OMFS and "Prestige"

[Sublimazing]

Ask @nade0016 if the x amount of applicants he invited this year “could” have been all 70+, even 75+. He seems pretty straight up. I’m not sure of the answer, but I believe that applicants with interesting life stories, intern years, applicants with stellar letters stood out more. Not just myself, but I know many 80+ applicants who had 4 year programs reject them. Simply put, 6 year programs care more about score because they have their med schools to report to. This while 4 year programs are more apt to take a guy with a borderline 60 score who has done 2 intern years. The most impressive candidates I have met on the interview trail so far are not the ones with the best scores. Their personalities and life stories stand out. Much more than my cookie cutter life. Scores are not everything.

So if a 6 year program gets 150 apps all with scores ranging from 67-99 yes the average is higher.

If a 4 year program like VCU, Monte, Cinci, or Iowa gets 300+ apps with scores ranging from 55-99, yes the averages might be lower but by no means does it mean they are “less competitive.” If they wanted to, they can matriculate a higher CBSE score than most 6 year counterparts. Often they do.

Yeah i think most people just use the traditional definition of the word “competitive” as opposed to your personal one.

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[nade0016]

Interesting thread/forum. I love the discussion as this is a great way to hash out new or unique ideas. To respond to Bergus95, The applicant pool was larger this year due to the fact that most candidates didn't have to travel to interview. So some of the more aggressive applicants applied to a large number of schools. The old throw **** at the wall and see what sticks technique. If that is true then the applicants with lower scores would have less interviews and that is what I am hearing "on the street". I think the in-person interviews help limit the applicant pool to a degree. You really have to want to go to program to apply as most programs require a separate application fee and then you have to travel/hotel/etc. Makes for an expensive process. I remember putting it all on credit cards just hoping to get through the cycle.

Could I have invited all 70+ or 75+ CBSE score applicants? Yup, could have but I don't want only those individuals. There were some very high scores on the CBSE this year. But if all you have is a great score thats not going to be enough.

We look at the entire applicant not just the score, as I believe most programs do. We have a committee of about 8 people that review each application and give a "yeah" or "nah" to interviewing the person. I depend on the other committee members experience and training to help guide me who to interview. After everyone has finished reviewing, I look at the 24 applicants with the most "yeah's" and invite them to interview. As happens each year, a few accept and then later decline for a multitude of reasons. And then I invite the next applicant with the most "yeah's" to fill in the spot that opened up. Is it the best technique? probably not, but its pragmatic and has worked for the few years I have been with my program.

After I invite applicants to interview we do not provide the CBSE score to the interviewers. Some are the same people that reviewed the applicants but nobody remember the CBSE of individual candidates. At the interview process its not the CBSE score but the person I want to get to know.

Don't know if this belongs in this forum as I believe we were discussing the different machinations of what the specialty could/should/would become. I like that 4v6 topic as it has a huge nuance and so many different factors. Where do we go as a specialty? That really depends on what you want to do with as a person after finishing residency. I train 4 year residents, 90% go into a private practice and a few stragglers go for academics. Then there is the occasional fellowship. But if I look back at the last 5 years, 18/20 are PP. 1 academic and 1 fellowship (PP cosmetics). Is perio taking over implants and grafting, etc? Probably a little bit, I see it at my institution but I also see the faculty and students coming to me with questions and difficult cases not going to the perio department. So I think OS is still seen as the "Top dog" at my institution. I am OK with that and I have a reason so bear with me.

I believe the GP DDS will be placing the vast majority of dental implants in the next 10 years. The technology for virtual planning and guided implant placement with position and depth control is exploding. From my PP setting I see the GP's starting to hear the call of the lab, telling them that they can single tooth implants and maximize profits. I think that is what we are going to start seeing more of in the next few years. Essentially, the GP takes a CBCT and intra-oral scan, send the data to a lab and they provide the GP with a plan. The plan will include guides, drills, temp tooth, etc. The cost will continue to go down as it has over the last few years. So the pros/perio take over of the simple implants will be short lived. The complex all-on-4 situations will go to ClearChoice. Their marketing and financing will take over that market in the next few years as well. Aspen dental just bought ClearChoice so it is going to expand exponentially in the near future.

Again, this is just my opinion and being that it is Saturday and cold/grey there may be a bit of booze floating into this post............

 

[aaaaa]

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.

7 years to become an oral and Maxillofacial surgeon is not feasible no matter what continent you practice (europe or NA). Neurosurg where i trained was 7 years and I don’t know of a surgical specialty that has longer training without a fellowship, a research year is irrelevant. Even if we took 7 years to become a non fellowship trained oms who almost entirely does tmj/trauma/orthognathic that is way too long with way too narrow scope of practice for that amount of time. Cleft/cosmetics and cancer will still require a fellowship prolonging that training another 1-2 years which would be 8-9 years of training.... can’t happen, the specialty will disappear or just become a plastics or ent fellowship.
Add on the debt of dental school and med school with possibly 5 years of interest...no way.

the specialty may need to widen its scope or decrease the amount of residency positions over time. Our main way to make a living is dentoalveolar and most PP oms I know do full scope as a hobby because it doesn’t pay well. Unfortunately the expansion of what general dentists/prosth/perio think they’re qualified to do will take a big hit on our specialty. Hopefully we can find a unified training track that helps solidify our position in dentistry and medicine

 

[C.elegans]

The future and viability of a specialty does not and cannot lie in a small subset of currently well-reimbursed procedures. Why? Because with technological and scientific advancements, at any moment, the said procedures may either become obsolete, become poorly paying due to restructuring of reimbursement models, or become more accessible to clinicians from other fields.

Well where does the future of a specialty lie in you ask? I would say it lies in the ability of a field to consistently train a group of strong academicians who churn out new scientific and clinical discoveries, expand scope of practice, invent new treatment paradigms, and train the next generation to continue the legacy. We do not need to look far for a prime example of this. Plastic surgeons are always on the forefront of new flap designs and surgical techniques, as well as inventing completely novel fields like gender affirmation surgery and migraine surgery. They have an abundance of physician scientists who do some great work on the basic science side as well (like wound healing and tissue engineering) which feeds back into clinical breakthroughs. This is probably why PRS has such a wide scope and is never in true danger of becoming obsolete as a specialty. A field that remains stagnant and complacent in its current success does not have a future my father always used to tell me, and I cannot agree more.

Our perio colleagues have taken this mantra to their hearts. With the advent of dental implants, there was no longer an absolute need to salvage teeth with poor prognoses as in the old days. Perio would likely not have survived as a specialty if it weren't for the pioneers in perio who contributed extensively to the implant literature and basic science research on bone biology, which in turn allowed them to push aggressively to expand their scope in to dental implant and pre-prosthetic surgery. We only have ourselves to blame if we feel like we are losing ground on implants, or if we are not gaining any ground in areas like facial cosmetic surgery (if only OMFS were blessed with a 100 more Joe Niamtus). Who would refer patients to us when we as a field seem to have no interest in advancing the scientific knowledge behind the surgeries we claim to be experts in? A small group of extremely driven and accomplished OMFS academicians are currently carrying our entire field, and as trainees, we owe them our gratitude. But once they too retire, can we be sure we have a next generation to continue the legacy?

A separate but related issue is the miserable failure of dental education to get students more interested in academic and scholarly activities. CODA's requirements on scholarly work for dental schools, and furthermore for OMFS residency, is a joke. Frankly, our dental background is what seems to be holding us back in terms of academic prowess and drive. We simply are not trained to think like academicians, and this translates to a general lack of research productivity as a field in whole. This is where I believe a medical school education becomes useful. I once saw data that in the past 10-20 years, dual degree OMFS were much more likely to pursue fellowship training and a career in academics compared to single degree OMFS. While there may be many reasons behind this (such as self selection), I personally think the medical school education and the heavy emphasis medical schools place on academics somewhat influences dual degree OMFS to go down this path unconsciously.

 

[nade0016]

The future and viability of a specialty does not and cannot lie in a small subset of currently well-reimbursed procedures. Why? Because with technological and scientific advancements, at any moment, the said procedures may either become obsolete, become poorly paying due to restructuring of reimbursement models, or become more accessible to clinicians from other fields.

Well where does the future of a specialty lie in you ask? I would say it lies in the ability of a field to consistently train a group of strong academicians who churn out new scientific and clinical discoveries, expand scope of practice, invent new treatment paradigms, and train the next generation to continue the legacy. We do not need to look far for a prime example of this. Plastic surgeons are always on the forefront of new flap designs and surgical techniques, as well as inventing completely novel fields like gender affirmation surgery and migraine surgery. They have an abundance of physician scientists who do some great work on the basic science side as well (like wound healing and tissue engineering) which feeds back into clinical breakthroughs. This is probably why PRS has such a wide scope and is never in true danger of becoming obsolete as a specialty. A field that remains stagnant and complacent in its current success does not have a future my father always used to tell me, and I cannot agree more.

Our perio colleagues have taken this mantra to their hearts. With the advent of dental implants, there was no longer an absolute need to salvage teeth with poor prognoses as in the old days. Perio would likely not have survived as a specialty if it weren't for the pioneers in perio who contributed extensively to the implant literature and basic science research on bone biology, which in turn allowed them to push aggressively to expand their scope in to dental implant and pre-prosthetic surgery. We only have ourselves to blame if we feel like we are losing ground on implants, or if we are not gaining any ground in areas like facial cosmetic surgery (if only OMFS were blessed with a 100 more Joe Niamtus). Who would refer patients to us when we as a field seem to have no interest in advancing the scientific knowledge behind the surgeries we claim to be experts in? A small group of extremely driven and accomplished OMFS academicians are currently carrying our entire field, and as trainees, we owe them our gratitude. But once they too retire, can we be sure we have a next generation to continue the legacy?

A separate but related issue is the miserable failure of dental education to get students more interested in academic and scholarly activities. CODA's requirements on scholarly work for dental schools, and furthermore for OMFS residency, is a joke. Frankly, our dental background is what seems to be holding us back in terms of academic prowess and drive. We simply are not trained to think like academicians, and this translates to a general lack of research productivity as a field in whole. This is where I believe a medical school education becomes useful. I once saw data that in the past 10-20 years, dual degree OMFS were much more likely to pursue fellowship training and a career in academics compared to single degree OMFS. While there may be many reasons behind this (such as self selection), I personally think the medical school education and the heavy emphasis medical schools place on academics somewhat influences dual degree OMFS to go down this path unconsciously.

OOOOhhhhhh, don't get me started on Dental Education, "most" dental schools have lost the plot. Anatomy? Why, Pathology, they just scrape the surface, Pharmacology? The students who rotate through my clinic have no idea how to write a prescription. The students don't know what Stanfords guide or Pharmacopeia is. I tell the students they should ask for their tuition back if they don't know how to write a prescription. Some very nice points in this post. I don't personally agree with all of them but well spoken and articulated. And if you have met Joe Niamtu, you know, one is enough. and I love Joe.

Can we start a forum about how dental education is drifting away from medicine and becoming a trade..............

 

[treedent]

Can we start a forum about how dental education is drifting away from medicine and becoming a trade..........

My professors talk about this all the time. I know that the schools that do classes with med student for the first 2 years catch a lot of heat on SDN (mostly cost related), but their commitment to teaching medicine is certainly respectable and should be more appreciated by some.

 

[C.elegans]

OOOOhhhhhh, don't get me started on Dental Education, "most" dental schools have lost the plot. Anatomy? Why, Pathology, they just scrape the surface, Pharmacology? The students who rotate through my clinic have no idea how to write a prescription. The students don't know what Stanfords guide or Pharmacopeia is. I tell the students they should ask for their tuition back if they don't know how to write a prescription. Some very nice points in this post. I don't personally agree with all of them but well spoken and articulated. And if you have met Joe Niamtu, you know, one is enough. and I love Joe.

Can we start a forum about how dental education is drifting away from medicine and becoming a trade..............

I sincerely appreciate your presence on the forum and the wisdom and insight that you bring. It is not everyday that trainees get to have these discussions on potentially sensitive topics with a current PD and Chair of an academic OMFS department. Your non-authoritarian persona despite your position is amazing.

I also want to emphasize that while I am someone who tends to have strong opinions on topics that I am passionate about, I am just a PGY-1 so what do I really know lol. Always open to constructive feedback and correction from anyone if I have my facts wrong or I am misinformed. I'm just glad that we can have these important discussions in a respectful and non-judgmental manner. We are all in this together and although people may have differing opinions on certain matters, everyone ultimately wants the best for our specialty.

 

[nade0016]

As I sit in my drinking chair looking over this post I wonder about the debt load that DDS students are being strapped with currently. As an example, there is a dental school in the US charging 100K per year for SOD tuition. I have a recent resident OMS graduate that between his wife and him they have 1 mil in student loans without dental school. Is this sustainable? If we expect our specialty to go for 7 years ( I am advocate for 6 ) then I think there would need to be some sort of universal "free" tuition or reduction in tuition. I cant see MD (Medical School) as an option as the debt will be too much and the applicant pool will dry up. I am looking for ideas to help find a way to get the MD in with no tuition. It's going to be tough to find a way. I am open to ideas and discussions about our specialty and where we go from here.

 

[nade0016]

From an insiders view I don't expect the 5 year program/s to survive long. The continued increase in demands from medical schools will put those out of commission at some point, look at Nebraska as an example. What happens with medical schools is they increase the number of "required" courses that OS residents have to complete and programs can't make the 30 months of OS (as required by CODA). As a CODA OMS program inspector I can say that is the number one concern that PD's have with Medical schools, at 6 years programs. Currently, most programs are allowed to "double dip" and claim certain medical school rotations as part of the 30 OS months. If that ability to double dip ever changes the MD programs will be tough to continue. That is why I am an advocate for the CODA/GME agreement to help relieve some of the stresses associated with medical school vs. OS requirements. Let's make Anesthesia in Medical School 4 months and a SubI. Or remove the CODA standard that states that residents on off-service rotations must be treated like PGY-1 residents. How is that accomplished if you are a medical student on anestheisa as some programs currently have it set up? It doesn't match up but it is overlooked by CODA.

As far a tuition goes....some programs being free and some not creates a unique environment. On the plus side is forces other programs who are not free to look at scholarship opportunities as they will not be as competitive and will possibly get "lower quality" candidates. On the negative, what if that "free" tuition changes during residency, you signed up for free medical school only to be told that is no longer there and you need to take out loans. Maybe for some reason you can't obtain the loans due to debt load. Then what? Do you get kicked out of residency? These are obviously "what if" scenarios but things to think about.

Love the thread.