So you matched OMFS but not where you wanted?

[desertrat12]

Full disclosure, I just matched and haven't been through residency yet - I fully realize I'm likely wrong on all sorts of levels...but just had an interesting discussion with a friend that some may find helpful...

I had an interesting conversation with a buddy who matched, but at a place further down his rank list. His excitement for matching was almost dwarfed by his disappointment of falling in love with his #1 and #2 spot, only to end up somewhere else. I couldn't believe it. I thought about hitting him upside the head to smack some sense in him to be grateful that he matched! But we ended up chatting for a while and in the end, he ended up feeling good and was thrilled with matching. I hope no one else is feeling this way, it's more than a privilege to match anywhere, but in case you are...here are some things that were discussed that helped change his mind, and some random other stuff we talked about...

1. you are now matched to this program, you have no other option, stop wishfully thinking about what can't be
2. you are still going to become an OMFS, the career you've dreamt about for 4 long years, its happening, you've made it into residency!
3. the program isn't full scope enough for you? - all that fancy full scope stuff often requires a fellowship anyway, and you can do that out of any residency
4. the program is more full scope than you want? - take this amazing chance to expand your surgical skill and all the knowledge that comes with it
5. the program doesn't do enough implants? - an attending at our school become the largest volume implant clinic in our area and had nearly 0 implant training during his residency (long time ago) - but dedicated himself to continually learning
6. the program doesn't do cosmetics? - do you really want to be trying a bunch of cosmetics without a fellowship on the patient base that can afford cosmetic cases? sounds risky
7. the program isn't in the area you want? - the inside of the hospital is pretty standard throughout the country
8. the program isn't close enough to your spouses family? - uh is that a bad thing?
9. the call schedule is more than you wanted? - really? such a great opportunity to see more and learn more
10. the call schedule is lighter than you wanted? - again, really?
11. you don't jive as well with the residents? - great opportunity to learn the important skill of working with people different than you
12. you don't jive as well with the attendings? - my experience is lots of attendings speak the same language - hard work, be responsible, be prepared, and have a willingness to be corrected

It seemed that every rock we turned over there was another thing like this. The bottom line, like so many of us have heard - the best residency in the country is the one you get into.

Its not all about where you go
Its vastly more important HOW you go about your time there

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[Strag]

Nailed it on the head and this goes for about any residency and even general dentistry after dental school. Our profession as a whole is a continual educational journey. It’s what you make out of it and even then there are opportunities later in life that you have to actively pursue to get to where you want to be. You have a great mindset already going into residency!

 

[Sublimazing]

I get the general sentiment...but when you work your ass off for 4 - 6 years yet never cut a sag, place a minuscule amount of implants, don’t feel comfortable going through a neck, take 30+ minutes to do a trach, or leave feeling under trained in any component of core omfs...you’re going to be bitter and it happens to a lot more omfs than you think.

OMFS training is in its own league...when the gen surg residents are complaining about working 100 hour weeks and 26 hour shifts while you’re churning out 120 hour weeks / 38 hour shifts (and they have an attending in-house with 2 upper levels on their same service...you’ve got an upper level sitting at home with his phone on silent and attending who you haven’t talked to since your interview)...you soon realize that you’re working harder than almost anyone in the hospital...and any deficiency in your training feels like a real slap in the face.

So be happy you matched...stay optimistic...but your gratitude won’t mean much until you have that certificate.

 

[desertrat12]

I get the general sentiment...but when you work your ass off for 4 - 6 years yet never cut a sag, place a minuscule amount of implants, don’t feel comfortable going through a neck, take 30+ minutes to do a trach, or leave feeling under trained in any component of core omfs...you’re going to be bitter and it happens to a lot more omfs than you think.

OMFS training is in its own league...when the gen surg residents are complaining about working 100 hour weeks and 26 hour shifts while you’re churning out 120 hour weeks / 38 hour shifts (and they have an attending in-house with 2 upper levels on their same service...you’ve got an upper level sitting at home with his phone on silent and attending who you haven’t talked to since your interview)...you soon realize that you’re working harder than almost anyone in the hospital...and any deficiency in your training feels like a real slap in the face.

So be happy you matched...stay optimistic...but your gratitude won’t mean much until you have that certificate.

Thanks for the input and first hand reality check.

Off the original topic, but:
1. What are you referring to with “cut a sag”?
2. When you are referring to going through the neck, what are you referring to? I’ve heard this said a number of times, and I’ve been in on cases from a full neck dissection to a risdon approach for a mandible fracture. I’m assuming people mean something much more in depth than a risdon, but not necessarily leaving residency fully competent in doing their own neck dissection?

 

[Sublimazing]

Thanks for the input and first hand reality check.

Off the original topic, but:
1. What are you referring to with “cut a sag”?
2. When you are referring to going through the neck, what are you referring to? I’ve heard this said a number of times, and I’ve been in on cases from a full neck dissection to a risdon approach for a mandible fracture. I’m assuming people mean something much more in depth than a risdon, but not necessarily leaving residency fully competent in doing their own neck dissection?

1. Sagittal Split Osteotomy
2. A risdon would technically count but colloquially we used it specifically to refer to an incision large enough to perform a resection or place a recon plate.

 

[desertrat12]

This is all awfully true.

It’s be really interested in what residents/recent grads ended up regretting about their programs. I got all sorts of advice about what to look for in a program, but it was mostly superficial stuff like finding a program I get a long with the residents, make sure they do enough sedations and implants... but don’t hear much in the likes of what sublimazing posted. That’s good stuff.

 

[Sublimazing]

How often are you doing traches/going through the neck in private practice? I can’t imagine I would feel too bad if I never do them in the real world.

Private practice trachs probably almost never...personally going through the neck...easily once a month.

My whole point was that if you end up trapped in your clinic because you’re not trained enough to do anything else then you were bamboozled. And if your goals are to just sit in clinic and compete with GPs and Perio for implants then why bother with OMFS?

 

[Sublimazing]

Impacted wisdom teeth and sedations

...kidding aside, I get your point. Just wonder if 90% of OMFS’s aren’t doing this on a regular basis, wouldn’t you end up feeling uncomfortable doing these procedures anyways 10 years from having done them? Would this make 90% of Oral Surgeons incompetent since so many are staying in private practice? I’m not sure the answers to these questions. But it does seem to be the reality.

Oh so you’re looking to compete with the non-cat drop outs.

And if you graduated competent with those skills you likely wouldn’t let them lapse for “10 years”. Every OMFS grad takes trauma call...every OMFS gets benign path consults...and most OMFS get TMJ referrals...going through the neck is always going to come up.

You’re also missing the point of my post and just kind of blindly arguing your own notions (your normal schtick). Those were just examples. The point is that any program that works your ass and graduated you feeling deficient causes resentment...and because omfs programs pretty consistently work your ass omfs residents often graduate bitter.

 

[desertrat12]

1. Sagittal Split Osteotomy
2. A risdon would technically count but colloquially we used it specifically to refer to an incision large enough to perform a resection or place a recon plate.

Thanks!

 

[GimmeTheScalpel]

Your personal advice sounds oddly threatening, but thank you.

And my arguments are valid ones on a public forum. Also never picked fights, but rather presented my point of view. Key word “my” point of view.

You really need to stop fighting/arguing with residents so much. Recurring habit with you as @Sublimazing is now the 3rd or 4th one you’ve tried to go back and forth with.

 

[Ivy.ch]

The post-match blues are real, but not necessarily because the applicant didn’t match where he/she wanted. I think there’s a couple reasons...

- Suddenly, all of the possibilities collapse into one unchanging future.
- A feeling of being trapped by a long contract. Realizing it will be even longer than dental school (which most applicants have hated for the past 4 years).
- While applicants tend to focus on the pros of each program, when matched, the cons can become the focus.
- Feelings of “did I make the right decision?” amplify.
- Worries that the applicant didn’t get a full picture of the program from the interview. Especially true in COVID times.
- Sometimes an applicant can mentally prepare to match to one place, but end up somewhere else.
- Friends, family, residents, and faculty all have biases, and when you match, some people can’t hide their disappointment that you didn’t match where they wanted.

And yes, matching way down on the list can also be a factor.

Anyone who matches should feel extremely fortunate and excited, but sometimes it can take a couple weeks to warm up after the application cycle. The cycle, especially this year, was brutal.

 

[desertrat12]

The post-match blues are real, but not necessarily because the applicant didn’t match where he/she wanted. I think there’s a couple reasons...

- Suddenly, all of the possibilities collapse into one unchanging future.
- A feeling of being trapped by a long contract. Realizing it will be even longer than dental school.
- While applicants tend to focus on the pros of each program, when matched, the cons can become the focus.
- Feelings of “did I make the right decision?” amplify.
- Worries that didn’t get a full picture of the program from our interview. Especially true in COVID times.
- Sometimes an applicant can mentally prepare to match to one place, but end up somewhere else.
- Friends, family, residents, and faculty all have biases, and when you match, some people can’t hide their disappointment that you didn’t match where they wanted.

And yes, matching way down on the list can also be a factor.

Anyone who matches should feel extremely fortunate and excited, but sometimes it can take a couple weeks to warm up after the application cycle. The cycle, especially this year, was brutal.

Excellent points

 

[aaaaa]

Almost no one wants to do head and neck...but again you’re still missing the point. A lot of programs leave graduates ill equipped in core OMFS, and that’s why so many OMFS are bitter about their training and trapped in their office.

I’m also not taking anything personally...go over your post history (the half you haven’t deleted) you’re repeatedly argumentative and always have to have the last word.

I’ve yet to see you contribute anything useful on this forum, so I’m adding you to my block list.

Just as some personal advice...there are hundreds of OMFS residents who lurk on this forum...and you picking fights with parkland residents and being disruptive in general isn’t a good look. Hopefully your username is gibberish because it probably won’t be hard to piece together who you are on the interview trail...and “that’s that guy from sdn” definitely happens. People have sunk their chances of matching on this website, i doubt you’re looking to be the next one.

I don’t think this is completely true that many programs leave their surgeons I’ll equipped to perform core “broader scope” procedures. I think docs who chose to sit in their office taking out teeth and placing implants has more to do with that docs personality and probably more importantly with the amount of debt they have. If it was because they were poorly trained then only the surgeons from “bigger, busier, broader scope” programs would take trauma, do orthognathic/tmj/benign path/etc. I personally don’t see that. I know several surgeons from smaller, less broad scope programs that sit in their office but their co-residents are in the OR every week. There are also docs from the most broad scope big programs that had a huge amount of training that just sit in their offices too. It’s not all about where you trained.

I think there are a handful of programs where you won’t get adequate broad scope training but you should have known that when you applied because the true country club programs are well known. At the end of training you should be comfortable performing an open joint, doing trauma/orthognathic/benign path. Worrying about whether you’ll feel comfortable doing those procedures when you graduate in 4-6 years from now won’t help. Just work hard and learn as much as you can now that you’ve matched.

 

[Masterus]

I agree with Sublimazing. I don't want to rank on OMFS training but the sad reality of OMFS training is that the majority of residencies will probably not prepare you to comfortably do all core major surgical OMFS procedures (you'll be very slow) - 24 months has an upper level is very little time of training when you have residencies like ENT where you start operating as a 2nd year through your 5th year.

TMJ - this has pretty much become a fellowship level thing to be able to do full scope TMJ because so many places do not have the volume. Disc plication is hard and joint replacements are rarer and rarer these days and they're also difficult due to the anatomy w/ the facial nerve and being near the skull base. Endoscopy is getting more advanced as well.

Orthognathics - Look at the the number of orthognathics cases done per resident across the country - it's very low compared to countries like Canada where every program is pumping out hundreds of orthognathics a year. You will be extremely slow as a fresh grad at orthognathics if you choose to do that because there just aren't enough orthognathic cases per graduate. Even grads from orthognathic surgery heavy programs are doing these cases extra slow once they don't have an attending to guide them. (It takes years and time to get faster at this).

Trauma - This is the one category I think grads are very competent in especially grads from the south.

Benign Pathology - This is also something OMFS graduate somewhat competent in. Small pathology is pretty straightforward and most recent graduates OMFS should be able to do this.

Dentoalveolar - This is played down by some programs, residents and program directors and please do not let them play it down. Dentoalveolar is not easy and you will not be good at it just because you can dissect a neck. My head and neck attending says there is nothing harder than taking out a tooth that keeps breaking on you. It is not the actual placing of implants that is hard but rather it is the treatment planning involved which you will not learn unless your program does a ton of them. (this is probably the number 1 deficiency of most grads and that is treatment planning). I've had friends who have graduated from some major programs and they all have to learn so much more about treatment planning and dentoalveolar once they've graduated. Lateral window sinus lifts are also an important skill - I've heard of graduates being deficient in this as well as zygomatics, complex implant dentistry.

But at the end of the day, who cares. You matched, you're gonna be an OMFS. Everyone I've ever talked to were happy at their program. Your motivation and interests as a resident will drive you farther than what your program offers at the end of the day. Even programs that teach you everything have bad graduates that are not as competent as graduates from a program that did less. If you want to learn more about something; read, study, go to fellowship, take a course.

 

[desertrat12]

I agree with Sublimazing. I don't want to rank on OMFS training but the sad reality of OMFS training is that the majority of residencies will probably not prepare you to comfortably do all core major surgical OMFS procedures (you'll be very slow) - 24 months has an upper level is very little time of training when you have residencies like ENT where you start operating as a 2nd year through your 5th year.


TMJ - this has pretty much become a fellowship level thing to be able to do full scope TMJ because so many places do not have the volume. Disc plication is hard and joint replacements are rarer and rarer these days and they're also difficult due to the anatomy w/ the facial nerve and being near the skull base. Endoscopy is getting more advanced as well.

Orthognathics - Look at the the number of orthognathics cases done per resident across the country - it's very low compared to countries like Canada where every program is pumping out hundreds of orthognathics a year. You will be extremely slow as a fresh grad at orthognathics if you choose to do that because there just aren't enough orthognathic cases per graduate. Even grads from orthognathic surgery heavy programs are doing these cases extra slow once they don't have an attending to guide them. (It takes years and time to get faster at this).

Trauma - This is the one category I think grads are very competent in especially grads from the south.

Benign Pathology - This is also something OMFS graduate somewhat competent in. Small pathology is pretty straightforward and most recent graduates OMFS should be able to do this.

Dentoalveolar - This is played down by some programs, residents and program directors and please do not let them play it down. Dentoalveolar is not easy and you will not be good at it just because you can dissect a neck. My head and neck attending says there is nothing harder than taking out a tooth that keeps breaking on you. It is not the actual placing of implants that is hard but rather it is the treatment planning involved which you will not learn unless your program does a ton of them. (this is probably the number 1 deficiency of most grads and that is treatment planning). I've had friends who have graduated from some major programs and they all have to learn so much more about treatment planning and dentoalveolar once they've graduated. Lateral window sinus lifts are also an important skill - I've heard of graduates being deficient in this as well as zygomatics, complex implant dentistry.

But at the end of the day, who cares. You matched, you're gonna be an OMFS. Everyone I've ever talked to were happy at their program. Your motivation and interests as a resident will drive you farther than what your program offers at the end of the day. Even programs that teach you everything have bad graduates that are not as competent as graduates from a program that did less. If you want to learn more about something; read, study, go to fellowship, take a course.

This brings a few questions to mind...

1. Most places I interviewed at, including where I matched, are pretty top heavy. But some places claimed to let their first years do some cutting. Are these programs “superior”? or is this cutting first year somewhat equivalent to dental schools that claim to get their students in the clinic early but in reality that is just doing some prophys and not really helping much.

2. How fast is a well experienced surgeon doing a bsso, for example? Lots of variables I know, but I heard from residents at programs I interviewed at that they were confident in the orthognathic experience they were getting, maybe they are unaware of the speed some people are able to perform and their view point is relative. And is there any benefit other than production time if you do a procedure 2 hours faster? Could a recent grad who is slow safely build up their speed over time like often happens with new dental grads as they build up speed over the years?

Thanks for your input! I certainly didn’t think of this stuff as I was going through the ranking process.