagined picking up extra days for money early on. But I know Aspen is always desperately looking for surgeons. If you go to any of the resident conferences, Aspen usually sends a rep and they’ll be happy to talk numbers with you.Can we get back on topic instead of this boring 4 vs 6 year argument? I need to make myself feel better by reading about how well corporate OMFS does so I can feel better about my decision![]()
What I came to realize pretty quickly is, it doesn’t really matter. The argument is really only made on SDN. We both respect each other as colleagues in an incredibly small field, and so we stick together. You can find whatever you are looking for in 4 or a 6 year program. Most come out and practice the same scope, regardless of 4 vs 6. We’ve both been on a hard earned journey with alot of sacrifice on the way. We are lucky to do what we do at the end of it. It’s the best kept secret in healthcare. We want to preserve that.This is not a knock on 6 year programs btw, I ranked both 4 and 6 year programs primarily based upon the quality of the OMFS training (and partly for my ego), and I was willing to set aside my desire to optimize for finances knowing that I was going to be trained/be mentored under certain faculty. I think this was the right approach, for me at least. At the end of the day, I think you can optimize for both paths and double down on the strengths of your training and STILL live a more fantastic and fulfilling life than 99% of all humans that ever existed.
Could you expand on this please?I fully admit my saltiness/regret subconsciously affects my perspective on how beneficial the 6 year vs 4 year route is, as things currently are in the field.
Nope, I’m a realist.aren't you a dental student?
I was very disappointed to hear that Clear Choice is only open Monday-Thursday. I imagined picking up extra days for money early on. But I know Aspen is always desperately looking for surgeons. If you go to any of the resident conferences, Aspen usually sends a rep and they’ll be happy to talk numbers with you.
Anesthesia model and potential changes down the road mostlyCould you expand on this please?
Is there a real possibility oral surgeons will lose the ability to do their anesthesia?Anesthesia model and potential changes down the road mostly
It only takes one dead kid. God forbid 🙏Is there a real possibility oral surgeons will lose the ability to do their anesthesia?
But isn’t the ADA (and other healthcare organizations) always talking about “increasing access to care?” If OS lost the ability to do independent anesthesia, I would think it would be that much harder to provide servicesWho knows man, anything could change at any time. AAOMS and OMSPAC are doing their best to protect us, but gotta be prepared for anything
That’s code for more lower-trained midlevels doing doctor stuff so healthcare companies can pay lower salariesBut isn’t the ADA (and other healthcare organizations) always talking about “increasing access to care?” If OS lost the ability to do independent anesthesia, I would think it would be that much harder to provide services
Look at dental therapists; they are practically dentists that are supposed to "serve underserved communities" (at least the one's in MN). However, a large sum of graduates work in suburban/urban areas that don't have issues with access to care. Just another way to pay lower salaries. Dental Therapy | School of DentistryThat’s code for more lower-trained midlevels doing doctor stuff so healthcare companies can pay lower salaries
I think moonlighting is something important to talk about but is commonly kept on the low/not talked about it during interviews. For those that can moonlight, they know how much of a game changer it is especially during med school.I'm curious how much you make moonlighting + resident salary
This is not typical. This is actually quite rare. Applicants should definitely not expect those numbers in residency.I think moonlighting is something important to talk about but is commonly kept on the low/not talked about it during interviews. For those that can moonlight, they know how much of a game changer it is especially during med school.
For my program, I would say residents typically make 60-100k a year. I've heard of people making more - it all depends on how much you want to work. Some weeks I'll work 50 hours a week moonlighting. Other weeks I'll work 1 day. If you can go to a program that allows moonlighting, do it.
I’m pretty sure a single degree guy I know is fellowship trained microvascularAspen guaranteeing 750k in certain markets, but I think the numbers from other corps are just as good if not better, but with better workflow.
Im in a 4yr, but I think the argument between 4vs6 is overplayed. Who cares, both end up in the same board certification and scope unless you’re deadset on microvascular or full body cosmetics.
CorrectI think it means 8 to 10k in production for that day, then whatever the percentage is, maybe 40%
Sure,Why is itinerant practice not allowed? I just read the code of conduct, and at the end it says that it does not apply to charity work or academic settings. So if it’s charity work all of a sudden you don’t have to form a patient relationship and such? Could you further explain
That has been my experience working for PDS as well.I work part time for PDS, on slow days in take home 4-5K. Otherwise it’s 8-10, sometimes better. It depends on the office/location. But some guys refuse to come in unless they get like 10K/day. Lots of variables
What post op duties can OMS delegate? Could they indirectly supervise a nurse or other GP if they took photos of the post op area and then say be in a 60 mile radius?Sure,
AAOMS Code of Professional conduct. Section C.5.a-g (Itinerant Surgery: Defined as elective oral and maxillofacial surgery performed in non-accredited surgical facilities other than the facility or facilities owned and/or leased by the oral and maxillofacial surgical practice employing the oral and maxillofacial surgeon.)....etc.
View attachment 371637
I have some experience with this topic.
But in reality, the deal is do not push your post op duties to non-OMS and make sure you have a plan in place for appropriate follow up and that patients can reach you. Then any OMS would be fine.
Careful........I shuttered when you wrote "academia."
Depends on your agreement with the GP, NP, procedure you perform in office, etc. More than likely if an OMS is in this kind of practice they will have a system figured out to get patients the care they need in a reasonable time frame. Now for the sake of completeness. OMS takes out a set of thirds in an office 250 miles away. Patient returns with submand. swelling 3 days later, GP looks and thinks it is OK, sends patient home with ABX. Patient develops Ludwigs, dies. The state board and then AAOMS CPC will review the case. The board may or may not take action depending on each states abandonment statutes since you delegated post op care to a person of lesser training, which is seen as unethical in some states. AAOMS always sees this as unethical and could pursue several options, ranging from letter of counsel to expulsion. From personal experience most OMS who are brought to the CPC for practicing itinerant surgery do have the process in place to have another, local OMS handle post ops if needed. The complaints are usually from the local OMS sick of treating the itinerant OMS post op complications and reporting them to the AAOMS CPC. Just goes to show how a friendly phone call to a local OMS could save you time and effort if practicing in this situation.What post op duties can OMS delegate? Could they indirectly supervise a nurse or other GP if they took photos of the post op area and then say be in a 60 mile radius?
From a 6 year guy leading a 4 year program......amen!I’m always perplexed when this topic is mentioned in SDN. I do believe DD was merely saying that a 6 year trained would perhaps have an easier path to do that particular fellowship…not that a 4 year trained cannot, does not, or is not qualified to do that fellowship. We all select to go to a 6 vs 4 year residency for our own reasons. I have purposely chosen to attend a 6 year residency for specific reasons (e.g., they focused on the exact training I wanted + a good atmosphere to be trained in…that simple). I always chuckle a bit when I see the back and forth that happens when this topic is discussed…it’s really not that complicated.
Thank you for giving your time to us on SDN and for an excellent answer!Depends on your agreement with the GP, NP, procedure you perform in office, etc. More than likely if an OMS is in this kind of practice they will have a system figured out to get patients the care they need in a reasonable time frame. Now for the sake of completeness. OMS takes out a set of thirds in an office 250 miles away. Patient returns with submand. swelling 3 days later, GP looks and thinks it is OK, sends patient home with ABX. Patient develops Ludwigs, dies. The state board and then AAOMS CPC will review the case. The board may or may not take action depending on each states abandonment statutes since you delegated post op care to a person of lesser training, which is seen as unethical in some states. AAOMS always sees this as unethical and could pursue several options, ranging from letter of counsel to expulsion. From personal experience most OMS who are brought to the CPC for practicing itinerant surgery do have the process in place to have another, local OMS handle post ops if needed. The complaints are usually from the local OMS sick of treating the itinerant OMS post op complications and reporting them to the AAOMS CPC. Just goes to show how a friendly phone call to a local OMS could save you time and effort if practicing in this situation.
lastly, It's not illegal, it is seen as unethical to have OMS delegate responsibilities to those of lesser training.
Hope this helps.
We’re jaded out here. What can I sayCareful........
What are the chances that OMS gets extremely reduced reimbursements for wisdom teeth? And loses single surgeon anesthesia model? Are these minor or are they very serious possibilities?I need to throw a bone to the under represented single degree OMS on this forum 🤣
Here is why I ranked a few single degree programs above 6 year programs.
The scope and volume of cases of the program matters much more than 4 vs 6 years. There are 4 year programs that produce far better trained OMS than many 6 year programs and vice versa. This is highly program specific. Classifying programs as 4 vs 6 year is misleading. Classifying them as strong, average or weak would be more beneficial. IMO there are only three reasons someone should pursue a 6 year program over a 4 year.
1. MD will allow more fellowship opportunities in craniofacial, head and neck and facial cosmetics. The right candidate can do any of those fellowships with a single degree, but it just makes more sense to have the MD if you want to practice these specialties in a competitive market.
2. You know you want a career in academics. If this is your desire then you have already accepted that you will be leaving millions on the table financially and delaying your career two additional years probably doesn't concern you. It's important to note that the scope and comfort you develop during residency will be the scope you carry into academics, so a weak 6 year program should never be ranked above a strong 4 year program simply for an extra degree. You will regret this. You are privileged based on your case log not your diplomas. As far as academic job opportunities go, there are several programs looking for faculty/PD/Chairs that can't find people that are interested. All this to say that you can easily pursue academics with a single degree, but you will have to deal with false notion that dual degree OMS are better trained because of their neurology, psych and OB rotations. For this reason it probably makes sense to do the 6 year just to ease your mind while in academics. Again, pursuing a 6 year program should not be at the expense of program quality. Anyone that is honest with themselves will admit that a single degree OMS from Shreveport, for example, is far better trained than 95% of dual degree OMS.
3. Ego. Unfortunately, despite the extra two years and additional rotations the medical community will always view you as a dentist first and foremost. They will underestimate your ability to provide anesthesia and ability to perform surgery regardless. This is complete nonsense, but this is the culture within medicine. General surgeons are superior to ENT/PRS, Medicine docs are superior to EM docs, Cardiologist are superior to medicine docs, etc.
Now, there are several reasons to pursue a 4 year program instead of a 6 year program.
1. Financial. It is such a costly decision and the cost is so under estimated. Here are a few points that come to mind. I'm sure there are more.
- Cost of medical school tuition, (null if medical school is free)
- Loss of two of your most productive years in private practice. This is easily 2-3 million dollars directly, + compound interest 😱. I don't have time to explain why these two years are your top grossing and not your first two after residency. There are other posts that explain this well if interested.
- Opportunity cost.
2. Opportunity Cost. This overlaps with financial, but is a separate issue in itself.
- There is no guarantee that OMS will continue to make extraordinary income in the coming years. The specialty of OMS is experiencing a lot of change right now. Why risk guaranteed high return years to pursue a medical degree?
- DSO's are on the rise, referral bases are being bought up at an alarming rate. These DSO's push to keep OS in house.
- Private Equity is buying up large numbers of OMS practices. Two years could mean the difference of you buying your dream practice vs Dental Care Alliance buying it. When OMS goes corporate it will be no different than any other medical specialty. The advantage of dentistry over most of medicine is that there is opportunity to own your own practice and reap the tax/financial benefit of that.
- A different OMS could join your dream practice, taking your desired job.
- Insurance companies are constantly finding ways to reduce their payout. We already lost orthognathic surgery- reimbursed less than a third molar case? Third molars are under attack as well. Insurance companies are claiming that multiple teeth taken out during one surgery fall under "multiple procedure payment reduction." The first extracted tooth is reimbursed at 100% and the remaining teeth are reimbursed at 50%. AAOMS is fighting this, but reality is that reimbursements will diminish. Make your money while you can.
- Single provider anesthesia/surgeon model is under attack
- This list could go on: tooth bud ablation technology, increase in "super" dentists, etc.
3. Very low return for two years of time. Are additional rotations on neurology, OB, Psych valuable? Sure. But, do they justify delaying your life two years and risking the above things? In my opinion, no. Will they make you a better OMS? In my opinion, no. If these rotations were truly beneficial then residents wouldn't moonlight during them. They would be focused on learning the field. Single degree OMS complete gen surg, trauma surg, ED, medicine, ICU rotations, ENT, PRS, etc. You learn the hospital system just as well. You place chest tubes, you push adenosine in ICU, you do medical workups all the same. The reality is that in most 6 year programs you are sacrificing OMS months for low yield rotations.
4. Depending on the state you want to practice in you may or may not be able to advertise your medical degree. There are posts that explain this if interested. But for this reason the number of 6 year programs that you can pursue and actually receive the benefit of advertising a MD is reduced.
In short, the program case diversity and volume of surgeries matters much more than 4 vs 6. If you can find a single degree program that provides the things you are interested in then the shorter route is easily the most logical. This is why more applicants apply to four year programs.
Multiple Procedure Payment Reduction is already happening with some insurance companies and Medicaid reimbursements hardly make it worth the risk of doing the surgery. So this is a real possibility that is already happening.What are the chances that OMS gets extremely reduced reimbursements for wisdom teeth? And loses single surgeon anesthesia model? Are these minor or are they very serious possibilities?
What’s going to happen when no dentist does any procedure for Medicaid? Will the government finally raise reimbursement? Dental students right now see this and probably won’t ever consider doing it with their debt burden.Multiple Procedure Payment Reduction is already happening with some insurance companies and Medicaid reimbursements hardly make it worth the risk of doing the surgery. So this is a real possibility that is already happening.
Losing single provider anesthesia/surgeon is a real possibility, but less likely than above. This depends on the state though. Look at states like California and North Carolina. As someone already mentioned this would reduce access to care which, IMO, is the only thing protecting us. This model does have a track record of being extremely safe which is nice, but unfortunately when accidents happen emotions rather than facts can create legislation.
Unlikely that fees will be increased when the size of the pie grows year after year. Gov can increase FQHC's and lobby to have student loan reimbursement non-taxed income, this is the only way I see more providers servicing this population without disadvantaging themselves as well due to debt burden. The other issue is, not all states Medicaid services are the same, so procedure mix can be very limited or robust, which also influences whether or not a dentist wants to work somewhere their scope is limited vs maximized.What’s going to happen when no dentist does any procedure for Medicaid? Will the government finally raise reimbursement? Dental students right now see this and probably won’t ever consider doing it with their debt burden.
Multiple procedure payment reduction for extractions (among other dental procedures) has been reverted/nixed. ADA/AAOMS was successful in getting this reversed for numerous CDT codes, specifically with regard to CMS/Medicare. Any medical insurance companies who had adopted the MPPRs for CDT codes are likely to follow suit and also reverse their policies.What are the chances that OMS gets extremely reduced reimbursements for wisdom teeth? And loses single surgeon anesthesia model? Are these minor or are they very serious possibilities?
The catch is that you might end up dead before starting to practicethe goated approach is to go military, have dental school paid for, get paid 120k a year as a resident, and moonlight during payback years
If finances is what you’re mainly concerned with, your suggested route does not beat going the traditional path (single degree - non military), and working full time in the private sector. The civilian/private omfs would have easily caught up before the military omfs was out of his 4 year service obligation.the goated approach is to go military, have dental school paid for, get paid 120k a year as a resident, and moonlight during payback years
I’m not in any sort of residency training yet, but to me the health insurance and the security of having BAH would make residency in the military less stressful.the goated approach is to go military, have dental school paid for, get paid 120k a year as a resident, and moonlight during payback years
I’m not in any sort of residency training yet, but to me the health insurance and the security of having BAH would make residency in the military less stressful.
Yeah we rotate through 5 hospitals for trauma experience. We are on face call 24/7 365 someway or another though and we usually get 5+ trauma ORs a week.The lack of call and trauma does as well in the military. They typically have to send their residents off to other programs for this experience.
Making more money oftentimes means you are taking risk.I’m not in any sort of residency training yet, but to me the health insurance and the security of having BAH would make residency in the military less stressful.
As my wife would say: *should* is a dangerous word. If you making (income) 8-10k a day, you are making 2 million a year (income). Very very very few oral surgeons make this much (however, I know a few who are). This is far from the norm.Nope, your 40% should be 8-10k per day
Producing 8-10K/day as an oral surgeon is very low.
Take home is 30% collections?As my wife would say: *should* is a dangerous word. If you making (income) 8-10k a day, you are making 2 million a year (income). Very very very few oral surgeons make this much (however, I know a few who are). This is far from the norm.
I wouldn't say 8-10k production is very low. Id say it is less than the average for most practice models. I'd argue that some traditional OS practice models aimed for 8-10k a day. It could mean 5 wisdom tooth cases at 2k a pop.
I work for aspen. Average aspen production for an oral surgeon is 15k per day.
I don't think the DSO model is for everyone. But if you can make it work for you, and you can put up with the increased risk, the disorganization (read: circus), and work with it - it can be quite profitable; and the best thing about it: you don't have to put down a bunch of money for a business loan, or rent a property or buy instruments or whatever. "plug and play" if you will.
I’ve heard minimum 40%, if not 50%Take home is 30% collections?
40-44% in the DSO model. PP can range quite a bit depending on base salary, bonuses, etc.I’ve heard minimum 40%, if not 50%
40% minus some expenses (like bad debt, and assistant wages), which ends up bringing my take home down to like 33-35%Take home is 30% collections?
50% is usually what you get if you go to a dentist's office and do work there.I’ve heard minimum 40%, if not 50%