OMFS vs Ortho

Discussion in 'Dental Residents and Practicing Dentists' started by DrTooth19, Feb 8, 2018.

  1. DrTooth19

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    I am a third year DMD student. When I first came into dental school, I was really interested in OMFS, but then started to gear towards ortho. Mainly because of the patient population, cleaner oral cavity, easy lifestyle, fun treatment planning, and happy current orthodontists I talk to. But a part of me feels a little guilty not doing OMFS. I also find so much excitement doing extractions or hearing of doing implants (I havent placed one myself yet). I am gearing up my application to do ortho, but I am scared that maybe I am making the wrong choice and will want to do OMFS one day.

    Any advice from current ortho or OMFS residents for which to do? And if anyone switched, why? I appreciate your time!! :)
     
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  3. G4P

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    Did you even take the NBME? Seems like Ortho is where you wanna go so just go for it
     
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  4. 2TH MVR

    2TH MVR Orthodontist
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    Wow ... you couldn't have picked two more diverse specialties. I mean Ortho is about as non-invasive as it gets. Surgery is mucho invasive. I performed some surgery today. I helped a 12 yr old with a loose primary tooth hanging by a thread of tissue. lol. Orthodontists are very anal, detail oriented individuals. I've never met a surgeon who was ultra detail oriented. Orthodontists work with supporting staffs to see a large number of patients in a day. Almost like a factory. Surgeons work with fewer patients daily. In ortho .... you are "married" to your patients for at least 2 years, if not longer. Surgeons .... one or two hours.

    As for the job outlook during the current business climate .... seems like the OMFS have it better than the Orthos. Fewer surgeons as compared to the number of orthodontists is one reason. Technology has made ortho "possible" for lesser trained individuals.

    Good luck with your decision.
     
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  5. Medin2017

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    Don't forget the residency positions you have to pay for that have been opening up and contributing to saturation in the field. Definitely made getting into ortho possible for lesser individuals as well.
     
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  6. DrTooth19

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    Honestly, OMFS scares me because even though my grades are really good, I cannot remember a lot of medical information we learn in school, even if I study it 5 times. And I love learning about the medicine. Yet, I can remember a lot of dental information no problem. I am not sure why. I also am afraid of putting 4 years into a residency that will make me depressed from working crazy long hours every week. I know post residency, I will probably be good and happy but the road to get there is hard and I am already pretty burnt out.

    Whereas for ortho, I am on the track. And I like it too. Treatment planning is fun, the patients are mostly cool, the residents are all happy. What I am afraid of about ortho is getting bored after 10 years of practicing.

    I know these are 2 completely different things, but they hooked my interest compared to anything else. General dentistry in terms of crowns and fillings is cool too, but not as cool as OMFS and ortho.
     
    #5 DrTooth19, Feb 8, 2018
    Last edited: Feb 11, 2018
  7. G4P

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    I've met some microvascular OMFSs and boy they are super anal.
     
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  8. Medin2017

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    Difficulty in residency is definitely something to consider. Those hours are no joke.
     
  9. 2TH MVR

    2TH MVR Orthodontist
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    I didn't mean that OMFS are not anal in a bad way. They tend to look at the bigger picture as opposed to fitting cusp tips into fossas.
     
  10. The Anhedonia

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    This is, of course, categorically false when considering the entire scope of OMFS. Cancer patients require years of treatment and followup; craniofacial patients sometimes decades of follow-up procedures; TMJ patients often require multiple arthroscopic procedures and lots of out-patient oral medicine type treatment --- all of which are facilitated by these non-detail oriented surgeons you are talking about ;)
     
  11. 2TH MVR

    2TH MVR Orthodontist
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    Must have touched a raw nerve. Sorry if you feel butt hurt over what I said. You took everything I said out of context. Maybe next time I'll speak with fewer details.o_O
     
  12. alldemteeth

    alldemteeth ...but no toothbrush

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    When the title of the thread becomes real life...
     
  13. 2TH MVR

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    I'll expound on what I was saying. I did not have any intentions of disparaging my OMFS colleagues and unfortunately my comment gets taken out of context. Orthos work with fractions of mm. OMFS work with mm. Ortho treatment uses smaller increments of measurements than surgeons. We're anal about fractions of millimeters. I should have used a different term than DETAIL ORIENTED. My bad. Orthos for the most part see patients every month during active treatment and then see the same patients for retention checks. This is good and bad. Sometimes it would be nice to do a procedure (extract #1,16,17 and 32) and only see the patient a few times and move on.

    These are pros and cons to ortho and OMFS. Orthos ..... ON AVERAGE see their patients MORE OFTEN and MORE ROUTINELY than a "typical" OMFS extracting 3rd molars, doing implants, biopsies, cuspid exposures, sinus lifts, orthognathic surgery, etc. etc. I'm sure there are outliers out there (Pablo ....maybe) that see their patients more often and wonder if their mandibular setback was off a 1/2 millimeter.
     
  14. vellnueve

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    Not sure that those are outliers. We have more than a few patients that staff have been seeing for 20-30 years.
     
  15. The Anhedonia

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    Butt not hurt, quite comfortable actually.

    Took everything you said quite literally in context my friend. That's what "context" means. Good thing orthodontists only have to be detail-oriented with teeth, not basic rules of language ;)
     
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  17. 2TH MVR

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    Not to derail this thread any further .... thought I would add one more important real world distinction to the OP's question. Referrals tend to only go one way. Orthos refer to surgeons. Not the other way around. In the real world if you are an Ortho and you have a disagreement or personality conflict with a surgeon. Well .... they just lost your referrals. Predictably there will be multiple surgeons at your door requesting your referrals. That's business in the dental world.

    Signing off this thread. Time to go walk my dog. :)
     
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  18. charlestweed

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    When the tuitions for dental school and post grad residency were much lower many years ago, it’s much easier to make the decision to specialize. If you don't like one specialty, you can just switch to another specialty and waste a few grands. But now with much higher tuitions and student loan debt, you can’t just pick a specialty that you think you will enjoy. You have to be more careful about picking the right specialty that you think will help you pay off the loans faster and easier….can’t really have a good lifestyle if you constantly worry about paying back student loans.

    Ortho:
    -Due to oversaturation of ortho grads, it becomes harder to get good paying jobs at the corp offices. And if you do, they may only give you a few days a month. To keep yourself busy, you may have to work at different GP (or pedo) offices, travel to another state, work on the weekends, and start your own office etc. If you don’t want to do any of these, then you shouldn’t specialize.
    -Unlike the OS’s, who rely 100% on GP referrals, you can advertise your practice directly to the public. However, it becomes harder for the ortho offices to attract patients due to oversaturation. A lot of patients are now shopping around for the best price. To increase case acceptance, you may have to lower your fee, be fast and efficient (so you can treat high patient volume with fewer staff in a day), accept cheap insurance plans (and medicaid) that other ortho offices around yours don’t accept, have late and weekend hours etc.
    - Learn how to keep the overhead low by working at low overhead offices (ie the corp offices). If you don’t know how to keep the overhead low, your profit margin will be small…..and you will hate ortho. It’s doesn’t matter how much you love ortho and how much how much you enjoy diagnosing and treatment planning….you can’t really enjoy a job that doesn’t pay well or doesn’t help you pay off your student/business loans.

    Oral surgery:
    -As 2THMVR stated earlier, your success depends on GP referrals, how well you communicate with the GPs, your clinical skills, your office hours, the type of insurance plans your office accepts etc. If you don’t like going door to door meeting the GPs, then OS is not for you.
    -Your job is to make the GP’s life easier. You need to place the implants in a position that the GP can easily restore. If the GP’s don’t know how to restore implants, you have to go to their offices and teach them. If a GP accidently pushes a root tip into a sinus, you have to be readily available to help get that root out.
    -You are competing against the perio. If a perio is better at communicating with the referring GP's, you’ll lose the patients to that perio.
    -Your office has to accept the insurance plans that the GP offices also accept. If your office doesn’t, they will refer patients to another OS office that does.
    -You will have to be willing to perform a wide variety of procedures even when certain procedures don’t pay you well. My OS is willing to do a 2-Jaw orthognathic surgery on a my medicaid patient for $1500 for each jaw.

    I know a few OS residents, who quit their trainings and applied for ortho. I haven’t yet seen an ortho who switched to OS.
     
    #16 charlestweed, Feb 10, 2018
    Last edited: Feb 10, 2018
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  19. Medin2017

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    Doesn't that make sense given the nature of os residency? Idk about other residencies but someone is obviously a lot more likely to leave an 80 hr per week commitment than switch towards that no matter the light at the end of the tunnel.
     
  20. 0rgansm

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    So the OS is getting paid $3k for a days worth of work? That doesn’t sound too bad for charity work, lol.
     
  21. Rainee

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    No you don’t get it. Doing that kind of surgery is a huge liabialty, sedation, work up, setup in the OR, post op complications and a headache to deal with... all for 1500 each jaw. 3k is not profit, you have to take into account overhead. You probably make next to nothing. That’s why it’s literally a charity case. Charity means no profit... it doesn’t mean low fees and take home 3k.

    I can sit and prep three crowns in 1 hour and make 3000 without any liability. Drink coffee while my assistant packs cord... go on Facebook and chat a bit before checking off temporaries.... if I want to make it a charity case my lab bill is 240 for 3 crowns... and an hour of my time much better then reconstructing a jaw.

    You can’t do that while reconstructing a jaw.

    He meant to say that as an omfs you have to deal with high risk procedures with crap pay sometimes. It might not sound bad... 3k each jaw but until you have to do it... do it first then talk.
     
    #19 Rainee, Feb 11, 2018
    Last edited: Feb 11, 2018
  22. ncide

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    Cleaner oral cavity? Ortho by far has the most disgusting mouths.
     
  23. vellnueve

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    I don't think you know of what you speak.
     
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  24. ncide

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    12 year olds have immaculate home care, especially with metallic braces on top of their teeth. When the oral surgery staff would come to assist us with our ortho patients, they were taken aback how bad oral hygiene can get and often wouldn't want to work with some of our patients because of it.
     
  25. schmoob

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    Perio pt mouths can be pretty bad.
     
  26. charlestweed

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    But the orthodontist only has to stare at these digusting mouths for a few seconds. The chairside assistants are the ones, who have to suffer when they work on these patients. I don’t even need to yell at the kids nor speak to their parents about poor OH….the chairside staff take care of these for me.

    It's so clean that some orthos wear shirt and tie to work. A lot of them don't even wear gowns. The only time they wear protective gears is when they use the handpiece to remove cement at final debonding appointment.
     
  27. ncide

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    I suppose I am biased then since I was one of those chairside staff that had to deal with it, and some mouths were absolutely foul. Do you not have your assistants do the final debonding procedure for you in its entirety? That's what we did as staff.
     
  28. vellnueve

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    Come see my ED patients.
     
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  29. charlestweed

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    My staff remove the brackets and bands for me. Patient goes rinse his/her mouth. Xrays are taken. I then come in to remove the cement with a handpiece. I start removing cement and polishing all 4 posterior quardants first. By the time the blood and saliva start to accumulate on the patient's throat, I am ready to move on to polish the anterior 3-3.... no suction needed. The entire cement removal and polishing process took me than 5 minutes.

    For patients with hyperplastic gingiva.....to prevent blood from splashing everywhere, I place a cotton roll at the gum line while I polish.....again, it's a 1-operator procedure... no suction needed.
     
    #27 charlestweed, Feb 11, 2018
    Last edited: Feb 11, 2018
  30. sgv

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    If that's your only source of interest for OMFS, you may have a had a very narrow exposure to the scope of OMFS. The unfortunate situation for most dental students is that their exposure to OMFS is bound by the walls of the dental school where the occasional syncope patient or difficult extraction requires the consult of an OMFS to bail them out. Few rarely experience its scope in the OR and hospital floor.

    If you ask residents what interested them in OMFS in the first place, it was never just "dental". It was always the big surgeries that caught their attention. Most of us find dentistry, especially ortho, boring and would never consider ortho regardless of the pay. We want to cut. Not sit around and treatment plan. OMFS is challenging. Facial anatomy is complex and we prefer it to be because it keeps surgery interesting. If you're an anatomy aficionado, which you should be if you're trying to be a surgeon, when in orthodontics do you get to dissect through layers of soft tissue, identifying and skeletonizing nerves, ligating blood vessels, cutting and fixating bone, and physically recontour someone's face in the same amount of time it takes dental students to prep and restore a crown? How much anatomy are you exposed to in other dental specialties? Do you find medicine far more interesting than dentistry? Would you rather learn how to medically manage a patient in the OR and hospital than learn how to reline a denture? The scope of OMFS is such that reading Plastic & Reconstructive surgery (who in dentistry can perform primary and secondary cleft lip and palate repair?), ENT (who in dentistry can perform turbinectomies and neck dissections?), Orthopaedic surgery (who in dentistry practices the principles of rigid and nonrigid fixation along buttresses and has borrowed techniques like perioperative TXA from the orthopods?), Anesthesia (how many dentists can say they've pushed propofol, fentanyl, rocuronium, sugammadex, phenylephrine, ephedrine?), Oral Pathology (who manages MRONJ, CGCG?), and Orthodontic journals have become relevant to its practice to some degree. What specialty in medicine, let alone dentistry, could you theoretically find in a single operating room an OMFS resecting a mandible, a second OMFS harvesting a free fibula flap while simultaneously placing implants, and a third OMFS administering general anesthesia? Could you stand in an OR and retract for 10 hours and then take call for two days straight? Most good residents are after the challenge and don't grumble and whine about the hard work. Some even flaunt their ability to take call for 3 days straight as a form of machismo.

    The average dental student doesn't find any of this appealing and that's okay because OMFS would not be a good fit for them. You could argue about the stark difference between residency and private practice lives of a large percentage of OMFS who limit their scope to T+T but that does not necessarily mean that the profession as a whole agrees that that is the direction it wants its members to head towards. Ideally, great strides should be made by each graduating OMFS to keep maxillofacial in oral & maxillofacial surgeon.
     
    #28 sgv, Feb 11, 2018
    Last edited: Feb 11, 2018
  31. 2TH MVR

    2TH MVR Orthodontist
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    Well said @sgv. I can definitely see the enthusiasm in your post. It's clear that you enjoy what you do.

    Interestingly, back to the original post .... the OP is trying to decide between ORTHO and OMFS. I was trying to establish how an individual could be interested in two such diverse specialties. Both are so different. I know when I was in dental school .... I had absolutely no interest in surgery .... therefore the Ortho route. I remember the students interested in OMFS also thought dentistry (ortho) was boring and they wanted to go the surgery route.
     
  32. Biffster

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    I find all this macho talk about being anatomical experts to be humorous given my experience as a resident in orthodontics. I took gross anatomy with dissection along with OMFS and other MD surgical specialty residents. (Yeah, I don’t know why we did this either)

    Anyway, in the end the body the orthodontists dissected was beautifully done and structures were dissected out nicely and were readily identifiable. The OMFS cadaver could hardly be used to tag for the final because it was in bad shape. MD cadavers were marginal.

    Final grades for class showed orthodontists dominated the top scores with the OMFS and MD surgeons lagging noticeably behind. The guys who would never again wield a scalpel dissected circles around the surgeons and ultimately scored far better overall.

    Sample size was quite small, but still makes me chuckle when OMFS (or other surgeons for that matter) act like they are God’s gift to anatomical study. Obviously after years of additional training the OMFS should have finally progressed beyond this level and passed up the orthodontists who only look at real anatomy via panos and cephs, but I have to admit the residents I saw first hand had no special skill in this area. I hope they had a great work ethic to overcome their other deficiencies.
     
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  33. Awarara

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    look out, we got a badass over here, is there anything orthodontists can't do? :D
     
  34. DrTooth19

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    There is definitely a stark difference between the two specialties, I acknowledge that. Even though I first was really interested in OMFS, I gave my full attention to every specialty to ensure I did not make the wrong decision. I shadowed, assisted, and took advantage of whatever opportunities I could in dental school. When I came across ortho, I fell in love. I realized what really interested me in OMFS was the wisdom tooth extractions and very very minor surgical procedures, and like @sgv noted, that isnt all OMFS is. I didn't know that in undergrad. But I know that if I really want to do that, I can go through those four years of residency and then go into private practice doing just that. But I dont think I have the stomach for residency.
    But guess what, in ortho, I get to place TADs ;) They aren't as complex as regular implants, I understand, but they're still pretty cool. And maybe I get to do some simple primary dentition extractions! :) And I get the advantages of the fun patient population, building connections with my patients, and using my head for solving puzzles :)

    I just need to make sure I am making the right decision. In today's world, ortho is not the same as it was before. GPs do invisalign and can refer less, ortho residencies cost a lot of money, I am already in debt from dental school. What if my limited view of what I have seen and figuring out what I like is wrong? So I came to all of you.

    And I really appreciate all of your comments! Thank you for taking the time out to answer them. I hope to be as happy as you all are with your careers and not have a single regret :)
     
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  35. sgv

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    lol
     
  36. PhansterZ

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    Interesting finding. Your hypothesis may get some research funding.
     
  37. Biffster

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    I think OMFS is an incredibly cool specialty. Their training is uniquely broad for a surgeon of any kind with all of the anesthesia training they get along with a broad surgical experience. I just find the false bravado and chest puffing talk to be humorous.
     
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  38. Biffster

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    LOL. Might be the first time “badass” was used to describe an orthodontist.

    To be honest we ortho residents were a little dismayed by this outcome. We assumed the surgeons would have done much better. I will say the ENT guys did a good job on the ossicles.
     
  39. The Anhedonia

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    dude you trained at a baller program if you're using sugammadex. :cool:
    My hospitals anesthesia cost-committee wet themselves when they were told how much sugammadex costs
     
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  40. G4P

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    I have a feeling the OMFS and "other MD surgical specialties" just did not care enough.
     
  41. avangusva

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    I don't think anyone here can ever claim they do the job of another specialist. I'm going to agree OMS and Ortho are completely different specialties but still important. How many orthognathic cases could be done without one or the other?
     
  42. Mr.Scalpel

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    [​IMG]
     
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  43. Localnative

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    This man should be granted sainthood, stat.
     
  44. Firm

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    You'll always have work as an OMFS, can't say the same thing about Ortho. The Orthos that are happy are usually the older, established one. If you want to suffer for about 10-15 years, you can be a happy Ortho too!
     
  45. Big Time Hoosier

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    Can’t we all just get along?! You’re all special in my book.

    Big Hoss
     
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  46. Medin2017

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    Kind of funny representation of specialties here (although small).

    You've got 3 orthos, 2 of which are trying to say how good they have it compared to others and 1 saying how orthos are smarter and better than OMFS.

    Then you've got the OMFS just talking about their own jobs and for the most part ignoring the orthos.

    Then you have the person who is going into or applying to pediatrics telling people to get along and saying they're special.

    Just what I would expect
     
    #44 Medin2017, Feb 13, 2018
    Last edited: Feb 13, 2018
  47. CaliDDS1986

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    Suffer? Seems a bit strong. If you can’t get steady work as an ortho, why can’t you just be a super GP with an ortho residency? You’ll never have a shortage of work.
     
    #45 CaliDDS1986, Feb 13, 2018
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  48. Firm

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    I guess you could do that. You'll have an even harder time trying to build your practice. Ask me how I know.
     
  49. Biffster

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    Firm,

    I don’t spend much time on these forums. What is the axis of evil your avatar refers to?
     
  50. CaliDDS1986

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    Really? What happened when you tried? I mean you would have to have in your business plan that you’ll get no referrals so you would just have to build up the ortho side of the practice from marketing and internal referrals. The plus is that you would have a steady stream of cash flow from the GP side of the practice.
     
  51. charlestweed

    Dentist Silver Donor Classifieds Approved

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    You are welcome. We, orthos, actually have a lot of free time to post on this forum.... to relieve the boredom. The corp offices, where I am at, give me 1 hour for bonding, banding, re-bonding loose brackets, appliance deliveries, final debond etc but these procedures only take us 15-30 minutes to complete. They give me 30 minutes for regular adjustment visits (wire changes, wire bendings, retainer checks etc) but these procedures only take us 5-10 minutes to complete. So I have plenty of free time here at the corp. I have to bring a laptop and books to kill time. That’s why I continue to hang on to this job for 15 + years. It’s hard to let go an easy job that pays well.

    If you like to challenge yourself with difficult high risk surgical procedures, then OMFS is for you. I am lazy. I just want to do low risk procedures so I can come home worry-free. I had the experience in dealing with dry sockets and post-op bleedings on patients who were on Coumadin meds when I was a GPR resident. It wasn’t fun. Back then I was still single. It must be hard for those who have a family and kids and have to worry about all these post op complications.
     
    #49 charlestweed, Feb 13, 2018
    Last edited: Feb 14, 2018
    DrTooth19 and dante72 like this.
  52. charlestweed

    Dentist Silver Donor Classifieds Approved

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    Yeah and the surgical results are amazing. When he told me that medicaid paid him 15 for jaw surgery, I said to him it wasn’t too bad because I thought he meant $15k. But then he corrected me in saying that it was 15 hundred, not thousand. He told me his implant and wisdom teeth cases helped finance all his orthognathic cases, which he really enjoys performing.

    A couple of years ago, he left his private practice to his partner to work full time at Kaiser Permanante hospital, where he gets to perform orthognathic surgeries all day long. Now I have to refer my medicaid patients to another (also very good) OS, who accepts medicaid, or to Loma Linda. For non-medicaid patients, I convince them to switch their health plans to Kaiser so they can see this OS friend of mine, whom I think is one of the best in the country.
     

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