Which OMFS programs are considered "highly competitive"?

[nade0016]

Just a caveat. Im not trying to down one program. My point is that the northeast training is much weaker on average than the south. However, to answer the response above.

Rutgers is still a good program and busy. Every program has pluses and negatives. You just don’t know unless you are a resident at the program or know people there. You don’t operate on real cases til chief year at Rutgers and now that will get diluted by 2 more upper levels splitting the rotations. A lot of programs don’t tell you that you don’t get good cases like orthognathics cases until chief year. (This is very common) (Dental students don’t even know to ask this) Rutgers is absolutely one of the strongest in dentoalveolar. It pales in comparison of OR to some of the stronghold programs in the south. Their orthognathics is good but not amazing. I’m not sure where you are getting your information from. Aziz did 100-150 orthognathics cases a year. Those cases are now done by a fellow and Monte residents. There is a paper published in the last 1-2 years that show that most surgeons pale in comparison to 100 orthos a year. Very few programs hit those numbers or greater than those days. Long gone are days of crazy ortho numbers. There is a bottleneck of ortho cases. I doubt Rutgers has increased their ortho load by 30 percent to match the increase in resident load given they lost 100-150 cases lmao. And the busiest programs are doing 150-200 a year. Any program that increases resident numbers, you will expect to do less ortho per resident. There is less and less ortho compared to 30-40 years ago. The ortho patients get referred to the same surgeons until they retire.

Resident surgical logs mean jack****. You can log stuff if you are a 5 and a 6 in the same cases. If you want to see actual surgical volume, ask to see the OR schedule. That will tell you the volume. There are a few programs out there averaging 40-50 OR cases a week each case may have multiple procedures. They also have a true inpatient service.

Malignant path is the future. It is to coming every program and will become eventually become core of the specialty. Even Rutgers does cancer…

God I hope not. Malignant path takes over a program and slowly pushes everything else out as it is so resource intensive. I have significant experience in this area. I think residencies where there is an opportunity to experience malignant path is good but when it is the primary focus of the program I am reluctant to recommend that program to an intern/student.

I personally would love to see a focus on TMD/Orthognathics/benign path in our specialty. Not sure why malignant path has a fellowship but orthognathics does not have a recognized fellowship, but that would take away from chiefs doing the procedures. And I completely agree on the resident surgical log, sadly, there is not an alternative that is acceptable currently. I would like to see our residencies have a more robust number requirement for training and to eliminate the cross logging that goes on. OMS would see 5-10 programs close nationwide but that would be a good thing to help focus the training on the resident and not the numbers. OMS also needs to define what a sedation is. Having a nurse give the meds and your faculty present to monitor should not count. If there are two residents in the room with one delivering meds while the other operates should be eliminated. The residencies need to create a more real life experience obviously with some training wheels on. Personal opinions from 12 years in the trenches as a academic and as a CODA site visitor.

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[deleted923283]

God I hope not. Malignant path takes over a program and slowly pushes everything else out as it is so resource intensive. I have significant experience in this area. I think residencies where there is an opportunity to experience malignant path is good but when it is the primary focus of the program I am reluctant to recommend that program to an intern/student.

I personally would love to see a focus on TMD/Orthognathics/benign path in our specialty. Not sure why malignant path has a fellowship but orthognathics does not have a recognized fellowship, but that would take away from chiefs doing the procedures. And I completely agree on the resident surgical log, sadly, there is not an alternative that is acceptable currently. I would like to see our residencies have a more robust number requirement for training and to eliminate the cross logging that goes on. OMS would see 5-10 programs close nationwide but that would be a good thing to help focus the training on the resident and not the numbers. OMS also needs to define what a sedation is. Having a nurse give the meds and your faculty present to monitor should not count. If there are two residents in the room with one delivering meds while the other operates should be eliminated. The residencies need to create a more real life experience obviously with some training wheels on. Personal opinions from 12 years in the trenches as an academic and as a CODA site visitor.

Would love less off-service months and more OMS months. Compared to other specialities, we spend way too much time away from home team. But not sure how we can accomplish that as a speciality.

 

[free flap friday]

I'm a 6 year guy, but there are a lot of 4 year programs that are strong. The general gist is the strong 4 year programs tend to have very strong dentoalveolar and the OR training is OK. It teaches you to do the OR surgeries. The bottom are some that stand out to me.

Oklahoma wasn't mentioned but it is the busiest orthognathics 4 year in the country. It is also busier than almost 95 percent of 6 years in terms of orthognathic surgery volume. The busiest programs that do a substantial amount of orthognathics (4 or 6) near 100-150 double jaws a year. Oklahoma is skying over 300 double jaws a year. Sullivan has built an orthognathic empire. Sullivan's fastest double jaw was 57 minutes and that is with a resident cutting one side. He apparently expects absolute efficiency in the OR. Obviously if you're talking total volume of all cases, then there are 6 years that are busier overall. They almost double UNC's orthognathics numbers who is traditionally one of the strongest for orthognathics. Very strong in bread and butter.

Minnesota is a truly full scope 4 year program out there. Head and neck, cleft/cranio are all there. This might be the only 4 year that does full scope OMFS.

VCU is great at private practice with very strong dentoalveolar training in the clinic. The OR volume is ok. You get enough to know how to do the procedures, but the OR volume is not very high.

Iowa is great at private practice and orthognathiic surgery. The OR volume is also not crazy. You'll be good at orthognathics.

UIC is great at private practice and has moderate volume OR.

Montefiore is the busiest implant OMFS program in the country. Residents routinely graduate with 300-400 implants. (This is like all 5 graduating chiefs and not some single star resident that games the system and gets 300 implants). OR experience is okay, and they've improved orthognathics experience with Aziz, but 5 residents is still a lot people to adequately share OR cases.

Also, Oklahoma is probably the only program where the residents treatment plan the entire orthognathic case in VSP (the resident does the VSP in dolphin themselves). Best treatment planning education in a residency program imho

 

[Torshammer]

Thoughts on the strength of UCLA and UCSF OS programs?

 

[nade0016]

Would love less off-service months and more OMS months. Compared to other specialities, we spend way too much time away from home team. But not sure how we can accomplish that as a speciality.

Could not agree more.

 

[BYU4you]

That’s probably a good thing. Busy training in the northeast seems to be a relic of the past with NYU not having attendings to staff cases or sedations and Rutgers doubling the size of their program in 5 years and dividing the volume to each resident by more than half and the loss of their busiest orthognathic attending. You pretty much need to go to the south or midwest for good training. People stay in the northeast for location.

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.
-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 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.

Also, Oklahoma is probably the only program where the residents treatment plan the entire orthognathic case in VSP (the resident does the VSP in dolphin themselves). Best treatment planning education in a residency program imho

It's hard for me to believe that the comments in this thread may actually be from residents and not dental students. Such huge generalizations being tossed around based off of heresay and rumors? I heard more about changes happening in my program from residents interviewing than our own attendings knew about. All completely bananas or taken very wrongly out of context.
Or when I ask how they got their info on Loma Linda that makes them want to come here. They start saying things like "The best in the west" etc.
Nice, I see you've read the same 8 threads from 2004,2006,2011,2017 etc. that I was reading myself a decade ago.
Maybe you know a resident here? I just came back on service after medical school and general surgery year, it's vastly different than when I was last on.
Maybe you externed here? Well thats a vastly different experience for everyone. Did you spend the week with Dr. Stringer doing orthognathic?
Which as a side note, at the very spry age of 80+yrs old will do somewhere in the realm of 120+ orthognathic himself this year, not counting his work at kaiser doing more orthognathic on the weekend, as well as multiple other surgeries. (under estimating likely as hes at around 30 cases over the last two months) You could only imagine what he was throwing down in his 70's. The argument of "what happens when he leaves" is old enough that every one of our attendings had the same question when they were in residency. There's on average at least another 1-2 cases a week outside of his as well from other attendings.
It's been this way for literal decades:

Big names in orthognathic surgery

Who would you consider to be the "big names" in orthognathic surgery? That is, they do a lot of cases, have made big contributions to the field, etc... William Arnett? Timothy Turvey? Larry Wolford? Jeffrey Posnick? If you had to have orthognathic surgery and wanted to choose the "best" who...

forums.studentdoctor.net

OMFS Externship

Well, I just finished my first day of my externship at Loma Linda and all I can say is, "I don't know jack about oral surgery." There is so much to know it's insane. I already have a big ol' list of stuff to look up tonight, but the program seems pretty cool so I'm stoked.

forums.studentdoctor.net

Or this one with the numbers being at least the same:

Loma Linda OMS Chief 1st assist Log

Loma Linda OMS program is often overlooked when applying. Here is some info on cases the graduating chiefs got to cut. Cover 3 hospitals – LLU Medical Center, Riverside County, Arrowhead County Attendings: Dr. Herford MD DDS FACS - Chair, Dr. Dean MD DDS FACS - Program...

forums.studentdoctor.net

That was posted 14 years ago. The numbers havent gotten worse, in fact now we do have cancer and a good amount of it too. With no fellows, NPs,PAs. But we work a lot of the time in conjunction with ENT doing the resections and restorations for Jaws in a Day as they take care of the flap portion. They even will be primary on the patients, but the nursing staff here and SICU know it well. It doesnt hurt that the SICU generally will have at least one OMFS,ENT resident or Plastics at any given time either.

This isnt a random moment in time either. That thread from 2011 with the logs?
Here are the attendings listed at that time 14 years ago.
Dr. Herford MD DDS FACS - Chair, Program Director Dr. Dean MD DDS FACS - Program Director, Dr. Stringer DDS, Dr. Tanaka DDS, Dr. Elo DDS, Dr. Moreta DDS, Dr. Roberts MD.

So still have 5 of those 7 still around.
We are still covering THREE level 1 trauma centers every third week for facial trauma. As you can imagine there is no shortage. With Arrowhead Regional the county hospital for the nations largest county of San Bernardino we are facial trauma 24/7, and to add to that, we are the ENT service as well as there are no Plastics, or ENT residents. That Dr. Roberts ^ is the ENT service outright as well as whichever resident is rotating with him that month or on any given evening.

I don't say all of this to brag or anything, I say it to say that there are plenty of great programs out there with great attendings doing great things. Most people have never heard of Dr. Stringer and yet he has been quietly and single handedly performing a large portion of all orthognathic cases for the entirety of the inland empire and even the greater Los Angeles Area with Kaiser Sunset (and multiple surgeons) taking the other portion.
Im sure there are many other examples like this that just dont get talked about. We are tucked out away from the LA Programs, a 30-45 min drive from the nearest airport, have a religious institution in the name that somehow really takes over the conversations when discussing the program. I don't think I or any other resident has thought about that aspect of it since a couple classes in med school at most, its so much of a non-factor outside the application I dont even know how to comment on it when asked.
The full scope OMFS programs are here and cancer is another skill we can add to a long list of useful ones and has greatly improved the residents competence in all other areas. Im not sure why we or those others out there don't get talked about much, but I think we are just kind of doing our thing. Im the only one who has really been on SDN much, we dont get too many externs probably because of inconvenience and having 3 other programs within a 50 mile radius with bigger brand names. The religious aspect hilariously is a barrier to applicants as well. Im not sure where anyone DOES get info from, maybe reddit for medical school or something but they certainly dont get it from any current or past resident because I've never heard of anyone who has gone here for OMFS gripe in any serious manner about being a religious institution, because I don't know what would even be the complaint. Couple that with the fact that we spend almost more of our time at the other hospital we cover which is not affiliated.

The larger issue is just the student debt. I will ultimately be in private practice but desparetley want to and will cover trauma wherever I go. I definitely wish I had a plan to do more of that and less dentoalveolar but financially it just wont be possible. If full scope programs go away, its not from cancer taking over its from an inability to pay the price.

 

[AssuredOx7]

My experience from externships and interviewing is that the majority of OMFS programs will train you to be a competent oral surgeon. In particular for 6 year programs, a major consideration was the cost of medical school. Some programs have medical schools that cost sooooo much while others were affiliated with state medical schools with significantly lower tuition and/or paid a salary/stipend during attendance. It didn't make sense to me to rank a program highly that had a medical school portion of training that added significant amount of debt.

 

[free flap friday]

Oklahoma wasn't mentioned but it is the busiest orthognathics 4 year in the country. It is also busier than almost 95 percent of 6 years in terms of orthognathic surgery volume. The busiest programs that do a substantial amount of orthognathics (4 or 6) near 100-150 double jaws a year. Oklahoma is skying over 300 double jaws a year. Sullivan has built an orthognathic empire. Sullivan's fastest double jaw was 57 minutes and that is with a resident cutting one side. He apparently expects absolute efficiency in the OR. Obviously if you're talking total volume of all cases, then there are 6 years that are busier overall. They almost double UNC's orthognathics numbers who is traditionally one of the strongest for orthognathics. Very strong in bread and butter.

Did he pay you to say this? 😂 😆

 

[stealyoface]

My experience from externships and interviewing is that the majority of OMFS programs will train you to be a competent oral surgeon. In particular for 6 year programs, a major consideration was the cost of medical school. Some programs have medical schools that cost sooooo much while others were affiliated with state medical schools with significantly lower tuition and/or paid a salary/stipend during attendance. It didn't make sense to me to rank a program highly that had a medical school portion of training that added significant amount of debt.

I would only consider cost of medical school if I was between two places I really liked and used it as the tie breaker. I wouldn’t forego training somewhere I loved in favor of a place I didn’t like as much just because the medical school tuition is cheaper. 6 years of your 20s and early 30s is a long time and you want to be somewhere you’re happy. We’re fortunate to have gone into a very lucrative career and money won’t be tight for us

 

[Life of Pablo]

I would only consider cost of medical school if I was between two places I really liked and used it as the tie breaker. I wouldn’t forego training somewhere I loved in favor of a place I didn’t like as much just because the medical school tuition is cheaper. 6 years of your 20s and early 30s is a long time and you want to be somewhere you’re happy. We’re fortunate to have gone into a very lucrative career and money won’t be tight for us

I mean…we’re talking about the difference between 300-400K pre-interest in some instances when you include COL. I interviewed at some programs where their med school was 80-100K+/year and you had to pay 3 years of it and they were also in very expensive locations (read: CA, WA, NY). That’s not a trivial amount - even with the salaries OMS make. Especially if you are planning on starting a family during residency (which many do), cost is still a very important issue, and I wouldn’t just blindly choose the program I love.

 

[stealyoface]

I mean…we’re talking about the difference between 300-400K pre-interest in some instances when you include COL. I interviewed at some programs where their med school was 80-100K+/year and you had to pay 3 years of it and they were also in very expensive locations (read: CA, WA, NY). That’s not a trivial amount - even with the salaries OMS make. Especially if you are planning on starting a family during residency (which many do), cost is still a very important issue, and I wouldn’t just blindly choose the program I love.

Ah I didn’t apply to those states. 3 years of tuition at those prices isn’t great

 

[PatsMan1]

So what you're saying is don't count myself out for any of them, and if I meet the requirements I should just apply regardless of the program?

I guess where my question stems from is I'm likely not going to finish top 2 or 3 in my class, so with that in mind I was wondering if there are any programs that usually only select students that are top of their class, in which case I would not even consider applying. But from what I am gathering from your response I should just apply because they are all competitive?

Lots of fake news about Rutgers BTW

 

[PatsMan1]

While TMJ was considered bread and butter, with the lack of interest in the last few decades in learning this, the skill has dwindled. Open TMJ surgery (arthroplasty) is considered bread and butter but open joint surgery is considered antiquated with much less predictable outcomes. On top of this, modern age TMJ surgery is a fellowship level skill or a beyond residency skill. Most surgeons in the country cannot do advanced arthroscopy but the skill is spreading slowly. No program in the country teaches residents to do level III arthroscopy. You are doing your patients a disservice without level III arthroscopy if you are opening the joint and plicating. It is now the standard of care now for the mid range Wilkes patients. Opening joints is the past unless absolutely necessary for a discectomy or TJR. Level II and III arthroscopy are considered much harder than a TJR. MGH with McCain and UAB with Louis are maybe the only programs in the country that give residents exposure to level III arthroscopy. That is why there are TMJ fellows at these two institutions. McCain and Louis arthroscopically suture and plicate the articulate disk. Not even Aronovich at Michigan or Bouloux at Emory are trained in level III arthroscopy which also have TMJ fellowships. They are busy on level II arthroscopy which you can learn and then attend some Nexus (McCain) courses to master level III. Most surgeons cannot even do a level II arthroscopy and need a fellowship for this and a large majority of surgeons in the country can barely do level I.

level 3 arthroscopy cases now happen at Rutgers and there are no fellows so residents get training here

 

[PatsMan1]

Just a caveat. Im not trying to down one program. My point is that the northeast training is much weaker on average than the south. However, to answer the response above.

Rutgers is still a good program and busy. Every program has pluses and negatives. You just don’t know unless you are a resident at the program or know people there. You don’t operate on real cases til chief year at Rutgers and now that will get diluted by 2 more upper levels splitting the rotations. A lot of programs don’t tell you that you don’t get good cases like orthognathics cases until chief year. (This is very common) (Dental students don’t even know to ask this) Rutgers is absolutely one of the strongest in dentoalveolar. It pales in comparison of OR to some of the stronghold programs in the south. Their orthognathics is good but not amazing. I’m not sure where you are getting your information from. Aziz did 100-150 orthognathics cases a year. Those cases are now done by a fellow and Monte residents. There is a paper published in the last 1-2 years that show that most surgeons pale in comparison to 100 orthos a year. Very few programs hit those numbers or greater than those days. Long gone are days of crazy ortho numbers. There is a bottleneck of ortho cases. I doubt Rutgers has increased their ortho load by 30 percent to match the increase in resident load given they lost 100-150 cases lmao. And the busiest programs are doing 150-200 a year. Any program that increases resident numbers, you will expect to do less ortho per resident. There is less and less ortho compared to 30-40 years ago. The ortho patients get referred to the same surgeons until they retire.

Resident surgical logs mean jack****. You can log stuff if you are a 5 and a 6 in the same cases. If you want to see actual surgical volume, ask to see the OR schedule. That will tell you the volume. There are a few programs out there averaging 40-50 OR cases a week each case may have multiple procedures. They also have a true inpatient service.

Malignant path is the future. It is to coming every program and will become eventually become core of the specialty. Even Rutgers does cancer…

Lots of fake news about Rutgers lol boss I did quad zyg mand aox, TJR ankylosis case, double jaw orthognathics + gonial angle and malar implants, cyst removal aicbg bone graft in past week as a senior lol primary surgeon

 

[PatsMan1]

If you’re graduating with 150-200 orthognathics cases that means you’re getting much less experience operatively elsewhere in other domains of OMFS as your block time is taken over by those cases. I can tell you that one doesn’t need to do this many cases to feel confident

But in all honesty a vast vast majority of people who graduate will do private practice t&t. Most programs nowadays do not give you strong training in both implants and sedations (some weak training at both, some do lots of sedations but very few implants)

And at Rutgers I’ve done over 300 implants and 300 sedations (currently 5/6) I’m expecting to graduate with over 500 implants and between 450-500 sedations (this includes Omfs peds sedations and longer multi hour Omfs sedations). Excellent dentoalveolar and implant training at Rutgers + very strong OR experience hard to find nowadays

 

[PatsMan1]

God I hope not. Malignant path takes over a program and slowly pushes everything else out as it is so resource intensive. I have significant experience in this area. I think residencies where there is an opportunity to experience malignant path is good but when it is the primary focus of the program I am reluctant to recommend that program to an intern/student.

I personally would love to see a focus on TMD/Orthognathics/benign path in our specialty. Not sure why malignant path has a fellowship but orthognathics does not have a recognized fellowship, but that would take away from chiefs doing the procedures. And I completely agree on the resident surgical log, sadly, there is not an alternative that is acceptable currently. I would like to see our residencies have a more robust number requirement for training and to eliminate the cross logging that goes on. OMS would see 5-10 programs close nationwide but that would be a good thing to help focus the training on the resident and not the numbers. OMS also needs to define what a sedation is. Having a nurse give the meds and your faculty present to monitor should not count. If there are two residents in the room with one delivering meds while the other operates should be eliminated. The residencies need to create a more real life experience obviously with some training wheels on. Personal opinions from 12 years in the trenches as an academic and as a CODA site visitor.

Malignant path is taking over Omfs programs nationally is an accurate statement

 

[nade0016]

Would love less off-service months and more OMS months. Compared to other specialities, we spend way too much time away from home team. But not sure how we can accomplish that as a speciality.

Me to, problem lies with CODA, programs are required to send a resident off service for at least 13-15 months. Although what would we eliminate? Surgery, Anesthesia, Medicine? All are needed.

 

[dent1010]

Not an exhaustive list but the stronger programs listed routinely get very competitive applicants with high CBSE scores as well as extensive CVs with research, externships, awards, etc. You will need to have a well rounded CV with a higher CBSE score to be ranked well at one of these programs.

Stronger/more competitive programs:
-University of Alabama
-Parkland
-University of Michigan
-USC
-University of Kentucky
-LSU
-Oklahoma
-VCU
-Mayo
-Cincinnati
-Jacksonville
-UF Gainesville
-UT Houston

Weaker/less competitive programs:
-West Virginia
-A number of the New York 4 year programs
-University of Minnesota
-Temple
-Denver Health
-Boston
-Allegheny

Where would schools like UConn, NOVA-SE, Maryland, and Loma Linda belong on this scale?