UCSF is, by no means, stating that single degree OMFS are inferior practitioners. But dual degree surgeons have tangible benefits from their additional training and MD degree. If you only want to operate out of your dental office, then a single degree program would be best for you. If you want to practice predominately in a hospital setting and you want parity with the physicians, then the dual degree is the better choice.
Remember that Harvard pioneered the concept of a MD-DDS oral surgeon. If there were no tangible benefits, Harvard's pilot program would have disappeared. Today nearly 50% of all OMFS residency program are dual degree.
Don't be myopic.
Tangibility I can agree with, but what about significance? For the majority of practicing OMFS, what are the benefits and drawbacks of 6 year programs vs. 4 year programs? Lets examine:
Tangible Benefits:
1. MD degree and licensure. Really, that's the only tangible benefit. Lets unpack what exactly this means though in the new subsection, tangible sub-benefits(!):
a. Availability of post-certificate fellowship training.
b. Additional job security. Say during the repeat penis reduction surgery I'm scheduled to have in April, the CRNA accidentally gives me an accidental intra-arterial dose of Phenergan and my right arm falls off. In addition to my fat disability policy kicking in and the giant settlement from the hospital, I can live out me dream of going back to residency (and becoming a radiologist)!
c. Minor job preferences. There are a few job postings I've seen requesting dual-degree applicants only. Very few.
d. MD portability. No regional licensing with an MD so it may be easier to move if you can practice solely under that degree.
YMMV.
e. Formal general surgery year. I hear this one sometimes, bandied about with something along the lines of "It makes you a better overall surgeon." Sure, maybe in the grand scheme of things if we could quantify every single stitch and stick-tie, yes. However, I imagine the magnitude of that effect is incredibly small, and the number of lap appendectomies you need to do to make you 1% better at doing an arthroscopic disc repositioning is likely more than you'd get if you did 5 full years of formal general surgery residency. In terms of inpatient management, I would tend to agree that more general surgery is better. But by how much? How many dual-degree surgeons spent the majority of their general surgery time on high-yield inpatient management services like SICU or trauma as opposed to bottom-of-the-honey-bucket rotations they stuck you into so a categorical resident wouldn't have to do it?
Intangible benefits (?):
1. Prestige. Your mom will tell all her friends about your double doctor degrees. Your Tinder profile is on lock (
YMMV). Every physician will still think of you as a dentist, even the SICU
intern you're calling report to because you just did a frontal craniotomy. Your general dentist colleagues will call you to ask what the dose of various antibiotics are, and try to get you to prescribe them their cholesterol medicine across state lines.
2. Academics. I don't really buy this one. It certainly
seems like there's a disparity in single vs. dual degree surgeons going into academics, but I'd be a lot more likely to ascribe that to a conscious decision on the part of the graduating residents before I would the people hiring them. Simply, you don't actively make the choice to go for the more rapid route of training (which is by all means equivalent) without holding several opinions which would makes academic OMS an unpalatable career choice. Certainly wouldn't be a salary difference between the two (save if someone was fellowship trained), and remember, the majority of OMS academicians are currently
single degree surgeons.
3. Insurance billing. "You can bill medical OR dental insurance, whichever pays more!" I've seen that here several times, and I may have even blindly repeated it too. Single degree surgeons can also do this.
4. Eventual conversion to a single training pathway. I personally think this will eventually happen. The number of dual degree surgeons entering academics grossly outweighs the number of single degree surgeons, and programs are converting to dual degree on a yearly basis with few to none going in the reverse direction. When or how (or if?) it will go down is difficult to ascertain
5. Top of the heap. This could go under prestige, but some people can[t live with being seen as having taken an "inferior" track. If there's a longer option that carries more titles and prestige, they will value it higher.
Tangible Drawbacks:
1. Opportunity cost. You're giving up two years of your average lifetime salary or delaying retirement by two years. Worse if you take advantage of your ability to do a fellowship (MORS are all 2 years now, craniofacial moving in that direction). Generally, fellowship training in OMS is associated with a
decrease in expected salary due to moving away from high-paying, low-complication bread and butter OMS procedures.
2. Actual cost. Most places you have to pay med school tuition, and of course eat, drink and Netflix and chill(
YMMV). That means more loans and more cost. Don't forget thousands in fees to sit the medical licensing exams, and doubling your yearly cost for licensure. Plus two years of additional interest on all those loans you took out for dental school.
3. MD portability. Hope you didn't want to practice in Pennsylvania or Nevada, two states famous for denying medical licenses to OMS for not completing the required number of years of ACGME accredited residency. Not a problem for all programs, but for many.
Lets now examine the straight
dollar value of the benefits versus the drawbacks amortized over a 40 year career. I'm going to use
very general ranges to simplify things Since intangible benefits by necessity have no intrinsic value, their valuation is solely dependent on the individual evaluating them. We'll address that later.
Tangible benefit dollar value - 1-2 x 10^5
I think this is pretty generous. I could pay some more monthly premiums and wipe out the benefit of being able to follow my dream of becoming a medical radiologist after my iatrogenic amputation. Maybe I can get a slightly better job, or one in a slightly more ideal area, etc...
Tangible drawback dollar value- 1-2 x 10^7
No way to get around this. The cost of lost income is huge, even if you're a lifetime academic. The real cost is not insignificant either, especially if you end up at your USC/NYU-type private medical schools with wildly spiraling out of control costs.
So we can see, it's at least a million dollar decision.
So what does this mean? The individual needs to evaluate whether the intangible (or low-value tangible in my eyes) benefits outweigh the costs in their personal calculation. I think we benefit from having multiple pathways so people can evaluate these various factors and move along an educational pathway appropriate for them, their world view and their values.
You yourself indicated that, in your view, it's most appropriate for a single degree oral surgeon to stay in their office all day and shuck wizzies, and a dual-degree surgeon to spend their time in the hospital. You even mentioned 50% of graduates are in dual degree programs. But 50% of graduates don't work in a primary hospital setting. Not even 50% of
dual degree graduates work in hospital settings. I'd wager not even 20% of dual-degree graduates go into a primary hospital or academic practice. That being the case, who's the one who's really myopic? (It's still the OP)
TL;DR:
-Real dollar cost vs. benefit is hands down non-existent for dual degree training over single degree training, need to rely on personal valuation of numerous intangible benefits which by definition only apply to the individual.
-Probably a significant relative difference in the number of full time hospital based practitioners between the two tracks, but the absolute difference is likely minimal compared to the number going into clinic-based cashola private practice.
