In my last year of residency, my $0.02 on the culture of OMFS. I think a lot of the friction comes from generational divides, attending experiences in residency vs current resident experiences, and the background of the residents themselves.
Generational divides/attending-resident culture
In my opinion, attendings fall into a few different categories
- wonderful human beings who care about patients, have a passion for educating, and would succeed in private practice (somewhat rare)
- well-intentioned people who have some sort of personality disorder/mental illness that would preclude them from succeeding in private practice, and have been institutionalized so long by academia that they get away with their behavior but overall do care deeply about the profession and educating residents, even if they don't have the emotional bandwidth to show it (common)
- truly terrible human beings who relish torturing trainees and don't care about patients or trainees, only being big-time surgeons (very rare)
This mix can create a lot of friction. One area of differing views between residents and attendings that creates contention:
Attendings who are 40s or older lived through a time in training where their General Surgery experiences were much more educationally beneficial, fun, and autonomous on average. No endless EHR monkey tasks and lack of opportunity to do procedures and see/do cool stuff; they were very hands on and had independence and autonomy. Therefore, they view residency as a more valuable and well-rounded experience than residents today, who, on average, have had a much more disappointing time on General Surgery, whose programs now use OMFS residents as low cost labor and prioritize training their own NPs/PAs/residents. This is a whole different discussion, but I think most people would agree that this creates the attitude from younger residents of "this is a waste of time" which causes friction from the older attendings who think "that was an integral part of my training"
Very old attendings often are disappointed at the "entitlement" of current residents who simply do not understand what the previous generations had to go through to legitimize the specialty. I encourage every resident to read "The Humpty-Dumpty Syndrome" by Mort Goldberg to get a sense for what the boomers had to go through to create the opportunities we have today. Doesn't excuse some of their behavior, but definitiely increases our understanding of their perspective.
OMFS on service training quality of experience has also dipped from what the previous generations talks about. There is more hand-holding, less surgical autonomy now vs back then, as well as a higher BS EHR burden now. I think it's safe to speak for everyone currently in residency to say we wouldn't mind the work hours of the previous generation if it were actually filled with worthwhile surgical experience, increased volume and autononomy, but sadly the state of healthcare and surgical training has changed to not make that a reality anymore. Therefore, attendings view current residents as not as hardworking as their generation, even if opportunities/circumstances have shifted beyond their control.
Another area and something I see commonly, even if not verbalized: attendings harbor resentment of current residents. It's a great time to be seeking an associate position from a salary perspective these days. Attendings see residents who objectively are less skilled and experienced leave residency, chase high 6-figure salaries with private equity or corporate year one, never again to utilize 80% of what attendings poured their heart and soul into teaching them, abandoning the identity of the specailty for money. I can't blame anyone for doing this given the current economics of student loans/cost of living etc, but I can see how attendings internalize this and then grow to resent residents and make their lives miserable as a result. Not agreeing with the behavior, but can absolutely see its origins.
Intraresident culture
Residents I have met/worked with vary wildly. I think there are a lot of things at play.
As much as I hate sounding like a boomer, I think COVID has drastically changed a lot of things. We are living through the batch of residents that got essentially unlimited time off to inflate their CBSE scores, had limited interaction with patients/more limited externships, and made the decision of matching into OMFS without really knowing what they're getting themselves into. This is already going away with mostly a return to the normal in-person educational pathway. Another big shift is COVID letting people who otherwise never would have sniffed work-life balance get a taste of it, and a whole new wave of people prioritize a 3 day work week and time with their family, traveling etc while they're young. Residents see their peers from their hometowns or high school achieving this, and become resentful. Some will try to manipulate the schedule/assign work to other residents, do anything they can to try to improve their work life balance, including pawning off work to other residents. These are generally the wealthier, more entitled residents, who likely never had part time jobs or previous life experiences, have no education loans etc. We all know the type. Just my observation.
There is also a divide in philosophy between "that's how I was treated when I was an intern, so that's how I"ll treat my interns" vs "let's not destroy the interns for no reason, I'm gonna try to educate them in a reasonable, compassionate way". This dichotomy has always existed and will never go away, with the pendulum swinging however there is hope that the latter is prevailing.
Another elephant in the room is the more recent decrease in the quality of OMFS applicants. Dental students are now of a generation that prioritized work-life balance as never before. They are a lot less likely to sign up for 4-6 years of poor work life balance in their late 20s/early 30s than previous generations. The rise of super GPs on social media lead them to believe they can have specialty money without the time commitment, and despite the odds of them succeeding fresh out of school as a competent, safe super GP, they use this idea to make decisions about their career (that they usually later regret) This, plus the increasingly exorbitant cost of higher education vs stagnant inflation adjusted salaries (even before the Big Beautiful Bill) has made OMF applications:available spots decrease. These leaves programs taking residents of poorer quality just to avoid going unmatched/leaving an unmatched spot open. It then trickles down to poorer quality non-cats. Competitiveness of the field will never truly bottom out as long as the salary potential remains, but it will be very interesting to see what happens over the next decade with the BBB, increasing debt and cost of living, with no reduction of practice overhead or weakening of PE or corporate in sight.
Everything in the above paragraph makes residency a lot less likely to be made up of a bunch of hard working, normal, middle class kids trying to achieve the American dream mixed in with the children of physicians/dentists who were raised well with a good head on their shoulders and don't act like they were raised with a silver spoon in their mouths. All of them with previous life experiences/work experiences and having had played team sports (I interviewed incoming interns last application cycle and was overjoyed and surprised that every interviewee had held some sort of employment outside of school in their livers). I think every residency would function far better with this mixture of residents, who would have better, more coachable attitudes and therefore improve relationships with attendings, and ultimately improve the culture of OMFS.
Anybody who is not in OMFS or surgical training in general who has read this far generally cannot appreciate how much teamwork and interpersonal relationships matter in surgical subspecialties Other dental specialities and GPs can survive training with a much more individualistic mindset and in an environments that doesn't account for a lot of what makes the OMFS and surgical subspeciality culture what it is.
I think that the culture will shift in ways that are both positive and negative, and each individual can actually impact a program's culture a lot with a good attitude and good decisions. Interested to hear everyone else's thoughts.
