EDITORIAL
J Oral Maxillofac Surg
Why Do You Want to Be an Oral and
Maxillofacial Surgeon?
Each year, during the oral and maxillofacial surgery
(OMS) residency interviews, eager, ambitious, and
bright-eyed applicants describe their motivations for
OMS. When asked, ‘‘What are you looking for in an
OMS program?’’ most applicants exclaim emphatically,
‘ I want full-scope OMS training.’’ Yet after 4 to 6 years
of training in full-scope OMS, nearly every resident
eventually transitions into a limited-scope, office-based,
dentoalveolar, and dental implant private practice.1
During this year’s interviews, I asked each applicant
what they wanted to do after residency. Most appli-
cants stated that they planned to be in private practice,
doing bread-and-butter OMS, including teeth and tita-
nium. Some said they would take a trauma call and
would like to do a little orthognathic surgery. Of
course, some also provided the go-to, all-inclusive, I-
don’t-want-to-offend-anyone-answer. ‘‘My plan is pri-
vate practice with a part-time academic affiliation,’’ is
a catch-all designed to check all the right boxes for
the interviewer.
I was surprised by a clear dichotomy when
comparing the single and dual degree applicants.
Most 6-year applicants stated they wanted to enter ac-
ademics or a hospital-based practice. Many expressed
an interest in fellowship training, and they hoped to
use residency to determine which one to pursue.
These students’ curricula vitae listed substantial
research experience as evidence of interest in schol-
arly activity.
While it is difficult to obtain comparable data across
all training programs, we keep close tabs on graduates
of my current program. Among 43 past residents, 2 are
in full-time academic careers (one is single-degree and
one is double-degree who also completed a fellow-
ship), and one is in a part-time academic/private prac-
tice setting (a single-degree resident). This leaves 40
surgeons (93%) who are in private practice. Most of
these surgeons practice office-based dentoalveolar
OMS, while only a minority have incorporated a wider
scope of practice.
Why would a dental student want to spend 4-6 years
training in full-scope OMS, if only to practice narrow-
scope OMS? Is the allure of being a surgeon or a real
doctor blinding applicants from a more deliberate
consideration? Is the desire to be at the top of the
dentistry food chain, as one applicant colorfully stated,
so enticing that applicants do not think their careers
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82:261-262, 2024
through sufficiently? Do they only care about the
name and the title, or do they think that the specialty
ranks highest among top-earning dental specialties?
Do they learn something about the specialty or about
themselves during residency that alters their trajec-
tory? While most students seek full-scope training
enthusiastically, the reality is that most will not use
the entirety of that training in clinical practice.
Certainly, we want the best dental students to pur-
sue careers in OMS, but we should push and prod
them beyond the rehearsed response to articulate a
cogent position during the interview. Training pro-
grams must develop better screening tools to identify
those applicants who will do their best to maintain full-
scope practices with hospital privileges and on-call re-
sponsibilities.2
The motivational flaw of the applicant begins with
the personal statement on the American Dental Educa-
tion Association Postdoctoral Application Support Ser-
vice application in which the applicant describes their
aha moment. There are remarkably few variations of
those accounts wherein the applicant witnessed an
amazing Lefort down fracture, or watched surgeons re-
constructing a panfacial trauma case, after which they
just knew that this was what they wanted to do. Not
once have I heard an applicant proclaim that their in-
terest in OMS began the moment they saw an incred-
ible tooth extraction or a breathtaking dental implant
case. At least this would give me confidence that the
applicant has a true sense of what most oral and maxil-
lofacial surgeons do in private practice.
During the interviews, a few bold dental students
said that the main reason they would pursue private
practice over academics is based solely on salary.
One student admitted that if the compensation were
the same, they would choose academics in order to
practice full-scope surgery. However, when asked to
describe the salary difference—whether short term
or over the span of a career—none could provide a
concrete answer. Perhaps those of us who hold aca-
demic positions need to do a better job at dispelling
the urban myth that academics is the poor man’s
OMS practice.
Interestingly, not one applicant mentioned the pos-
sibility of signing on with a Dental Service Organiza-
tion3; although these have become popular choices
given the increasing amount of educational debt.2
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Many applicants claimed they garnered consider-
able experience in third molar extractions, implants,
and sedation in dental school. For these individuals,
especially considering the ample opportunities for
additional training courses or mini-fellowships, I
wondered why they would invest 4 or 6 years to end
up practicing what they are already trained to do.
One applicant offered two reasons. The first is that
the full-scope training will provide them with tech-
niques acquired in complex surgeries that will benefit
them even when performing more basic procedures.
The other reason is that an oral and maxillofacial sur-
geon has a reputation for greater experience and
more extensive training when compared to a general
dentist who extracts teeth and places implants. This
invokes trust and confidence from patients who prefer
an advanced surgical specialist over a general dentist
for these types of procedures.
When a resident declares a preference for private
practice, in what way, if any, does this color the rela-
tionship between educators and trainees? Some might
argue that it places an undue burden on professors and
attendings whose job it is to bring all residents to a
level of competence in complex procedures, even
when it seems likely they might never perform them.
But that is the nature of academics: to expose the
trainee to the highest quality of care and to demand
the highest quality of performance. Whether we are
able to inspire them to adopt these practices as their
life’s work is a reflection on us as teachers. What
they do with the knowledge and skills we impart is
their decision.
These days, with profound financial implications for
training and many emerging practice models, it may be
shortsighted to judge OMS candidates based on their
hypothetical career plans. In point of fact, we are ill-
advised to judge an applicant’s career plan pre-
emptively at the interview stage. Knowing what we
know about the rewards and fulfillment of practicing
OMS, we should trust that the experiences gleaned
during residency will speak for themselves. Exposure
to the unpredictability and depths of hospital practice
has led many oral and maxillofacial surgeons to dig
deeper, pursuing fellowships in head and neck
oncology, microvascular surgery, or craniofacial defor-
mities. Still others discover a heightened interest in
EDITORIAL
scholarly activity, leading them to emulate their faculty
members with an academic career.4,5
Perhaps organizations, such as the Resident Organi-
zation of the American Association of Oral and Maxil-
lofacial Surgeons, can work with American
Association of Oral and Maxillofacial Surgeons to
develop more illustrative demographic and perfor-
mance data about our specialty.6 Dental students
would benefit from a better understanding of the
OMS landscape, including the percentage of private
practice surgeons, academic surgeons, private/aca-
demic surgeons, scope of practice, salary and compen-
sation, and other critical data to help them make more
informed decisions about career choice and scope of
clinical practice. In addition, they would benefit
from knowing if there are specific programs that are
better fits for those who have academic versus private
practice aspirations.7 In the end, it may not be possible
for the fourth-year dental student to forecast their
future with clarity given their limited access to infor-
mation and lack of experience in the field. Perhaps it
suffices that they consider OMS as a career, and we
should encourage their experiences during OMS resi-
dency to guide their practice decisions.
MICHAEL MILORO, DMD, MD
SECTION EDITOR
References
1. Hupp JR. Oral-Maxillofacial surgery residency training-practice
pattern mismatch? J Oral Maxillofac Surg 72:1–2, 2014
2. Jones JP, Ellis E. Trends associated with debt loads among oral and
maxillofacial surgery chief residents. Oral Surg Oral Med Oral
Pathol Oral Radiol 128:590–596, 2019
3. Hupp JR. Thoughts on dental. AAOMS Today 20(3):38–39, 2022
4. Roudnitshy E, Hooker KJ, Darisi RD, Peacock ZS, Krishnan DG. In-
fluence of residency training program on pursuit of academic
career and academic productivity among oral and maxillofacial
surgeons. J Oral Maxillofac Surg 80:380–385, 2022
5. Lanzon J, Edwards SP. Inglehart. Choosing academia versus pri-
vate practice: Factors affecting oral maxillofacial surgery resi-
dents’ career choices. J Oral Maxillofac Surg 70:1751–1761, 2012
6. Palla B, Callahan N, Miloro M. One survey to rule them all. J Oral
Maxillofac Surg 79(2):282–285, 2021
7. Bagheri SC, Meyer RA. Do you want to be a donkey? J Oral Max-
illofac Surg 80:975–977, 2022
Ó 2023 American Association of Oral and Maxillofacial Surgeons
https://doi.org/10.1016/j.joms.2023.12.002