So you want to be an oral and maxillofacial surgeon.
You’re an overachiever that isn’t satisfied with just being a dentist and want the extra degree
of surgical expertise. Let’s debunk the public perception myths and give it to you straight.
This is the reality of oral and maxillofacial surgery.
Dr. Jubbal, MedSchoolIinsiders.com.
Welcome to our next installment in So You Want to Be. In this series,
we highlight a specific specialty within medicine,
such as oral and maxillofacial surgery, and help you decide if it’s a good fit for you.
You can find the other specialties on our So You Want to Be playlist. If you want
to vote in upcoming polls to decide what future specialties we cover, make sure you’re subscribed.
If you’d like to see what being an oral and maxillofacial surgeon looks like,
check out my second channel, Kevin Jubbal, M.D.,
where we'll be covering a day in the life of an OMFS in the future.
Oral and maxillofacial surgery, or OMFS for short, is a subspecialty of dentistry that
focuses on the surgical management of the face, jaw, and oral cavity.
When most people think of OMFS, the first things that come to mind are wisdom teeth extractions
and dental implants. Although these are a large part of what an OMFS does,
their actual scope is much broader.
To start, all OMF surgeons are trained extensively in administering anesthesia. They learn everything
from establishing and maintaining intravenous lines, to managing airways, to performing
endotracheal intubation. They are also taught how to manage any complications or emergencies that
might occur during anesthesia administration. For this reason, it is very common for OMFS in
the outpatient setting to simultaneously serve two roles – being both surgeon and anesthetist.
The surgical scope of OMFS also goes beyond what many expect. OMF surgeons perform
a variety of reconstructive and corrective surgeries both individually and as a part of
an interdisciplinary healthcare team. When treating oral and oropharyngeal cancers,
for example, an OMF surgeon may work alongside a plastic surgeon
and a head and neck trained ENT to remove the lesion and reconstruct the area.
They also perform a variety of corrective jaw surgeries to treat issues resulting
from facial deformities, TMJ disorder, or malocclusions. A great example of this
is orthognathic surgery where they manipulate the positioning of the
maxilla and mandible to treat conditions like malocclusion and sleep apnea.
OMFS can perform emergent surgeries for life-threatening conditions such
as Ludwig’s angina. And like other surgical specialties,
they split their time between procedures and consultations. Those that work in an academic
center will further divide their time between academic responsibilities such as teaching and
research. This brings us to an important method of differentiating an OMF surgeon’s practice.
In the academic setting, OMF surgeons will on average see more complex and
emergent cases compared to community or private practice settings. Presenting concerns include
severe head and neck infections, orbital floor fractures with extraocular muscle entrapment,
and gunshot wounds to the face - all of which require immediate surgical intervention.
True emergencies like these are rare though and at most hospitals,
facial trauma call is split between some combination of OMFS, plastic surgery, and ENT.
Community practices are few and far between. The majority of OMF surgeons work in private practice.
Here they will typically see less complexity compared to the academic setting. In general,
they will also receive higher compensation and have greater flexibility in their hours.
For this reason, it is common for many OMF surgeons in academia or community
to only work part-time and split their time with private practice.
OMFS is an often misunderstood field. Many people associate it with just
pulling teeth; however, the procedures that OMFS perform can be complex and
can have a significant impact on their patient’s day-to-day life.
It's not uncommon to confuse OMFS, ENT, and plastic surgery given the high degree of overlap.
While somewhat of an oversimplification, think of ENT surgeons as the masters of complex work
deep inside the head and neck region, such as cancer resections. Think of plastic surgeons
as masters of soft tissue, from one end of the spectrum helping ENTs with coverage after cancer
resection through complex flaps, to pioneering facial aesthetics on the other end. And think
of OMFS as the masters of anything related to the teeth or temporomandibular joint, or TMJ.
The path to OMFS starts with completing dental school. If you want to get involved
in a similar line of work through the medical school track, check out ENT,
also known as otolaryngology, which we’ve covered in a previous So You want to Be episode.
After dental school, there are two pathways to becoming an OMFS:
the four-year program and the six-year dual degree program. Both will certify you to practice as an
oral and maxillofacial surgeon; however, the six-year degree will also grant you an MD.
In terms of the curriculum between four and six-year degree programs,
there is a high degree of variability depending on the particular program.
In general, six-year degree programs will have longer surgical rotations plus added time spent
on medical school coursework. In fact, with these added obligations it’s very much possible
that six-year degree programs will give you less oral surgery experience than four-year programs.
OMFS is competitive as a dental school specialty. Applicants to both 4-
and 6-year programs tend to be at the top of their class during dental school.
It is also the only dental specialty that requires studying for and taking
the Comprehensive Basic Science Exam (CBSE) which is essentially an abbreviated USMLE Step 1 Exam.
So in addition to studying for dental exams and dental boards like everyone else,
OMFS aspirants will need to additionally prepare for this test. The average CBSE score for students
accepted into OMFS programs is 68.9 which is equivalent to about 195 to 200 on USMLE Step 1.
According to data from the National Matching Service, in 2021,
only approximately 48% of applicants matched into either four- or six-year OMFS residency
programs. Applicants that don’t match the first time around have three options. The first,
and increasingly common option, is to do a non-categorical internship year offered by
an OMFS residency program and apply again. Alternatively, students can spend this gap
year practicing dentistry or completing a one-year general practice residency before applying again.
The good news is that dental school is more attainable than medical school.
The average dental school matriculant has a GPA of 3.5 and a composite DAT score of 20 which is
around the 75th percentile. In comparison, the average MD matriculant will have a GPA of 3.7
and MCAT score of 511 which is in the 88th percentile. If you want to learn more about how
competitive medical school and dental school are and how they stack up against other professional
schools, I made a video explaining the differences - link in the description.
After completing OMFS residency, you can further
subspecialize with fellowship. There are three main fellowship options:
Head and Neck Oncology, Facial Cosmetics, and Cleft and Craniomaxillofacial Surgery.
Even then, most fellowship-trained surgeons will still perform basic OMFS procedures as well.
Head and neck oncology is a 2-year fellowship focusing on the ablation and reconstruction
of malignant tumors of the head and neck, with special attention to the oral cavity,
salivary glands, and maxillofacial complex. This fellowship also provides
training in microvascular reconstruction.
Of note, this fellowship is more commonly completed by ENT surgeons than by OMFS.
Facial cosmetics is a one-year fellowship that provides additional experience with
facial cosmetic procedures including facelift, blepharoplasty, and rhinoplasty.
Cleft and craniomaxillofacial surgery is a one-year fellowship providing surgical
experience in treating cleft lip and palate, craniofacial surgery,
and other major facial deformities. Of note, most craniofacial fellowship-trained surgeons are
plastic surgeons, which we’ve covered in a separate So You Want to Be episode.
There's a lot to love about the field of oral and maxillofacial surgery.
OMF surgeons see the full spectrum of patients: from young to old and healthy to sick. The types
of cases that they see are also, for the most part, fairly routine. Procedures like
dental extractions, dental implants, biopsies, infections, arthrocentesis,
guided bone regeneration, and trigger point injections are the bread and butter of OMFS.
Like most other surgical specialties, OMFS offers near-instant gratification and treatment of
ailments. Whether relieving pain from TMJ disorder or restoring function through dental implants
and orthognathic surgery, most OMFS procedures have favorable outcomes and mortality is low.
Job satisfaction is high amongst OMF surgeons. In one survey, approximately 84% reported
satisfaction with their career and 77% reported they would choose a career in OMFS again.
OMF surgeons are highly compensated, even with respect to other specialized
dental and medical fields, making an average of $465,000 per year.
It’s important to note that the majority of OMFS work in private practice,
and those working in academic or community settings will often receive lower compensation.
Private practice also provides greater independence, which often
translates to prioritizing shorter and more straightforward cases to boost compensation.
That being said, OMFS is not for everyone.
The private practice route, which is common amongst OMFS, requires running a business
and the additional administrative work and complexity that is associated with that.
Like many other surgical specialties, the training to become an OMF surgeon is long and comes with
additional opportunity cost. Unlike the medical school pathway, residency isn’t required after
dental school. That means rather than going out to practice as a general dentist and making a
solid income, you’ll instead be committing an additional 4 to 6 years for OMFS residency.
OMFS residency is also highly competitive, with only 48%
of applicants getting accepted each cycle.
Diversity in the field has historically been lacking with regards to gender.
The field is 87% dominated by men. This has started to change in recent years with
higher proportions of female students being accepted into OMFS residencies;
however, as it stands now, the reality is that most OMF surgeons are men.
At the end of the day, how can you decide if OMFS is a good fit for you?
If you’re set on working in the oral and maxillofacial region then OMFS can be a great fit.
If your life outside of medicine is important to you, OMFS can provide
the flexibility to perform surgery while still having time for your own family and interests.
If you love camaraderie and pride yourself in being a leader amongst leaders,
you will appreciate the fact that general dentists
and dental specialists will often turn to you for your help and advice.
That being said, you should only pursue OMFS if
you are truly certain you want to work in the oral and maxillofacial region.
Over 50% of medical students end up changing their minds about what specialty to pursue
during medical school. Since OMFS requires going to dental school instead of medical school,
your options are limited if you decide OMFS isn’t for you. Going the medical school route can offer
you more flexibility while still allowing you to do similar work as an ENT surgeon.
Big shout out to Dr. Michael Benichou, OMFS resident at Brooklyn Hospital Center,
for helping me in the creation of this video.
If you do decide to pursue medical school, it’s high ROI to work with
experts who can help you craft the strongest medical school or residency application.
As you look at resources and companies to work with, seek out those who are actual
MD physicians, not PhD or other types of doctors that didn't go to medical school.
Look for those who have achieved stellar results themselves, a track record of
success with positive ratings from customers, and a systematic approach so you know you'll
always receive high-quality service. If you decide on Med School Insiders, we'd love to
be a part of your journey in becoming a future physician. Visit us on MedSchoolInsiders.com.
Thank you all so much for watching! If you enjoyed this video, check out our So You Want to Be an
ENT, or another specialty on our So You Want to Be playlist. Much love, and I'll see you guys there.