Last Updated on September 22, 2022 by Laura Turner
Robert Nadeau DDS, MD is in his seventh year at the University of Minnesota School of Dentistry and his tenth year as an educator.
Tell us about your professional journey.
Dr. Robert Nadeau: My journey started in 2001 with my acceptance to dental school at the University of Minnesota. I had applied prior but was waitlisted. I got a call that a spot opened about three weeks prior to the semester. Surprise!
During the first semester of dental school, I really enjoyed anatomy and physiology. Then we had a lecture on what Oral and Maxillofacial Surgery is about along with the scope of practice for this specialty. I was immediately drawn to the surgical nature of this aspect of dentistry. It was during my first year of dental school that I decided that I wanted to try and specialize in Oral and Maxillofacial Surgery. I studied hard and did all the things I was told to do to put myself in a good position. I only had three interviews for my first application to OMS residency and did not match. I then lucked into an internship position at the VA Hospital in Minneapolis. I needed the internship year to help improve my application and to get more experience in Oral Surgery. I had seven interviews for my second time applying and was matched to the University of Missouri, School of Dentistry Advanced Training Program in OMS at Truman Medical Center. This was a combined certificate and medical degree training program. It was six years in length and two and a half of those years were in medical school. I finished medical school in 2010 and completed my residency in 2012. I stayed in Kansas City as a faculty for three years before returning to the University of Minnesota Division of Oral and Maxillofacial Surgery in 2015. In 2018 I assumed the role of director of advanced training in Oral and Maxillofacial Surgery and in 2020 was named interim division director for Oral and Maxillofacial Surgery.
When did you first decide to become an Oral and Maxillofacial Surgeon? Why?
I was not really sure what to do with my life after college. I was building houses and working in an environmental lab running tests but that was pretty unfulfilling. I had a fraternity brother whose dad was a dentist and it sounded unique, and in the healthcare industry which I liked. That’s what sent me on my path to dentistry. I spent the next 2 years working full time and taking courses to fulfill the pre-requirements for dental school. The spark in regards to oral surgery came from a lecture about the scope of practice for oral and maxillofacial surgery during dental school. During that lecture one of the faculty showed a picture of a very brutal facial injury due to a dynamite blasting cap. The repair and recovery photos were so incredible. I had never even dreamed that this was part of dentistry but I was hooked at that point.
How/why did you choose the dental and medical school you went to?
My choices of professional schools were limited due to my lower collegiate GPA of 3.1. So I had very few choices but since I was from Minnesota, staying in the state was a good financial choice and I was in a long-term relationship with someone who had a good-paying job and could help support me through school. Luckily I was able to stay in-state. For medical school, that was a required part of my oral surgery residency so I had only one choice, and the University of Missouri, Kansas City Medical School is where I went. I only had to complete the required rotations and pass the NBME exams to graduate. So my medical school was truncated but still an experience I really enjoyed, even though I was a resident at the same time.
What was the hardest part of dental and medical school for you?
The hardest part of dental school was balancing lab work versus bookwork. Both take tremendous amounts of time but are equally important. It was a lesson in learning that you must prioritize certain parts of schooling and that other parts might suffer. Learning to be OK with that is crucial to dental school. As for medical school, I think the hardest part was trying to get excited about rotations or topics I really had no interest in. Putting in the effort to do something I knew I was never going to do or be involved with was difficult. It was also difficult being a resident at the same time as a medical student. Studying for exams while on call at a trauma center where oral surgery is the only facial trauma team on call.
What was your favorite part of dental and medical school?
In dental school, my favorite part was working with my hands, getting to learn skills, and honing my dexterity. For medical school, it was the hardcore medical learning. I really enjoyed the way medicine teaches subjects by organ systems from basic to complex. That really clicked for me and made learning fun.
What surprised you the most about dental and medical school?
For dental school, it was how unprofessional some students were. There was a normal level of professionalism but a small group of students were there to just get the degree and move on. They were more concerned with parties, social events, etc; schooling was a definite second-tier issue for them. But as long as they didn’t fail the school didn’t really seem to care. This still frustrates me to this day as I think dental schools think of students as undergrads yet my medical training was completely the opposite. In medical school, you were expected to be a professional and carry yourself like one at all times. They would actually hold a student back if they did not convey the professionalism expected. So my surprise was the lack of professionalism in dental schools and the expectation of professionalism in medical school are quite a stark contrast.
What information/advice do you wish you had known when you were beginning dental and medical school?
I wish I had known to not worry about student loans. There is such an emphasis on trying to limit the loans you take out. Yet now, 10 years out I barely think of them at all. I pay them monthly and it does not really have an effect on my income. So my advice to all the students in professional school. Take the loans, don’t fixate on them. It will help reduce your stress. They seem like huge numbers but in the end, a career in medicine and dentistry will be lucrative.
Learn more about Oral and Maxillofacial Surgery, which combines dentistry and medicine, by reading profiles of other surgeons:
If you had it to do all over again, would you still become an Oral and Maxillofacial Surgeon? Why or why not?
Absolutely, I love what I do and I will do it as long as I can. Adding teaching into my professional career has been the most fun and rewarding part of being a professional. It keeps me on my toes, keeps me feeling young and I have created a really nice network of professionals who I think are helping their communities due to something I helped create. Even if I was just a small part of their education.
What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?
The job market for Oral and Maxillofacial Surgeons is really good. About two surgeons retire for every one that graduates. The number of residency spots has not changed much in 30 years. Most graduates can be very choosy and take their time finding the type of practice they want and in a location they want. The starting salaries for OMS are among the highest in all of medicine and dentistry. I chose to stay in academics to use the training I was given and to honor those educators that took the time to teach me at the expense of personal wealth. Unfortunately, most, 90% or more, oral surgeons just go to private practice and only perform office-based procedures. This is because it pays so well and is an easy lifestyle. The other option is academic or hospital-based practice which does not have nearly the same level of salary. I think that more of us would be in academics if it paid better but the academic salaries in dental schools, medical schools, and educators are usually quite far behind the private practice professionals. It’s a sad environment that we have created here in the US.
What did you like most about being an Oral and Maxillofacial Surgeon?
I love surgery, especially trauma surgery. I don’t think that a lot of people know that Oral and Maxillofacial Surgeons cover a lot of facial trauma in hospitals. In fact, the most recent study showed that Oral Surgeons take facial trauma call in hospitals more frequently than ENT or Plastics. Tooting my own horn a bit there. Even though it can be difficult and the hours can be long, I like a bit of an adrenaline rush and trauma surgery does that for me. The other part I love is teaching as well as learning to be a teacher. It is not something that you learn in school or residency. So sometimes you need to learn how to teach others what you do. I feel that I have some innate talent for education but I have also worked at being a better teacher.
What do you like least?
The fact that most non-dental/medical people have no idea what an Oral and Maxillofacial Surgeon is and what our scope of practice is can be frustrating.
Describe a typical day at work in your current position.
This really depends on the day. On my clinic days, I arrive at about 7:45 to the clinic to review patients scheduled in the clinic. Then I supervise residents who are performing in-office procedures and see a few post-op until about 12:00. We routinely run into our lunch hour, so noon is hopeful. In the afternoon I staff residents who see consults, pre-ops, and post-ops in the afternoon. After the clinic patients have been seen I usually have a few meetings or finish some administrative tasks. On operating room days, I usually start between 7:30 and 8:00 so I try to arrive 30 minutes prior to the first case. We operate until 4-5 pm and then round on any patients we have in the hospital. There are not too many hospital patients at the University but there can be more at other institutions. In my private practice, I start seeing patients at about 7:00 am and I try to arrive about 30 minutes prior to the first case to review anything that was added to my schedule the day prior. Then I perform procedures until about 3:00 pm then I finish my notes and head home.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work about 50 hours a week and probably more if I am doing administrative work at home or on weekends. I also take trauma call at 2 hospitals so sometimes a lot more hours if there are emergency cases. I get good sleep, and that is not an issue except for rare occasions. I take 2 large vacations every year and many small ones during the year. I am given four weeks (20 days) of vacation per year in addition to professional meetings. I usually don’t use them all as I don’t really like vacations. I love what I do so I don’t like leaving. Vacations are more work for me than being at work so it is not attractive. Strange right?
How satisfied with your income are you now?
I am comfortable with my income, yes. Do I wish I had an income similar to private practice oral surgeons? Yes, but I live pretty simply, have an old car, and no kids. So there is no major financial drain or effort I need to be worried about. I still make good money and don’t have any wants. I am very open about this. I make right around $500K per year. I could make more but I think that is plenty.
If you took out educational loans, is/was paying them back a financial strain?
I did have loans and they have never been an issue except during residency. Those needed to go into forbearance as dental specialties are not allowed to defer loans. Once I finished residency and started getting paid, the loans were not a concern.
In your position now, knowing what you do – what would you say to yourself 10 years ago?
Go for it, don’t worry about moving to another city or part of the country. What happens next will be the best 10-15 years of your life. You will become a good doctor and surgeon and really enjoy what you do. Your wife and family will support you no matter what decision you make. Fear of the unknown is OK but learning to be open to new places, people and ideas will shape the rest of your life. You will make some of your best friends during residency. Residency is like military training, being in the trenches for 6 years forces you into friendships that are stronger than most others.
From your perspective, what is the biggest challenge or problem in Oral Surgery today?
The biggest challenge to our profession is twofold. First, we have dual tracks in Oral and Maxillofacial Surgery. About half of the programs grant a certificate only while others have a medical degree track as well as a certificate. So there is a lot of confusion about who can do what and what the training entails for each. Even though they are very similar. In the next few years (5-10) our specialty will need to make a choice to either split or eliminate one of the tracks. Second, the fact that oral surgeons provide in-office anesthesia while performing the procedure makes some medical professionals very uncomfortable. There have been very direct efforts to make this not an option and to eliminate the ability to operate while also providing sedation to a patient. This is all in the name of safety, yet OMS offices, not dental, are some of the safest places in the US to receive anesthesia, statistics support this over and over again. I think that at some point a state agency will take this practice away from oral surgeons putting a huge burden on society both financially and structurally, and possibly creating a treatment environment similar to the old west. Get ready to bite on a leather strap while having a tooth removed.
Where do you see Oral and Maxillofacial Surgery in 10 years?
I see them continuing along the same path but with a much-reduced footprint in hospitals. As venture capital groups buy up private practices at alarming rates I am concerned that they will begin to focus on only the money-making aspect of oral surgery and leave out the hospital component. This will make getting and maintaining hospital privileges a must for new oral surgeons as I think there will be fewer of us offering to take hospital facial trauma call.
What types of outreach/volunteer work do you do, if any?
As I teach and I think of that as my outreach work. Otherwise, I do not have time for any currently.
Do you have a family? If so, do you have enough time to spend with them?
I am married and I have plenty of time for my spouse. I probably work too much and could take more time off but I like what I do so I prefer not to. We do not have kids otherwise I do think that I would need to step back some of my efforts to be able to focus on them.
Do you have any final advice for students interested in pursuing Oral and Maxillofacial Surgery?
Oral Surgery is a very competitive field to get into. Work hard in dental school and explore the specialty. This will help you make sure it is something you want to pursue. One in four get accepted into oral surgery training, that’s only 25% of applicants. So the competition is fierce and you will need to stand out. Currently, medical students are not allowed to apply to OMS training. But that may change in the future.
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