OMFS and "Prestige"

[treedent]

It seems like it's pretty random as to who is getting interviews this season. I know there's always lots of talks about how its best to go to one of the "prestigious" schools to land a residency position. I was wondering if anyone has any insight on whether or not that seems to be the case this cycle. Are people from UCLA/UCSF/Harvard/UConn/Columbia fairing better than others, or is it tough for everyone out there?

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[Polkadotfan]

I don't go to one of those schools and I have 10+ interviews along with others at my school I'm pretty sure. I don't regret going to an inexpensive school at all, but I wish I had gone to P/F if just to relieve some stress

 

[Sublimazing]

I don't go to one of those schools and I have 10+ interviews along with others at my school I'm pretty sure. I don't regret going to an inexpensive school at all, but I wish I had gone to P/F if just to relieve some stress

texas school then?

 

[Ivy.ch]

All the top guys/gals this year who I’ve met- the ones I’m seeing again and again at each interview - are all from public schools. I’ve met 1 Penn and 1 Harvard applicant so far.

Interviewers seem impressed that I scored well on the CBSE from a state school. They know we didn’t get the medical school curriculum to help us, and they’ve mentioned that more than once.

 

[dolfin]

All the top guys/gals this year who I’ve met- the ones I’m seeing again and again at each interview - are all from public schools. I’ve met 1 Penn and 1 Harvard applicant so far.

Interviewers seem impressed that I scored well on the CBSE from a state school. They know we didn’t get the medical school curriculum to help us, and they’ve mentioned that more than once.

What is a good score if you don’t mind me asking?

 

[nade0016]

Depends, what are you trying to do? 6 v. 4 year program? 4 years programs are going to look less at the CBSE unless that is all they have to evaluate your academic/didactic prowess. 6 year programs are going to be under a bit of pressure from the medical school to select students who can pass USMLE step 1 first time. Medical schools are partially judged on how many people fail Step 1. So Med schools look at scores over 210-215 as good scores and the student will not need much help to pass Step 1. During my time at a 6 year program I did run into the med school pushing against or even refusing to accept an applicant with a low CBSE score. Remember you must be admitted to medical school in 6 year OMS programs not just match to the residency. Are there outliers, sure, but I think that seems to be the trend for MD/OS programs that I do CODA site visits at.

This year will be particularly hard for applicants as dental students had time off to study for the CBSE while those in intern/GPR's probably did not. Those who scored well while in the internship/GPR will be looked at closely. Just a strange year but students are smart and are beginning to figure the out how to score high on the CBSE.

 

[OMSx]

4 years programs are going to look less at the CBSE unless that is all they have to evaluate your academic/didactic prowess.

Assuming all other portions of an application are good (no red flags), what class rank % and CBSE score would qualify somebody for an interview at a 4 year program?

 

[klownzo]

This year will be particularly hard for applicants as dental students had time off to study for the CBSE while those in intern/GPR's probably did not. Those who scored well while in the internship/GPR will be looked at closely. Just a strange year but students are smart and are beginning to figure the out how to score high on the CBSE.

Are you bundling all dental students in the more more time off to study or did you look at dates of when the CBSE was taken? There's been debate on here if people that took the test this last round will be scrutinized a little more than previous test dates.

 

[nade0016]

I will be very honest with the previous 2 posts. I do not look at the dates and frankly don't care. The score is the score. Get a score above my minimum and thats all I need. I will say that applicants with really high scores make me nervous that they will be looking for 6 years programs and using 4 year programs as back up. But thats probably my crippling self doubt.

As for class rank and CBSE, be ranked in the the top 25% with a CBSE above 165 and I won't give it another thought. Then I will start looking at the CV, personal statements and letters of recc. Again, as previous, do not have non-OMS write letters or recc. They are usually not taken on the same level as an OMS letter as those individuals have not been through OS residency and really don't know what OS residency means.

There is a large difference between OS professionally and OS residency. What I mean is as a program director I want an applicant that is ready to be in the trenches. A hard worker who can multitask, think on their feet and handle difficult situations. I want an applicant I think will succeed and not bail out when the road gets tough. There needs to be a bit of intelligence but also a "linebacker" mentality. I see applicants all the time that have no experience in the trenches, no idea what they are getting into with a residency. So I am looking for an applicant who has seen what it means to be a resident.

Grades, Class Rank, CBSE, Boards get you in the door. Then show me how you will be my left hand man in the clinic, the OR and on call. Show me you can handle difficult patients with ease and respect. Tell me who you want to spend 4-6 years making minimum wage to suture up a face at 3 am in the morning on a drunk guy spitting at you. It's a tough ask but I can tell you that every year at interviews I can list those applicants who get it and those that do not very quickly.

Whew, that was a lot. Klownzo and OMSx, I hope I answered your questions. I get a bit long winded on these forums.

 

[Ivy.ch]

I will be very honest with the previous 2 posts. I do not look at the dates and frankly don't care. The score is the score. Get a score above my minimum and thats all I need. I will say that applicants with really high scores make me nervous that they will be looking for 6 years programs and using 4 year programs as back up. But thats probably my crippling self doubt.

As for class rank and CBSE, be ranked in the the top 25% with a CBSE above 165 and I won't give it another thought. Then I will start looking at the CV, personal statements and letters of recc. Again, as previous, do not have non-OMS write letters or recc. They are usually not taken on the same level as an OMS letter as those individuals have not been through OS residency and really don't know what OS residency means.

There is a large difference between OS professionally and OS residency. What I mean is as a program director I want an applicant that is ready to be in the trenches. A hard worker who can multitask, think on their feet and handle difficult situations. I want an applicant I think will succeed and not bail out when the road gets tough. There needs to be a bit of intelligence but also a "linebacker" mentality. I see applicants all the time that have no experience in the trenches, no idea what they are getting into with a residency. So I am looking for an applicant who has seen what it means to be a resident.

Grades, Class Rank, CBSE, Boards get you in the door. Then show me how you will be my left hand man in the clinic, the OR and on call. Show me you can handle difficult patients with ease and respect. Tell me who you want to spend 4-6 years making minimum wage to suture up a face at 3 am in the morning on a drunk guy spitting at you. It's a tough ask but I can tell you that every year at interviews I can list those applicants who get it and those that do not very quickly.

Whew, that was a lot. Klownzo and OMSx, I hope I answered your questions. I get a bit long winded on these forums.

Sir, I have two questions for you. We appreciate you helping us out in the forums. I already applied, so it won’t help me much, but for future applicants sake.

1) you mention having only OMFS letters. If one has 3, does it hurt to add another non-OMFS? I thought I had a unique relationship with someone at school so I added that letter in addition to my required 3. Everyone needs 3 OMFS, that’s the unofficial rule.

2) you mention assuming high scorers will go to 6-years. We’ve definitely seen that happen this cycle - applicants who really want a 4-year program with fantastic scores did not get many interviews to 4’s, but received plenty from 6’s. Is there a way to avoid being brushed off as a 6-year guy/gal with a high score?

 

[nade0016]

Folks,

A high CBSE should not be a hindrance but I think this year is so abnormal that we may see a bit of that. Remember, PD's don't see where you apply other than our program so I don't know what your plans/goals are. I would say to make sure that if you want a 4 year program you must somehow show that in the application. Make it evident. If you are not sure and just applying to all programs then you must be ready to accept applications to 6 year programs and be accepted by 6 year programs. But there are worse things.

I would focus on a good score and if you do not want a 6 year spot then make sure you state that in your personal statement but be prepared to not have 6 year an option then.

As for letters of recc. 3 OMS letter. Additional letters from non-OMS don't do much for me in selecting who to interview. I am much more persuaded by a phone call or email from a PD or Chairman. I usually get a couple every cycle and I take those very seriously. So if you are really interested in a program have your PD or Chairman reach out to the program you are interested in.

Let me give you my personal experience. I did not want a 6 year program and went to interview for the 4 year spot where I trained. After the interview the Chairman stated he really thought I would be a great fit for the 6 year program. As it was my second time around the interview cycle I didn't want to miss any opportunities so I added the 6 year option. Guess what, I matched to the 6. At first I was concerned about the "opportunistic cost" but after finishing residency I would not do it a different way.

There are certainly arguments to be made for 4 versus 6 and I think there will be reckoning in the specialty in the next 10 years that will probably resolve this and push OS in the US to a more UK type model. 2-3 Years for a "exodontist" and 6 years for the OMFS Trauma, Hospital based surgery portion of the profession. As someone who sits on a few committees where these items are discussed I see this train coming down the tracks.

I could wax poetic in the differences, 4 v 6, as a 6 year trained PD/Chairman at a 4 year program. But alas, perhaps another time.

 

[klownzo]

Folks,

A high CBSE should not be a hindrance but I think this year is so abnormal that we may see a bit of that. Remember, PD's don't see where you apply other than our program so I don't know what your plans/goals are. I would say to make sure that if you want a 4 year program you must somehow show that in the application. Make it evident. If you are not sure and just applying to all programs then you must be ready to accept applications to 6 year programs and be accepted by 6 year programs. But there are worse things.

I would focus on a good score and if you do not want a 6 year spot then make sure you state that in your personal statement but be prepared to not have 6 year an option then.

As for letters of recc. 3 OMS letter. Additional letters from non-OMS don't do much for me in selecting who to interview. I am much more persuaded by a phone call or email from a PD or Chairman. I usually get a couple every cycle and I take those very seriously. So if you are really interested in a program have your PD or Chairman reach out to the program you are interested in.

Let me give you my personal experience. I did not want a 6 year program and went to interview for the 4 year spot where I trained. After the interview the Chairman stated he really thought I would be a great fit for the 6 year program. As it was my second time around the interview cycle I didn't want to miss any opportunities so I added the 6 year option. Guess what, I matched to the 6. At first I was concerned about the "opportunistic cost" but after finishing residency I would not do it a different way.

There are certainly arguments to be made for 4 versus 6 and I think there will be reckoning in the specialty in the next 10 years that will probably resolve this and push OS in the US to a more UK type model. 2-3 Years for a "exodontist" and 6 years for the OMFS Trauma, Hospital based surgery portion of the profession. As someone who sits on a few committees where these items are discussed I see this train coming down the tracks.

I could wax poetic in the differences, 4 v 6, as a 6 year trained PD/Chairman at a 4 year program. But alas, perhaps another time.

Thanks for the insight. If there is a split in the speciality like in the UK, do you think 4 year trained surgeons will start to be limited in what they can do at that time? Is a 6 year degree more "future proof" for full scope omfs? Also would love to hear your thoughts on the 4 vs 6 debate. Thanks!

 

[dentident]

I will be very honest with the previous 2 posts. I do not look at the dates and frankly don't care. The score is the score. Get a score above my minimum and thats all I need. I will say that applicants with really high scores make me nervous that they will be looking for 6 years programs and using 4 year programs as back up. But thats probably my crippling self doubt.

As for class rank and CBSE, be ranked in the the top 25% with a CBSE above 165 and I won't give it another thought. Then I will start looking at the CV, personal statements and letters of recc. Again, as previous, do not have non-OMS write letters or recc. They are usually not taken on the same level as an OMS letter as those individuals have not been through OS residency and really don't know what OS residency means.

There is a large difference between OS professionally and OS residency. What I mean is as a program director I want an applicant that is ready to be in the trenches. A hard worker who can multitask, think on their feet and handle difficult situations. I want an applicant I think will succeed and not bail out when the road gets tough. There needs to be a bit of intelligence but also a "linebacker" mentality. I see applicants all the time that have no experience in the trenches, no idea what they are getting into with a residency. So I am looking for an applicant who has seen what it means to be a resident.

Grades, Class Rank, CBSE, Boards get you in the door. Then show me how you will be my left hand man in the clinic, the OR and on call. Show me you can handle difficult patients with ease and respect. Tell me who you want to spend 4-6 years making minimum wage to suture up a face at 3 am in the morning on a drunk guy spitting at you. It's a tough ask but I can tell you that every year at interviews I can list those applicants who get it and those that do not very quickly.

Whew, that was a lot. Klownzo and OMSx, I hope I answered your questions. I get a bit long winded on these forums.

Wish I knew to explicitly say I wanted to only do a 4 yr program. Got a +75 and haven't heard back from more programs than expected.

 

[nade0016]

Tough to know why that is. If you would like me to look over your application please feel free to contact me directly. I will give you my 2 cents for whatever its worth.

Bob

 

[Startingover123]

Tough to know why that is. If you would like me to look over your application please feel free to contact me directly. I will give you my 2 cents for whatever its worth.

Bob

Is there any talk that the CBSE will go pass/fail when step goes pass/fail? If so what will happen to OMFS apps?

 

[nade0016]

Thanks for the insight. If there is a split in the speciality like in the UK, do you think 4 year trained surgeons will start to be limited in what they can do at that time? Is a 6 year degree more "future proof" for full scope omfs? Also would love to hear your thoughts on the 4 vs 6 debate. Thanks!

Sure, if the profession went the UK route, 4 years (I think it will limited to 2-3 years) would end up with a limitation on scope practice. Probably would be limited to Teeth and titanium, biopsies and oral based procedures. Everything else hospital/surgical would go to the "OMFS" surgeons. I think fellowships will remain but only be available to OMFS 6 years. Yeah, I think a 6 year is more "future proof" if you don't know what you plan to do. If you are planning on T&T then in your dad's office after graduation then no need to go for the MD.

6 versus 4 currently is really interesting to me. I was a dyed in the wool 4 year guy until it wasn't an option. After finishing med school I cannot envision another way to do it. I love teaching my residents medicine and they complete 3 months of medicine. They get medicine but they don't know medicine. I delivered 10 babies in med school. I survived 3 night call shifts in a Psych ED hospital and I spent 6 months on inpatient medicine. I am very comfortable (although less so every year) managing hospital patients. If AAOMS and ABOMS decide its 4 or 6 we have a problem. Be a 4 year dental specialty with no fellowships and no options outside of T&T and basic OS scope. OR GO entirely 6 year and try to align more with the GME model of training and practice but lose more ground to our periodontal colleagues. This is a tough call as each has positives and negatives. Thats why I think there needs to be 2 tiers for the profession to survive.

Training wise, why not go for the gusto. With reimbursement for dental procedure declining and not going to go back up, with challenges to the anesthesia model and with rapid take over of DSO models (Someone mentioned that above and they are correct). T&T OS, I believe, will be less attractive in the next 10 years and may suffer a crisis of need.

These are my observations and opinions and nit universally seen nations wide. I have a recent grad who went to the middle of nowhere and started at 500K base salary. And other recent grads getting 2-300K but needing 1 mil to buy in. Student loans going up, cost of living increasing but not not salaries. This could be an issue. Not now, OS is good currently but OS's need to be on the look out.

 

[nade0016]

Is there any talk that the CBSE will go pass/fail when step goes pass/fail? If so what will happen to OMFS apps?

Not that I have heard of as of yet. Would be tough to make a test that is supposed to help identify weaknesses in knowledge a P/F exam.

 

[nade0016]

Not that I have heard of as of yet. Would be tough to make a test that is supposed to help identify weaknesses in knowledge a P/F exam.

Also, if CBSE went P/F it would severely hinder applicants from P/F Schools as then I would have no way to judge academic prowess. An applicant could be the 99/99 student in the class and I would have no way to know. My guess is AAOMS/CODA would adopt the GRE or some other academic knowledge measure/exam.

 

[Sublimazing]

Sure, if the profession went the UK route, 4 years (I think it will limited to 2-3 years) would end up with a limitation on scope practice. Probably would be limited to Teeth and titanium, biopsies and oral based procedures. Everything else hospital/surgical would go to the "OMFS" surgeons. I think fellowships will remain but only be available to OMFS 6 years. Yeah, I think a 6 year is more "future proof" if you don't know what you plan to do. If you are planning on T&T then in your dad's office after graduation then no need to go for the MD.

6 versus 4 currently is really interesting to me. I was a dyed in the wool 4 year guy until it wasn't an option. After finishing med school I cannot envision another way to do it. I love teaching my residents medicine and they complete 3 months of medicine. They get medicine but they don't know medicine. I delivered 10 babies in med school. I survived 3 night call shifts in a Psych ED hospital and I spent 6 months on inpatient medicine. I am very comfortable (although less so every year) managing hospital patients. If AAOMS and ABOMS decide its 4 or 6 we have a problem. Be a 4 year dental specialty with no fellowships and no options outside of T&T and basic OS scope. OR GO entirely 6 year and try to align more with the GME model of training and practice but lose more ground to our periodontal colleagues. This is a tough call as each has positives and negatives. Thats why I think there needs to be 2 tiers for the profession to survive.

Training wise, why not go for the gusto. With reimbursement for dental procedure declining and not going to go back up, with challenges to the anesthesia model and with rapid take over of DSO models (Someone mentioned that above and they are correct). T&T OS, I believe, will be less attractive in the next 10 years and may suffer a crisis of need.

These are my observations and opinions and nit universally seen nations wide. I have a recent grad who went to the middle of nowhere and started at 500K base salary. And other recent grads getting 2-300K but needing 1 mil to buy in. Student loans going up, cost of living increasing but not not salaries. This could be an issue. Not now, OS is good currently but OS's need to be on the look out.

where are you hearing or seeing that we’d go the UK route?

 

[aaaaa]

Sure, if the profession went the UK route, 4 years (I think it will limited to 2-3 years) would end up with a limitation on scope practice. Probably would be limited to Teeth and titanium, biopsies and oral based procedures. Everything else hospital/surgical would go to the "OMFS" surgeons. I think fellowships will remain but only be available to OMFS 6 years. Yeah, I think a 6 year is more "future proof" if you don't know what you plan to do. If you are planning on T&T then in your dad's office after graduation then no need to go for the MD.

6 versus 4 currently is really interesting to me. I was a dyed in the wool 4 year guy until it wasn't an option. After finishing med school I cannot envision another way to do it. I love teaching my residents medicine and they complete 3 months of medicine. They get medicine but they don't know medicine. I delivered 10 babies in med school. I survived 3 night call shifts in a Psych ED hospital and I spent 6 months on inpatient medicine. I am very comfortable (although less so every year) managing hospital patients. If AAOMS and ABOMS decide its 4 or 6 we have a problem. Be a 4 year dental specialty with no fellowships and no options outside of T&T and basic OS scope. OR GO entirely 6 year and try to align more with the GME model of training and practice but lose more ground to our periodontal colleagues. This is a tough call as each has positives and negatives. Thats why I think there needs to be 2 tiers for the profession to survive.

Training wise, why not go for the gusto. With reimbursement for dental procedure declining and not going to go back up, with challenges to the anesthesia model and with rapid take over of DSO models (Someone mentioned that above and they are correct). T&T OS, I believe, will be less attractive in the next 10 years and may suffer a crisis of need.

These are my observations and opinions and nit universally seen nations wide. I have a recent grad who went to the middle of nowhere and started at 500K base salary. And other recent grads getting 2-300K but needing 1 mil to buy in. Student loans going up, cost of living increasing but not not salaries. This could be an issue. Not now, OS is good currently but OS's need to be on the look out.

There is already a crisis of need for full scope OMS. It’s a speciality that sadly has overlapping scope with multiple other doctors in every aspect except maybe TMJ. GPs now do many implants and 3rds, plastics overlaps with trauma, cosmetics and craniofacial/orthognathic and ent overlaps with trauma, cosmetics and H&N cancer. This is why there are only a handful of private oms (not affiliated with a residency) who are able to maintain a full scope practice without supplementing with T&T. The thought of creating a 6 year OMFS tract vs 3 yr oral surgeon tract isn’t realistic especially with the amount of “oral surgery” that general dentists do. Why would you need 3 years of “oral surgery” residency when many gps do implants and thirds without that?

How many “highly qualified 6 yr OMFS” are really needed in the US to do tmj/orthognathic and trauma (outside a residency program) and not also practice dentoalveolar/implant surgery? 1000 total? There is too much overlap. Cancer, cleft and cosmetics will always require additional fellowships just like it does for plastics and ent. If that’s the direction the specialty is headed then I worry it will be taken over completely by ent and plastics eventually. There simply isn’t a big enough need to train doctors to only do full scope oms with the amount of overlap there is with plastics/ent/dentists.

Look at other medical specialties. There is a little overlap for some specialties but ones like Derm, urology and Orthopaedics have done a very good job in cornering off their scope. I’ve rarely met a non oms physician who complained about not being busy enough. Can’t say the same for any type of dentist. Most wish they were busier and that’s where the problem lies. Too many dentists becomes too many dentists trying to expand their scope becomes too many dentists and specialists not being busy enough.

I would love to only practice hospital surgery like trauma/tmj/orthognathic but the reimbursement is horrible and I don’t think there is a big enough need even if the reimbursement was better, there are too many docs. Maybe more patients would have surgery if insurance paid more but I doubt it. Anyway, just throwing in my two cents. I think the specialty is awesome and I love it, just wish we had done a better job 20 years ago expanding and cornering off our scope

 

[nade0016]

where are you hearing or seeing that we’d go the UK route

Purely speculative.

 

[nade0016]

There is already a crisis of need for full scope OMS. It’s a speciality that sadly has overlapping scope with multiple other doctors in every aspect except maybe TMJ. GPs now do many implants and 3rds, plastics overlaps with trauma, cosmetics and craniofacial/orthognathic and ent overlaps with trauma, cosmetics and H&N cancer. This is why there are only a handful of private oms (not affiliated with a residency) who are able to maintain a full scope practice without supplementing with T&T. The thought of creating a 6 year OMFS tract vs 3 yr oral surgeon tract isn’t realistic especially with the amount of “oral surgery” that general dentists do. Why would you need 3 years of “oral surgery” residency when many gps do implants and thirds without that?

How many “highly qualified 6 yr OMFS” are really needed in the US to do tmj/orthognathic and trauma (outside a residency program) and not also practice dentoalveolar/implant surgery? 1000 total? There is too much overlap. Cancer, cleft and cosmetics will always require additional fellowships just like it does for plastics and ent. If that’s the direction the specialty is headed then I worry it will be taken over completely by ent and plastics eventually. There simply isn’t a big enough need to train doctors to only do full scope oms with the amount of overlap there is with plastics/ent/dentists.

Look at other medical specialties. There is a little overlap for some specialties but ones like Derm, urology and Orthopaedics have done a very good job in cornering off their scope. I’ve rarely met a non oms physician who complained about not being busy enough. Can’t say the same for any type of dentist. Most wish they were busier and that’s where the problem lies. Too many dentists becomes too many dentists trying to expand their scope becomes too many dentists and specialists not being busy enough.

I would love to only practice hospital surgery like trauma/tmj/orthognathic but the reimbursement is horrible and I don’t think there is a big enough need even if the reimbursement was better, there are too many docs. Maybe more patients would have surgery if insurance paid more but I doubt it. Anyway, just throwing in my two cents. I think the specialty is awesome and I love it, just wish we had done a better job 20 years ago expanding and cornering off our scope

Are you truly pre-dental as indicated?

 

[Silver_arrow]

Training wise, why not go for the gusto. With reimbursement for dental procedure declining and not going to go back up, with challenges to the anesthesia model and with rapid take over of DSO models (Someone mentioned that above and they are correct). T&T OS, I believe, will be less attractive in the next 10 years and may suffer a crisis of need.

Please explain why you think dual degree trained OMFS, is superior in regards to general anesthesia. In both daily practice, and credentialing wise (maintaining future privileges to administer general anesthesia).

 

[aaaaa]

Are you truly pre-dental as indicated?

No longer pre dental. Sorry if my post was blunt, just my opinion overall. Probably better places to discuss the future of OMS. I do think dental students should be warned though, dentistry is changing like crazy. Oms is a great specialty but unfortunately has a crazy amount of overlap with other specialties

 

[nade0016]

Please explain why you think dual degree trained OMFS, is superior in regards to general anesthesia. In both daily practice, and credentialing wise (maintaining future privileges to administer general anesthesia).

Not sure that my opinion came through well. I think 6 years residents (in general) have a better handle on medical conditions and how they affect anesthesia (in general). I often speak with my residents (4 year) about medical conditions and they look at me funny. Thats probably a problem with my program that I need to address. They give me a sort of " I really don't know about that" type of stare.

Do some programs train the residents well in anesthesia ( office based ), yes they do. Do some programs educate to the base minimum required by CODA and just let their residents loose on the public. For sure they do. I would say that for the most part, OMS does a really nice job of providing anesthesia and services to the public, but the shadow of "dentistry" still hangs in the air. If you look at the most recent newspaper/internet articles related to adverse outcomes in dental offices. The articles do not differentiate between dentists and OMS. The headline always reads " Dentist kills kid" and OMS is lumped into this group even though it is BS. That is the problem. We will always be lumped into the "dentist" category as long as AAOMS allows it to happen.

There is an assault from the medical/anesthesia community on the OMS specialty. As a partner of the chairman of OMSNIC, I get to see the weekly hate-mails he gets from the medical community regarding our anesthesia model. This will continue to be a problem until we (AAOMS) change the hearts and minds of the general public. The general public still believe we are dentists regardless of advanced training. This is the greatest challenge currently facing our profession.

I have been really proud of J Swift (OMSNIC) and AAOMS as they have done a decent job of refuting the "claims" from the medical community, but not the public. My current feeling/opinion is that as long as GA privileges are with dental boards and we are safe. But this issue will raise its ugly head again in the future. Let's be prepared, as a profession. to defend our practice model. Both from a professional and ethical standpoint. Whether thats 4 versus 6. Who cares, lets be a team and show the medical community that we know how to treat patients efficiently and safely.

Lastly, why not create a united front. Either go with 4 or go with 6. Start in 2030. Let say that AAOMS/ABOMS must decide by 2030 and as a specialty we are 4 or 6. I don't really care. I am six year trained but lead a 4 year program. I am OK either way but I think as a specialty we need a united front and making the training either 4 v. 6 would be a first step to creating a unified specialty.

I have also been drinking with family today so my arguments may be rambling and incoherent. So take that for what it is.

 

[nade0016]

No longer pre dental. Sorry if my post was blunt, just my opinion overall. Probably better places to discuss the future of OMS. I do think dental students should be warned though, dentistry is changing like crazy. Oms is a great specialty but unfortunately has a crazy amount of overlap with other specialties

you kidding? I love the passion! Keep it coming. I didn't think you sere pre-dent based on the fact that you have been on SDN since 2007. You got me beat, I entered residency on 2006. So any input in the forum is great.

 

[C.elegans]

6 versus 4 currently is really interesting to me. I was a dyed in the wool 4 year guy until it wasn't an option. After finishing med school I cannot envision another way to do it. I love teaching my residents medicine and they complete 3 months of medicine. They get medicine but they don't know medicine. I delivered 10 babies in med school. I survived 3 night call shifts in a Psych ED hospital and I spent 6 months on inpatient medicine. I am very comfortable (although less so every year) managing hospital patients. If AAOMS and ABOMS decide its 4 or 6 we have a problem. Be a 4 year dental specialty with no fellowships and no options outside of T&T and basic OS scope. OR GO entirely 6 year and try to align more with the GME model of training and practice but lose more ground to our periodontal colleagues. This is a tough call as each has positives and negatives. Thats why I think there needs to be 2 tiers for the profession to survive.

Hello sir,

I read your posts with great interest, especially in the fact that you are a dual degree OMS who is PD of a 4 yr program. Im curious, if you have the option to transition your program in to a 6yr, would you be willing to do so? I realize many 4yr programs do not have an affiliate medical school for this to be an option, but I also know of various 4 yr programs that have an affiliate medschool and probably have the option to go the 6yr way (for example, Yale, Medstar, U Minnesota, Cook County, etc.)

I also think that OMS residents typically have a strong reputation in medschool for being hardworking and intelligent. Maybe increasing representation of OMS in medschools will help the specialty as a whole in that future physicians actually become more aware of the OMS scope and the fact that we are not "dentists" who drill and fill?

Interested to hear your thoughts!

 

[Masterus]

This is a great thread. I thought I’d chime in.
There is a great deal of overlap with plastics and ENT BUT there is a great need for certain procedures. I read a stat that over 40 percent of hospitals in California couldn’t staff an ENT or Plastic surgeon to fill all their days of trauma call. I’m sure there is a shortage nationally because no one wants to take call in practice. OMFS are needed in this regard. Also, in terms of malignant path, many regions of the country have so much head and neck cancer that the ENT program is inundated with cases and people are waiting to be seen or to go to surgery. Just like for us, head and neck is a fellowship and many ENT elect to go private practice rather than deal with that patient population. There are regions where omfs may struggle touching tha scope aka northeast but there has been an increase in the number of programs that do head and neck cancer which is great!!

Craniofacial will never be a normal omfs scope because there are so few cases a year. We live in the US where it is rare. A single craniofacial surgeon can cover a 500 mile radius and still only do 25 cleft lips a year which is considered busy.

Please don’t down play the 3rd year of medical school where you are on the wards. When I was interviewing a few years back, people would say med school is very easy or it’s useless you just get it for the degree.

Now, having gone to a program that does 3rd of med school. Med school is what you make of it but also super beneficial. I would avoid programs that do the preclinical years 1 or 2 but in 3rd year, you are exposed to the annals of medicine that you would otherwise not see going to a 4 year. There’s a lot of benefit - Understanding how the hospital works, seeing how to work up the most common symptoms such as chest pain, SOB, delirium. A 4 year OMFS is not the same as a 6 year OMFS. The MD is not just a degree. Dental school is not equivalent to medical school in any regard. You will never learn the modalities of treatment and the algorithms of how to workup chest pain, abdominal pain, etc. You’ll understand patient history so much better and understand why they are on certain drugs or why they had certain surgeries. Medicine is a constantly evolving field and what you learn in medical school now some knowledge may contradict what your OMFS attending learned 30 years ago or they’ve come up with new regimens. Remember medical and dental training is under the model of training broad and being exposed to everything and then narrowing your scope.

 

[GimmeTheScalpel]

This is a great thread. I thought I’d chime in.
There is a great deal of overlap with plastics and ENT BUT there is a great need for certain procedures. I read a stat that over 40 percent of hospitals in California couldn’t staff an ENT or Plastic surgeon to fill all their days of trauma call. I’m sure there is a shortage nationally because no one wants to take call in practice. OMFS are needed in this regard. Also, in terms of malignant path, many regions of the country have so much head and neck cancer that the ENT program is inundated with cases and people are waiting to be seen or to go to surgery. Just like for us, head and neck is a fellowship and many ENT elect to go private practice rather than deal with that patient population. There are regions where omfs may struggle touching tha scope aka northeast but there has been an increase in the number of programs that do head and neck cancer which is great!!

Craniofacial will never be a normal omfs scope because there are so few cases a year. We live in the US where it is rare. A single craniofacial surgeon can cover a 500 mile radius and still only do 25 cleft lips a year which is considered busy.

Please don’t down play the 3rd year of medical school where you are on the wards. When I was interviewing a few years back, people would say med school is very easy or it’s useless you just get it for the degree.

Now, having gone to a program that does 3rd of med school. Med school is what you make of it but also super beneficial. I would avoid programs that do the preclinical years 1 or 2 but in 3rd year, you are exposed to the annals of medicine that you would otherwise not see going to a 4 year. There’s a lot of benefit - Understanding how the hospital works, seeing how to work up the most common symptoms such as chest pain, SOB, delirium. A 4 year OMFS is not the same as a 6 year OMFS. The MD is not just a degree. Dental school is not equivalent to medical school in any regard. You will never learn the modalities of treatment and the algorithms of how to workup chest pain, abdominal pain, etc. You’ll understand patient history so much better and understand why they are on certain drugs or why they had certain surgeries. Medicine is a constantly evolving field and what you learn in medical school now some knowledge may contradict what your OMFS attending learned 30 years ago or they’ve come up with new regimens. Remember medical and dental training is under the model of training broad and being exposed to everything and then narrowing your scope.

I agree with most of this and think it’s great but would like to address a couple points...

Don’t let whether you do M2 (or in our case M1) dictate your rank order. Being on the wards is very important in learning clinical medicine and how to take care of patients with a wide spectrum of issues. Regardless, for those of you that didn’t do Pre clinical Med school as part your dental education (unlike Masterus), it’s useful to learn foundational medicine so you are somewhat prepared for your M3 year and not a deer in the headlights. Of course, if you went to a dental school with a medical curriculum and not the dilute fluff biomedical courses most get in D1 and D2 compared to M1 and M2 content, then it’s not really advantageous for you to re-learn all that material, but again it shouldn’t significantly determine what OMFS program you choose. There are pros and cons to each medical curriculum for 6 year programs. All of our preclinical didactic coursework is 1 year long (M1) so we do 1 year of that and 1 year of core clerkships. Depending on the med school, you’ll be taught with many clinical correlates, etc that will ultimately prepare you for your learning experience on the wards. Majority of programs will have you doing at least some portion of time in a didactic biomedical setting learning organ systems anyway. Ultimately, one more time, it shouldn’t be high on your list on factors involved in ranking.

 

[GimmeTheScalpel]

I would tread carefully with broad and general statements such as "A 4 year OMFS is not the same as a 6 year OMFS." It seems like you are in your 2nd year of a 6 year program so I would wait to make statements like this.

While there is no doubt that going to a 6 year "might" give you a broader surface of training, many will argue that you will become a better trained Oral and Maxillofacial Surgeon at more 4 year programs than 6 year programs. Unless you go to a program which essentially tries to do as little medical school as possible, that will almost always be the case. The reality is that the field is very standardized and CODA is what regulates the gambit of training that is OMFS.

Most of the framework of OMFS is paved on the backs of single degree guys and many of the 6 year programs are viewed as spending too much time in medical school and too little time on pertinent services. Better word choice:

"A 4 year OMFS program is not the same as a 6 year OMFS, it can offer better training in the field or worse depending on where you go."

This isn’t a productive argument (what has more merit: 4 vs 6) and won’t go anywhere. Two issues:
1) Some in academic OMFS are in favor of accreditation by ACGME actually or joint accreditation with ACGME and CODA especially when it comes down to integration and unity with medicine as a whole.
2) Our time on service is incredibly short compared to our colleagues in other surgical fields. 30 month minimum is very short, whereas ENT and PRS are spending much longer on their own services and less time on general surgery (no integrated medical school time either). It’s an issue. So 4 vs 6 in the grand scheme of things might be better served as 5 vs 7 (or even more depending on if a program wants to integrate protected research time) in residency length but no doubt this would face opposition.

 

[aaaaa]

This is a great thread! With the expanded scope of general dentists, the anesthesia battle and length of training being so long (6yrs) with less surgical training length compared to other surgical specialties would the specialty be better served becoming a medical specialty like in France? How about removing plastics from the head and neck and just having “head and neck” residency which is a 4-5 yr residency that has fellowships in
- craniofacial
- cancer
- all the other ent fellowships
- tmj, orthognathic, trauma
- cosmetics

 

[Masterus]

To my original post. My only point is that the greatest value of medical school lies in 3rd year and exploring the various clerkships while learning the content on step 2 which is truly medicine (knowing treatment algorithms instead of memorizing histology). In most cases, to have matched means you have had enough mastery of the content from step 1 to do well on the cbse which is usually the goal of M1/M2 - mastery of the basic sciences. Take that information and use it as you will - it may or may not be important for people. I totally agree that there's a lot more important factors involved in residency selection than the nuances of what years of med school you do as long as you get to do M3.

The reason I say this is because I did the first 2 years of medical school fully integrated. Coming into intern year, there was a lot of gaps in my medical knowledge that I was only able to fill in somewhat by my own reading and education from the upper levels. M3 has really filled in a ton of gaps that were left after intern year and would have been useful even in intern year especially taking care of our head and neck patients. At the same time, I've been able to learn the major takeways in medical school related to OMFS better because of my experiences from intern year that I can apply them to.

My only other point here is that the MD adds to your medical knowledge. I'm not saying that a 6 is better than a 4 but rather it does not hurt to know more medicine and to understand your patients medical history that much more.

There are great and terrible 4 and 6 year programs and the field is not standarized by all means. A 4 year and a 6 year OMFS are not the same inherently due to the differences between the scopes of the programs and the addition of medical school and varying lengths of general surgery. There's not even a standarized pathway for the 6 because of the length of medical school, scope of program and general anesthesia. The pathways of training are so vastly different.

What I am trying to say isn't that one is better than the other, but rather that it has created a huge dichotomy in training pathways in OMFS. There is an insane difference in training among all programs - it is actually pretty insane. Like Gimme said earlier, we spend a minimum of 30 months at a program where what you do in those 30 months heavily depends on what program you are at. You could see no OR cases to you could only see OR cases and then there's a huge variability in what kind of OR cases you see. In the field of plastics and ENT, it is fairly standarized, you are in the OR and you have clinic and it's not as polarized - the scope doesn't change that drastically between programs and they are on service for nearly 48+ months. The issue is that the field doesn't really know what it wants! In the UK, every oral surgeon has a MD, knows how to do a neck dissection and has experience in head and neck cancer ablation and flap design, but that doesn't mean they all do it. (I'm not saying we have to be like them) A lot of them will still do only dentoalveolar. Just like how there are a ton of ENTs here who learn the same thing and will just go do tonsil and tubes. They are at least exposed and knowledable about all aspects of their specialty. For them, their scope is nicely defined and they pick accordingly what they want to do. What hurts our specialty is the vast differences in scope training leading to a difficulty in defining what our profession truly does.

 

[aaaaa]

To my original post. My only point is that the greatest value of medical school lies in 3rd year and exploring the various clerkships while learning the content on step 2 which is truly medicine (knowing treatment algorithms instead of memorizing histology). In most cases, to have matched means you have had enough mastery of the content from step 1 to do well on the cbse which is usually the goal of M1/M2 - mastery of the basic sciences. Take that information and use it as you will - it may or may not be important for people. I totally agree that there's a lot more important factors involved in residency selection than the nuances of what years of med school you do as long as you get to do M3.

The reason I say this is because I did the first 2 years of medical school fully integrated. Coming into intern year, there was a lot of gaps in my medical knowledge that I was only able to fill in somewhat by my own reading and education from the upper levels. M3 has really filled in a ton of gaps that were left after intern year and would have been useful even in intern year especially taking care of our head and neck patients. At the same time, I've been able to learn the major takeways in medical school related to OMFS better because of my experiences from intern year that I can apply them to.

My only other point here is that the MD adds to your medical knowledge. I'm not saying that a 6 is better than a 4 but rather it does not hurt to know more medicine and to understand your patients medical history that much more.

There are great and terrible 4 and 6 year programs and the field is not standarized by all means. A 4 year and a 6 year OMFS are not the same inherently due to the differences between the scopes of the programs and the addition of medical school and varying lengths of general surgery. There's not even a standarized pathway for the 6 because of the length of medical school, scope of program and general anesthesia. The pathways of training are so vastly different.

What I am trying to say isn't that one is better than the other, but rather that it has created a huge dichotomy in training pathways in OMFS. There is an insane difference in training among all programs - it is actually pretty insane. Like Gimme said earlier, we spend a minimum of 30 months at a program where what you do in those 30 months heavily depends on what program you are at. You could see no OR cases to you could only see OR cases and then there's a huge variability in what kind of OR cases you see. In the field of plastics and ENT, it is fairly standarized, you are in the OR and you have clinic and it's not as polarized - the scope doesn't change that drastically between programs and they are on service for nearly 48+ months. The issue is that the field doesn't really know what it wants! In the UK, every oral surgeon has a MD, knows how to do a neck dissection and has experience in head and neck cancer ablation and flap design, but that doesn't mean they all do it. (I'm not saying we have to be like them) A lot of them will still do only dentoalveolar. Just like how there are a ton of ENTs here who learn the same thing and will just go do tonsil and tubes. They are at least exposed and knowledable about all aspects of their specialty. For them, their scope is nicely defined and they pick accordingly what they want to do. What hurts our specialty is the vast differences in scope training leading to a difficulty in defining what our profession truly does.

To my original post. My only point is that the greatest value of medical school lies in 3rd year and exploring the various clerkships while learning the content on step 2 which is truly medicine (knowing treatment algorithms instead of memorizing histology). In most cases, to have matched means you have had enough mastery of the content from step 1 to do well on the cbse which is usually the goal of M1/M2 - mastery of the basic sciences. Take that information and use it as you will - it may or may not be important for people. I totally agree that there's a lot more important factors involved in residency selection than the nuances of what years of med school you do as long as you get to do M3.

The reason I say this is because I did the first 2 years of medical school fully integrated. Coming into intern year, there was a lot of gaps in my medical knowledge that I was only able to fill in somewhat by my own reading and education from the upper levels. M3 has really filled in a ton of gaps that were left after intern year and would have been useful even in intern year especially taking care of our head and neck patients. At the same time, I've been able to learn the major takeways in medical school related to OMFS better because of my experiences from intern year that I can apply them to.

My only other point here is that the MD adds to your medical knowledge. I'm not saying that a 6 is better than a 4 but rather it does not hurt to know more medicine and to understand your patients medical history that much more.

There are great and terrible 4 and 6 year programs and the field is not standarized by all means. A 4 year and a 6 year OMFS are not the same inherently due to the differences between the scopes of the programs and the addition of medical school and varying lengths of general surgery. There's not even a standarized pathway for the 6 because of the length of medical school, scope of program and general anesthesia. The pathways of training are so vastly different.

What I am trying to say isn't that one is better than the other, but rather that it has created a huge dichotomy in training pathways in OMFS. There is an insane difference in training among all programs - it is actually pretty insane. Like Gimme said earlier, we spend a minimum of 30 months at a program where what you do in those 30 months heavily depends on what program you are at. You could see no OR cases to you could only see OR cases and then there's a huge variability in what kind of OR cases you see. In the field of plastics and ENT, it is fairly standarized, you are in the OR and you have clinic and it's not as polarized - the scope doesn't change that drastically between programs and they are on service for nearly 48+ months. The issue is that the field doesn't really know what it wants! In the UK, every oral surgeon has a MD, knows how to do a neck dissection and has experience in head and neck cancer ablation and flap design, but that doesn't mean they all do it. (I'm not saying we have to be like them) A lot of them will still do only dentoalveolar. Just like how there are a ton of ENTs here who learn the same thing and will just go do tonsil and tubes. They are at least exposed and knowledable about all aspects of their specialty. For them, their scope is nicely defined and they pick accordingly what they want to do. What hurts our specialty is the vast differences in scope training leading to a difficulty in defining what our profession truly does.

I agree completely, we need a standard education track. It would legitimize the specialty in the medical field especially and hopefully would help with public perception which is a problem in some parts of the country.

 

[nade0016]

Hello sir,

I read your posts with great interest, especially in the fact that you are a dual degree OMS who is PD of a 4 yr program. Im curious, if you have the option to transition your program in to a 6yr, would you be willing to do so? I realize many 4yr programs do not have an affiliate medical school for this to be an option, but I also know of various 4 yr programs that have an affiliate medschool and probably have the option to go the 6yr way (for example, Yale, Medstar, U Minnesota, Cook County, etc.)

I also think that OMS residents typically have a strong reputation in medschool for being hardworking and intelligent. Maybe increasing representation of OMS in medschools will help the specialty as a whole in that future physicians actually become more aware of the OMS scope and the fact that we are not "dentists" who drill and fill?

Interested to hear your thoughts!

Ah, excellent comment and question. Would I be willing to transition the U of MN program from 4 to 6? Long story short here:

When I was hired at the U of MN in 2015 the Dean of the SOD was Dr. Leon Assael. A 6 year trained OS/MD himself. He and the Chairman of OS at the time went to the Med School at the U of MN and asked about initiating or transitioning our program to a 6 year curriculum. The Dean of the School of Medicine looked at the proposed OS/MD curriculum and stated that to get an MD at Minnesota you must complete 4 years. No less since the U has an integrated 1-4 curriculum. An integrated curriculum basically means that M1/M2's are on the floors when not in classes, rotating in the hospital and certain medicine clinics. So the SOM was not open to the idea of an altered curriculum to accommodate OS residents. That is where it was left about 5 years ago. I would consider transitioning the program under the right circumstances but it would need a significant amount of planning and would need to benefit my program greatly. And frankly, I don't have that kind of time or support from the SOD at this time.

I am quite happy at the progress I have made over the last 2 years as PD of my little 4 year program. I have added a rotation that increases direct exposure to malignant path and additional trauma, limited some of the BS courses the school used to make residents take, and I believe I have created a more learning friendly environment. That was my goal when I got the job. I wanted to create a residency that people desired to come train at and know that the faculty are there to educate not denigrate. Beyond that I am just happy to have a group of residents who work hard, enjoy being around each other and, for the most part, get along well.

I hope this answers your question

 

[C.elegans]

I hope this answers your question

Thank you very much for your explanation. The fully integrated SOM curriculum does seem like somewhat of an inconvenience. U of MN has an excellent med school which could potentially serve as a great asset in my humble opinion.

It would be interesting to hear the reason why other 4 yr programs with the option are not transitioning to 6yr. Also, NYP-Weill Cornell program seems to be the only one in the nation to go against the trend and revert from a 6yr back to a 4yr in the past couple years. Curious what the reasoning behind that change was.

 

[Peon.]

Thank you very much for your explanation. The fully integrated SOM curriculum does seem like somewhat of an inconvenience. U of MN has an excellent med school which could potentially serve as a great asset in my humble opinion.

It would be interesting to hear the reason why other 4 yr programs with the option are not transitioning to 6yr. Also, NYP-Weill Cornell program seems to be the only one in the nation to go against the trend and revert from a 6yr back to a 4yr in the past couple years. Curious what the reasoning behind that change was.

I heard it was because too many failed the step exam

 

[C.elegans]

This isn’t a productive argument (what has more merit: 4 vs 6) and won’t go anywhere. Two issues:
1) Some in academic OMFS are in favor of accreditation by ACGME actually or joint accreditation with ACGME and CODA especially when it comes down to integration and unity with medicine as a whole.
2) Our time on service is incredibly short compared to our colleagues in other surgical fields. 30 month minimum is very short, whereas ENT and PRS are spending much longer on their own services and less time on general surgery (no integrated medical school time either). It’s an issue. So 4 vs 6 in the grand scheme of things might be better served as 5 vs 7 (or even more depending on if a program wants to integrate protected research time) in residency length but no doubt this would face opposition.

Although this would probably never happen during my life time, I am a strong proponent for dual ACGME and CODA accreditation. In the current status quo, dual degree OMS are too often disadvantaged and are forced to jump through additional hoops for various board certifications and licensing simply because OMS is not a ABMS recognized specialty and our months on OMS do not count toward ACGME accredited post-grad training.

While I suspect a handful of OMS programs that are struggling to meet CODA standards would inevitably shut down if ACGME were to get involved with their more stringent standards, I personally think this is a necessary growing pain for the long term viability and competitiveness of our specialty.

I also agree that minimum 30 months is a tad short. Some old school surgeons do not consider specialties like ophthalmology and OBGYN as "real" surgical specialties and this is because they do not undergo the traditional 5 year minimum surgical training that specialties like ENT, Ortho, GS, and Urology have in place. Integrated research time is a whole different story that we can discuss another time perhaps haha.

 

[Bereno]

I agree that OMFS needs to align their curriculum and requirements to their long term goals. I have been a proponent of 4 year programs (having graduated from a 4 year program myself), but do note the benefits of more medical education. For this reason, I think homogenizing the training into a 5 year program (instead of a 4 or 6 year) would be a reasonable bet. Spit-balling here, but adding 3 more months of medicine, 3 more months of gen surg, 3 months on related specialties (ENT and plastics), and 3 more months on service would be a good start. Consider doing away with the MD since so many programs would simply not be able to provide one, and just have one, track. For the current 6 year programs, offer 1 year fellowships if you want as well, maybe this would get some people to do more fellowships? I am not sure, but I think it could potentially strengthen our specialty.

 

[nade0016]

Leon Assael is not 6 year trained. In fact, he is not 4 year trained. He was of the era where they could be 3 year trained

Hes not? Holy crap. I was hoodwinked. I just assumed.

 

[nade0016]

Although this would probably never happen during my life time, I am a strong proponent for dual ACGME and CODA accreditation. In the current status quo, dual degree OMS are too often disadvantaged and are forced to jump through additional hoops for various board certifications and licensing simply because OMS is not a ABMS recognized specialty and our months on OMS do not count toward ACGME accredited post-grad training.

While I suspect a handful of OMS programs that are struggling to meet CODA standards would inevitably shut down if ACGME were to get involved with their more stringent standards, I personally think this is a necessary growing pain for the long term viability and competitiveness of our specialty.

I also agree that minimum 30 months is a tad short. Some old school surgeons do not consider specialties like ophthalmology and OBGYN as "real" surgical specialties and this is because they do not undergo the traditional 5 year minimum surgical training that specialties like ENT, Ortho, GS, and Urology have in place. Integrated research time is a whole different story that we can discuss another time perhaps haha.

I agree with you, I wish the ABOMS/AAOMS/CODA would approach ACGME and discuss a 2 for 1 scenario where 2 years of OMS training is equivalent to 1 year ACGME. I think this could help put OMS on a somewhat level footing with ACGME programs and reduce some of the hoops/roadblocks.

 

[GimmeTheScalpel]

I agree that OMFS needs to align their curriculum and requirements to their long term goals. I have been a proponent of 4 year programs (having graduated from a 4 year program myself), but do note the benefits of more medical education. For this reason, I think homogenizing the training into a 5 year program (instead of a 4 or 6 year) would be a reasonable bet. Spit-balling here, but adding 3 more months of medicine, 3 more months of gen surg, 3 months on related specialties (ENT and plastics), and 3 more months on service would be a good start. Consider doing away with the MD since so many programs would simply not be able to provide one, and just have one, track. For the current 6 year programs, offer 1 year fellowships if you want as well, maybe this would get some people to do more fellowships? I am not sure, but I think it could potentially strengthen our specialty.

Why would you rather have the specialty do away with the MD rather than earning one? Every OMFS being a physician isn’t necessarily a bad thing and might actually create universal collegiality between our field and other surgical specialties in the hospital setting. Like Masterus said, it depends on what the scope of the practitioner is. Might not even be a bad idea to have separate residencies for oral surgery and maxillofacial surgery like in Europe. I think this has been mentioned on the forum before. Or every program expanding to 7 years to create more time on service and confer a medical degree down the line. Many surgical residency programs are 7 years, it isn’t that far fetched.

 

[piratewow]

Or every program expanding to 7 years to create more time on service and confer a medical degree down the line. Many surgical residency programs are 7 years, it isn’t that far fetched.

Many of my classmates that were interested in OMFS initially are now applying to perio because they get to do implants, extractions, and sedation and only have to spend 3 yrs in a more laid-back residency. They get to do 80% of PP OMFS without the hassle.
The average person wanting to be a dentist wants to be "chill", hence why the 4 yrs are so much more competitive ( applicant volume wise) than 6 yrs.
While I agree with you philosophically , I also think that this will lead to more interest in perio and less interest in OMFS as a specialty, unless med school -> OMFS becomes a more viable pathway, but then they would have an unfair advantage (CBSE and P/F) over many dental students.
The most competitive surgical specialties are only 4-5 yrs (PRS,ENT, Uro, Ophtho).
If I wanted to be a surgeon I would probably gamble on going to med school instead if my only option as a dental student was a 7 yr residency, because let's be honest, not many people come into dental school being that passionate about OMFS ( mostly because pre-med/dents don't know much).

 

[parkinglottoilet]

Many of my classmates that were interested in OMFS initially are now applying to perio because they get to do implants, extractions, and sedation and only have to spend 3 yrs in a more laid-back residency. They get to do 80% of PP OMFS without the hassle.
The average person wanting to be a dentist wants to be "chill", hence why the 4 yrs are so much more competitive ( applicant volume wise) than 6 yrs.
While I agree with you philosophically , I also think that this will lead to more interest in perio and less interest in OMFS as a specialty, unless med school -> OMFS becomes a more viable pathway, but then they would have an unfair advantage (CBSE and P/F) over many dental students.
The most competitive surgical specialties are only 4-5 yrs (PRS,ENT, Uro, Ophtho).
If I wanted to be a surgeon I would probably gamble on going to med school instead if my only option as a dental student was a 7 yr residency, because let's be honest, not many people come into dental school being that passionate about OMFS ( mostly because pre-med/dents don't know much).

Just because the 4 year spots get more applicants doesn't mean it's more competitive. The average CBSE of a 6 year applicant is 11 points (on the old scale) higher than a 4 year applicant.

 

[GimmeTheScalpel]

Many of my classmates that were interested in OMFS initially are now applying to perio because they get to do implants, extractions, and sedation and only have to spend 3 yrs in a more laid-back residency. They get to do 80% of PP OMFS without the hassle.
The average person wanting to be a dentist wants to be "chill", hence why the 4 yrs are so much more competitive ( applicant volume wise) than 6 yrs.
While I agree with you philosophically , I also think that this will lead to more interest in perio and less interest in OMFS as a specialty, unless med school -> OMFS becomes a more viable pathway, but then they would have an unfair advantage (CBSE and P/F) over many dental students.
The most competitive surgical specialties are only 4-5 yrs (PRS,ENT, Uro, Ophtho).
If I wanted to be a surgeon I would probably gamble on going to med school instead if my only option as a dental student was a 7 yr residency, because let's be honest, not many people come into dental school being that passionate about OMFS ( mostly because pre-med/dents don't know much).

Plenty of OMFS think Perio shouldn’t be doing sedations or impacted 3rds or zygomatic/pterygoid implants. Plus they wouldn’t know how to manage the medical or surgical complications that could ensue. Nicked the lingual nerve... Perio doing the repair? or We spend 5 months on anesthesia in residency. But yeah it depends what you want to do. If you don’t want to do any orthognathic, or cover trauma call, or any TMJ, or cosmetic, then sure don’t do OMFS.

PRS, ENT and urology aren’t 4 years. They are 5-6, or 7 if they incorporate a mandatory research year. They don’t need to spend 2 years in medical school or a year in general surgery to get medical licensure so of course they can have a 5-6 year residency and spend most of it on service, which is why OMFS is in this conundrum.

 

[piratewow]

Most cases are simple, most general dentists can do things with experience and CE. The complex patients take much longer which means reimbursement is lower. At my school perio and prosth both place implants, with prosth doing all on 4s, full arch stuff, etc. I am not going to say what is best for the patient, what we should do ethically, how we can be the best trained, etc. Because the answer for that is obvious (full MD/ACGME accredidation). However, you will not attract the best applicants if your specialty is almost double the length of other specialties with the same or lower salary. The fact is the majority of OMFS applicants (and surgeons) are not die-hard academics.
There's a reason H&N is not very popular in ENT, with approx. 50% of spots going unmatched each year. Things like QOL, salary, time spent training, do matter to many people.
ENT, PRS, and Uro are only 5 years not 6, unless you don't match the 1st time.

 

[GimmeTheScalpel]

Most cases are simple, most general dentists can do things with experience and CE. The complex patients take much longer which means reimbursement is lower. At my school perio and prosth both place implants, with prosth doing all on 4s, full arch stuff, etc. I am not going to say what is best for the patient, what we should do ethically, how we can be the best trained, etc. Because the answer for that is obvious (full MD/ACGME accredidation). However, you will not attract the best applicants if your specialty is almost double the length of other specialties with the same or lower salary. The fact is the majority of OMFS applicants (and surgeons) are not die-hard academics.
There's a reason H&N is not very popular in ENT, with approx. 50% of spots going unmatched each year. Things like QOL, salary, time spent training, do matter to many people.
ENT, PRS, and Uro are only 5 years not 6, unless you don't match the 1st time.

Aren’t you a D3? Cool down.

At my program PRS is 7 years. It’s 7 years at John’s Hopkins. 6 at Penn, Stanford and NYU, to name a few. ENT is 5-6.

 

[GimmeTheScalpel]

It’s called cherry picking. How many zygomatic/pterygoid implants do you think are being done out there? How many can afford it? How many single tooth implants are being done for every one of them.

If I was trained in moderate to deep sedation, I would absolutely be doing every 3rd I possibly could that I felt comfortable with. Refer the OS my tough ones or worse, when **** hits the fan send them his/her way.

What I’m describing is the reality of our specialty right now. Best we address it than hide our heads in the sand.

My former attending actually did lots of zygomatic and pterygoid implants. He felt comfortable doing them and learned them in his residency. Sees lots of geriatric patients with atrophic maxillas.

What is the reality of our specialty? Are you an attending?

 

[Bereno]

Why would you rather have the specialty do away with the MD rather than earning one? Every OMFS being a physician isn’t necessarily a bad thing and might actually create universal collegiality between our field and other surgical specialties in the hospital setting. Like Masterus said, it depends on what the scope of the practitioner is. Might not even be a bad idea to have separate residencies for oral surgery and maxillofacial surgery like in Europe. I think this has been mentioned on the forum before. Or every program expanding to 7 years to create more time on service and confer a medical degree down the line. Many surgical residency programs are 7 years, it isn’t that far fetched.

Subtleties here are the key. I do not want to do away with the MD for the sake of getting rid of it, I was proposing a way to unify the specialty. For practical purposes, it would likely be much more difficult for all OMFS residencies to start delivering an MD, than for for them to stop delivering the MD. It would be far more feasible for a 4 year program to simply expand the time on service and rotations. Once again, this is for the long term goal of unifying the specialty and carving a well defined field for us.

Regarding the oral surgery vs maxillofacial surgery idea, I tend to have an odd view on this. I can understand the impetus for such a system, but on the other hand I can also see it creating counter productive issues as well. For example, an "oral surgeon" that does only oral surgery (implants and whizzies) might just become a advanced scope periodontist instead, negating the need for the oral surgeons. Furthermore, the "maxillofacial surgeons" could easily encroach on the world of ENT and plastics and not have much of a foot to stand on. Reimbursement would be difficult, and potentially 7 years of residency for poor reimbursement might be a tough sell. After all, who would refer to these maxillofacial surgeons? For this reason, I can see maxillofacial surgeons turning into a medical specialty, and if that did happen it might just become and ENT subspecialty. I could be totally wrong, but I can see a potential for these issues becoming large problems if it went this route.

 

[Sublimazing]

4 year is more competitive. They get more applicants. Way more. Don’t confuse more applicants and higher average scores.

Many many applicants this year are realizing that. If any 4 year program in the nation wanted to hand pick all their interviewees to have 70+’s they could. They have the luxury of being able to interview any CBSE they want.

I have received many a rejection from 4 year programs this year and have gotten almost all my “top” 6 year invites. Not sure what the method to the madness is, but when you have 300 applicants, score is not what a program is strictly looking for. That is sometimes the easiest thing to find.

The more applicants the more competitive. That is why internal medicine is the most competitive medical specialty.

 

[GimmeTheScalpel]

Why put down someone, even a D3? Maybe he knows more about the field than even perhaps you. Maybe he has a sibling, a parent, or another in the field that makes him more uniquely aware.

You go to Michigan, so I am assuming you like H&N. Be proud of that. Nothing he said was egregious or meant to come at you. The fact is most OMFS applicants want nothing to do with malignant cancer. Same with our ENT counterparts. That statement takes nothing away from you. Be prideful of the fact that you go to a premier institution for learning and training in a subset of the field that you were drawn to.

You’re making pretty strong statements, regarding ‘competitiveness’ of 4 vs 6 in a public forum. Very dichotomous. Also you would be better off not assuming things about programs or people at a broad scope place. Not everyone here does H/N. You won’t stop arguing anyway but good luck with the match process.