The Lack of Importance of Research in Oral and Maxillofacial Surgery Residency Programs

A current article in press 2011 (at the time of this writing) will appear in the Journal of Oral and Maxillofacial Surgery. The article is titled Attitudes and Opinions of Residency Directors and Residents About the Importance of Research in Oral and Maxillofacial Surgery Residences by Ali E. Mohammad, Al M. Best, and Daniel M. Laskin.

The conclusion of the article is quite grim

The failure of all residency programs to provide actual research experience for their trainees has resulted in a decrease in the contributions that such programs have traditionally made to the literature and the advancement of the speciality. It is important that steps be taken to reverse this trend.

The article describes a study that was conducted to determine the research status done by residents in oral and maxillofacial surgery training programs.  A questionnaire was developed for both program directors and residents and sent to 101 oral and maxillofacial surgical residency programs in the U.S. in 2008. Forty-three percent (44) of program directors responded and 29.1% of residents (277 of 951) responded to the questionnaire.

A real startling result about this study is the question that was asked to both program directors and oral and maxillofacial surgery residents. The question was:

Do you believe that research experience is important for someone pursuing private practice?

A total of 15 (34.1%) of program directors said No and a total of 29 (65.9%) said Yes. A total of 177 (63.9%) of residents said No and a total of 100 (36.1%) said Yes.

To me this is very negative result. Research is absolutely necessary to continue to improve medical care. Anyone who is a visitor to knows that I take research seriously and really am troubled by the fact that medicine has in the past for the most ignored evidence of treatments and only more recently have we seen evidence based medicine emerge. Further any sane individual who has seen my site also knows that the current methods of extracting wisdom teeth even in completely healthy young adults can in some individuals really lead to very serious life long problems.

Research in the area of wisdom teeth and other topics for oral and maxillofacial surgeons is certainly essential to have a successful practice for a long time with satisfied patients.

The article says (by citing numerous studies)

Although it is often said that research experience helps future practitioners evaluate the literature more critically and that it is important for developing the skills needed for critical thinking and lifelong learning there is no direct evidence to support such claims.

I would argue that being able to have research experience would directly correlate with the ability to successfully treat the largest number of patients, meaning those with better awareness of the literature and critical thinking skills will most likely be able to benefit their patients the most.

John Wennberg is well versed in the unwanted variations in practice. Medicine suffers from supply sensitive care where supply of physicians, healthcare facilities, and medical equipment can influence what kind of medicine patients receive. In a recent article by John Wennberg. Time to tackle unwarranted variations in practice. BMJ. Vol. 342, pages 687 – 690.  March 26 2011 he states

Those living in regions with a high intensity pattern of care—who, by virtue of where they are treated, receive more visits, imaging examinations, and admissions—have worse or no better survival than those living in low intensity regions.

Certainly all clinicians need to have the necessary skills to conduct and assess research. If they don’t then they really need others who may not be clinicians (or former or limited) but well educated researchers performing this task and informing them of the results which they can carry over into practice.

The real underlying problem here is directly related to financial and economic.  It is well known that in the U.S. in particular the cost of Medical School is out of control and extremely expensive. For example let’s look at the cost of Harvard Medical School over 2010-2011 which is $45,050. Over four years the cost of tuition alone would be over $180,000.

The residents where asked

Would you spend an extra year in their residency performing research if it were a funded position?

To which 103 (90%) said No! and 11 (10%) said Yes. When asked to clarify

If no, is this because of already existing debt?

Then 47 (44%) of residents said No and 60 (56%) said Yes. Clearly some are greatly impacted by the high costs of education particularly those in medical school programs (MD – dual degree).

Even more surprising is the fact that 25% (11 of 44) of program directors said their residents do not engage in a research project and 41% (114 of 277) said they do not perform research during their residency. This is in violation of Accreditation Standards for Advanced Specialty Education Programs in Oral and Maxillofacial Surgery which state that advanced specialty education students/residents must engage in scholarly activity.

The mean annual salary of an oral and maxillofacial surgeon is $212,120 (May 2010) according to the United States Department of Labor Bureau of Labor Statistics.

The mean annual salary for someone like myself (I have a masters in biomedical engineering) is $84,780 (May 2010) according to the United States Department of Labor Bureau of Labor Statistics.

The mean annual salary for someone living in the U.S. is around $41,000 (2009) according to the U.S. Social Security Administration.

Why should someone like myself or someone worse off financially than myself (like the average American Citizen) pay oral and maxillofacial surgeons such a high wage when the current residencies programs are producing surgeons who fail to have research experience which consequently is lowering the quality of literature and research.  This huge difference in salary is ridiculous. Oral and maxillofacial surgeons command on average over 5 times the salary of an average U.S. citizen and over 2.5 times the salary of a well educated professional like myself.

Salary is based on the ability to perform and add value to people’s lives. It is time for these oral and maxillofacial programs to get their act together. Even if they make some strides to do so I still don’t believe the current salary is anywhere close to justifiable when they cannot even evaluate the literature on wisdom teeth which is causing thousands of Americans each year to be left with permanent injury unnecessarily.

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