Can you afford to become an oral and maxillofacial surgeon?BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i163 (Published 29 January 2016) Cite this as: BMJ 2016;352:i163
- Robert Isaac, foundation trainee1,
- Divya Ramkumar, specialty doctor in oral and maxillofacial surgery2,
- James Ban, specialty registrar in restorative dentistry3,
- Madhav Kittur, consultant oral and maxillofacial surgeon4
- 1Royal Glamorgan Hospital, Llantrisant
- 2Royal Gwent Hospital, Newport
- 3Bristol Dental Hospital, Bristol
- 4Morriston Hospital, Swansea
- Correspondence to: , , ,
Doctors need two degrees to become oral and maxillofacial surgeons, which has big implications for the cost of training, say Robert Isaac and colleagues
Oral and maxillofacial surgery is unique in medicine in that it requires primary qualifications in both medicine and dentistry. This has profound implications for training. The pathway to becoming a consultant is longer than in other surgical disciplines: 17 years if a dentistry degree is obtained first or a minimum of 19 years if medicine is the first degree.
Personal expense—in addition to the loss of income, forfeit of a pay protected salary, and reduced pension contributions while obtaining the second degree—may have detrimental effects on the number of people seeking a career in the field. In light of such financial burden, can you afford to become an oral and maxillofacial surgeon?
We discuss the cost of courses, examinations, and subscriptions, which we took directly from the relevant websites (fig 1⇓). Where possible, we looked up courses affiliated with the British Association of Oral and Maxillofacial Surgery. If such information was not available we requested it by email.
Currently there are 34 medical schools in the UK, eight of which use the graduate medical school admission test and 24 use the United Kingdom clinical aptitude test to select candidates. These exams cost £237.50 and £65, respectively, and the study aids vary from £30 to £299.12
Four of the 17 dental schools that offer an undergraduate dentistry degree also offer a four year graduate entry programme, compared with 15 medical schools offering a three or four year graduate entry programme. Hence the completion of education can take between eight and 10 years, equating to £72 000 to £90 000 in tuition fees.
The essential postgraduate membership exams—membership of the Faculty of Dental Surgery, as well as membership and then fellowship of the Royal College of Surgeons—cost a total of £4962, excluding annual subscriptions.
Indemnity and registrations
Students who fund themselves through the second degree with locum medical work or dental practice need to keep up their professional registration. This can vary from £2892.51 to £3856.68 for General Dental Council registration during a three or four year medical degree and from £1170 to £1950 for General Medical Council registration during a three to five year dental degree.34
Applicants to a specialty training year three (ST3) position must be registered with both governing bodies. The cost of dual registration, to the point of certificate of completion of training (CCT), would be £14 726.04-£15 693.21 if dentistry is the first degree or £10 873.02-£11 263.02 if medicine is the primary qualification.
All candidates must also have suitable indemnity for the entire length of training. Consequently, up to CCT a candidate who studies dentistry as their primary degree should expect to pay in excess of £1348 and those who study medicine first would expect to pay a minimum of £1740.56
Recommended courses and conferences
The oral and maxillofacial surgery specialist advisory committee recommends various courses for trainees. Although they are not mandatory, trainees will be questioned about which courses they have attended or are planning to attend at each academic review of competence progression meeting. A trainee can expect to spend between £11 799.50 and £35 750.50 to enrol on a dental implant course, for example (fig 2⇓).
Throughout training and for the remainder of lifelong practice, trainees are encouraged to maintain an interest in the specialty by attending national and international conferences and meetings, where they are also expected to present their own research. The costs of attending the Annual British Association of Oral and Maxillofacial Surgeons Conference, the biennial European Association for Cranio-Maxillofacial Surgery, and the International Association of Oral and Maxillofacial Surgeons Conference are £475, £250, and £287.42, respectively, excluding travel and accommodation.
It is also considered good practice to be a member of the BMA at £222 a year and possibly the British Dental Association. Oral and maxillofacial surgery training also has implications in terms of pension contributions. If trainees stop their NHS work when doing their second degree, they lose three to five years of pension contributions. The new NHS pension scheme is based on career average earnings, so the four years away from NHS employment can have a significant effect on a pension.
During the second degree, NHS bursaries can help reduce tuition fees, and applicants should contact their local education authority to find out what they are entitled to. There are also a number of grants available from the NHS, the British Association of Oral and Maxillofacial Surgeons, and private companies.
Applicants are advised to search for regional courses, which can greatly reduce some essential course expense.7
Owing to the practical nature of surgery and the need to attend a greater number of training courses, preparing for an ST3 post in oral and maxillofacial surgery is more expensive than in other specialties.7 The NHS has devised personal specifications to help applicants tailor their career progression in preparation for ST3 application. Because of the increasingly competitive nature of this process, candidates can take on a huge financial burden making themselves stand out from other candidates.78
The NHS should consider contributing more to the training of oral and maxillofacial surgery candidates, as it does with other with other NHS employees. The NHS graduate scheme has no cost to the individual trainee,8 so why are surgical trainees expected to fund significant aspects of their own essential training?
The length of training is longer for those candidates who have their primary degree in medicine. But this route is marginally more affordable, costing a maximum of £113 105.02, compared with £116 700.21 for a first degree in dentistry (excluding the additional cost of postgraduate courses)
So, can you afford to become an oral and maxillofacial surgeon? Given the meteoric strides the field has taken in recent years, prospective trainees should consider that if successful, they may well change the face of surgery.
Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.