Hi!
I'm starting dental school next fall and I'm very interested in maxillofacial surgery, especially cleft lip and palate surgeries.
I was wondering what the difference was between maxillofacial surgeons that did a 4 year surgery residency but have a DMD degree as opposed to a maxillofacial surgeon that did a dual degree and is DMD, MD.
I'm going to Nova Dental School and they have the 4 year surgery residency which i would like to pursue but should i be looking into dual degree specialties instead if i was to do cleft lip and palate surgeries??
THANKS!!
Gary "6-pack" Ruska here,
This question has been asked many a time and the answer hasn't changed much since Jesus first asked it about 2 millenia ago.
That being said, GR will be happy to give you GR's input on your question:
1. What's better, a 4-year or a 6-year program?
Answer: Neither is better nor is worse. There are good and bad OMFS programs. Some of the good ones are 4-years, some of the bad ones are 6-years and vice versa. What is really important, more than the length of training, is the
content of said training. There are 4-year programs that will certainly train you to do clefts, massive trauma, cancer (Carle) and 6-year programs that will train you to do not much more than orthognathics, wizzies and implants (Columbia).
2. So what's the big deal about getting an MD then?
Answer: There are many reasons to get an MD, though almost no one on this board will tell you to go to a six-year program solely because an MD is essential.
Here are some advantages of getting the MD:
a) Medical knowledge. This is not to say that 4-year guys don't know their medicine, but it would be illogical to suggest that actually getting a medical degree does not, in some way, provide you with a greater core of medical knowledge. Now, what you choose to do with that knowledge is up to you. GR would venture to guess that the medical knowledge difference between 4- and 6-year OMFS in private practice is probably the same after about 5-years out.
b) Fellowships. Most OMFS fellowships do not require an MD, though fellowships in OMFS often are in areas with significant overlap with other medical specialties: Head and Neck Oncology (ENT), Facial Cosmetics (ENT, plastics), Craniofacial (Plastics). So, while an MD may be a minimal asset in terms of getting you a fellowship, it will almost be a necessity if you have any intention of practicing your area of fellowship expertise upon completion of training, as the powers that be may not credential you without the MD. Caveat: Even having the MD still makes this an uphill battle in most instances, though OMFSers tend to prevail and obtain privileges more often than not.
c) Safety/security. One never knows how laws will change and the MD is a security card that may protect you against laws designed to keep "dentists" from performing things like cosmetic surgery. There are some alarmists within OMFS who believe that, in the next 20-30 years, the field will split into "Oral Surgery" and "Maxillofacial Surgery", like in the UK, and that the 4-year guys will be oral surgeons and the 6-year guys will be maxillofacial surgeons. While GR sees this as unlikely, especially given the overwhelming success that AAOMS has had at securing laws that do not limit scope of practice on the basis of degree, the MD does afford you some protection against such laws.
d) Ego. This is, unfortunately, a lesser talked-about phenomenon for getting the MD, but certainly a factor for many dental students (and OMFS residents and even attendings). You can't be an FACS (fellow, American College of Surgeons) without the MD. That being said, GR can relate the following things to you: 1) having gone through medical school, GR notes that medical students, by and large, think that nothing is harder than medical school (which is not true, the most obvious anecdotal evidence being that dental school was harder for every OMFS resident GR has ever met, when compared to medical school) and can be very obnoxious individuals, 2) people in medicine rag on eachother like no one else and collegiality is often lacking and 3) in a group of MDs, you will
always be "the dentist", no matter what your training and background. Therefore, GR would suggest that satisfying your ego is a poor reason to get then MD. Besides, the two-extra years for the MD could be better spent in OMFS private practice. GR hears that luxury cars do great things for the ego.
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With regard to your specific plans, GR would offer two observations. The first being that there are probably more craniofacial surgeons in the US per capita than anywhere else in the world and that the US has the lowest prevalence of births with craniofacial anomalies relative to anywhere else in the world, an unfavorable ratio for a surgeon.
What does this mean for you? Clefts, craniosynostoses and the like tend to be referred to senior surgeons at established craniofacial centers. Younger surgeons (plastics and OMFS) often have a difficult time establishing a practice in these areas and get the bulk of their early expertise participating in overseas programs, while waiting for one of the older guys to retire. To complicate matters even more, most craniofacial centers will have a plastic surgeon and an OMFS on the team and the plastic surgeon will typically do the primary lips/craniosynostoses/LF3s and the OMFS will do the orthognathic surgery/alveolar bone grafting/implant placement in adolescence. Even this model is not seen in some centers, where plastic surgeons will do orthognathic surgery as well (though it should be noted that many of the plastic surgeons in these situations also have DDS/DMD degrees and oral surgery training).
What's the take home point? Even if you did get an MD and did a craniofacial fellowship, you would probably end up being part of a craniofacial team and primarily involved with doing orthognathic surgery, alveolar bone grafting and implant surgery --> all things that can be done without an MD and without fellowship training. You could certainly do clefts and the like overseas, but your domestic practice would be as described above.
Agreed
