SA3 - Decision-Making Factors on Career Choice and Switch in Oral and Maxillofacial Surgeons: A Rise of Private Equity Groups and Dental Service Organizations

Abstract: Statement of the problem: Educational debt load of oral and maxillofacial surgeons is exponentially increasing every year, and can affect their career choice.

Purpose: To evaluate the effect of educational debt load and other factors on career selection of oral and maxillofacial surgeons.Materials and

Methods: Cross-section study with survey questions were designed. Anonymous survey email was sent out to the oral and maxillofacial surgeons in the United States. The primary predictor variable was debt load when finishing residency training. Secondary predictors included demographics, current debt load, and income level. The inclusion criteria were full-time oral and maxillofacial surgeons who graduated in or before 2023. Career choices included private practice (PP), military obligation (MI), corporate dental service organizations (DSO), private equity (PE), fellowship (FE), academic faculty (AC), nonacademic hospital (HO). Categorical covariates were compared across the career switching groups using Fisher exact tests while Wilcoxon rank-sum tests were used for continuous variables.

Results: A total of 967 survey responses were received for 2 months. When finishing residency, educational debt was $218,000 ($186,000) for all and $367,000 ($181,000) for recent graduates. First career income was $464,000 ($751,00) for all and $548,000 ($821,000) for recent grads. Initial career choice was PP (73.7%), MI (8.9%), DSO (3.9%), PE (1.4%), FE (5.7%), AC (7.3%), and HO (1.8%). Also 41.8% of surgeons switched a career and pursued PP (57.6%), MI (1.2%), DSO (9.6%), PE (12.3%), FE (0.2%), AC (16.1%), and HO (2.9%). The desired career choice was PP (73.5%), MI (1.3%), DSO (2.4%), PE (3.8%), FE (3.8%), AC (15.8%) and HO (2.1%). From 10% to 13% of recent graduates pursued PE for first career in the last 3 years while 0% to 14.8% did DSO in the last 5 years. Higher likelihood of switching career was observed if having a PhD, pursuing academics or military for first career, desiring research opportunities, and having worse quality of life. When choosing first career, career switchers did not consider income potential, employee benefits, independence, institutional red tapes, hospital privilege, collaboration with other doctors, career satisfaction, freedom in scope of practice, location, and making an impact on society. If having no debt, the participants desired to pursue academics with less dentoalveolar and implant surgery and benign oral pathology but more expansion into orthognathic and trauma. First career income was significantly lower in those who switched ($363,000 vs. $530,000, P < .001). Desired income was higher in those who did not switch ($1.07 million vs. $969,000, P = .001). Fifty-eight percent of career switchers reported $443,000 higher income than their first career income. Current debt was significantly lower in those who switched ($66,000 vs. $10,000, P < .001). The scope of practice for initial vs. current vs desired career are the following: dentoalveolar/implant (91.6% vs. 89.4% vs. 79.8%), benign oral pathology (43.0% vs. 59.5% vs. 36.8%), orthognathic surgery (29.5% vs. 19.8% vs. 38.1%), trauma surgery (23.5% vs. 16.1% vs. 24.3%), cosmetics (3.1% vs. 4.1% vs. 6.2%), TMJ (4.8% vs. 5.8% vs. 5.0%), cleft and craniofacial (2.2% vs. 2.6% vs. 6.1%) and cancer and free flap (2.0% vs. 2.6% vs. 3.5%). Sixty-eight percent of participants think that most oral and maxillofacial surgeons will be a part of PE within 10 years. After multivariable logistic regression adjustment, likelihood of picking a PE or DSO career increased significantly for year of graduation and per $10,000 debt when finishing residency.

Conclusion: Recent graduate surgeons with higher educational debt load were likely to join in PE and DSO.ReferenceJones J et al. OOOO. 2019 Dec;128(6):590-596. Trends associated with debt loads among oral and maxillofacial surgery chief residentsKhetpal S et al. JOMS. 2021 Mar;79(3):513-515. Trends in private equity deals in oral and maxillofacial surgery and dentistry.

Figure 1 - Regression analysis for PE DSO with current career
Figure 2 - Regression analysis for PE DSO with first career
Figure 3 - percentage of OMS in PE DSO