I never said no exposure at all. Every resident in the country is going to get exposure to cancer/free flaps in one way or another.
For example OS residents rotate for a month with ent/plastics.
Or, following a resection done by omfs, os residents typically hang around the or and watch ent do a free flap. Personally I did many of such cases during residency. After I would resect a large ameloblastoma, I’d watch two ENT attendings come in with their residents and do the reconstruction with a fibula (and watch them yell at their residents the entire time and not let their residents cut the case).
As mentioned many times previously - programs that are cancer heavy, with a fellow - will have its drawbacks. They will lose out on other things that they could have been doing (TMJ, orthognathics, benign path, implants, dental alveolar, even trauma cases).
And what true benefit did they gain ? Suctioning, retracting, doing parts of a trach, minimal parts of a neck dissection?
What does the resident have to show for it ? I’ve been out for 10 years now and I can tell you all my colleagues who did cancer in residency - none of them feel comfortable doing the ablative portion on their own (even if given a team of residents). They don’t feel comfortable taking on a cancer case by themselves (ablative portion). They would have to do a fellowship before they felt comfortable. So what was the point ? They can’t even use it in practice. 99 percent of us will do private practice. The only individuals who benefit are the fellows/attendings because they use the residents as cheap labor and scut work. Also the residents act great as a punching bag when the fellow/attendings want to blow off steam lol (cancer heavy programs have the reputation also as being malignant). Hey you generalized that all NE programs suck so I’ll give my generalization here.
Take me as an example I did a ton of orthognathic surgery in residency. So many I don’t even recall the amount of osteotomies. I cut every case myself because I had the most amazing attendings. Trauma - we took >85 %at our hospital. I did over 300 implants upon graduation and a ton of large ridge augmentations/sinus lifts, block grafts. We also did tmj total joint replacements, and a ton of benign path resections, using ent for the free flaps afterwards. And yes I cut all of these cases myself- I didn’t just hold a retractor, suction and get yelled at. I was really busy during this time and felt truly productive. By taking time away to do cancer I would have lost out on cutting a ton of other cases, especially if I was just retracting/closing etc.
Again you’re misrepresenting what I’m saying. Just keep it real dude.
I never said residents should only do dental alveolar in the clinic.
They should be busy doing surgery - the full scope. In fact I recommend all resident try to match to the busiest program possible.
I’m against residents being used as scut labor - retracting suctioning etc doing minimal parts and not eventually taking on a lead role. That’s a waste of their time. Especially if it takes time away from doing other relevant cases which they could potentially be cutting the entire case themselves. I can confidently say when I left residency I could take on any trauma, orthognathic, benign path case (with hip graft) and total joint replacements.
250-300 k is nonsense. No os makes that money. I can tell you that is not even remotely accurate.
“Do I understand that some H and N surgeons are pulling 7 figures ? Hitting 7 figures is nothing special for a private practice os. That’s all I’m going to say on this forum.
I’m going to repeat it again I never said that residents should have no understanding of cancer. They should and they all do.
With the vast majority entering private practice and having zero interest in cancer following residency, my argument is that there is no need to convert the majority of programs into making them cancer heavy. A rotation and some minimized exposure would probably be all that’s needed.
The curse in OMS. Recap of unmatched spots in 2024
The curse has begun
-a few decades ago, some leaders in OMS started subspecialty fellowship training like cancer, free flap reconstruction etc
-over 20-30 years, their fellows became faculties of other residency programs because they cant really practice cancer surgery in private practice setting just like ENT head and neck surgeons. Many of them are foreigners, like surgeons trained in different countries but came to US for fellowship. They can't practice outside of academia due to license issues, so they end up staying in academia as cancer surgeons. They are very biased and polarized.
-It is to the point that residency programs are having hard time recruiting young academic surgeons who dont practice cancer. Academic surgeons who practice general core OMS became hidden gems because they can make so much more money when they work in private practice in cushy lifestyle.
-those fellowship-trained faculties are in stiff competition against plastic and ENT. Most craniofacial and free flap recon are dominated by Plastics. Head and neck is dominated by ENT. In fact, OMS head & neck is a half-ass pseudo head & neck training.
If someone is truly interested in head and neck, they should do a fellowship in ENT head and neck.
-most programs having cancer OMFS faculties are in rural areas or undesirable locations. No plastics and ENT want to live there.
-to run a smooth cancer service, cancer surgeons need multiple NPs and PAs to round, flap check, see high number of complex patients in clinic for surveillance and follow ups, go down to ED for consult on very complex patients, do extensive charting, communicate with other services and do billing and insurance etc.
-Unfortunately, scut works just became unavoidable tasks of residents in many cancer programs. Instead, residents end up spending significantly less time mastering core OMS procedures (i.e. dentoalveolar surgery, outpatient anesthesia, orthognathic surgery etc.). Residents coming from programs heavy in cancer graduate are so much weaker in core OMS. They don't graduate with placing 300+ implants, 1000+ sedations, 100+ orthognathic susrgeries and dozens of complex alveolar ridge grafting with predictable results. OMS programs are becoming weaker over time. They are not training true OMS surgeons.
-Work environments get
really stressful and malignant in many cancer services. Some cancer surgeons are nice. Many are not. Malignant culture breeds malignant surgeons. If you externed at some cancer programs, you know who I am talking about. Like other SND members said on this post, residents are just
punching bags of those malignant faculties. They don't support resident education because they want residents to make more money for them. Cancer surgeons talk about RVUs all the time. They squeezing nickels and dimes out of procedures with terrible reimbursements.
-those facutlies who have never been outside of academics tend to gaslight their residents. It is dangerous because culture in head and neck makes residents believe that dentoalveolar surgeons are just weak sauce or going to private practice is like a shame. In reality, they are stuck in academia because they can't get out.
-those cancer programs also need to hire multiple noncategorical interns to take first calls, take all the blames for mistakes and yelling from malignant attendings. Even though those interns have a low NBME score, OMS programs heavy on cancer will still hire them to serve as their warm bodies. Otherwise, cancer services cannot survive. The cancer programs brainwash them with false hope of matching in the following year even with low NBME scores. In reality, they end up not landing on interviews but just serve as warm bodies just like the ones who worked hard but did not match in the previous years. In the following year, the empty noncat spots get filled with fresh, naive dental students. The cycle continues. What will happen when there are not that many red shirts going around? Those programs just increase residency spots. This move will destroy our specialty. Look at what just happened to Ortho and Pedo over a decade.
-Everybody on SDN now knows that noncat year without having a solid score is completely useless. Remember that residency programs want cheap labors.
-ACGME work hour limit is 80 hours per week for medical residents. Unfortunately, OMS is a dental specialty. Since OMS is CODA-accredited, OMS faculties love to utilize their residents for free labor. There is no work hour limitation from CODA. They dont care whether residents are on call every other day or even every day in some programs. They love to push their residents beyond 80 hour work week. It is resident abuse. It violates the rights as an employee in healthcare.
-glorified days of big scope programs are over. Many OMS programs heavy on cancer training cant afford to have many PAs or NPs. Also, no midlevel providers want to work for those malignant surgeons.
-the focus of cancer programs are using residents as glorified PAs so attendings can make more money. If programs are expanding their cancer service, that is a huge red flag. They don’t care about what’s the best for residents. They don't care about resident education.
-NPs and PAs are employees. They can quit, complain and report to the hospital administrative for malicious behaviors of their surgeons. Residents cannot. Residents have to suck it up and just do it. Otherwise, residents get pulled out of service, kicked out of the programs and forced to leave. Lawsuits from former residents against OMS faculties are happening in those malignant programs. For those who were on interview cycle 2023-2024, you know what I mean.
Conclusion
-cancer is NOT a core scope of OMS. It is just a subspecitalty. exposure to cancer and flaps is great. However, it shouldn’t take up big portions of residency training.
-many cancer attendings are foreigners. They can’t practice outside of academia due to licensure issues.
-many cancer attendings want to make residents believe that cancer should be the main focus of residency training. Cancer surgeons make money from doing cancer surgery. They are brainwashing the next generation of OMS surgeons and residents.
-you will find that all those fibula and neck dissections are complete garbage in private practice. You just wasted your time.
-if you are interested in cancer, then just do fellowship. Don’t waste 4 or 6 years of your life on something useless. As a resident, you just need to get some exposure on how the whole process works: biopsy, cancer workup, resection, neck dissection, regional vs free flap, post-op management, tumor board, patient care from admission to ICU to floor to discharge. 1 - 2 month is more than enough so that you can pass the ABOMS oral board. Dr. Ying in Alabama and Dr. Lee in Maryland are great examples. Both went to a program that didn't do any cancer in Boston. They were interested in head and neck, did 2 years of fellowship in highly reputable programs, and became excellent microvascular surgeons.
Red flag programs
-presence of multiple cancer faculties.
-there is no fellow, NP or PA
-spending most of your time assisting in OR, flap check, floor work and flap duties. Just ask interns and residents about their flap life.
-most elective cases are cancer
-minimal exposure to dentoalveolar surgery, complex implant cases with good outcomes and outpatient anesthesia. If residents placed more implants in fibula than mandible / maxilla, they are not in the right program for private practice.
-faculties are not comfortable with doing routine dentoalveolar procedures under sedation or local anesthesia
-malignant attendings. Just talk to externs, ex-noncats and alumni of the program about those attendings. Unfortunately, they made a lot of enemies over time who trashtalk on places like SDN.
-programs that have a history of losing residents or firing interns. Don’t believe in those BS reasons. There are some great teaching programs with almost zero attrition rate over a decade, which is an objective data. Whatever opinion of someone is subjective.
If OMS residency training keeps expanding to subspecialties, we will eventually lose its core scope of practice. ENT in sleep medicine and Plastics in craniofacial practices are doing orthognathic surgery. More non-OMS dentists and specialists are doing more implant surgery every year. Perio, GPR and AEGD programs are pushing for third molar extractions and IV sedation training. More GPs and periodontists will do full arch surgeries. OMS will eventually lose its identity. OMS should do our best to protect our core scope of practice.
The match result and the open spots in 2024 reflect the current state of OMS residency training. It is a wake-up call in our specialty. The current trend is the result of malignant faculties abusing their residents, violating work hours, brainwashing their residents and providing useless scut rather than high quality clinical education.
That is the curse in OMS.
If you are in the match cycle 2024-2025, please rank your list wisely. Don't regret after a few years down the road.
Lets see how a new match cycle turns out in 2025. Many 6 year programs doing cancer will have open spots on the day of match.
