Prof. James Hupp: an academic career vs. private practice of oral and maxillofacial surgery

Editor’s note

Oral and Maxillofacial Medicine is a relatively young speciality that recognizes and fosters the interplay between medical health and oral health. Leaders in the field have been instrumental in dental education since the 1920s. Over 40 years ago, Prof. James Hupp began his residency training in oral and maxillofacial surgery, and now he is an experienced expert in the field.

Frontiers of Oral and Maxillofacial Medicine (FOMM) is honored to have an interview with Prof. James Hupp talking about the critical issues and latest advances in the field now, the training pathways in oral and maxillofacial surgery, his thoughts on an academic career or private practice and other topics.

Expert’s introduction

James Hupp (Figure 1), DMD, MD, JD, FACS, is a career-long academician who is dedicated to fostering excellence in healthcare education and training.

Figure 1 James Hupp, DMD, MD, JD, FACS.

Dr. Hupp joined Washington State University’s new Elson S. Floyd College of Medicine in 2018 as the Vice Dean for Student and Faculty Experience, having previously served as the Founding Dean of the School of Dental Medicine of East Carolina University in North Carolina. Prior to that leadership role, he was the Dean of the School of Dentistry at the University of Mississippi. Dr. Hupp served as the Chair of Oral-Maxillofacial Surgery at the University of Maryland Medical Center and the University of Medicine and Dentistry of New Jersey (now part of Rutgers University). He also served as residency program director at those institutions, as well as at the University of Connecticut Health Center and was on the faculty of the Department of Surgery at Vanderbilt University Medical School. Throughout his career and leadership positions he remained active in teaching, patient care and scholarly activities.

Dr. Hupp has been the editor-in-chief of the Journal of Oral and Maxillofacial Surgery since 2011. He was a director, officer and then President of the American Board of Oral and Maxillofacial Surgery. He has served on accreditation residency review committees and in a number of roles related to residency program, as well as school and medical center accreditation. He continues to author numerous textbooks, book chapters and articles.

Dr. Hupp received his BS degree in biological sciences from the University of California, Irvine, and then went on to Harvard for his first two years of medical training and complete dental training there as well, receiving his DMD cum laude. He completed his MD and surgical training at the University of Connecticut, followed by internal medicine at the Harbor-UCLA Medical Center. He later went on to earn a law degree at Rutgers University and his MBA at Loyola University of Maryland.

Dr. Hupp has been a Fellow of the American College of Surgeons since 1995, and is also a Fellow of the American and International Colleges of Dentistry.

A close look at Oral and Maxillofacial Surgery

FOMM: Having been in the field of oral and maxillofacial surgery for years, what do you think are the critical issues facing the field right now, and how might they be solved?

Prof. Hupp: I can only speak with any authority about issues facing OM surgeons in the USA, but not elsewhere in the World. They all relate to how our specialty is positioned with the healthcare system in our country. The most common need for our services in our country is the management of routine dental infections (this may be true everywhere). Even though I feel our specialty is the best group of dentists to provide routine exodontia, especially when advanced forms of pain and anxiety control are needed, there are two major issues we face. First, there are not enough OMSs to do all the work, particularly in underserved areas of the USA. Second, even if a patient has some form of insurance, it commonly does not totally cover the costs of providing care for routine exodontia. These factors open the door to two things. First, general dentists will often do their own exodontia, which is fine when they perform it effectively and safely, but problematic when they do not. Second, in the absence of OMSs and other dentists being available, mid-level providers will eventually fill the vacuum. This too might be fine, but can lead to problems if they are not properly trained and do procedures beyond their capabilities. With respect to more advanced form of exodontia such as management of impactions, OMSs in the USA will continue to face increasing competition from other dentists. It is unclear what how we should respond other than continuing to provide high quality services, in a timely manner, at a reasonable cost.

FOMM: What are some latest advances in the field of oral and maxillofacial surgery?

Prof. Hupp: The most exciting advances in my mind relate to five things: first, the ability to use advanced forms of technology to more accurately diagnose, plan and perform surgery is wonderful to see. The use of imaging to then print 3D models, surgical guides and even fixation devices is helping increase the precision of surgery and prediction of its outcomes. Second, advances in genomic medicine are allowing more personalized approaches to making diagnostic and therapeutic decisions when managing surgical pathology. Third, improvements in our understanding of proteins that help guide wound healing and in vivo development of new tissues offer great promise in the field of oral and facial reconstruction. Fourth, growing understanding of how to safely operate on growing fetuses will allow preterm repair of congenital facial deformities. Finally, improved imaging, combined with robotics, will allow surgeons to perform procedures more accurately using less invasive approaches to manage facial deformities, injuries and pathology, including the use of augmented-reality surgery.

Experience in academic arena

FOMM: Why you particularly interested in the study of oral and maxillofacial surgery?

Prof. Hupp: I was led to our field by the initial desire to learn dentistry, combined with a love of biological sciences and a fascination with all the patient conditions that can be managed using our oral-maxillofacial surgical judgment and skills. No other branch of dentistry has such exciting diversity.

FOMM: Would you like to introduce us to the research projects that you are involved in?

Prof. Hupp: I no longer do research since I focus my efforts these days on medical school leadership and editing of journals and books.

FOMM: Do you think an academic career is “better” than one in the private practice of oral and maxillofacial surgery? How much the financial factors influence on an academic career choice? What are the rewards and challenges of an academic career in oral and maxillofacial surgery?

Prof. Hupp: For me, academia is better since I love regular intellectual challenges, day to day variety in patient care problems and scholarly activities, working with students and colleagues, having an impact on organizations and communities, and not having to run a business. Financially, I know I did not receive as much monetary compensation as my private practice colleagues, but I was rewarded in what for me were more meaningful and valuable ways. In the end, my wife and I raised and paid well to educate four successful children, always lived in nice homes and neighborhoods, enjoyed vacations and family time, and are well-prepared for a very comfortable retirement when that occurs.

FOMM: What are the training pathways in oral and maxillofacial surgery in the USA?

Prof. Hupp: Four-year non-MD and 6-year MD pathways are the primary ones, with 1–2 years sub-specialty fellowships possible. For a time, there were formal OMS-PhD programs in existence, but few of those individuals entered research careers so I believe most of them were stopped.

FOMM: What sparked your interest in editing the book Contemporary Oral and Maxillofacial Surgery (COMS)? What are the key features of this book?

Prof. Hupp: My involvement in the COMS book began when the late Larry Peterson asked me to be a collaborator/co-editor over 30 years ago. I’ve thoroughly enjoyed my experience helping write and edit chapters since that time, with the book now in its 7th edition and translated into many languages. The book gives general dentists in training and practice a strong foundation in routine oral surgery, while also educating them about the scope of and on how oral-maxillofacial surgeon manage the full spectrum of oral-craniomaxillofacial surgical challenges.

FOMM: Besides, authoring numerous textbooks, book chapters, and articles, you have been the editor-in-chief of the Journal of Oral and Maxillofacial Surgery since 2011. In this special role, what phenomena you have observed in term of the academic publication in the oral and maxillofacial medicine?

Prof. Hupp: While we moved from hard-copy to electronic manuscript management while I was at Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology (OOOE), we made great strides in taking advantage of all that electronic manuscript management offers. We now have a very fast turn-around time between submission, peer review, acceptance and publication; so much so, that once a manuscript is accepted it appears on the electronic version of the JOMS within 3 weeks. We combine this with high expectations for timely reviews and the hard work of our large international team of peer-reviewers. This extremely fast flow of manuscripts through the publication system provides readers very rapid access to timely information, compared to the past when it would take a year or more for an accepted article to be available to read.

FOMM: Throughout your career and leadership positions you remained active in teaching, patient care and scholarly activities. How do you strike a balance whilst having such heavy workload?

Prof. Hupp: I find it is true that very busy and effective people are expert time managers, are talented multi-taskers, and willing to share the work and credit with others rather than trying to take it all for themselves.

Acknowledgments

We would like to express our sincerest gratitude to Prof. James Hupp for sharing his stories, insights and opinions with us.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the Editorial Office, Frontiers of Oral and Maxillofacial Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://fomm.amegroups.org/article/view/10.21037/fomm.2019.06.01/coif). SZ reports that she is a full-time employee of AME Publishing Company (publisher of the journal).

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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(Science Editor: Silvia Zhou, FOMM, fomm@amegroups.com)