Intended for healthcare professionals

Careers

How to become an oral and maxillofacial surgeon

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3720 (Published 09 June 2014) Cite this as: BMJ 2014;348:g3720
  1. Rory O’Connor, core surgical trainee 21,
  2. Malcolm Cameron, consultant oral and maxillofacial surgeon 2,
  3. Samintharaj Kumar, resident in plastic surgery 3
  1. 1Nottingham City Hospital, Nottingham, East Midlands, UK
  2. 2Addenbrooke’s Hospital, Cambridge, UK
  3. 3Singapore General Hospital, Singapore
  1. rory.oconnor{at}doctors.net.uk

Abstract

Becoming an oral and maxillofacial surgeon is challenging, but, as Rory O’Connor and colleagues explain, it is not as tough as many think, and, with an expected expansion in training numbers, job prospects are good

Soldiers in the second world war received life threatening and life changing facial injuries on the battlefield. The surgeons and dentists who treated them realised that these patients required a comprehensive approach to treatment, and so oral and maxillofacial surgery (OMFS) was born.

Since then the specialty has come a long way, and the expertise of the OMFS surgeon is far reaching, but its roots remain in jaw and facial trauma. Correcting facial deformity, and managing facial trauma and facial reconstruction are difficult and often complex, but the effect on a patient’s quality of life is profound and a just reward for any surgeon (box 1).

Box 1: Scope of practice

Aesthetic facial surgery
  • Congenital craniofacial, cleft lip, and palate surgery

  • Facial trauma

  • Head and neck reconstruction—including free flap surgery

  • Implants—dental, zygomatic, and orbital

  • Oncology

  • Oral medicine

  • Oral surgery

  • Orthognathic surgery

  • Salivary gland disease and surgery

  • Skin surgery

  • Temporomandibular joint disease and surgery

  • Thyroid surgery

OMFS is unique in requiring degrees in dentistry and medicine. This takes dedication, tenacity, and self sacrifice, but it is accompanied by outstanding education in an area that is subject to many varied and interesting conditions. The face is central to a person’s physical, mental, and emotional health, and this is why a career in OMFS can be so rewarding.

Sadly, many junior doctors and dentists believe that the training is unacceptably long. This is a myth. The average age of appointment to consultant is no higher than for other surgical specialties,1 because streamlining of training from specialty trainee (ST) 3 compensates for the time taken to become dual qualified.

Furthermore, as competition for jobs intensifies, trainees in other surgical disciplines are increasingly encouraged to obtain higher degrees that may not be relevant to their career. OMFS offers the opportunity to study for another degree with the benefit that it is a recognised part of training (box 2).

Box 2: Working in oral and maxillofacial surgery (OMFS)

A typical week for an OMFS senior house officer

You can work in OMFS as a singly qualified medic, and it is one of the most hands-on specialties for junior doctors. There is ample opportunity to hone your practical skills in minor oral surgery and theatre lists, and within a few months you will be removing teeth, suturing wounds, and taking biopsies independently. On call you close wounds in the emergency department, manage bleeding tooth sockets, treat head and neck infections, and assess patients with hard and soft tissue trauma. Often you can follow patients to theatre, where you will assist and, when appropriate, manage them as the primary surgeon. Outside theatre you will see patients in general OMFS clinics, and in specialist orthognathic, cancer, cleft, and salivary gland clinics. An afternoon may be reserved for teaching, and you will work between 1:4 and 1:6 weekends. A typical weekly timetable for an OMFS senior house officer is:

  • Day 1: Theatre or general clinical (am and pm)

  • Day 2: Minor oral surgery local anaesthetic list (am) and cleft clinic (pm)

  • Day 3: Preoperative clinic or cancer multidisciplinary team and clinic (am) and general clinic (pm)

  • Day 4: General clinic (am) and teaching, audit, administration (pm)

  • Day 5: Day case theatre or orthognathic clinic (am) and day case theatre or soft tissue local anaesthetic list

A typical week for an OMFS consultant

The consultant workload is divided into programmed activities (PA) that last for four hours. A typical week contains 10 PAs divided as follows:

  • Theatre: Four PAs (one day case and one inpatient list)

  • Clinics: Three PAs (two general clinics and one specialist clinic)

  • Teaching: One PA (senior house officer or student teaching)

  • Administration: One PA

  • On call: One PA (one day a week and 1:6 weekends)

Departmental meetings fit around this timetable, but on-call commitments are not too onerous as many emergencies can be treated within 24-48 hours or semi-electively. This means that you can maintain a good work-life balance. Most consultants sub-specialise in one of the areas above, and 70% do private practice.2

The dual qualification dilemma

The debate over whether a medical degree and a dental degree are necessary has long raged, but largely from outside the specialty. Within the speciality it is accepted that knowledge provided by a medical degree is essential for patient care and that this needs to be coupled with the detailed facial and dental knowledge and practical skills afforded by a dental degree. Nonetheless, the prospect of paying £9000 a year in tuition fees is eye watering.

Students on graduate entry medical and dental programmes can apply for an NHS bursary for the clinical years to cover £3465 of the fees, with a loan from Student Finance England for the remainder. This will be reviewed in 2015 and may change.

The British Association of Oral and Maxillofacial Surgeons (BAOMS) provides additional help by offering £2000 to students in return for written work, and universities offer further bursaries and awards. Some OMFS units employ second-degree students to provide on-call cover, giving the advantage of practising OMFS while studying (box 3).

Box 3: Advantages and disadvantages of oral and maxillofacial surgery

Advantages
  • Hands on from the start

  • Pro-trainee specialty

  • Support of the British Association of Oral and Maxillofacial Surgeons (from student to consultant)

  • Increasing research opportunities

  • Expansion into new fields such as thyroid and skin surgery

  • Private work opportunities with referrals from both the dental and medical professions

  • Going back to university

  • Small specialty so get to know everyone

Disadvantages
  • Tuition fees of £9000 a year

  • Potential reduction of earnings during a second degree

  • Registration with General Medical Council and General Dental Council is required with their attendant, but tax deductible, fees

  • Overlap with other specialties such as ear, nose, and throat and plastics leads to competition for work

  • Small speciality so everyone knows you

Junior training

Trainees take one of two paths depending on whether they studied dentistry or medicine first (fig 1). Typically, those first qualified in dentistry spend one year in dental practice, followed by an OMFS job, before applying to medical school.

Figure1

Oral and maxillofacial surgery training pathway

For the medically qualified, when foundation training is completed there is a choice: enter core surgical training before going to dental school, or vice versa. As it is more competitive to get into core training than into dental school, it is prudent to complete core training first, and some deaneries offer OMFS rotations at core trainee level. Apply to these, as working in the specialty before committing to another degree is important to confirm your interest. It also means that you can pass your membership of the Royal College of Surgeons (MRCS) exam before attending dental school. An advantage of doing core training after dental school is that only one year is required before applying to specialist training.

There are several four year dentistry programmes for graduates, and a three year course at King’s College London for doctors. Although returning to university can be a shock, the extra free time provides some recompense. Locum work can be lucrative, and you might find yourself earning more than you did as a junior doctor.

While at university all trainees should take up student membership of BAOMS and their associated Junior Trainees’ Group (JTG), both of which are free. The JTG represents students, junior doctors, and dentists interested in OMFS. They hold an annual conference and maintain a Facebook group and Twitter account to update trainees on specialty developments, training issues, and courses.

The BAOMS annual conference is in Edinburgh in July 2014 and is free for students, and the next JTG conference is in Newcastle in September 2014. Check out their website or Facebook group for details.

Higher training

To be eligible for specialist training (ST years 3-7) you need to have a medical degree, a dental degree, and the MRCS; to have finished one year of core surgical training; and to be registered with the General Medical Council and the General Dental Council. The Membership of the Faculty of Dental Surgery (MFDS) exam is helpful, but is not a prerequisite. Furnish your portfolio with closed loop audits, presentations, publications, teaching with objective feedback, and courses to improve your chances.

In February 2014 at the latest round of recruitment speciality training (ST3) 23 trainees interviewed for 17 posts, giving a ratio of 1.3 applicants per post.2 However, do not be lulled into a false sense of security, as candidates must demonstrate a high level of competence before an offer is made. This is measured using the score from the interview, and the bar is high, as all applicants tend to be extremely motivated and academically focused.

In December 2013 a pilot scheme offered run-through posts starting at a core surgical training level (CT1) for dual qualified individuals.3 Eight posts were available, running from CT1 to ST7.

In October 2011 there were 376 consultants in the UK with a modest increase in training numbers required to meet future demands.2

If you are interested in pursuing a career in OMFS, contact an OMFS consultant in your area. He or she will be delighted to hear from budding OMFS surgeons. Alternatively there is lots of information on the BAOMS website, and their office can let you know whom to contact locally.

Further information

Footnotes

  • We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None declared.

References