OMS Residency AMA 2020

[PhansterZ]

Haven’t done one of these in a while. I’m enrolled in a 6-year combined MD-OMS residency program. On my anesthesia rotation, so I have a lot of free time. Ask me anything!

Here’s a link to the previous AMA I did 2 years ago.

OMS Residency AMA

I’m in a 6-year integrated OMS program. Just finished my OBGYN rotation, and have some free time. Ask away!

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[ToothJockey]

Are you sure you don't wanna do this in the Dental forum instead? You posted this in the pre-dental forum, not sure if you did this intentionally. Most people on here just wanna get into dental school haha

I read your past AMA. Are you still interested in academics now that you've spent more years in residency, or has your view shifted?

 

[deleted903013]

When did you decide you wanted to go into oral surgery?

 

[PhansterZ]

Are you sure you don't wanna do this in the Dental forum instead? You posted this in the pre-dental forum, not sure if you did this intentionally. Most people on here just wanna get into dental school haha

I read your past AMA. Are you still interested in academics now that you've spent more years in residency, or has your view shifted?

Hopefully wherever I post it, people may find it helpful.

At this point, I'm still undecided on what I want to do. Wherever I end up, I would like to be able to practice broad scope and not let my training go to waste.

 

[PhansterZ]

Thanks for your time.

Are guided surgeries going to be more prevalent in orthognathic And reconstruction cases? As in cbct + surgical guide + 3D printed prosthesis?

Are nerve repair surgeries becoming better with better material and techniques?

The short answer to all your questions is yes. For orthognatics, Virtual Surgical Planning (VSP) is taught at most if not all training programs. VSP can also be used for reconstruction and for pre-bending of plates, saving time in the OR. Nerve repair has grown tremendously the past 10 years, with the adoption of Axogen nerve graft for Inferior alveolar nerve repair. Whether you will get training in these techniques will be dependent on the program that you match into.

 

[PhansterZ]

When did you decide you wanted to go into oral surgery?

At the end of my second year. I was a little late to the game, as I was planning on doing general dentistry. But I enjoyed what I saw in the OR during my OMS rotation and felt there was nothing else I would rather do.

 

[PhansterZ]

What’s your favorite sub specialty within oms? Favorite oms surgeon?

What is the general consensus among academic Oms with regards to the new dental anesthesia specialty? Camaraderie/animosity?

Right now, I'm still in my early stages of training and I currently do not have a favorite subspecialty. As for favorite surgeon, you will only intimately see the attendings at the programs you are training operate. You pick up things by having them teach you, so you end up operating them like them.

As for the new dental anesthesia specialty, it just recently became official, but there a growing number of dental anesthesiology providers that has served the community, with great safety records. The way the set up is with the DA will make it very unlikely that that OMS will ever work together with them. We are the only specialty in Medicine or dentistry to be allowed a single-operator anesthesiologist-surgeon in a case, so we sedate people in our offices while also taking out teeth/putting implants. Dental anesthesiologists usually travel to dental offices and work with general dentists/pediatric dentists, and sedate their patients. I can see how private practice oral surgeons can be affected, as an anxious patient, who would before be referred to the oral surgeon for tooth removal, can stay "in house" at his general dentist office. But there are still very few dental anesthesiologists compared to the vastly growing number of corporate dentists, who keep everything "in house". So for OMS, we don't really feel threatened by the specialty as much as the corporations taking over dentistry. @Sublimazing may have more to say, as he finished his DA residency and now finishing up his OMS residency.

 

[BYU4you]

Just got accepted into 6yr-MD program, what are some books and study materials you recommend. Would you recommend studying anything at all before I start in July or just enjoy my life while I still can? Thanks

 

[PhansterZ]

Just got accepted into 6yr-MD program, what are some books and study materials you recommend. Would you recommend studying anything at all before I start in July or just enjoy my life while I still can? Thanks

How is your program structured? Do you go into intern year first, or medical school first?
If it's intern year, then being able to suture quickly and efficiently would make your life easier, so practice on that. "Borrow" some sutures, buy pork belly, make cuts, go on youtube for suturing techniques, and go have at it. There should be a period where you will take buddy call and your residents will teach you all you have to know about examining patients, writing notes, practice sewing and when to call for help. If you want a good book to read, then Kademani and Tiwana's Atlas of Oral and Maxillofacial Surgery would be a great book.
If you're starting out in second year med school, you don't have to do anything at all. Maybe study ahead for step 1.

 

[Pearl E. White]

@PhansterZ thank you for doing this. Any advice for a D1 who isn't sure yet if they want to specialize? Also, what is your daily schedule looking like these days?

 

[Big Time Hoosier]

We are the only specialty in Medicine or dentistry to be allowed a single-operator anesthesiologist-surgeon in a case

Do you foresee this coming to an end?

Big Hoss

 

[PhansterZ]

@PhansterZ thank you for doing this. Any advice for a D1 who isn't sure yet if they want to specialize? Also, what is your daily schedule looking like these days?

The simple answer to that is to work hard, keep up your grades, so that when 3rd year dental school rolls around, you are in a position to specialize in whatever field you want. If you have a lower class ranking, then it will be more of an uphill battle to match into the more competitive specialties, or match into your desired location.

I have just completed my 5 months of anesthesia, and am starting general surgery tomorrow. Anesthesia schedule is dependent on the hospital you train at, but here at Shreveport, we have a pretty good deal. You don't work on weekends, you don't work on holidays, and you don't take call. You come to work around 6 AM and you'll be finished around 3 PM every day. Sometimes there are not enough people to cover you, so you end up staying later than 3, but everyone leaves by 5 PM. This happens about once every 2-3 weeks.

For general surgery, the schedule is tougher, but due to the 80 hour work week implemented by ACGME, life has been better for the residents in general surgery as compared to residents that worked 20-30 years ago, who have pulled over 100 hour work weeks. I'm on my Surgical Intensive Care Unit (SICU) rotation in March, and I'm going to be working ~6 AM-5 PM from Sunday to Friday, taking Saturday off.

 

[PhansterZ]

Do you foresee this coming to an end?

Big Hoss

We have a very good track record, and very low incidence of mortality (from 0.5-1 deaths / 100,000 patients), depending on research cited. This mortality rate is similar with the anesthesiologists/CRNA performing anesthesia. The outpatient deaths are mostly attributed to poor case selection with sicker patients. Our model of sedating healthy patients ( ASA I and II), and performing the procedure (mostly wisdom teeth) works well. The sicker patients can be sent to the hospital to be sedated by a CRNA / Anesthesiologist.

Assuming you will be doing 4 sets of wisdom teeth per day under sedation, 4 days a week, 40 weeks a year. That's 640 sets a year. Over a 20 year period, that is 13,000 sets of wisdom teeth you'll be doing. So in your career, ~ 1 of 8 of OMS will experience a death in their office. So good case selection is paramount to performing safe anesthesia.

 

[batman12345]

We have a very good track record, and very low incidence of mortality (from 0.5-1 deaths / 100,000 patients), depending on research cited. This mortality rate is similar with the anesthesiologists/CRNA performing anesthesia. The outpatient deaths are mostly attributed to poor case selection with sicker patients. Our model of sedating healthy patients ( ASA I and II), and performing the procedure (mostly wisdom teeth) works well. The sicker patients can be sent to the hospital to be sedated by a CRNA / Anesthesiologist.

Assuming you will be doing 4 sets of wisdom teeth per day under sedation, 4 days a week, 40 weeks a year. That's 640 sets a year. Over a 20 year period, that is 13,000 sets of wisdom teeth you'll be doing. So in your career, ~ 1 of 8 of OMS will experience a death in their office. So good case selection is paramount to performing safe anesthesia.

When did you have to take the CBSE? When did you begin to study for it? Is it fine to prefer a 4 year over a 6 year program?

 

[Pearl E. White]

The simple answer to that is to work hard, keep up your grades, so that when 3rd year dental school rolls around, you are in a position to specialize in whatever field you want. If you have a lower class ranking, then it will be more of an uphill battle to match into the more competitive specialties, or match into your desired location.

I have just completed my 5 months of anesthesia, and am starting general surgery tomorrow. Anesthesia schedule is dependent on the hospital you train at, but here at Shreveport, we have a pretty good deal. You don't work on weekends, you don't work on holidays, and you don't take call. You come to work around 6 AM and you'll be finished around 3 PM every day. Sometimes there are not enough people to cover you, so you end up staying later than 3, but everyone leaves by 5 PM. This happens about once every 2-3 weeks.

For general surgery, the schedule is tougher, but due to the 80 hour work week implemented by ACGME, life has been better for the residents in general surgery as compared to residents that worked 20-30 years ago, who have pulled over 100 hour work weeks. I'm on my Surgical Intensive Care Unit (SICU) rotation in March, and I'm going to be working ~6 AM-5 PM from Sunday to Friday, taking Saturday off.

How did you determine which program you wanted to join? I understand you are supposed to go on externships and spend time with the residents, but... when? My school is year-round. Do you just ask questions like lifestyle during residency? (Of course, it is going to be hard no matter where you go.) Get a feel for the vibe/camaraderie amongst the residents, etc.?

 

[AppalachianDentalBoy]

The simple answer to that is to work hard, keep up your grades, so that when 3rd year dental school rolls around, you are in a position to specialize in whatever field you want. If you have a lower class ranking, then it will be more of an uphill battle to match into the more competitive specialties, or match into your desired location.

I have just completed my 5 months of anesthesia, and am starting general surgery tomorrow. Anesthesia schedule is dependent on the hospital you train at, but here at Shreveport, we have a pretty good deal. You don't work on weekends, you don't work on holidays, and you don't take call. You come to work around 6 AM and you'll be finished around 3 PM every day. Sometimes there are not enough people to cover you, so you end up staying later than 3, but everyone leaves by 5 PM. This happens about once every 2-3 weeks.

For general surgery, the schedule is tougher, but due to the 80 hour work week implemented by ACGME, life has been better for the residents in general surgery as compared to residents that worked 20-30 years ago, who have pulled over 100 hour work weeks. I'm on my Surgical Intensive Care Unit (SICU) rotation in March, and I'm going to be working ~6 AM-5 PM from Sunday to Friday, taking Saturday off.

How did you evaluate programs you externed at compared to those you only interviewed with? What were your priorities when creating your rank list?

 

[CarcinomaInSitu]

Have several externships scheduled and was wondering what chapters in Kademani's should be prioritized heading out to these externships. I was also wondering if you know any other good resources for surgical H&N anatomy. Thanks again

 

[PhansterZ]

When did you have to take the CBSE? When did you begin to study for it? Is it fine to prefer a 4 year over a 6 year program?

You have to take the CBSE prior to submitting your application for residency.
The CBSE is offered twice a year, once in February and again in August. Most schools have deadlines after August, so you can try as many times as you want, up to August the year you're applying.
I studied 4 months for it.. 2 months of just going over the material, and 2 months of doing Uworld.
Yes, it's fine if you prefer 4, 6, or even Case Western's 5 year program. Just have a reason why you're doing one or the other.. or why you applied to both.

 

[PhansterZ]

How did you evaluate programs you externed at compared to those you only interviewed with? What were your priorities when creating your rank list?

There are a lot of factors that determines how you are going to rank and that is really a personal decision you will make. When I made my rank list, I looked for affordability of the city, the weather (I hate snow), the broad scope of the program, how I got along with the residents, etc.

 

[PhansterZ]

Have several externships scheduled and was wondering what chapters in Kademani's should be prioritized heading out to these externships. I was also wondering if you know any other good resources for surgical H&N anatomy. Thanks again

Kademani's is way more than what you need for the externships. I would say the trauma chapters are pretty cool to read.
Depending on the program you extern at, you may or may not take out teeth. At Shreveport, we love teaching externs how to take out teeth.
The bible for surgical H&N anatomy is Ellis' Surgical approaches to the Facial Skeleton.

 

[PhansterZ]

How did you determine which program you wanted to join? I understand you are supposed to go on externships and spend time with the residents, but... when? My school is year-round. Do you just ask questions like lifestyle during residency? (Of course, it is going to be hard no matter where you go.) Get a feel for the vibe/camaraderie amongst the residents, etc.?

If lifestyle is what you're looking for, don't go into this field. You will be working more hours that you will ever imagine. You would be completely miserable if you went into this for the lifestyle. I luckily matched into this program, and feel privileged to be training under world-classed surgeons. Sometimes you don't pick where you match, but they pick you.

I'm not sure how to answer the question about camraderie amongst residents. We get along pretty well as a group here, but with so many people with differing personalities, there's bound to be conflict in all of the programs. And when new residents join and others leave, the dynamic will be very different.

 

[lOuDMoUTH]

Hey,

Aspiring future OMS resident. Thank you for taking time an doing this AMA!

My questions are:
1. Does externing at a particular school give a better chance to get an interview? If so, how much of an influence do you think it would have?
2. Is there anything that you wish externs knew/practiced before showing up for their externship, or maybe something that would really amaze the residents?
3. Do you believe, that there is a shift in the avg matriculation for CBSE scores?

 

[PhansterZ]

Hey,

Aspiring future OMS resident. Thank you for taking time an doing this AMA!

My questions are:
1. Does externing at a particular school give a better chance to get an interview? If so, how much of an influence do you think it would have?
2. Is there anything that you wish externs knew/practiced before showing up for their externship, or maybe something that would really amaze the residents?
3. Do you believe, that there is a shift in the avg matriculation for CBSE scores?

Currently on Surgical ICU night shift. In between gun shot wound traumas.

1. Externing at a particular school will provide us with a better idea of who you are. If you work hard, friendly to deal with and if your personality matches with the residents, then it will give you a huge advantage when applying. If you are lazy, or if you rub some residents the wrong way, then externing will work against you.
2. Nothing a dental student does will amaze the residents. Think about it this way... would anything a first year dental student do amaze a fourth year one? if you can help them out in clinic like take out teeth, if you can suture lacerations, be a fun and interesting to hang out with, then it will make our life better. And of course, every resident has different personalities, so while one resident can like you, another can hate you. Haha. But from being around a good number of externs... being quiet works the best. Only talk when spoken to, and always be willing to help out.
3. I’m not sure the answer to that. A few years ago, I saw that the average cbse for a matched applicant was 64. I’m at a 6 year program, so our average cbse matched resident is closer to 75. Just don’t worry about what other people are scoring. Focus and study as hard as you can and obtain the highest score possible.

 

[tallnlanky]

Was there anything in particular that drew you to join a 6 yr program? As far as I understand, the training between 4 yr and 6yr residents is similar, and both groups can carry out similar procedures (barring any fellowship training).

 

[batman12345]

Can 4 year graduates do fellowships?

 

[PhansterZ]

Was there anything in particular that drew you to join a 6 yr program? As far as I understand, the training between 4 yr and 6yr residents is similar, and both groups can carry out similar procedures (barring any fellowship training).

Getting the MD in 2 extra years was the main reason. It's a very powerful degree. Yes, 4 and 6 year residents will mostly be performing wisdom teeth extractions and placing implants, because that is the most profitable, but having the MD can open a path up to opportunities that may be more difficult than without one. For example, California would not let single degree OMS perform facial cosmetic surgery. For a long time, single degree oral surgeons were not able to obtain the FACS designation (ACS finally allowed the single degree folks to join in 2014). For fellowships, you're generally more competitive if you have the MD, although not having it doesn't mean you can't do one. If you go into academics, having the MD is another card you can use to really climb up the ladder, and fight less with hospital politics (although, many still consider us dentists even with the MD). Many academic programs, when looking to hire, will prefer surgeons who have the MD.

It's really a personal choice on what you want to do. Your hand skills are based on what you are exposed to, your innate ability to operate and how much time you spent honing your surgical skills. Having an MD will not make you a better surgeon, per say. Although, having the MD will give you a greater medical foundation, as you will have to complete all the Steps (1, 2CS, 2CK, 3) to be a licensed physician. If you are dedicated, you can learn all of the medicine on your own too, but the standardized testing will ensure at least a minimum knowledge base that all licensed physicans need to relied upon to know.

 

[Xtract]

Hey @PhansterZ ,

i read that you decided late second year to pursue OMFS. How did you tailor your app around this with minimal time to fill up the CV? (research,ECs,etc.) Or does it really just come down to rank/CBSE/externship/interview?

 

[The Tooth Guy]

Thank you for all of the information you've been putting on SDN!

My dental school is currently ignoring this spring semester's GPA due to COVID, and is not taking it into account for class rank. Likewise, they are giving us the option to choose pass/fail or letter grades to get put on our transcripts even though the dental school will not be taking those grades into account. Since the transcripts are still sent when applying to residency programs, do you think it would be a bad idea to cherry pick the classes that are guaranteed A's and pass/fail the rest? Due to having to adjust to online learning only, I'm not entirely sure I could get the same grades that I would if I was in school physically. Alternatively, since my school is making our GPAs a wash anyway, do you think it would be a bad idea to pass/fail everything then?

I am a D1 at the moment and did very well my first semester, but I am just unsure of whether I would need to run the risk of slapping a B on my transcript in an attempt to reinforce my first year on paper.

Thanks!

 

[PhansterZ]

Hey @PhansterZ ,

i read that you decided late second year to pursue OMFS. How did you tailor your app around this with minimal time to fill up the CV? (research,ECs,etc.) Or does it really just come down to rank/CBSE/externship/interview?

Tbh, I didn't tailor my application towards OMFS, and probably one of the reasons why I didn't match the first time applying.
I had a good rank, took the CBSE and did well. Then went on a 7 weeks of externships.
But you can always improve your odds of matching by doing OMFS research, going on mission trips, volunteering more etc.. although don't do it at the expense of your rank/cbse.

 

[PhansterZ]

Thank you for all of the information you've been putting on SDN!

My dental school is currently ignoring this spring semester's GPA due to COVID, and is not taking it into account for class rank. Likewise, they are giving us the option to choose pass/fail or letter grades to get put on our transcripts even though the dental school will not be taking those grades into account. Since the transcripts are still sent when applying to residency programs, do you think it would be a bad idea to cherry pick the classes that are guaranteed A's and pass/fail the rest? Due to having to adjust to online learning only, I'm not entirely sure I could get the same grades that I would if I was in school physically. Alternatively, since my school is making our GPAs a wash anyway, do you think it would be a bad idea to pass/fail everything then?

I am a D1 at the moment and did very well my first semester, but I am just unsure of whether I would need to run the risk of slapping a B on my transcript in an attempt to reinforce my first year on paper.

Thanks!

Really up to you. If it makes you feel better, go ahead and cherry pick classes you'll get an A in. Won't affect your class rank anyhow. Programs tend to pay more attention to Class rank than GPA. Getting a B on your transcript is not end of the world. Doesn't look pretty, but I got a few B's in dental school. A person with a GPA of 3.75 with a #2 class rank looks better than someone with a GPA of 3.90, with a class rank of #20. And we always have the CBSE to equalize disparities in class rankings. Grade inflation at certain schools is real.

 

[Sentinel8483]

What's the pay like as an OMS resident in US? I'm a surgical reg overseas about to start my dentistry degree.
Also, what are the chances of IMGs getting into a US training program? (4 year only). I would imagine it would be next to zero?

 

[Sentinel8483]

45k before benefits.

not alot is it?do they scale up as you progress to senior position?

 

[2thDoc11]

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