Future of OMFS.. GPR vs OMFS

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

tothepark

Full Member
15+ Year Member
Joined
Jul 19, 2008
Messages
238
Reaction score
56
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..

Members don't see this ad.
 
The grass is always greener. If I were you, I'd go out and talk to a couple private practice oral surgeons and general dentists. Academic professors are a little detached from the private practice world, which is where most oral surgeons (and general dentists) end up. If you enjoy oral surgery, can stomach the residency, and have the credentials- then you should pursue oral surgery IMO.
 
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 am not an oral surgeon so I can only comment on this point #2.

I've talked to many of my friends, who are endodontists, periodontists, OS, orthodontists, and they all say that going door to door is the least favorite part. Some of them choose to work for dental chains, multispecialty group practices, Kaiser Permanante hospitals, and dental schools etc so they don't need to go door to door. Unfortunately, visiting the GP offices is the only way to gain the referrals from the GPs and to keep your schedule busy. Don't expect the patients go straight to your OS office for 3rd molar extractions, dental implant placements, impacted canine exposures, orthognathic surgeries, biopsies etc. The reason the patients come to your OS office is their general dentists, orthodontists, pedodontists tell them to go see you. You can have your OS office right next to a GP office and still don't get any referral from this GP. The GPs will not refer to you if they don't know anything about you because you never come to talk to them and your office has no track record of doing good work. You can mail your referral cards to every single GP office in your area and still don't get the referrals from any of these GP offices. When the GPs see your cards in the mail, they probably throw them away and continue to refer their patients to the OS office that they've felt comfortable to send their patients to. Why risk making the patients upset by sending them to an unknown OS office?

By going door to door to meet with the GPs, you at least have a chance to show them how your office is different from other established OS offices. Does your office accept medicaid? Is it open on Saturdays? Can you come to their office to help them with implant treatment planning and restorations? Does your office accept insurance or is it a fee for service office? What can you do that other OS's in the area can't?

It is very important to have good communications with the referring GPs. The GPs don't just send their patients to your office for you to perform the procedures that they don't feel comfortable in doing them. A lot of times, they send their patients to you because they need to hear your professional opinions. Many GPs think you are more knowledgeable than them since you are in school longer than them. You should never assume that they are the restorative dentists, they are captain of the ship, and they will dictate where you should place the implants. Some GPs will admit to you that they don't feel comfortable in handling certain multidisciplinary cases and they need your help in treatment planning these difficult case. They may ask you to help guide them through the whole full mouth reconstruction process: from implant placements to delivery of the final restorations. If you spend your time to communicate with them and to help them deliver successful treatment results for their patients, you will be their hero. If you show the GPs your confidence in handling difficult multidisciplinary cases, you will never have to worry about losing their referrals in the future. But if you find it is a PITA and time consuming to talk to the GPs and you'd much rather stick to quick procedures such as 3rd molar extractions, then you shouldn't wonder why they don't refer implant cases to you.
 
Last edited:
  • Like
Reactions: 8 users
Members don't see this ad :)
Wow, thank you charlestweed, for your very informative response. I truly do appreciate that you took the time to respond to my concerns. Your perspective on this issue from the GP side, does really add new layer to the discussion, which should've been there from the first place. What is the most important thing to you, when referring your patients to a specialist? (cost, personality, cooperation, etc.)
 
Wow, thank you charlestweed, for your very informative response. I truly do appreciate that you took the time to respond to my concerns. Your perspective on this issue from the GP side, does really add new layer to the discussion, which should've been there from the first place. What is the most important thing to you, when referring your patients to a specialist? (cost, personality, cooperation, etc.)


IMO,

The two most important things for you to have are a website and a presence on Yelp. I have used Yelp for more things that I can remember, including health care. When I looked for an orthodontist, I didn't even ask my dentist--I did my own internet research.
 
IMO,

The two most important things for you to have are a website and a presence on Yelp. I have used Yelp for more things that I can remember, including health care. When I looked for an orthodontist, I didn't even ask my dentist--I did my own internet research.
I believe Yelp is not the best thing in term of seeking for any professional care. Please look up the complaints were filed against them in BBB.
 
IMO,

The two most important things for you to have are a website and a presence on Yelp. me have used Yelp for more things that me can remember, including health care. When me looked for an orthodontist, me didn't even ask my dentist--me did my own internet research.


I can't post without the site changing the words around, site must have a virus...
 
Last edited:
I honestly thought I was having a stroke reading all these comments. Either that or I'm stuck in an episode of the Ali G Show
 
Maybe they're doing this for April Fools day?
 
Wow, thank you charlestweed, for your very informative response. I truly do appreciate that you took the time to respond to my concerns. Your perspective on this issue from the GP side, does really add new layer to the discussion, which should've been there from the first place. What is the most important thing to you, when referring your patients to a specialist? (cost, personality, cooperation, etc.)
The most important one has to be the specialist's clinical experience. The GPs refer the cases out because they know that they can’t handle certain cases properly with their limited clinical experience and they want the specialist, who has a lot of experience in treating difficult cases, to take good care of their patients. A good specialist should be able to make correct diagnoses 100% of the time and to present to the patients all the available treatment options that fit the patients' budget. For an example, to restore a missing tooth #8 with a collapsed ridge due to recent trauma, the patient would have to pay $6000 for bone graft + implant placement + implant restoration + provisional restoration while waiting for the implant to integrate. $6000 may be too much for someone who only makes $12/hour. A good specialist should be able to come up with a much cheaper alternative acceptable treatment option: $900 for connective tissue graft to augment the collapsed ridge and $1800 for the GP to restore the missing #8 with a 3-unit bridge.

I think the second most important one is the cost. The GPs stop referring patients to you if you charge their patients too much. A few of my referring GPs have asked me if I know any OS who can extract wisdom teeth at reasonable cost because the OS’s they know charge their patients too much. I always tell these GPs about the OS, whom I regularly refer my patients to. His office is one of the few OS offices that accept medicaid. If the patients can't afford to pay for sedation, he is ok doing the procedure under local anesthesia. He loves doing orthognathic surgeries even though he gets paid very little. His partner did an extra year of orthognathic surgery fellowship at Kaiser. If my patients need jaw surgery but don’t have insurance, I always tell them to go see him since he charges very reasonable fee for cash patients. His office is located 20-30 miles from my offices but I still send my patients to him instead of to the local OS.
 
A good specialist should be able to come up with a much cheaper alternative acceptable treatment option: $900 for connective tissue graft to augment the collapsed ridge and $1800 for the GP to restore the missing #8 with a 3-unit bridge.

That is still 2700 on a near minimum wage salary = not happening immediately. Removable device and then save for or finance the implant should be the priority. Cutting down two virgin teeth for a bridge may be cheaper in the short term but over longer course of time may prove to be more costly.
 
That is still 2700 on a near minimum wage salary = not happening immediately. Removable device and then save for or finance the implant should be the priority. Cutting down two virgin teeth for a bridge may be cheaper in the short term but over longer course of time may prove to be more costly.
Patient should, of course, be informed by the doctor the pros and cons of each treatment option. IMO, having a fixed 3-unit bridge is 100x better than wearing a flipper. For many low income patients, it not easy to save up $6000. If they have money, they usually spend on something else instead of putting a small amount each month in the saving account. And they are too poor to qualify for Care Credit. In certain cases, a 3-unit brigde gives the patient better esthetic result than a poorly placed implant (due to lack of bone and ridge thickness). With the bridge, you can control the tooth emergence profile better.
 
Last edited:
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.
 
  • Like
Reactions: 20 users
Top