Hey guys.
As I near the end of my first year, I would like to do an overview of my program, and hopefully give you an unbiased (or at least an attempt at a unbiased) insight to what University of Michigan Oral & Maxillofacial surgery is about.
This is NOT to compare my program to any other programs, and it is solely to give information to current and future applicants.
6-year MD & certificate combined program.
Residents per year: 3
Fellow per year: No more than 1 at a time.
Full time faculties: 7
Oldest U.S. OMS program in function. Inaugural class of 1917. Many notable graduates including but not limited to: Drs. Reed Dingman, James Hayward, Ole Jensen, Edward Ellis III, Norman Betts, Dale Baur, Brent Ward, Sean P. Edwards.
Hospitals Covered: 1!
Technically we are one gigantic health system complex that encompasses our main hospital, research facilities, cardiac center, cancer center, children's & woman's hospital, and med school. NO need to drive around at night covering multiple hospitals. The only traveling you do is to the dental school during your rotation there, and it is about 5 blocks away. You can walk or drive there. You work mainly from University Hospital & Mott Children's and Von Voigtlander Women's hospital.
Were not in-house call unless youre covering airway for fresh tracheostomies. So a lot of times you may be able to deal with most businesses at home, without having to go in. Not usually the case for trauma week though. No tooth call. GPR covers tooth call. We deal with multi-space abscess, eye or airway compromising abscesses, odontogenic or not.
Scope of Practice:
This I feel like is the main reason why Michigan attracts many potential residents year after year, & my reason for wanting/matching to Ann Arbor. The only aspect of Oral & Maxillofacial surgery and its expanded scope that we do not do often is cosmetics.
- Dentoalveolar: You are the only resident when you rotate through the dental school as a first year, and get to do whatever comes in the door: including 3rds under sedation; preprosthetic surgery FMX, tori, alveoloplasty; biopsies; ortho ext & exposures. When you are upper level, there are two, ½ days at the hospital dedicated to 3rds & other dentoalveolar surgeries under sedation. We use fent, midaz, propofol, ketamine, etc.
- Orthognathics: Dr. Edwards alone does about 170-200 patients a year. We have 2 new faculties who are starting to build their practice, so I think we do ample amount of orthognathics. Most of our orthognathic surgeries are not straight forward, and are referred to us from outside orthodontists and oral surgeons. Majority of the cases are bimax, oftentimes multi-piece maxilla and sometimes multi-piece mandible. Fellowship trained in craniofacial, Ive also seen Dr. Edwards incorporate Le Fort 2 osteotomy for orthognathic surgeries. We used Dolphin and Medical Modeling.
- Cancer: We cant talk about University of Michigan without talking about Cancer. We do ablative/resection, neck dissection, microvascular free tissue transfer, and reconstructions all under our department. It is nice to see a patient go from huge tumor, resection and reconstruction in one day, and years later and get implants placed by us for prosthesis. We have maxillofacial prosthodontics integrated to our department, and you get to learn how to work with prosthodontists also. We think about 1/3 of our service is spent doing cancer AND reconstructive surgery. It is more appropriate, I think, to talk about reconstruction separately from cancer, as not all cancer patients get reconstruction except for maybe skin graft.
- Reconstructive: We do free fibula, scapula, ALT, pectoralis, SMAS, Nasolabial flap, cervicofacial, radial forearm, costochondral, iliac crest, tibial, BMP, ramus, etc. We deal with good amount of benign and malignant path, as well as cleft and post trauma patients to be exposed to all kinds of reconstructions. Faculties differ in what they like to use for reconstruction, and having 7 full-time OMS faculties, you see many different surgical techniques.
- Pediatric/ Craniofacial: Dr. Aronovich and Dr. Edwards are both craniofacial fellowship trained surgeons, and we have busy pediatric clinics. You see a whole gamut of syndromic patients, cleft craniofacial patients, and also sadly pediatric cancer patients. If you can deal with the parents, I think youll be comfortable with pediatric patients when youre done.
- Trauma: Trauma is split between OMS, ENT, and Plastics. Were on facial trauma every 3 weeks, no anatomical restriction. Ann Arbor is not a rough town, and although we are near Detroit, gun and knife goes to the many Detroit hospitals. However, you can pretty much assume that U of M covers the rest of the state. We get patients flown in from the upper and west side of the state all the time. Besides moderate number of person-to-person trauma, I think we get good amount of weird traumas. What I mean by that is we get a lot of dog bites, horse or other animal trampling, self inflicted gunshot wounds, tractor injuries, ATV injuries and etc. One of my first trauma patient was GSW to face who got radial forearm and fibula free flap, who then went on to receive paramedian forehead, calvarial bone and conchal cartilage graft for nose reconstruction. All by our department.
- TMJ: We have 3 faculties who do TMJ surgeries, one of them who only do TMJ surgeries. This includes arthrocentesis, arthroscopies, temporalis flaps, costochondral grafts, total prosthesis, etc. We also have, under our department umbrella, TMD faculty who does non-surgical treatments.
- Obstructive Sleep Apnea: We are part of the sleep disorder clinic that includes neurology, oto, gastro, and etc. We do the jaw surgeries. Oto does tonsils and adenoids.
- Anesthesia: You do 4 months (well I guess 5 months now) during your 1st year. Youre treated as an anesthesia resident, and they get you working very fast. You get comfortable doing GA, and they let you do as much as you want, including spinals, epidurals, LMA, MAPS, etc. Youve dealt with enough medicine at this time that you dont feel lost administering anesthesia even to ASA 3 & sometimes ASA 4 patients.
Faculty: Program director is Dr. Edwards, and oncology and microvascular reconstruction fellowship director is Dr. Ward. Chairman is Dr. Helman. I believe all 7 of our full-time faculties are fellowship trained in something, and they are all very approachable. Of course we respect them, but it wouldnt be unusual for us to be joking on each others behalf. I think no matter what I say, it wouldnt be doing them justice. Lets just say I feel very fortunate to have such great faculties.
City: Supposedly it is voted one of the best cities to live in US, year after year. I would say being from a metropolitan area it is more like a larger suburb mixed with a college town. I dont feel like Im missing anything by living here, and Detroit being only 30 minutes away, if you need to go to a ball game or a concert, they are all within reach. It does get cold here though, but youd expect that from any Midwestern or Eastern programs. I havent explored too much of the whole state, but there are many beautiful areas near by. No good skiing or snowboarding though.
Med School: Med school is consistently ranked very high. When you go to med school here, it is not something you just do to get over with. Its tough, and they expect a lot out of you. However, if youre a surgeon who would like to practice the full scope of oral surgery and work in hospital setting, I think it definitely prepares you well.
Residents: Every time someone externs at our program, I tell them this is my favorite aspect of the program. We really appreciate each other and work well together. I think being a smaller department in the hospital we have to work together well to get things done. Something that I didnt think much of while applying, but now feel is one of the KEY thing that you should look for. The only way to find out if you fit in well is externing or interviewing though.
Research: If you want to do research, there are ample opportunities to do so. Dr. Feinberg was the Chair of research for International Association of OMS, and now Dr. Helman is. Other faculties are also very well published.
Negatives so far:
- Overall I think the positives overweight the negatives. I dont think we have very much mid-level support such as physicians assistant or nurse practitioners. Not an absolute bad thing, but something that I think could we improve.
- Back end heavy: as an intern, youre doing a lot of dentoalveolar, closing lacs, closing graft or flap sites, doing tracheostomies and etc. As upper level is when you really get your hands dirty with whatever you can handle and whatever you hope to experience.
- Not typical Midwest cost of living: Ann Arbor is pricey compared to many other places in Midwest. Not exactly sure why, but it is. However, I think our salary is fair. You get $200 per month for food for being on call to help out.
Okay, I'm not sure if I did justice to our program, but that's about all I got tonight. Also, this is a 1st years perspective, and Im sure my mind about certain things will change over the 6 years Ill spend here. If there are some mistakes/ things that you'd like to add, feel free to do so. I just hope that this is helpful info for guys applying in the years to come.
It was great! That was quite an exciting experience.
I learned much more about OMFS. I would definitely love to do more externships. In the meantime....I am preparing for NBME CBSE...
