Specialty decisions

Started by koobpheej
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koobpheej

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My question for you all has to do with deciding to specialize. I realize that an important part of delving into a specialty is knowing you have a passion for whatever discipline you are pursuing. How do you find out if you have that passion required? What is the deal with externships, how do you find out about them?
I am currently D1 at UOP, and have thought about specializing. Unfortunately before dental school, my dental exposure was limited to the shadowing/ observing I did. In all the procedures that I watched (not exhaustive of all procedures), I was by far the most intrigued and fascinated by the endos. I need to find out if I have that level of passion to pursue an endo residency, or if I would be perfectly happy performing endos as a GD.
 
Just keep up your grades so the opportunity is there and worry about where you want to specialize (if at all) after you've had some time in the clinics. I think telling people now that you want to specialize in endo before having ever even picked up a file will send the wrong impression. It makes you look like all you're after is the money - even if you're not. Definitely not the way you want future references to think of you.
 
also..

maybe do the summer research projects if offered at your school.
...you'll make some extra bucks usually... and you'll have "the research" for for cv.
 
In my opinion the general dentist is more than qualified to do anything that a specialist can. Prove me wrong I dare you!
 
TuffyDMD said:
In my opinion the general dentist is more than qualified to do anything that a specialist can. Prove me wrong I dare you!
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Facial fractures, orthognathic surgery, many implant cases, cleft lip/palate, cosmetic facial surgery, tumor/cancer resection, general anesthesia...should I go on?
 
Certainly look into the specialties, talk with the faculty in that specialty, and ask if you can assist in the grad clinic if you have any free afternoon. Most importantly concentrate on your grades. If there's one thing common to every dental school, it's the surprise 1st yr students have when they realize how incredibly smart all their classmates are. So study hard. It's tough to say what you'll really be interested in 3/4 yrs down the road. What interest you now is often completely different in another couple yrs after you've gone through some preclinic and clinic.

Also, to my knowledge externships are really only important for OMFS. I'm sure they exist for other specialties, but not near to the extent nor is it as important.
 
If you considering specializing, then you must take the time to find out about that particular specialization. Once you generally familiarize yourself with the specialty with clinical experiences, then you must ask yourself if you're willing to sacrafice your time and committment to that particular specialty during and beyond dental school.

Students wish to specialize usually are at least top 1/3 of the their class. You must have a committment and attitude to do well in classes and be involved in extracurriculars.

To specialize, you need certain personality as well.

How do I know that I want to specialize? Simply because I want the best for myself and I want to continue to challenge myself with academics and further education. What I believe it's the best education for myself? OMFS, of course due to its scope of practice and the amount of challenge the training will provide! Four more additional years or more of training, not will I learn more to better myself, but in addition, I will be having a blast doing procedures in the scope of practice within OMFS.

I have tasted failure in the past in academia, now that I have to chance to learn dentistry, I want to go as far as I can go that the world of dentistry allow me. If OMFS is another 10 years after dental school, then I still would sign up for it!

The drive to specialize, starts within and not without. Which specialty....take time to learn about them!
 
Dude, your in your first year......study hard, get good grades and then worry about specializing once you know what you actually like doing. Don't waste your time jumping into a specialty too early, just worry about having the grades that will allow you to specialize later if you want. Oh, and make sure you drink some beer and have some fun along the way, no one like a boring person.

Oh, and tuffy is a homo.
 
Yah-E said:
[....]To specialize, you need certain personality as well.[....]
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Do you mean one's personality would need to fall within a range of certain types of personalities? I'm curious: which ones?
 
Yah-E said:
I have tasted failure in the past in academia, now that I have to chance to learn dentistry, I want to go as far as I can go that the world of dentistry allow me. If OMFS is another 10 years after dental school, then I still would sign up for it!
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Another 10 years and you'd still do it? That sounds like a broad statement. You know that academia can only teach you so much, and the REAL learning comes in those hours when you are on your own.

Of course I'm not putting down your career goals, I just think people should realize that an extra 6 years of residency and another degree doesn't mean that they know more than the guy who chooses not to do any residency.
 
After 2 years as a GP - I can honestly say I am intrigued by Ortho and OMS where as in dental school I kinda liked Perio. I think this intrest has come about through assisting the Oral surgeon with OR cases (Fractures and Orthognathic Surgery), Seeing my own px go through with Ortho tx that I have referred out, Extracting Pre-molars on my px for the orthodontist and having gone through ortho and orthognathic surgery myself!

If I had no loans to payback, no mortgage I would definately be looking into one of these specialities most likely ortho - but it was fascinating to listen to my the oral surgeon who did my surgery (I can't even believe we have the same dds degree)!
 
I think the majority of students looking into ortho--especially those looking into the specialty before entering dental school--had a memorable experience with braces when they were younger (myself included).
 
trypmo said:
Do you mean one's personality would need to fall within a range of certain types of personalities? I'm curious: which ones?
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This is quite interesting. A lot of my classmates have gone through various hospital rotations....and a lot of them mentioned that many oms residents they've encountered are cocky mofos. Of course there are exceptions.....
 
ItsGavinC said:
people should realize that an extra 6 years of residency and another degree doesn't mean that they know more than the guy who chooses not to do any residency.
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I think those that eventually go for DDS/PhD know more than the general DDS. These are the true hardcore individuals who LOVE/LUST academia/research. 😍
 
Correct me if I am wrong but I think Gavin was making a reference to MD/DDS vs DDS. I coul dbe wrong though
 
ItsGavinC said:
I just think people should realize that an extra 6 years of residency and another degree doesn't mean that they know more than the guy who chooses not to do any residency.
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Maybe I'm not catching what your saying b/c this statement sounds really silly. The whole point of a residency and extra training is so that you will know more than the guy who chooses not to do a residency.
 
UNLV OMS WANABE said:
Maybe I'm not catching what your saying b/c this statement sounds really silly. The whole point of a residency and extra training is so that you will know more than the guy who chooses not to do a residency.
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Mmm, sort of. It's actually so you will have more experiences and more training, but that does NOT always equate to "knowing more".

My point was mostly that Andy's desire to "go as far as I can go that the world of dentistry allow" doesn't mean he has to follow an academic pathway of learning. He's chosen to do that, which is great, but there are many general practitioners out there who have gone farther in the world of dentistry and medicine than those who have devoted years and years to residencies.
 
I'm simply stating that if I have chosen to specialize in a certain specialty, I don't mind doing the years, 1, 2, 4, 6 or even 10! Length of training is definitely something one must consider in their decision to specialize which the original poster had asked.
 
Hey Gavin, being in a dual degree DDS/MD program I'm pretty sure it does mean that the specialist will know more than the dentist....about that specialty. It certainly doesn't mean that the specialist will know more about every specialty or aspect of dentistry..but I would think that would be implied.

And Geeze Yah-E 10 years? I would think that at some point in your life there is more than just your career? I am in a 6 yr program but I don't think I would give too many more years than that, there is a lot to do in life beyond oral surgery, oral surgery is just a route to get there.
 
Gavin's statements have some merit. My partner is a GP that pushes the upper limit of what most General practioners do (implant placement and restorations, all endo and endo surgeries, perio surgeries) and then there is me with 2 years of experience just trying to become good at the basics. Even when it comes to oral surgeons there are those who probably no less about dentistry than a GP and take wisdom teeth out all day and that's it (and I know some of these) and there are ones like the oral surgeon who operated on me who is a wealth of knowledge and there is no way a GP could learn or have the skill to do what he does.
 
I don't know rob, I still ain't buyin the fact that any 6 year trained, dual degree Oral and Maxillofacial Surgeon could possibly know less than a dentist with his or her 1 semester emergency medicine class on how to give 2 puffs of albuterol to a man wheezing in their chair, or how to hook up an AED and push the "ON" button and follow the spoken directions to someone having an acute MI, I don't care how many CE courses on any cruise ships they took, there is no substitute to experience. Unless the MD and OMFS certificate were bought off the internet.......no way jose.
 
Even those oral surgeons who do nothing but shuck thirds all day know plenty. All the ones I have encountered who do this do it for the money, not because they don't know how to do anything else.
 
ItsGavinC said:
Mmm, sort of. It's actually so you will have more experiences and more training, but that does NOT always equate to "knowing more".

My point was mostly that Andy's desire to "go as far as I can go that the world of dentistry allow" doesn't mean he has to follow an academic pathway of learning. He's chosen to do that, which is great, but there are many general practitioners out there who have gone farther in the world of dentistry and medicine than those who have devoted years and years to residencies.
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There are many things that you just can't learn well through CE courses. How many GP you know can or dare do facial reconstruction like oral surgeons do?? Bone grafts?? If the skills of specialists can be self-trained, the spots won't be so competitive. Sure many GP dabble in oral surgery, endodotics, etc, but it's very rare case that their expertise actually equal or exceed that of the specialists. Just go to dentaltown and read the cases.
 
LestatZinnie said:
There are many things that you just can't learn well through CE courses.
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And there's also many things that you can't learn well through residency programs.

Look, we're talking apples and oranges here. I'm not talking about knowledge specifically, but rather about going as far as possible in our profession. My initial statement was that tons of years of training doesn't always mean you've gone as far as you can.

I think strong and creative contributions to our profession are much more beneficial than years and years of schooling.
 
As an aside: I'm certainly not being as clear as I would like in this topic, and I also think people are misunderstanding me (partly because of my lack of clarity).

I want to make it clear that I'm not trying to start any type of war on this issue. In respect of that, this will be my final post on this.
 
LestatZinnie said:
There are many things that you just can't learn well through CE courses. How many GP you know can or dare do facial reconstruction like oral surgeons do?? Bone grafts?? If the skills of specialists can be self-trained, the spots won't be so competitive. Sure many GP dabble in oral surgery, endodotics, etc, but it's very rare case that their expertise actually equal or exceed that of the specialists. Just go to dentaltown and read the cases.
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Actually, my partner does bone grafts - not from hips - but it doesn't take 4 years of specialty training to throw in some freeze dried bone and a membrane. I watched him the other day remove a membrane from one of his implant cases.

I'm not saying specialty training doesn't have its place but for someone who is just going to "shuck" 3rds all day just to make money - I don't think there too smart at all to waste 4 years of residency training just to do that which probably can be accomplished in CE, a 1 year GPR/or internship.

Like I previously said I respect the Oral surgeon that uses his/her scope of practice - and in that case the extra years of training is needed.

And for the record, I am not a big fan of ortho through CE either I personally feel ortho is the most unique specialty and least taught in dental school.

I think the point of this thread was to encourage people thinking about specialty to think about what is so appealing about that speciality. If its to do cosmetic/orthognathic resconstruction than great - and if its purely because I like extractions and want to make a ton of money pulling thirds (well then maybe extra years of training is really not needed).

I believe Gavin was trying to make the point that GP's can have a broad scope of practice without additional intense training. And Yah e was also making the point that true passion for one specific specialty would warrant additional intense training. Both are good points :horns:
 
GAvin, I think I get what you mean, and I agree. I don't think residency gives you that little extra bedside manner and treatment manner that makes you very good in PRIVATE practice. Residency makes you a superior academic, but since most residencies don't involve working on private practice quality patients, you have to learn to treat those people when your out in private practice with a little something different because they pay all the big bucks....residency really doesn't prepare you for that, and someone who has been in private practice all their life will already have that.


Oh, and Rob.....can your partner IV sedate....I don't think so because he don't know how......."sorry Mrs. Smith, your little 16 year old girl can't go to sleep because I take out Wisdom teeth without the compasionate option to sedate them because I can take out teeth just as good as the oral surgeon but i'm not allowed to sedate." Why do you think surgeons go through 4 years of training even if they only want to take out thirds.....because they want to know how to medically manage pts and offer them the option to be sedated which I believe is the standard of care with 3rd molars in our day.
 
north2southOMFS said:
Oh, and Rob.....can your partner IV sedate....I don't think so because he don't know how......."sorry Mrs. Smith, your little 16 year old girl can't go to sleep because I take out Wisdom teeth without the compasionate option to sedate them because I can take out teeth just as good as the oral surgeon but i'm not allowed to sedate." Why do you think surgeons go through 4 years of training even if they only want to take out thirds.....because they want to know how to medically manage pts and offer them the option to be sedated which I believe is the standard of care with 3rd molars in our day.
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his partner could always bring in a an anesthesiologist or a CRNA to offer that service to his or her patients...
not a novel idea....and it saves 4-6 years.


btw, to say a doc that's been shucking wizzies for 25 years is less an "expert" as the kid fresh out of an oral surgery program is shortsighted at best.

i think training and experience both somehow contributes to that knowledge thingie..
 
Actually, I'd rather have a "fresh out" oral surgery resident from a good program take my teeth out and manage my medical problems because that fresh out person just got done managing some of the sickest pts they will probably ever manage in their entire career as an OMFS. As my program director said, I can teach anyone to cut, managing the pt. postoperatively is where you shine.

So yes, that 25 year out dentist is less an expert.

I don't remember the last time the general dentist who takes out a lot of 3rds walked into a surgical intensive care unit and managed a pt's high potassium levels (which can kill you by the way), or low CO2, or high anion gap, or a pt whos sats are crashing and needs to be intubated. Still feel more comfortable with that dentist who has spent years shucking whizzies, oh yah he knows more.


When is dentistry going to get past the tooth technician mentality and realize there is a pt. with medical problems on the other side of that drill, not just 4 molars worth 1500 bucks?
 
i will say that i think u are assuming too little...about a general dentist's competency. there are some great docs out there...and there are also some dentists that are better off just plugging amalgam all day.


??
i'm not really sure how a disregard for the patient's medical history got worked into the discussion...
i can only say that in my short education i have never had the "tooth technician" mentality presented to me..



well,
personally i wouldnt need to play doctor since i have that anesthesiologist there watching over the vitals..
most anesthesiologists that i've met have had some medical training..
...and my guess is they've at least had a lecture or something on what to do when something goes wrong during GA cases..
 
"When is dentistry going to get past the tooth technician mentality and realize there is a pt. with medical problems on the other side of that drill, not just 4 molars worth 1500 bucks?"

First of all, a tooth technichian would not have spotted "potentially" Periapical Cemental dysplasia last week on an new black patient from pa's when there was a complaint of loose front teeth, discussed with a mother that her childs grinding habit may be associated with adenoid or airway problems (this afternoon), and have differentially diagnosed and successfully biopsied and sent to the lab a pyogentic granuloma (a few months ago). What makes you think that every GP is a Drill, fill and bill dentist?

Secondly, you don't need an oms residency to become certified in iv sedation depending on what state or province you are registered/licensed in.
 
how come all these recent posts eventually become an "oral surgeons aint all that" post? 😱
 
Doggie said:
how come all these recent posts eventually become an "oral surgeons aint all that" post? 😱
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www.toothgap.com - because now theres no need for orthodontists 😀 😀

JUst kidding! You guys no I'm your biggest advocates.
 
OEC is almost as cheesy as this toothgap.com

so take a look at the site toothgap.com's FAQ
one of them is, if you close one gap dont you create others?
the answer was yes, but put another band around the next gap and keep going until you fix them all by yourself

what a mess, hope its a joke
 
From toothgap.com:

"Just as orthodontics glue braces on your teeth you can apply a small amount of super glue between the teeth. Once together apply a small amount of super glue to the tip of a needle then slid the needle between teeth (make sure teeth our not wet). This will keep your teeth from going back. The glue can be removed by taking a needle and scrapping it off at later time. (Cautions -This option is not suggested because of the danger.)"

ORTHO IS TEH DOOMED!

Just the grammar and punctuation mistakes in this paragraph alone are enough to frighten me. Is this a real product?
 
I wasn't saying the OEC is cheesy. I meant that between all the new ortho programs they are starting up and now this do-it-yourself teeth gap thingy, orthodontists will be unemployed.

I say that with sarcasm, I know it's hard to convey on an internet forum.
 
texas_dds said:
OEC is almost as cheesy as this toothgap.com
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Hardly. Do you attend an OEC program?

As I said before, corporate sponsorship of academics is scary to most if not all of us, but this certainly isn't the first time it has been done. The programs are, as of now, accredited by the ADA.

I think part of the disdain for the OEC programs is because they are teaching Ortho. I honestly believe that if they were doing Perio or Prosth nobody would care.
 
ItsGavinC said:
Hardly. Do you attend an OEC program?

As I said before, corporate sponsorship of academics is scary to most if not all of us, but this certainly isn't the first time it has been done. The programs are, as of now, accredited by the ADA.

I think part of the disdain for the OEC programs is because they are teaching Ortho. I honestly believe that if they were doing Perio or Prosth nobody would care.
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Have medical or dental residencies been sponsored/organized by corporations before? I was curious what you were alluding to.

The program is accredited by the ADA, but the AAO disagreed with this approval and filed a complaint with the Department of Education. Now there are two likely reasons (IMO) the ADA went ahead and approved the OEC and ignored the AAO: 1) They realized the members of the AAO were just concerned about corporate ortho itself including possible competition, tarnishing the specialty, or other reasons. -or- 2) Regardless of the OEC programs being academically substandard there was an incentive for the ADA (and not with the AAO) to accredit.

The specialty of orthodontics seems to be stronger than ever. I doubt any orthodontists are concerned with the 10 or so graduates/yr from OEC taking away business. My concern (and I think most ppl's concern) is in a corporation dictating what you can and can't learn in a professional healthcare residency. The situation is similar to a corporate dental office (in my area such as Castle, Southern, or Monarch Dental) opening a dental school. I am not interested in ortho, but I am interested in what's affecting dentistry as a whole. Do OEC programs provide the variety of techniques and philosophies one would see at a typical ortho residency? Do they take the time to teach residents how to treat cleft lip/cleft palate, implant assisted ortho, orthagnathic cases, dealing with impactions, mounting cases with face bows and in CR, conducting research, etc. I admit to know nothing about ortho, except that it is an extremely complex and rather broad subject covering many techniques.

Perhaps I'm naive, but I tend to believe the AAO in what it recommends. Perhaps others don't, but at the very least there is reason to be skeptical about these programs and what they do teach or emphasize.
 
ItsGavinC said:
Hardly. Do you attend an OEC program?

As I said before, corporate sponsorship of academics is scary to most if not all of us, but this certainly isn't the first time it has been done. The programs are, as of now, accredited by the ADA.

I think part of the disdain for the OEC programs is because they are teaching Ortho. I honestly believe that if they were doing Perio or Prosth nobody would care.
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Sorry, Gav, but I'm with DDSSlave on this one. As soon as you take our education out of the hands of clinicians whose primary objective is training us to treat our patients' best interests, and place it before a corporation whose interest in profit-making far surpasses its interest in patient care, you've inherently and unavoidably compromised the profession. I'd be extremely interested in seeing documentation to compare OEC's curriculum with that of a few academic residencies. I highly doubt the results would be flattering to OEC.
 
aphistis said:
Sorry, Gav, but I'm with DDSSlave on this one. As soon as you take our education out of the hands of clinicians whose primary objective is training us to treat our patients' best interests, and place it before a corporation whose interest in profit-making far surpasses its interest in patient care, you've inherently and unavoidably compromised the profession. I'd be extremely interested in seeing documentation to compare OEC's curriculum with that of a few academic residencies. I highly doubt the results would be flattering to OEC.
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Once again it seems people have an extremely limited knowledge of the ADA accreditation process. Please, go to the ADA website and learn about the rigorous details that are necessary for CODA to grant a site accreditation. OEC's curriculum MUST match that of other residencies in order to be accredited. Whether or not they follow through with those plans is iffy, hence the "initial" accreditation that must be reviewed prior to graduation of the first group of residents. We also must remember that graduates must pass their specialty exams in order to practice.

Further, I think many are naive (Bill I'm not saying you are) if they think that education isn't already a profit-making business. It's truly a rarity to find a program that consistantly focuses on the best interests of patient care. This spans the board from medicine to dentistry. Education hasn't been in the hands of the clinicians (at least not as it ought to be) for years now.

AEGD programs are by and large sponsored by hospitals which are corporate institutions unto themselves. When budgets roll down and money is tight then residency programs (both dental and medical) are trimmed down. Does this affect the learning process? Absolutely. Are there ways to ensure it doesn't completely harm the process? Sure, it's called accreditation.

Corporations and sponsors touch every facet of our education, although we aren't accustomed to seeing their corporate badges slapped on everything we contact (yet). That doesn't mean there isn't heavy lobbying and politics happening behind the scenes, or massive amounts of money changing hands in the upper-wings.

And finally, we must remember that not every position at OEC programs is filled by a an "OEC scholarship" student. Some will attend these programs with not interest of ever working for the OEC.

The standards the OEC program is held to, along with every other Ortho program, are here: http://www.ada.org/prof/ed/accred/standards/index.asp#advanced
 
DDSSlave said:
erhaps I'm naive, but I tend to believe the AAO in what it recommends. Perhaps others don't, but at the very least there is reason to be skeptical about these programs and what they do teach or emphasize.
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There IS reason to be skeptical, and certainly until fruits of these programs are born, a reserved skepticism would probably do us all justice.

What the AAO recommends, or any other organization, should take a back-burner to what the ADA recommends. My following statement is much too broad to be considered an end-all-be-all, but it is typically true: dental associations have an extremely limited knowledge of the academic workings of schools and residency programs, and often their knowledge is half-baked at best.

This became apparent to me when members and elected officials of the Arizona dental association laughed at our new school because we were building a sim-lab. They thought that any school with a sim-lab must surely be a second-tier institution, since simulating clinical skills isn't possible. Of course, we know that sim-labs are excellent investments of time and money and are becoming quite the norm in dental education.
 
ItsGavinC said:
Further, I think many are naive (Bill I'm not saying you are) if they think that education isn't already a profit-making business. It's truly a rarity to find a program that consistantly focuses on the best interests of patient care. This spans the board from medicine to dentistry. Education hasn't been in the hands of the clinicians (at least not as it ought to be) for years now.
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Sorry Gavin, I disagree. Our school is in the middle of a search for a new dean, and from more than one prospective candidate (who are current deans at other programs) I have heard them say how amazed they are that our dental program does not operate in the red as ALMOST EVERY state institutions does. (I realize that this statement therefore only applies to the majority of dental programs, not the private ones.) Dental education-read dental school-is not in fact a profit-making business for the vast majority of non-private dental programs in the country, nor should it be.

But OEC will rake in the green for Lazzara. He's no dummy (financially, though I won't comment otherwise...) It's a huge moneymaker, and that's why his getting involved in dental education and not just dental practice is a BIG problem. I have no problem with people who try to make dentistry into a money-making business as long as patients are treated ethically and honestly. But pilfering into education is going too far. The AAO knows what it's talking about despite the initial accreditation that was issued. If you don't believe that, try to imagine (an exaggeration to make a point) what would happen if a bunch of Joe's off the street graded licensure exams. What if they passed people who pulp a class II, etc. when a state or regional board would have failed that candidate? Am I saying OEC produces inferior clinicians...not necessarily. Maybe the licensure candidate just had a bad day...but how can you verify that? That's what can happen when third parties - even CODA - ignore recommendations from those who are in the know. Quality generally succumbs to popular opinion.

OEC alone may serve to be THE factor that persuades me not to pursue on ortho residency because I don't want to end up working for Walmart in 30 years like a pharmacist or optometrist. Especially if dental education is making money on my loss.
 
ItsGavinC said:
What the AAO recommends, or any other organization, should take a back-burner to what the ADA recommends. My following statement is much too broad to be considered an end-all-be-all, but it is typically true: dental associations have an extremely limited knowledge of the academic workings of schools and residency programs, and often their knowledge is half-baked at best.
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You know, the more I learn about the ADA, the more I realize it is a self-fulfilling organization with little actual authority to do anything but serve as an, um "influence" for what they want. I applaud their efforts in preserving and standing up for organized dentistry and it's ideals.

Remember, the AAO is the ADA of orthodontics...so if the ADA deserves any credibility to represent general dentists (which is what they try to champion), the AAO seems to deserve the same opportunity to represent orthodontics. After all, your comment "dental associations have an extremely limitled knowlegde...." is dead on - and the ADA is the biggest dental association out there. It is not anywhere near as in-touch with needs of orthodontics and orthodontic education as the AAO.

As Dr. John Roussalis, the ADA first vice president and an orthodontist told me in person in San Diego and the New Dentist Conference in June this year, OEC is a "huge potential problem" plaguing dentistry. That said from the perspective as an orthodontist. Pretty strong words from a pretty good source.

Nothing personal against you, Gavin. Just some thoughts from another perspective.
 
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