Something that has always stood out to me is the knowledge gap between each step on the path to becoming a practicing oral surgeon. This site was inspired by the vast chasm between the presumed knowledge of a budding OMFS resident versus the experienced wisdom of a practicing OMFS. The pathway from college student to an oral surgeon is fraught with information asymmetries. These exist on the paths from college to dental school, dental school to residency, and then residency to practice. These constantly changing sets of rules lead to unfamiliar playing grounds for the new arrivals. Experienced surgeons and companies can exploit these knowledge gaps. This is where green dental students, residents, and newly-minted oral surgeons are taken advantage of, and where you must rely on the guidance of others. This requires an immense amount of trust. The majority of AccessOMFS has existed to bridge the gap between dental school and residency and help elucidate the process of becoming an oral surgeon. As AccessOMFS continues to mature, the goal will be to fill in the other gaps. A major issue with dental students, and to even a larger extent with residents, is that they have the goal of becoming an oral surgeon but no solid post-training plans. With ever-increasing debt loads and the corporatization of health care, there are endless opportunities to be taken advantage of for those coming out of residency. Here, we seek to lay out the different opportunities available, as well as the pitfalls that exist.
As you plan for your future, here are some things to remember:
- Oral surgery is a highly lucrative profession in very high demand
- Your main competitors are Apple, Tesla, and other consumer products, not other oral surgeons. Patients largely see dental care as an optional luxury (implants), until it is an emergency (extractions, I&D)
- Corporate dentistry and private equity don’t care about you or the profession; you are skilled labor to them and their main goal is to make money for investors
- Patients and other medical practitioners largely do not know what oral surgeons do
- Most oral surgery residencies give you the skills to practice adequately
- Change is inevitable in the profession: increasing corporatization, change in anesthesia laws, etc
Armed with these facts, important decisions about your future can become less intimidating. If you are coming out of residency, the world is your oyster to seize what you want. You will likely be able to have anything you want, but not necessarily everything you want. OMFS is such a unique and exciting field because it is a well-paid profession with a wide scope and independence. Do you want to work 3-4 days a week pulling teeth and make six figures? Done. Do you want to do huge, life-changing cases and live in Manhattan? Done. Want to do research and influence scores of dental students and residents? Done. Want to make $3 million a year working to the bone? Done. Can you do everything? Not necessarily, but the profession gives you the ability to craft the path you would like and the ability to practice ANYWHERE. These nuances are determined by the future path YOU choose. Important note, the choice of your future life only exists if you make an active effort to plan AND take action, like anything else. However, even if you are indecisive and let life happen to you, things still shouldn’t end poorly. Your menu of choices is what we will cover below.
Private Practice
The overwhelming majority of oral surgeons either choose or find themselves in private practice. If you polled most residents about what this looks like, they would probably say something along the lines of “working 4 days a week pulling teeth and placing implants either in a group practice or DSO.” To be honest, this probably isn’t far from the truth. However, the possibilities within OMFS are endless. Some oral surgeons practice full scope, work out of hospitals, and travel as part of private practice. Some work more than 4 days a week and some work less. Your ability to practice the way you want is only limited by your creativity. These practitioners have such autonomy because they own their practice and thus, are their own “boss.” You get to call the shots and reap the rewards, and responsibilities, of what that entails.
So, how do you go about being a private practitioner? You have several options including 1. Joining an existing practice; 2. Buying out another practitioner; 3. Starting a practice.
Joining an Existing Practice
Most residents will join an existing practice as an associate when they graduate. This can range from a small private group to corporate practice. For those joining non-corporate practices, the goal is usually to buy in as a partner. This can be structured in many ways, all of which will be covered in a different article. For associates, pay is usually structured as a base salary with bonuses. Bonuses can be based on different levels of production or collections. This route is often felt to be the “safest” route. You are guaranteed pay, have office protocols and staff in place, and mentors available. Although this is the “safest” regarding low personal risk, you have no equity and, in many cases, the older oral surgeons are profiting from your work. If you do not have any aspirations of owning or running a business, then this is a fair deal.
Buying an Existing Practice
If you desire to own a practice right away and want something ready to go, you can always buy an existing practice. This is not a bad option as you can benefit from many of the same pros of being an associate as well as owning the practice. Depending on how you structure the deal, the existing owner can either stay as an employee for a designated amount of time to help with the transition or leave immediately. Some cons of this route include cost and culture. When you buy a practice, you buy all of it, good and bad. “Goodwill” is also a large amount of the cost of the practice. This is an intangible cost and does not guarantee you will get the same referrals as the previous owner. Additionally, is the preexisting culture good or bad? Many employees may not jump on board with your new way of doing things. How do you go about finding a practice for sale? First, you can check the AAOMS Career Line for advertised practices. Another option that works well is to use your state’s dental board to find surgeons that have been practicing for over 25 years and give them a call. You may find someone willing to sell.
Starting a Practice
For the entrepreneurial types willing to take a risk, this is an excellent route. Not only do you get the freedom to make all the practice decisions, but you also get to reap all the rewards. Starting your own practice may sound like a very risky proposition, but remember, in most areas of the nation oral surgeons are in very high demand. It is also a very lucrative business. Why do you think private equity is so eager to buy oral surgery practices? They know they can take several hundred thousand dollars off the top and leave oral surgeons with an immense amount of money to still make them happy. You’re doing all the work; Don’t you want the rewards to be yours? Before you count this route out, make sure to do your homework and run the numbers. Check demographics and make sure that running a business is something that you are interested in and capable of doing. Just because you are good at oral surgery does not mean you are automatically good at running a business. There are tons of poorly run oral surgery practices out there (hence private equity). You are also not alone in taking this path. Many oral surgeons have done this before. Several consulting groups can help you out. Although they can be expensive, wouldn’t you rather pay up front to avoid costly mistakes rather than make them? A good surgeon is a humble surgeon, and acknowledging the strengths of a team will only benefit you and your practice in the long run. Seek help when needed, and more importantly, know when to ask for it.
Academics
For the noble, there is always a home for you in academics. If you are willing to move, there always seems to be a need for oral surgeons in an academic hospital. The pros of this route include a safety net, great benefits depending on the institution, a plethora of resources and other practitioners, the ability to do much more advanced cases, and cheap labor (residents). Cons include typically lower comparative pay, relatively more active call, hospital politics, and limited administrative decision making. If you love to teach and do big cases, there is no better environment. However, if you like calling all the shots around you and moving fast, you may find this route frustrating.
Military/VA
A less pursued route, but viable one, is choosing to pursue a career with the military or Veterans’ Hospital. To be clear, these are very different routes themselves but offer somewhat similar pros and cons. For both, the benefits, expectations, and hours can be good. This is at the sacrifice of autonomy (to some extent) and the ability to make big practice decisions in the hiring/firing of staff, implementation of protocols, and equipment purchases. I am not intimately familiar with the specifics, but from observation and discussion, I have appreciated some of the aspects of working in a VA. Regarding the military, it is very heavy in dentoalveolar but depending on your facility, you may have the ability to do orthognathic surgery or other reconstructive procedures. I will defer the details of this tract to those such as Dr. Dan Hammer (Director, Division of Oral, Head and Neck Oncology and Reconstructive Surgery, Department of OMFS at Naval Medical Center San Diego) and other military surgeons. If you have experience here, feedback and opinions are always appreciated.
Although this list is not exhaustive, AccessOMFS hopes it provides a starting point to discuss future options. The experience and perspectives written about here are as objective as possible but will still include some biases, which is why your feedback is important and welcomed. A good surgeon is a humble surgeon, and acknowledging the strengths of a team will only benefit you and your practice in the long run. Best of luck and more to come!