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[bergus95]

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[OtoHNS]

Don't know about ophtho, but for ENT:

Average starting income among all jobs is probably mid to high $200s.
Average income once established for a few years is probably $350-400k.

If you want to work in a highly-desired city with lots of competition, you may be looking at less than $200k starting salary.
If you are willing to work in a rural, underserved area, I see headhunters advertising $500k plus to start (usually with paying off your student loans and other perks as well)

Hard to say exactly how much COVID has affected hiring, but it's probably not good, especially for private practices.

 

[Gilakend]

Don't know about ophtho, but for ENT:

Average starting income among all jobs is probably mid to high $200s.
Average income once established for a few years is probably $350-400k.

If you want to work in a highly-desired city with lots of competition, you may be looking at less than $200k starting salary.
If you are willing to work in a rural, underserved area, I see headhunters advertising $500k plus to start (usually with paying off your student loans and other perks as well)

Hard to say exactly how much COVID has affected hiring, but it's probably not good, especially for private practices.

Is this really the current premium for a rural area? Over 2x average plus other perks?

I'm interested in another surgical subspecialty and want to live in a rural area, I knew that there tended to be a slightly higher income but didn't realize it was that high.

 

[OtoHNS]

Is this really the current premium for a rural area? Over 2x average plus other perks?

I'm interested in another surgical subspecialty and want to live in a rural area, I knew that there tended to be a slightly higher income but didn't realize it was that high.

Apparently yes. I get regular emails from a few different headhunters that list a bunch of job openings. The most recent one from earlier this month has 2 jobs listed with $500k and $600k income guarantees, respectively. Many of the listings are not as specific, but say things like "income above the 90th percentile" etc.

There are likely some strings attached, and those income guarantees typically run out after a certain period of time, after which you are expected to support that salary with your workload.

 

[HighPriest]

I know a couple of guys who are pulling down $6-700,000 but that includes allergy, CT scanner, surgery center along with their normal practice. And they are hopping in clinic. It’s not just rural that matters, its rural and payer mix if you’re private. If you live in a poor area that’s mostly Medicaid, that ain’t so good.
Or whatever agreement you have with your employer (if not private) matters. Although most hospital jobs are going to try to keep you in the median unless you’re a major producer. But on the other hand if they have trouble recruiting because the town was built over a haunted graveyard of poo, they’ll pay you more.

I think the numbers above are pretty accurate.

You can’t compare it to OMFS because those guys are dentists. The ADA is like the freaking mafia, man. It’s the Wild West in dental practices - you can do whatever you want, whenever you want and you can decide what you charge, and insurance doesn’t cover it.

I have an oral surgeon near me who has convinced a cadre of family docs to send him all of the oral cancer biopsies they see. He sees them, biopsies them, charges them literally 10x what they would pay me after insurance, and then sends 100% of the cancers to the nearby urban center (2-3 hours away with traffic) for their surgery, even if it could be done here. I know this because some of them refuse to pay him what he’s asking and they end up on my door. And the ones who get surgery at the tertiary center come to me for post-treatment follow up.

I know another OMFS guy who advertises as “board certified oral surgeon and facial plastics surgeon.” He’s only board certified in oral surgery, but he wants you to read that the wrong way.

I knew a guy at a prior location who would CT every patient he saw no matter why they were there to see him, charge them for it since insurance wouldn’t cover it, and then did “airflow diagnostic” studies to try to diagnose them with OSA based upon their CT. And when I later saw them, got a sleep study, and told them they didn’t have OSA, they would get upset because he assured them they had it. Incidentally, he would also never see his post-extraction infections. He would just turf them to us. Like three days post/extraction “I don’t think it’s your tooth, go see ENT.”

And he made 2-3x what I did.

It’s a racket.

They’re not all like that. I know some really good guys in Oral surgery, but you really can get away with anything.

 

[HighPriest]

Careful how you go about spewing nonsense like this. Oral and (Maxillofacial) Surgeon's bread and butter is wisdom teeth and implants. When a set of 4 wisdom teeth is 2.5k under sedation and takes 30 min, you do the math. That and implants is where they make their money.

I can promise you everything else they do is essentially a hobby and fulfilling a need to their patients and their communities.

Facial Plastics is well within the scope of oral and maxillofacial surgery. There is something called the American Board of Cosmetic Facial Surgery, so I do not believe that the Oral and Maxillofacial Surgeon you are referencing is doing anything sketchy. There are people like Dr. Mark Urata who for instance is the Chief of the Division of Plastic and Reconstructive Surgery of the Keck School of Medicine of USC. He is both an Oral and Maxillofacial Surgeon as well as a Plastic Surgeon. There are people like Dr. Ryan Diepenbrock who is single degree Oral and Maxillofacial Surgeon; he Is "just" an Oral and Maxillofacial Surgeon. FYI he is the President of the American Board of Facial Cosmetic Surgery.

Then there are people like Dr. Joe Niamtu III, DMD. He is a single degree Oral and Maxillofacial Surgeon. He is a widely published and regarded Cosmetic Surgeon. Look him up.

As it comes to sleep apnea, look up Stanley Liu, an Oral and Maxillofacial Surgeon who presents at many of your ENT conferences.

We get it, medical reimbursements suck. But do not go on degrading a field like that calling it a racket. It would be like calling every ENT that does Facial Plastics, "not a qualified facial cosmetics surgeon." Or calling the entire field of rhinology a racket, something I hear frequently. Or Derm a racket because they do quick and high paying procedures.

I have never heard of an Oral and Maxillofacial Surgeon turfing post extraction infections. Considering the standard OMFS practice is build on dental referrals that would be the quickest way to build a bad rep and lose your referral base.

There are good practitioners and bad practitioners everywhere. All it takes is a few google searches to see a few of your ENT colleagues that do not reflect your field the best. Same can be said for any field. The first one did crack me up not going to lie. And the third article is something we as medical providers should perhaps read. Worth the time.

Long Island Lawmaker, Doctor Arrested After Trying to Trade Drugs for Sex: Sources

Suffolk County Legislator William Spencer — who is also an ear, nose and throat specialist — faces drug-related charges after he was arrested for allegedly attempting to meet with a woman with whom he could swap pills for sex, two senior law enforcement officials said.

www.nbcnewyork.com

America's most wanted: doctor found living in tent on Mont Blanc

After five-year disappearance, Mark Weinberger, wanted by the FBI, is discovered in the Alps by Italian police

www.theguardian.com

Why Doctors Are Losing the Public’s Trust - Physician's Weekly

We discussed this blog post, and more, with Dr. Girgis in a live #PWChat TweetChat at 3:00pm (ET) on November 30, 2017! In my mind, the doctor-patient relationship is sancrosanct. There is no relationship where the bond of trust should be so strong, outside of matrimony. As physicians, patients...

www.physiciansweekly.com

The best response is to not be one of the guys I mentioned, all of whom are real people and all of the above are real circumstances that actually happened.

You can deny that it happens all you want but that doesn’t change anything. As I said, I know a ton of very respectable Oral Surgeons, but I know more fishy oral surgeons than I do fishy dermatologists, plastic surgeons, or ENT guys (and I know some fishy ENT guys).

The guy I mentioned advertising as “board certified oral surgeon and facial
Plastic surgeon” did not do any sort of fellowship. I know this because I know him.
I know one oral surgeon who did a facial plastics fellowship. It isn’t that common.

You now have heard of an oral surgeon turfing post-extraction infections. Because that was a real guy who really did that with some regularity. At least four times in two years. And I got news for you: that happens fairlu often and in multiple places where I’ve worked. And God forbid a patient has an infection and no insurance, because most oral surgeons won’t even look at them. (Outside of the ones working at the public hospitals). I get at least one call every week with an odontogenic infection from a guy who needs an oral surgeon but none of them take call, so he’s SOL. But I do take call, so I see him, whether he can pay or not.
Now the post-extraction infections are far more rare (but they do happen), but the point is it isn’t just about how much reimbursement sucks. It’s about the other side of that coin: If they’re not making money because the patient is uninsured or because it’s a surgical complication, then they ain’t interested.

Just two months ago I was called to the ER to stop the bleeding on an extraction that was done earlier that same day. The oral surgeon didn’t even see the patient back, he just told him to go to the ER (where there are no privileged oral surgeons). He could anesthetize him and pull his tooth in clinic, but not even try to stop the bleeding.

Now I agree that this isn’t the norm. I was definitely using a degree of hyperbole above. Not all oral surgeons act like that. I would wager almost none of them in academia behave like that.

But it is fairly prevalent in the real world. And I agree there are good and bad docs everywhere (including ENT), but I definitely see a lot of shady Oral Surgeons. I’m not degrading the field because clearly Oral Surgery is a real, prestigious field that treats real, significant problems. But there’s a lot of money involved and it’s just not scrutinized the way the rest of medicine is simply because there’s so much out of pocket pay. Cosmetic surgery is the Wild West, too, for what it is worth.

Charging a Medicare patient $400 to do a tongue biopsy and then shipping them 2 hours away for a treatment they could get locally and a biopsy they could have had for 1/10th of that price isn’t fulfilling a need in the community. It’s taking advantage of someone who doesn’t know they have another option.

And if Stanley Liu is telling people that you can diagnose OSA without a polysomnogram based solely upon CT imaging, then he’s spinning quite a tail. I don’t think he does. oral surgeons are VERY capable of treating OSA. I wouldn’t begin to deny that. But CTing everyone in your clinic regardless of appointment type is fraud, man. And I’m not making that up, he told me he did that because “OSA is very under-diagnosed.” Maybe so, but the diagnosis is made by PSG. Not CT.

 

[HighPriest]

Dr. Joe Niamtu III, DMD. Look him up. Never did a fellowship either. It is not shady. Every training program is different, and some you will come out well trained to take on cases as you see fit. IMO everyone interested in Facial Plastics should do a fellowship, but an argument can always be made.

Plenty of shady physicians out there (including oral surgeons considering half are dual degree MD's as well). Plastics is full of them, and don't get me started about Anesthesia and pain management. Even Psych.

That said, I think alot of what you are saying is true. Many OMFS's choose not to take call. I think it is sad since the profession is hurt as a result. But, you cannot be a board certified OMFS if you do not have privileges. It's tough because with only 225 OMFS's graduating every year, the ones that really want to do primarily hospital based OMFS or academia account for maybe 50-75 OMFS's a year. The other 150-175 go into private practice. Small numbers and if you can be working 8-4, 4-5 days a week, making 500k+. Its hard not to get caught up in that life.

I find it interesting that you can’t be board certified oral surgery and not have hospital privileges? Is that right? Because all of th hospitals in this area require you to cover call in order to be privileged. So I’m not sure how they’re getting around that unless being privileged at your surgery center counts.

Not all oral surgeons are MD/DDS, man. The guy I know who did the oral surgery cosmetics fellowship was just DDS. Yeah, he did a residency which included medical rotations, but no MD.

And FWIW, the oral surgeons who I know and like are some of the best, most reliable people that I know. (Including the guy who did the plastics fellowship). They just have a lot of $#!tty colleagues out there.

Just don’t be one of those guys. Make $1,000,000 a year. Good for you. But take freaking call once/month.

 

[HighPriest]

Dr. Joe Niamtu III, DMD. Look him up.

If you advertise with insinuation that you are board certified in plastic surgery when you are not, that is shady. It’s fraudulent. That’s not the same as saying “I’m an oral surgeon who primarily does plastic surgery because that’s what I’ve dedicated my practice to doing.”

If I put “board certified in plastic surgery” on my Billboard, they would yank my licensing faster than you can blink. No matter how much of it I did in residency.

Now if i say “board certified in otolaryngology head and neck surgery. Offering: facial cosmetic surgery” that’s different. But trust me, this guy worded it like he did because he wanted the suggestion that he was a board certified plastic surgeon.

Patients don’t know what this lingo means. They don’t know who does what in their training. The whole idea behind board certification is it is (very ostensibly) supposed to mean you have proven that you know your stuff. So patients theoretically depend upon that.

Twisting that around to draw patients in is an ethical issue.

 

[HighPriest]

Most prefer not doing an MD. Whats the point if you can better utilize the years in practice/doing a fellowship. But some want it. It does make for an easier road in academia. It's harder to get into one of the 4 year residency spots than the 6 year.

For sure. They don’t need an MD to do what they do frankly.

 

[HighPriest]

I do think you have only seen a segment of OMFS. While the vast majority do high paying private practice procedures, a lot do head and neck, and pushing the front of even your field.

Check out the head and neck team in Portland, Oregon.

Portland Oral Surgery » Board-Certified Oral & Craniofacial Surgery In Portland » Head & Neck Surgical Associates

Board-Certified Portland Oral Surgeons by Head & Neck Surgical Associates. Wisdom teeth, dental implants, jaw surgery, sleep apnea, facial reconstruction & more in Portland Oregon.

head-neck.com

Also the person advertising the way you stated is definitely being shady and doing something illegal. Easily can be sued. Easily would lose that battle which is why I am so mind blown. But that is definitely an oddity if anything.

Oral surgeons do most of the oncology in other countries, but it is still pretty rare in the US. But these guys in my community aren’t doing oncologic surgery. And they aren’t sending the patients to oral surgeons in the tertiary center, btw. They’re sending them to other Otolaryngologists. That’s why I’m seeing the patients in follow up. Because the oral surgeons who did the biopsies won’t. And I’ve seen a few patients who had inappropriate treatment (wide local excision with no neck in T2 oral cancers and no imaging of the neck, for example) when the oral surgeons have decided to treat them locally. That’s definitely not what NCCN recommends.

I don’t claim to have met every oral surgeon. But I’ve working in three different cities across the West, moonlighted in three others, been credentialed at 11 hospital systems. And I’ve talked to a lot of ENT docs. My experiences are definitely not isolated.

BUT there are oral surgeons who send me oral lesions, send me tonsil patients, will see odontogenic infections post op to schuck the tooth. The good guys are out there too. They’re just harder to nail down.

When I was in the Army, basically all of the oral surgeons were excellent. Reliable. Always available. Which is why I wonder if it’s the cash money that spoils the pot.

 

[Pir8DeacDoc]

Oral surgeons do most of the oncology in other countries, but it is still pretty rare in the US. But these guys in my community aren’t doing oncologic surgery. And they aren’t sending the patients to oral surgeons in the tertiary center, btw. They’re sending them to other Otolaryngologists. That’s why I’m seeing the patients in follow up. Because the oral surgeons who did the biopsies won’t. And I’ve seen a few patients who had inappropriate treatment (wide local excision with no neck in T2 oral cancers and no imaging of the neck, for example) when the oral surgeons have decided to treat them locally. That’s definitely not what NCCN recommends.

I don’t claim to have met every oral surgeon. But I’ve working in three different cities across the West, moonlighted in three others, been credentialed at 11 hospital systems. And I’ve talked to a lot of ENT docs. My experiences are definitely not isolated.

BUT there are oral surgeons who send me oral lesions, send me tonsil patients, will see odontogenic infections post op to schuck the tooth. The good guys are out there too. They’re just harder to nail down.

When I was in the Army, basically all of the oral surgeons were excellent. Reliable. Always available. Which is why I wonder if it’s the cash money that spoils the pot.

My experience in practice in three states mirrors yours. I find myself frustrated that people with such extensive training and great skill set provide so little of that to the average Joe American.

I've perfected this line with the ER: "Just because you don't have an oral surgeon on call doesn't make me one".

Pull the thirds and make the millions, I suppose

 

[OtoHNS]

I don't have much to add to my colleagues above re. OMFS. My experience has been similar.

I know a few ENTs who are board certified in FPRS and exclusively practice in facial plastics but did not do a fellowship. If you demonstrate adequate case numbers in FPRS and pass their exam, you can still become board certified. With the very significant exception of rhinoplasty, none of the typical facial plastic surgeries are particularly challenging to do. The real challenge is managing the psychology and expectations of the patients, knowing who NOT to operate on, and marketing.

I would think the skillset of an OMFS would be fully conducive to doing all aspects of facial plastics except rhinoplasty. But when you can make $1M++ pulling wisdom teeth all day, why bother?

I did pull up the website of Dr. Niamtu who was mentioned above. Conspicuously absent from his list of procedures is rhinoplasty (and no, "filler rhinoplasty" doesn't count).

 

[VisionaryTics]

What percentage of ENT’s have their practice primarily devoted to tubes/tonsils, almost exclusively or rhinology? I am JW. I always hear ENT is a lifestyle specialty and my friends in residency say that it was their primary motivation (this also like that it’s a surgical specialty). But perhaps they could be disillusioned to the reality?

In contrast, I feel like most ENTs get attracted to the field because of head and neck anatomy, and fun mix of cases (plastics, sinus, endocrine, cancer, trauma, otology, etc). A lot of people get initially attracted because of head and neck oncology and the complex cases we do, but burn out during residency on horrible lifestyle and patient outcomes.

My friends who are general otolaryngologists are all pretty broad. They do otology (including stapes and implants), sinus (including CSF leaks and pituitaries), thyroid and parotid surgery, the occasional small tongue or laryngeal cancer, etc, in addition to tubes and tonsils.

In recent years, 50% of ENTs are general, 50% are fellowship trained, and 75%+ are in the community. The lifestyle is what you make it, but private practice, community ENT is a nice mix of well paying cases, healthy patients, good outcomes, reasonable hours for those who want it. You can work harder and take call and fill your schedule to bursting, and suffer a little bit on lifestyle but make plenty of cash.

And there are the rare masochists who trade in Early Nights and Tennis for oncology/reconstruction.

With regards to the OMFS kerfuffle above, I totally agree. 90% of the them are totally fine driving home in a Ferrari at 3pm doing wisdom teeth and implants. The other 10% are dicking around doing plastic surgery and oncology trying to puff up their egos at the expense of the patient. That's my experiences in multiple markets and multiple countries.

 

[aaaaa]

First, this thread is pretty silly trying to compare salary and compensation. If you’re asking about oms compensation ask an OMS, have your buddy ask local ENTs or Optho docs if he is considering those fields. Applying to oms and asking ent and Optho doc what they make is silly, you’re not an Optho or ent so who cares. Or look it up with a quick google search.

The perception of OMS among the ENT docs that have posted on this thread really saddens and surprises me as an oms. Where I’ve worked (multiple cities and multiple states) I’ve taken call at the local hospitals and some where oms covered 100% of the facial trauma and pretty much all the facial infections that weren’t tonsilar abscesses. In one of the cities (1M+ population) there were maybe 1-2 ent or plastics that would even take facial trauma call, everything else was covered by the oms docs so seeing that it’s the opposite in some areas is surprising and sad.
Do the ent docs mind sharing where they practice?

 

[HighPriest]

I don't have much to add to my colleagues above re. OMFS. My experience has been similar.

I know a few ENTs who are board certified in FPRS and exclusively practice in facial plastics but did not do a fellowship. If you demonstrate adequate case numbers in FPRS and pass their exam, you can still become board certified. With the very significant exception of rhinoplasty, none of the typical facial plastic surgeries are particularly challenging to do. The real challenge is managing the psychology and expectations of the patients, knowing who NOT to operate on, and marketing.

I would think the skillset of an OMFS would be fully conducive to doing all aspects of facial plastics except rhinoplasty. But when you can make $1M++ pulling wisdom teeth all day, why bother?

I did pull up the website of Dr. Niamtu who was mentioned above. Conspicuously absent from his list of procedures is rhinoplasty (and no, "filler rhinoplasty" doesn't count).

I know plenty of OMFS guys who do rhinoplasties although I agree with you. My concern isn’t that they’re doing them, it’s when they (one at least) state they’re board certified when they are not.

You can no longer, to my knowledge, just take the ENT facial plastics exam any longer. You must do a fellowship. But even when you could, you still had to pass an exam. Minimalistic as that is, it’s still an ethical issue. You don’t have to take an exam, but you don’t HAVE to tell people you’re board certified either.

 

[HighPriest]

First, this thread is pretty silly trying to compare salary and compensation. If you’re asking about oms compensation ask an OMS, have your buddy ask local ENTs or Optho docs if he is considering those fields. Applying to oms and asking ent and Optho doc what they make is silly, you’re not an Optho or ent so who cares. Or look it up with a quick google search.

The perception of OMS among the ENT docs that have posted on this thread really saddens and surprises me as an oms. Where I’ve worked (multiple cities and multiple states) I’ve taken call at the local hospitals and some where oms covered 100% of the facial trauma and pretty much all the facial infections that weren’t tonsilar abscesses. In one of the cities (1M+ population) there were maybe 1-2 ent or plastics that would even take facial trauma call, everything else was covered by the oms docs so seeing that it’s the opposite in some areas is surprising and sad.
Do the ent docs mind sharing where they practice?

Texas (large city), Washington State, Kansas (small town, medium size for Kansas), and moonlighting in Phoenix and North Dakota.

Glad to hear it isn’t that way everywhere. And it isn’t 100% that way here either. Just prevalent enough to be a little depressing.

At the state “big traumas hospital, facial trauma is split between ENT, OMFS, and PRS but they also train residents. In the Army OMFS did 99% of the facial trauma aside from maybe lacerations.

 

[HighPriest]

What percentage of ENT’s have their practice primarily devoted to tubes/tonsils, almost exclusively or rhinology? I am JW. I always hear ENT is a lifestyle specialty and my friends in residency say that it was their primary motivation (this also like that it’s a surgical specialty). But perhaps they could be disillusioned to the reality?

Not many doing just tonsil-tube practices. I have two extremely old partners who are just tonsil tube guys. It’s where ENT guys go to die. The elephant graveyard of ENT, so to speak. Or maybe if you lived in a large urban center with a ton of competition. I dunno. I do a lot of tonsils and tubes but part of the draw is head and neck, sinuses, ears, or even trauma (maybe sometimes). The variety is what draws people. Lifestyle is good because most of those things aren’t emergencies. Airways and bleeding are almost the only reason I come to the hospital at night, and that is fortunately unusual.

But you -could- just do, say, otology. Depending upon your situation that would basically always keep you out of the ER, if you could somehow swing not taking general ENT call.

 

[HighPriest]

The real challenge is managing the psychology and expectations of the patients, knowing who NOT to operate on, and marketing.

This, incidentally, is exactly why I don’t do cosmetic surgery.

I knew a locally well known cosmetic surgeon who told me (when I was a wee pup) that when he handed a patient chart to his scheduler/biller, he would write on it A, B, or C. A meant repeat patient, realistic expectations, follows instructions. They would quote them a discount. B meant new patient, standard fare. C meant crazy person or someone who required way too much pampering last time - price them out of surgery. If C was willing to pay, then it was worth the cash.

That’s Wild West there, too.

 

[HighPriest]

sounds very illegal lol

It is entirely cosmetic and entirely out of pocket. So you can do almost anything with pricing. Not illegal, just dubious. No desire to stick my nose in that business.

 

[aaaaa]

The best response is to not be one of the guys I mentioned, all of whom are real people and all of the above are real circumstances that actually happened.

You can deny that it happens all you want but that doesn’t change anything. As I said, I know a ton of very respectable Oral Surgeons, but I know more fishy oral surgeons than I do fishy dermatologists, plastic surgeons, or ENT guys (and I know some fishy ENT guys).

The guy I mentioned advertising as “board certified oral surgeon and facial
Plastic surgeon” did not do any sort of fellowship. I know this because I know him.
I know one oral surgeon who did a facial plastics fellowship. It isn’t that common.

You now have heard of an oral surgeon turfing post-extraction infections. Because that was a real guy who really did that with some regularity. At least four times in two years. And I got news for you: that happens fairlu often and in multiple places where I’ve worked. And God forbid a patient has an infection and no insurance, because most oral surgeons won’t even look at them. (Outside of the ones working at the public hospitals). I get at least one call every week with an odontogenic infection from a guy who needs an oral surgeon but none of them take call, so he’s SOL. But I do take call, so I see him, whether he can pay or not.
Now the post-extraction infections are far more rare (but they do happen), but the point is it isn’t just about how much reimbursement sucks. It’s about the other side of that coin: If they’re not making money because the patient is uninsured or because it’s a surgical complication, then they ain’t interested.

Just two months ago I was called to the ER to stop the bleeding on an extraction that was done earlier that same day. The oral surgeon didn’t even see the patient back, he just told him to go to the ER (where there are no privileged oral surgeons). He could anesthetize him and pull his tooth in clinic, but not even try to stop the bleeding.

Now I agree that this isn’t the norm. I was definitely using a degree of hyperbole above. Not all oral surgeons act like that. I would wager almost none of them in academia behave like that.

But it is fairly prevalent in the real world. And I agree there are good and bad docs everywhere (including ENT), but I definitely see a lot of shady Oral Surgeons. I’m not degrading the field because clearly Oral Surgery is a real, prestigious field that treats real, significant problems. But there’s a lot of money involved and it’s just not scrutinized the way the rest of medicine is simply because there’s so much out of pocket pay. Cosmetic surgery is the Wild West, too, for what it is worth.

Charging a Medicare patient $400 to do a tongue biopsy and then shipping them 2 hours away for a treatment they could get locally and a biopsy they could have had for 1/10th of that price isn’t fulfilling a need in the community. It’s taking advantage of someone who doesn’t know they have another option.

And if Stanley Liu is telling people that you can diagnose OSA without a polysomnogram based solely upon CT imaging, then he’s spinning quite a tail. I don’t think he does. oral surgeons are VERY capable of treating OSA. I wouldn’t begin to deny that. But CTing everyone in your clinic regardless of appointment type is fraud, man. And I’m not making that up, he told me he did that because “OSA is very under-diagnosed.” Maybe so, but the diagnosis is made by PSG. Not CT.

There are bad apples in every profession and they stick out more than the good ones. I know several shady OMS as well but most arent like the examples you all have stated. The guys groveling to a pcp in order to charge $400 for a biopsy or pretending to diagnose osa off a ct are probably struggling to stay busy and are doing shady stuff to make a buck.

We all have stories about shady work or bad outcomes from other specialties. I know of a facial plastics ent who’s office name reads “plastic surgery” and leaves out “facial plastic surgery”. Is that shady or misleading? I think so, at least a little. The general public thinks they’re seeing a plastic surgeon and they’re not. He is probably more qualified than a plastic surgeon to do what he does but he isn’t a plastic surgeon. I’ve been happy to send him all the facial cosmetic stuff I see and he is a good surgeon but it’s still misleading. Or the doc that drained a lateral pharyngeal abscess from a partially impacted wisdom tooth. He was happy to drain it but not take out the tooth and then send the patient to me to have the tooth removed. Problem is she couldn’t open from the surgical swelling so what the heck am I supposed to do with that? Wait a week and hope her neck doesn’t fill up with pus again until the swelling goes down? Thanks but no thanks. I’ve offered to come help in situations like that or even take the patient from the beginning and do the i&d and extraction but have been laughed at by that doc mostly because in his words I’m “just a dentist”. Well then quit sending “the dentist” all your self pay facial fractures. There is always an oms on call at every hospital I’ve been associated with and I guarantee if you asked a local oms to take call at a hospital where it’s needed you could find one. I know many private practice oms docs that take call without residents at many level 1 and 2 Trauma centers in most of the states you’ve mentioned (TX, OK, KS, NM, CO, UT, ID, MT, WA). Are you in a smaller area where the oms docs aren’t comfortable taking call? It seems like rural or semi rural oms don’t take call as frequently.

The biggest complaint I’ve heard from medical colleagues is that many OMS don’t take medical insurance but can you blame them with the biopsy example you gave? $400 for a soft tissue biopsy is a rip off but if Medicare only truly pays 1/10 of that and that’s what your clinic makes then thats ridiculous. That’s a procedure where I’d be loosing money in my office. Sterilizing instruments, gauze, local anesthetic, suture, scalpel, paying staff to fight to get the $40 from insurance company, etc. Its a nice service to the patient (and insurance company😊) at that cost but honestly reimbursement from medical insurance is absolutely BS. A local head and neck doc told me about a case where he did a fibula that failed and then had to do another flap and he got paid $3500 total. Probably 20 hours of surgery plus rounding everyday for who knows how long for $3500???? That’s absolutely BULL$&@“. For oms docs (and maybe ent?) it’s almost like the bigger the surgery the lower the pay and that’s not right. It’s not all about the money and I do many surgeries for free including draining pus or fixing someone’s face but medical reimbursement plain old sucks and for better or worse most oms don’t need to take it to make a living.

We all have bias about the noble greatness of our own specialty and the greedy dumpfest docs from other specialties. Neither is probably as accurate as we think. As a funny side note, I don’t know any OMS that own a Ferrari and the only doc I know of who has a Bentley is a facial plastics ent... seriously good for him though

 

[HighPriest]

There are bad apples everywhere. But I think you’ll find (and this thread is a microcosm) a lot of ENTs with bad experiences with their OMS colleagues in the vein of what we’re talking here. They may not admit it to your face. And it sounds like it may not even be an issue in your community since you’re willing to help out.

Not all OMS are like this. Of course. I hope I’ve made it clear above that I know many very good, reliable OMS guys. But I’ve had more bad experiences with OMS not engaging than any other specialty (other than Nurse Practitioners in any setting which blows anything the OMS guys have ever done out of the water). There’s some selection bias there of course because we work in the same neighborhood. I haven’t met any bad podiatrists, but there’s a few reasons for that I’m sure.

I would say if the facial plastics guy advertising as a plastics guy is turning is away (and not charging) anyone wanting a tummy tuck or a boob job, it’s not that big of a deal. If he isn’t, then it is. But there’s a big difference between leaving out the “facial” and claiming to be board certified when you aren’t. If he’s charging people to tell them he can’t do a breast implant, or if he’s doing them, then he’s a fraud too. You are honestly preaching to the choir if you want to pull out facial plastics guys and flog them.

The pharyngeal abscess? He probably didn’t feel comfortable pulling the tooth. I think I’ve pulled maybe three that weren’t attached to a jaw bone coming out at the same time. But the obstructing airway from a pharyngeal abscess is often an emergency. You can’t wait on it. So if your oral surgery colleague doesn’t take call and/or won’t come in, then you fix the airway issue and send the bad tooth to them. If they had taken the call in the first place, it wouldn’t have been an issue.

You offer to come in, and to take facial fractures. Which is awesome. And if you’re willing to do that, the guy who says you’re just a dentist is an @$$hat, and screw him. I have met only one oral surgeon who will do either of those things since I left the Army. All the local guys do is pull thirds, divert cancer, and tell me to piss off. And so they are just dentists. Because they just work on teeth. The guys I worked with in the Army? They’re surgeons. Because they are willing to do surgery, even if it isn’t convenient or profitable.

You are 100% wrong about asking a local OMS to take call and his being willing to do it. The hospital system has engaged them many times. (And not just where I currently live). They won’t do it. They don’t need to do it. The end. And if that was an isolated incident you wouldn’t hear of from so many ENT docs here (there aren’t THAT many of us on here to begin with, this is a decent turnout). And I don’t understand the argument that maybe they won’t if I’m in a rural area. If I’m in a rural area, I’m still taking call. Absolutely no reason they can’t as well. But they don’t. They don’t get excused because they moved to the boon docks.
That’s kind of my point - why should that matter for an OMS guy but not an ENT guy or any other guy? But FWIW, I’ve lived in both rural and urban areas (urban relative to the size of the state we are talking). Fwiw, yeah all of the OMS guys I’ve ever met outside the military who took call were in urban centers at level 1-2 trauma centers. But that isn’t the majority of the country. And it isn’t the majority of OMS guys either.

And yeah, reimbursement sucks. And I totally agree that it isn’t OMS’s fault. But if you live in a community, and you can offer a needed service to that community, and you aren’t hurting for cash, then the ethical thing to do is to at least try to offer that service. And when you don’t do that, you get called the bad guy. And you can either accept being thought of as the bad guy and be ok with it or you can’t. But if you can’t, take f@&$ing call.

I’m not saying you need to let the drowning man pull you under, but maybe make 1.8million/year instead of 2 million and help out your medical colleagues and your community and your patients. But that frequently isn’t what happens. And because of that there’s a reputation. And that’s all there is to it, frankly. Or don’t. But then don’t get upset if people think you’re only in it for the cash.

 

[aaaaa]

There are bad apples everywhere. But I think you’ll find (and this thread is a microcosm) a lot of ENTs with bad experiences with their OMS colleagues in the vein of what we’re talking here. They may not admit it to your face. And it sounds like it may not even be an issue in your community since you’re willing to help out.

Not all OMS are like this. Of course. I hope I’ve made it clear above that I know many very good, reliable OMS guys. But I’ve had more bad experiences with OMS not engaging than any other specialty (other than Nurse Practitioners in any setting which blows anything the OMS guys have ever done out of the water). There’s some selection bias there of course because we work in the same neighborhood. I haven’t met any bad podiatrists, but there’s a few reasons for that I’m sure.

I would say if the facial plastics guy advertising as a plastics guy is turning is away (and not charging) anyone wanting a tummy tuck or a boob job, it’s not that big of a deal. If he isn’t, then it is. But there’s a big difference between leaving out the “facial” and claiming to be board certified when you aren’t. If he’s charging people to tell them he can’t do a breast implant, or if he’s doing them, then he’s a fraud too. You are honestly preaching to the choir if you want to pull out facial plastics guys and flog them.

The pharyngeal abscess? He probably didn’t feel comfortable pulling the tooth. I think I’ve pulled maybe three that weren’t attached to a jaw bone coming out at the same time. But the obstructing airway from a pharyngeal abscess is often an emergency. You can’t wait on it. So if your oral surgery colleague doesn’t take call and/or won’t come in, then you fix the airway issue and send the bad tooth to them. If they had taken the call in the first place, it wouldn’t have been an issue.

You offer to come in, and to take facial fractures. Which is awesome. And if you’re willing to do that, the guy who says you’re just a dentist is an @$$hat, and screw him. I have met only one oral surgeon who will do either of those things since I left the Army. All the local guys do is pull thirds, divert cancer, and tell me to piss off. And so they are just dentists. Because they just work on teeth. The guys I worked with in the Army? They’re surgeons. Because they are willing to do surgery, even if it isn’t convenient or profitable.

You are 100% wrong about asking a local OMS to take call and his being willing to do it. The hospital system has engaged them many times. (And not just where I currently live). They won’t do it. They don’t need to do it. The end. And if that was an isolated incident you wouldn’t hear of from so many ENT docs here (there aren’t THAT many of us on here to begin with, this is a decent turnout). And I don’t understand the argument that maybe they won’t if I’m in a rural area. If I’m in a rural area, I’m still taking call. Absolutely no reason they can’t as well. But they don’t. They don’t get excused because they moved to the boon docks.
That’s kind of my point - why should that matter for an OMS guy but not an ENT guy or any other guy? But FWIW, I’ve lived in both rural and urban areas (urban relative to the size of the state we are talking). Fwiw, yeah all of the OMS guys I’ve ever met outside the military who took call were in urban centers at level 1-2 trauma centers. But that isn’t the majority of the country. And it isn’t the majority of OMS guys either.

And yeah, reimbursement sucks. And I totally agree that it isn’t OMS’s fault. But if you live in a community, and you can offer a needed service to that community, and you aren’t hurting for cash, then the ethical thing to do is to at least try to offer that service. And when you don’t do that, you get called the bad guy. And you can either accept being thought of as the bad guy and be ok with it or you can’t. But if you can’t, take f@&$ing call.

I’m not saying you need to let the drowning man pull you under, but maybe make 1.8million/year instead of 2 million and help out your medical colleagues and your community and your patients. But that frequently isn’t what happens. And because of that there’s a reputation. And that’s all there is to it, frankly. Or don’t. But then don’t get upset if people think you’re only in it for the cash.

Well this is all very surprising and sad but probably a good thing to know. I wish I could email this conversation to our association because it’s a huge eye opener to me and it is disturbing that our specialty has this reputation where many of you live and practice.

The doc that drained the pharyngeal abscess and didn’t call an oms to get the tooth out wasnt in a situation where an oms wasn’t available and it wasn’t the first time he did something weird like that. Like I said, where I’ve worked oms has a call schedule for 365 days per year so one was available. Not sure why he even said he would see the patient with an odontogenic infection when oms was available. She didn’t need a trach or anything like that and he didn’t ask for a hand because of ego or whatever other dumb reason he wants to give. Bad apple, but it doesn’t matter because most the ent docs I’ve worked with are awesome.

I’ve taken call and like taking call everywhere I’ve been because it’s a service to the community and to be honest it’s a lot more fulfilling to fix someone’s face or drain a bad infection than to take out wisdom teeth or place a dental implant. The oms docs I know and talk to feel and do the same so this is all really surprising.

i don’t know anyone making the amount of money previously mentioned for these procedures day in and out btw. Those rumors of how much money a specialty can make only make us look greedy and only make us look like dentists who sit in our offices all day. There are likely outliers, like the ent I know who drove a Bentley, but it’s not the norm from what I’ve seen. Bragging about how much money you can make per hour in a healthcare field gives the appearance that the motivation isn’t to help people but to take advantage of the current system (which is changing).

4-6 years of training to take out teeth and place implants is a complete waste. I only post a few of these things incase any oms residents might read this. Also, to clarify on board certification for an oms, yes you must have privileges but taking call isn’t a requirement. So I think many have courtesy privileges without the need to take call just to maintain board certification which isn’t the point of the rule. Hopefully our board changes the requirement to something where you actually have to do something in the hospital besides being a toof puller.

I know a few oms and ents that “take call” in rural areas but just divert it all to bigger hospitals. As that continues over 30 years they’re no longer comfortable dealing with pretty much any urgency or emergency. That’s where my thought about rural practices comes.

thanks for the conversation and a bit of reality check regarding our perception. Hopefully it will improve overtime

 

[HighPriest]

The doc that drained the pharyngeal abscess and didn’t call an oms to get the tooth out wasnt in a situation where an oms wasn’t available and it wasn’t the first time he did something weird like that. Like I said, where I’ve worked oms has a call schedule for 365 days per year so one was available. Not sure why he even said he would see the patient with an odontogenic infection when oms was available. She didn’t need a trach or anything like that and he didn’t ask for a hand because of ego or whatever other dumb reason he wants to give. Bad apple, but it doesn’t matter because most the ent docs I’ve worked with are awesome.

Yeah, he sounds like someone I wouldn’t want to work with based upon that information. When I finished residency and started working in the military system, I would routinely ask my OMS colleague to help out with orbital fractures. I knew how to do them, but he knew how to do them better. And that was best for the patients and I learned a thing or two.

don’t know anyone making the amount of money previously mentioned for these procedures day in and out btw.

No doubt. Usually the numbers spit out on forums are bogus or maybe represent an isolated case. The stereotype, accurate or not, is borne from a frustration among ENT docs that you can make more schucking thirds than you can doing a neck dissection - by a lot - but yet we often can’t get a hand at 0300 with a broken jaw.

We’re privileged at three regional hospitals and cover call for two more. I’m not aware of any way around taking call if you’re privileged. It’s possible, I suppose. I mean, they must be getting around it somehow.

The auto-divert system is real for ENT as well. For me, I always have one rule: if someone nearby can do a better job, then off you go. If not, I’m your guy. But as you say, once you start sending cases out you get real comfy real quick doing that.

And hey, man, fwiw it’s almost impossible to get ophtho to see a patient in house here too.