The Role Of An Oral & Maxillofacial Surgeon
An oral and maxillofacial (OMF) surgeon specialises in diagnosing and treating patients with diseases affecting the hard and soft tissues of the mouth, jaws, face, and neck. It is a broad specialty and includes surgical and non-surgical management of conditions in patients of all ages, from newborns to the elderly.
Their work with children is usually concerned with congenital craniofacial deformities including cleft lip/palate. Young adults often require surgery following an injury or accident, whereas elderly people normally present with oral cancer or skin tumours of the face and head (1).
Oral and maxillofacial surgery (OMFS) procedures range from minor to major surgery, including (1):
Surgical treatment of complex facial injuries and soft tissue injuries of the mouth, face and neck
Removal of head and neck benign and malignant tumours
Reconstructive surgery, including microvascular free tissue transfer
Removal of impacted teeth and complex buried dental roots
Cosmetic surgery e.g. face lifts, rhinoplasty, eyelid and brow surgery
Temporomandibular joint surgery
Salivary gland surgery for benign and malignant lesions
Surgical treatment of congenital facial deformities
Surgery of skin lesions of the head and neck
OMF doctors' job roles are mainly within a general hospital for routine surgery and a specialist unit for more complex surgery. While surgery is their primary responsibility, they also attend to inpatients during ward rounds, as well as work in outpatient clinics and the emergency department.
They work within a multidisciplinary team consisting of surgical, medical, and dental specialists, both within the operating theatre (e.g. anaesthetists, theatre nurses, other surgeons) and outside (eg orthodontists, neurologists, oncologists). As a consultant, they lead and manage a team (1).
Apart from the necessary skills employed by all doctors, aspiring OMF surgeons should exhibit certain qualities and traits. Since the speciality requires dual qualification in medicine (Bachelor of Medicine, Bachelor of Surgery; MBBS/MBChB) and dentistry (Bachelor of Dental Surgery; BDS/BChD), immense drive, commitment and enthusiasm are essential in this specialty.
In addition to a high degree of manual dexterity and excellent visuo-spatial awareness, a high aptitude for problem-solving and the ability to think and plan in three dimensions are vital. You will also need to demonstrate physical stamina to cope with the demands of surgery. Teamwork and leadership ability are crucial to effectively manage and lead your team (1).
The specialty is renowned for its wealth of cutting-edge surgical procedures and continues to evolve rapidly. For instance, surgeons often view and manipulate CT and MRI to produce virtual 3D models which facilitate improved pre-operative planning as well as navigation during surgery; this is particularly useful since the head and neck contain a number of vital structures lying in close proximity.
Furthermore, advances in surgical techniques have enabled OMF doctors to perform facial transplantation. Despite the fast-paced and busy nature of surgery, most OMF consultants claim they have a good work-life balance as a long working day at one point means time off elsewhere in the working week; as a result the specialty has witnessed increasing numbers of female surgeons (1).
A Typical Week
Most OMFS units adhere to a hub and spoke work model; this means you will be working at a central hub hospital dealing with major surgery and trauma management, and at a spoke hospital which delivers outpatient and day-case care. This configuration allows for a more evenly spread of on-call commitment across more consultants, making on-calls more manageable compared to other specialties.
Most OMFS consultants are on-call at varying frequencies during evenings, nights, and weekends. Owing to the nature of OMFS, consultants are rarely called in at night, but when they are, it is usually to perform life-saving surgery. Emergency work may include management of haemorrhage of the head and neck, airway issues, or road traffic accidents and violent assaults (1).
Clinical care accounts for approximately 75% of an OMFS consultant’s weekly schedule; a typical day may start at 8am and finish at 6pm, consisting of running clinics and ward rounds, or working in the operating theatre, or a mix of both (2). Some time must be allocated to teaching, audits, clinical governance, and departmental and regional meetings.
The Route To Becoming An Oral & Maxillofacial Surgeon
Interested medical students should join their university’s surgical society and attend conferences for an opportunity to explore the specialty and network with potential future colleagues.
You may also want to consider joining associated institutes or professional bodies such as the British Association of Oral and Maxillofacial Surgeons (BAOMS); their Junior Trainees’ Group provides support and information from current OMFS trainees (1).
During your foundation years, contact the OMFS department at your hospital and ask how you can get involved. Attend courses offered by the Royal College of Surgeons (RCS) and the Royal College of Surgeons of Edinburgh (RCSE) (1).
To qualify for OMFS specialty training, you will need to return to university and complete a second degree in dentistry; some universities, such as King’s College London, offer a shortened 3-year BDS. You may choose to complete your 2-year core surgical training (CST) before pursuing your BDS. Alternatively, you can return to university after foundation training and prior to CST, in which case CST may be shortened to one year provided you have gained relevant competencies during this time (please note, it is currently not possible to complete CST in less than two years in London); however, this route is not recommended as you may lack adequate exposure to surgery in general to make a reliable decision about your career.
Additionally, during or before CST, you must take the examination to obtain full Membership of the RCS (MRCS) (1).
Following CST and MRCS, you need to apply for specialty training in OMFS, which lasts five years (ST3-ST7) (1). In 2019, there were 23 applications for 24 ST3 training posts (3). Some run-through programmes (ST1-ST7) are available but are more competitive (4.14 applications per place) (3). At least six months’ experience in OMFS prior to specialty training is desirable.
Evidence of relevant academic and research achievements, such as degrees, prizes, awards, distinctions, publications and presentations, as well as audit and teaching experiences strengthen your application. Completion of an elective in oral and maxillofacial surgery will further demonstrate your commitment to the selection panel (1).
Be ready to move to a different location as certain hospitals – such as the Queen Victoria Hospital in East Grinstead, West Sussex – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (4). Some academic-minded trainees may pursue a research degree, eg an MD (2-3 years) or a PhD (3-4 years); however, this is not essential. By the end of specialty training, some trainees complete a 1-year Interface Training Fellowship in specialties which are open to or interface with other specialties (e.g. cleft lip/palate surgery, head and neck cancer).
In your last year, you will need to sit the Intercollegiate Specialty Examination FRCS (OMFS) in order to be eligible for the certificate of completion of training (CCT), after which you can go on to work as an OMFS consultant (5).
Some OMFS consultants develop specific interests and complete additional training in specialised fields of OMFS, including (5):
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020, the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant oral and maxillofacial surgeons may also wish to run private practices to supplement their salary. On average, they can make a profit of an additional 47% of their NHS salary by working in the private sector. This is higher than many other specialties, eg restorative dentistry (40%) or paediatric surgery (18%), placing oral and maxillofacial surgery in the top 20 specialties for private earning potential (6).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in OMFS, you may find it useful to consult relevant journals, such as the ones listed below:
British Journal of Oral and Maxillofacial Surgery
Journal of Oral and Maxillofacial Surgery
Journal of Oral and Maxillofacial Research
Dental, Oral and Maxillofacial Research
Annals of Oral & Maxillofacial Surgery
The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, scholarships, awards, tutorials, courses, webinars, newsletters, and learning resources relevant to OMFS:
Related Job Sources With BMJ Careers
More Complete Guides By BMJ Careers
If you are just interested in OMFS, you should register your interest (7) in the link from the BAOMS website which will result in a direct e-mail from a senior OMFS trainer https://www.formdesk.com/baoms/RYI_2019-20
If you think OMFS might be the career for you, have a look at the information about the BAOMS Mentoring and Support Scheme (BAOMS MSP (7,8)) including a paper from the BJOMS which shows it has an excellent record supporting trainees all the way through to Specialty Training.
Although, on paper, the training pathway to OMFS is longer than other surgical specialties, a recent paper has shown there is less than two years difference between OMFS trainees joining their specialist list and other surgical trainees (9).
When OMFS specialty trainees were asked what attracted them to the specialty there was a range of answers but most focussed on the range of work (hard & soft tissue surgery) and the great family friendly professional environment of OMFS departments (10).
Dentists and doctors interested in OMFS should join the OMFS specialty association (BAOMS) and tap into the information and support from the ‘Junior Trainee Group’ or JTG which has an active Facebook page and an excellent ‘Buddy’ scheme (11).
There are 16 OMFS training rotations in the four nations. Contacting your local OMFS Training Programme Director (find out their name by putting OMFS TPD JCST into Google) will give you a route to key information and someone to sign your MSP application if you need a signature.
1. Oral and Maxillofacial Surgery [Internet]. Healthcareer | NHS. [cited 2020 Jun 19]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/oral-and-maxillofacial-surgery
2. Model Job Plans by Specialty [Internet]. British Medical Association. [cited 2020 Jun 5]. Available from: https://www.bma.org.uk/pay-and-contracts/job-planning/job-plans-by-specialty/model-job-plans-by-specialty
3. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
4. Higher OMFS training (HEKSS) [Internet]. Queen Victoria Hospital. [cited 2020 Jun 19]. Available from: https://www.qvh.nhs.uk/about-us/education-at-qvh-2/education-at-qvh/specialty-training-posts/higher-omfs-training/
5. Careers in OMFS [Internet]. British Association of Oral & Maxillofacial Surgeons. [cited 2020 Jun 19]. Available from: https://www.baoms.org.uk/professionals/careers_in_omfs.aspx
6. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004
7. Magennis, P., Begley, A., McLean, A., Rapaport, B., Dhariwal, D. K., Brennan, P. A. & Hutchison, I. The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a ‘Register Interest in OMFS’ website and the MSP as two key resources created by the British Association of Oral and Maxillo. Br. J. Oral Maxillofac. Surg. 59, 935–940 (2021).
8. Magennis, P. BAOMS Mentoring and Support Programme (MSP) | British Association of Oral and Maxillofacial Surgeons. at <https://www.baoms.org.uk/professionals/baoms_mentoring_and_support_programme_msp.aspx>
9. Douglas, J., Begley, A. & Magennis, P. UK Oral and Maxillofacial Surgery trainees join the specialist list at a similar age to other surgical specialists. Br. J. Oral Maxillofac. Surg. 58, 1268–1272 (2020).
10. Kent, S., Herbert, C., Magennis, P. & Cleland, J. What attracts people to a career in oral and maxillofacial surgery? A questionnaire survey. Br. J. Oral Maxillofac. Surg. 55, 41–45 (2017).
11. Vithlani, G., Barr-Keenan, R., Chouhan, R. & Rowe, A. The junior trainee group ‘Buddy Scheme’. Br. J. Oral Maxillofac. Surg. 0, (2021).