Hey All,
I am a second year dental student, and I entered dental school wanting to pursue oral surgery. I am confident that I will have the qualifications to get into a program (top10%, research, publications, awards, leadership, etc.). However, after speaking to a couple of faculty oral surgeons, I am having doubts about my chosen career path.
One faculty stated, that he feels that it is no longer worth the time and money to pursue oral surgery (Especially if you're looking to run a bread&butter practice of doing extractions, implants, etc.). He said that I should instead do a GPR, that allows me to get a IV sedation certification, implant, and exodontia experience. Speaking to other colleagues and dentists, there seem to be some benefits to being a GP such as having hygienists, being able to have a long relationship with patients (leads to more referrals), and not having to get referrals.
1) Are any current Oral Surgeons, OMFS residents.. concerned about the amount of competition that they will face (with GPs, perio, etc placing implants) or the lack of referrals that they will get, now that more and more GPs are placing implants and doing extractions?
2) I feel that the process of going door to door to get referrals, just seems so painful and stressful, any comments on this? I believe that I am good at networking and building connections, but the thought that my practice will potentially rely on others, doesn't seem too appealing.
3) The field of oral surgery is astonishing! There are so many amazing procedures, but is it practical for a person to pursue this field, when many of these cases are extremely rare. One could go into academia (full time or part time), but is all the time spent in training worth the returns?
Thanks in advance..
Tothepark,
I, like you, had many of these same questions to work through when I was thinking of applying to oral surgery. I am now in residency and do not regret my decision. In order to answer your questions, you have to first, ask yourself a couple of questions:
1) Do you like doing general dentistry?
2) Do you like surgical procedures more?
3) Would you rather exclusively do surgical procedures?
If you enjoy doing crown and bridge and you only want to do surgical procedures now and again, you can certainly do a GPR and feel comfortable doing many extraction and implant cases. However, there is always a balance in deciding whether to do procedures as a GD:
1) Can you efficiently perform the procedure to make profit?
2) Do you perform enough of that procedure to justify the increase in cost of equipment, CE, and malpractice?
3) Will your results be as good for you patient?
3) Can you provide this service at the same level of comfort?
a)If your patients have bad experiences, they go to their friends and coworkers and share their bad experience.
This can be destructive to your practice. You might lose that whole family and their friends as patients for one procedure.
4) Do you love the procedure so much that you are willing to compromise on any of above concerns? If so, maybe you should be an oral surgeon.
If you want to exclusively perform surgical procedures, you will not do this as a GP. I met several individuals on the interview trail that thought they could feed their passion for surgery through general dentistry....hence why I met them on the interview trail for oral surgery. If you have a passion for surgery, you will never regret doing a residency.
Residency provides a lot of advantages:
1) Confidence
a) After you lay coronal flaps, perform neck dissections, graft bone from ribs and hips, piece together a gun shot wound, etc, you know that you can not screw up anything in dentoalveolar procedures that you can't fix.
2) True anesthesia experience
a) Second to only anesthesiologists, you will have performed more anesthesia than any other health-care provider. You can confidently and safely provide general anesthesia for your patients. However, more importantly, you understand the patients on whom you should avoid performing general anesthesia. A one-month rotation in a GPR where you observe most of the time is not the same as 5 months where you are running your own room.
3) Soft tissue management
a) The myth that oral surgeons don't know how to manage soft tissue is ridiculous. I think this is antiquated thinking. Anyone who can master the art of closing soft tissue on trauma patients who have lost half of their face can easily control gingiva and oral mucosa. You will understand the many subtle nuances of how to handle soft tissue, both inside and outside of the oral cavity.
4) Number of procedures
a) Placing 40 implants in a GPR is not that same as 200-500 as a resident. Extracting 500 teeth with 40 of them impacted 3rd molars is not the same as 3,000-5,000 teeth with 400 of them impacted 3rd molars.
b) Greater numbers allows you to see different outcomes and complications. Will you know what to do if the results aren't as planned?
5) Managing complications
a) No one fully appreciates why you need to train above and beyond what you will actually practice until they run into complications that are far beyond their capability. It doesn't look good when a GP or periodontist nurses osteomyelitis until it turns out the oral surgeon has to cut off half of their jaw. You don't appreciate how many serious infections, damaged nerves, and poorly managed cases end up at the hospital because of lack of experience handling the complications of what seems like simple surgical procedures.
6) Medical management
a) Patients today live longer and have more medical issues and co-morbidities than ever before. What makes anyone think this won't continue to increase?
In answer to your questions that you asked:
1) Are any current Oral Surgeons, OMFS residents.. concerned about the amount of competition that they will face (with GPs, perio, etc placing implants) or the lack of referrals that they will get, now that more and more GPs are placing implants and doing extractions?
- I am not worried about the landscape of dentistry changing so much that I will not have an adequate practice. While I admit that more GD's are placing implants, this is ignoring the market of implants as a whole. Far more implants are being treatment planned. This number will only increase as the newer generation of dentists who understand how to restore implants enter the field. The complexity of implant cases are also increasing. There will always be implant cases that are far too complex for a general dentist to try to tackle. These will still be referred to you and pay so much, it will make up for the single implant cases that weren't referred to you. Besides, there will always be GD's who do not like to perform surgery.
2) I feel that the process of going door to door to get referrals, just seems so painful and stressful, any comments on this? I believe that I am good at networking and building connections, but the thought that my practice will potentially rely on others, doesn't seem too appealing.
- I honestly think the idea of going door to door is played up a little much in your mind. If you are going to hate hosting educational events, playing golf, and eating fine dining with your referring doctors, then yes, trying to gain referrals might not be for you. Besides, how is trying to market yourself to patients as a GD really less stressful as far as building your practice? In fact, I would say being a general dentist would be more stressful because you have to figure out where you need to go to find your patients. At least as a specialist, you know your patients come from other doctors....that already narrows down who you have to market to.
- Yes, there are a lot of amazing procedures to be done in oral surgery. Once again, some of this goes back to the idea that I would rather learn <---------------------------------> this much and practice <-----> this much instead of learning <------> this much and wanting to practice <-----------------------------------> this much. At the very least, you can take trauma call at a local hospital every so often and continue using your surgical skills.
Good luck in deciding what you want to do in the future. Either way, I hope you are happy with whatever you choose.