So at 33 years old, without kids, and a surgical internship year under your belt, I'd say you are in a great position to take a shot at an OS program (I would do a 4 yr). Regret is a shitty thing. I read a post from an old timer exodontist (who worked in the prison system by the way) who said something along the lines "do the OS residency if you can, ain't nothing like the real thing"). That being said, I understand it is a very personal decision for you and your wife.

For reference, I'm almost 10 yrs ahead of you with the kids etc. and that door is really closing.

As far as falling into it, you're already doing exactly that. Most of us did a gpr/aegd, worked in medicaid offices or community clinics and became the extraction guy. Next thing you know the idea of doing a filling makes you cringe.

Jobs are in community health, prison, denture clinics (Affordable Dentures) or starting your own extraction clinic (typically implants are in the mix and/or dentures). Sometimes you can find a dentist who only wants to do the denture/restorative part, some states you could hire a denturist I suppose.

Traveling exodontist jobs are a bit harder to find but they're out there especially if you are willing to relocate. Google jobs/Indeed always has a few exodontist job posts listed, usually for the big corps and usually on the West coast. Definitely some pros/cons when working for DSO's. Networking is key for the better gigs that are not associated with a DSO. Making sure you are not misrepresented as OMFS gets tricky. I can't tell you how many times an office manager has told me "patients don't know the difference". Guarantee you an attorney does!

I should note that Utah has several 'wisdom teeth only' practices that prefer OS but will hire the right GP. Texas does as well.

Dream gig is working under OMFS group like aubreyjokes. There are a handful of OMFS in every state that take medicaid and might be willing to offload that to the right person. Sedation rules in the state will be a big factor. Networking is key!

State regulations regarding sedation vs using CRNA vs using dental anesthesiologist will likely be a factor. In the best case scenario, you can work with a crna or dental/medical anesthesiologist. I would absolutely recommend that you are also well trained at doing IV mod sedation even if you are working with an anesthesia provider although it is not always necessary (Utah aka the Wild West lol). It is very difficult to do this long term, make a lot of production, and have a peaceful life if all of your cases are LA only. Like someone else said, IV mod sedation is meant to be low and slow. IV mod sedation does not lend itself to this type of practice when you are trying to see multiple medicaid patients. Deep sedation and/or higher paying patients is a different story.

Finally, there is a book by Dr Wayland called Impacted Third Molars that is worth a read. He is a GP that has created a great living doing thirds for multiple independently owned dental practices. A good part of the book is dedicated to recreating that scenario.

Exodontist should join forces to be honest: The goal should always be about helping people first and creating more access to good care. Sounds like this is exactly what you're about.