By Matthew Pham, DMD, MD
I often heard the adage, “You can pick two out of the three: scope, pay, and location” when discussing employment as a resident. While I see the reality in this, I find it to be a very narrow perspective, especially right out of training.
Even in an OMS heavy program, it is rare to get more than 36 months of on service experience. That doesn’t change the fact that many residents strive to include full arch implant and maxillofacial surgery into their third molar and single implant heavy schedule. So while some will prefer to live in a city over the suburbs, or taking trauma calls versus not, I think the aspect of mentorship is greatly undervalued when selecting a practice to join.
I was very fortunate to train at a program that has a strong relationship with the prosthodontics department, allowing for me to complete full arch cases fairly routinely. I additionally spent elective time through the Osteo Science Foundation focusing only on implant surgery. However, there are still many multifaceted nuances to complex implant cases that are rarely learned by the end of residency.
I attended a full arch seminar given by a partner in my group earlier this year. The information was presented exceptionally, and there was even a cadaver component to the course. Yet what I realized is that the gap in confidently completing these cases is not the didactic information, but in continuing mentorship.
No CE course can substitute for being able to go over scans with an experienced surgeon, discussing treatment plan options and possible complications. Nothing can replace the resource of being able to have an expert in the field assist me in a difficult full arch and zygomatic implant case until I can one day do the same for a newly graduating surgeon.
My training was very heavy in maxillofacial surgery, with it not being unusual to have three orthognathic cases in a day. Even so, you can’t put a monetary value on being able to have a fellowship director and board examiner give pointers when setting patients up for unusual osteotomies like inverted L’s. This, in addition to cutting orthognathic cases with him or fellowship-trained partners, has taught me levels of efficiency that I honestly did not realize were possible.
Not only has the mentorship improved on skill sets I already had, they’ve expanded my surgical repertoire. Like many other residents, I learned arthrocentesis, total joint replacement, and diagnostic arthroscopy, but Level II arthroscopy was a foreign concept.
The surgeons in the group lecture nationally on TMJ surgery, and have been generous enough to teach me how to navigate these procedures technically. More importantly, they make themselves fully available, spending time to discuss their algorithms for different clinical scenarios.
I fully appreciate that not everyone will want to continue with maxillofacial surgery. The majority will be a part of more traditional “teeth and titanium” practices. Most of my day still consists of extraction and implant procedures, and having access to a large group of surgeons has helped me learn proficiency in implant techniques like titanium mesh grafting and osseodensification that weren’t as commonly used during residency. I truly believe that regardless of scope, nothing creates more confidence than having such a supportive network of people to learn from on a consistent basis.
Outside of mentorship, the aspect of resources has also changed how I view OMFS practices. Treatment planning implants in residency on computer software and converting them to surgical guides was cumbersome. Having a team in our group who does the legwork of this for me alone is invaluable.
Combining this with multiple in-house printers has translated to much more accurate and efficient implant surgeries in my practice. Facilities themselves can even be a resource if utilized properly. Having access to an in-office AAAHC OR significantly increases my ability to perform full-scope OMFS by minimizing the well-known administrative and logistical issues of hospitals. Merging the mentorship of my senior partners with our surgery centers has made orthognathic and TMJ surgery not only efficient, but profitable.
Unique resources also include providers that aren’t oral surgeons. Our group has formed a multidisciplinary approach by adding prosthodontists to the implant team. This creates a better, patient-centered result while also alleviating many stressful aspects of the process for the providers by allowing each specialist to focus on their area of expertise.
The orofacial pain specialists also add instrumental value. We all know that the majority of TMJ patients can be managed non-surgically. The orofacial pain specialists in our group allow for me to focus on those who are surgical candidates, making TMJ surgery a practical part of my practice.
Half a year into my position with the group, I’m fortunate to have a truly full-scope practice in a rapidly growing city while also being compensated well. The resources of in-office ambulatory operating rooms, in-house 3D printers, and a multidisciplinary team are truly game-changing aspects that I did not consider as a resident.
These things aside, I still feel most privileged to have the opportunity to continue to learn from the talented people in my group. I can’t stress enough to young surgeons how much I encourage you to find partners who are dedicated to educating and mentoring you in the early phases of your career. You’ll be a better, more well-rounded provider because of it.
Matthew Pham, DMD, MD
Carolinas Center for Oral & Facial Surgery
Dr. Pham is a dual-degree oral and maxillofacial surgeon at the Carolinas Center for Oral & Facial Surgery. He has a special interest in corrective jaw surgery, dental implants, and facial trauma.