Dr. Michael Wasson: The Pros and Cons of a Subspecialized Practice

Michael Wasson, DDS, from Scottsdale, Arizona, started in a generalized private practice but has since transitioned to an orthognathic/TMJ-focused practice. He shares what led him to this choice, the pros and cons of narrowing your focus, and his advice for new OMS professionals curious about which path to take.

ACOMS: Can you describe your journey into oral and maxillofacial surgery?

Michael Wasson, DDS (MW): My journey began in dental school when I became interested in OMS early in the curriculum. Next, I started shadowing the surgery residents in the clinic, the OR, and in their resident didactics.  As I gained exposure to the specialty, my interest continued to grow, and I quickly realized I would not be content in other areas of dentistry. Upon graduation, I completed a one-year internship at JPS Hospital in Ft. Worth, Texas, before being accepted into the University of Washington's OMFS Residency Program. 

ACOMS: What motivated you to start a private practice right after graduation, and what were some of the challenges you faced?

MW: Initially, I planned on pursuing a fellowship followed by an academic career. When I decided to join the private sector instead, the positions available were not a good fit. I also learned that being my own boss would offer numerous advantages that I was eager to take advantage of.

ACOMS: Why did you transition from a traditional private practice to an orthognathic/TMJ-focused practice?

MW: The transition wasn't always a part of the plan. I had TMJ and orthognathic surgery as a part of my first practice in Seattle, but it was only a fraction of the practice's surgical volume. When my family and I decided to move to Arizona, there seemed to be a lack of providers offering these services in substantial volume, despite a large population. I viewed this as both a professional and business opportunity, allowing me to do the procedures I enjoyed in an area that seemed underserved. I was also eager to continue to grow and develop as a surgeon, with this providing an opportunity to explore and expand my surgical acumen.

ACOMS: Can you share some insights into the differences between running a traditional practice and a specialized orthognathic/TMJ practice?

MW: Both practice models have pros and cons. In a traditional practice, there is less concern about whether you will succeed initially, and the seasonal variation is more stable. The downside is there is a much larger business operation with more staff, referrals, paperwork, supplies, etc. In a traditional practice, I found that I was constantly busy, which is nice, but it did not allow me to provide as much of a personalized touch with my practice and patient relationships, which was always my preferred way to practice. The referral dynamic can be interesting at times as well. With a more subspecialized practice, you can minimize several of these aspects, thereby lowering overhead and the moving parts and pieces. The downsides are that it can have a slower start-up, significant seasonal variation, and there is less control over the hospitals and medical centers that you are dependent upon.

ACOMS: What advice would you give to new graduates who are considering starting a general practice versus a specialized one?

MW: In my opinion, an entirely subspecialized new practice would be challenging for a recent graduate. Offering the procedures you have an interest in while having a subspecialized practice as your long-term goal is reasonable.  However, supplementing the practice with other aspects would likely reduce stress for two reasons:

1. There is the possibility that upon starting your career journey, you may not know the destination. You may find that family changes or children alter your plan and goals. As a new graduate in a start-up practice, I would plan for flexibility in any manner possible. This allows for shifts or changes in practice strategy as you or the market dictates. You may find, as many of our colleagues do, that the stress and difficulties of hospital-based procedures and surgery are not worth the headaches. Or you may find the exact opposite. 
2. Coming out of residency, you will likely have some (if not a large amount of) educational debt. Adding substantial debt with a new practice while limiting your scope is not practical for most people. The financial pressures will be there, and your debt obligations may become overwhelming. Supplementing your practice with dentoalveolar procedures, trauma call, or other scopes of practice can help with your practice exposure, visibility, and revenue during a stressful start-up period. 

ACOMS: Do you miss anything about your previous practice setup, and what have you learned from your current practice format?

MW: I miss many of the referral relationships and staff members from my first practice. It was also a great learning experience and confidence builder that taught me that my practice philosophy could be successful. However, I feel that I had accomplished most everything I could in a traditional practice, and the excitement of building and developing started to wane. I would also add that while uncomfortable to discuss, provider burnout is a real phenomenon. Being involved in a wide scope involving numerous institutions as a solo practitioner can become burdensome as each aspect demands your best no matter what is transpiring in the others.

I have learned from both practices more about myself and my preferred manner of practice. I've always strived to spend time with my patients and solve complex problems while taking on patients and cases others may not. This was challenging to do as a solo practitioner as your third molar patient (rightfully) expects the same attention as your large reconstructive case.  

I have also learned that I thrive with more work-life balance, and when I can constantly evolve my surgical skills and practice. My current practice allows this, in addition to professional growth in other avenues such as resident education, research, and cohosting a weekly jaw surgery podcast called Down Fracture. As a result, I am simultaneously more fulfilled professionally while also having time and opportunities to contribute to our specialty in other ways.