Can OMFS do procedures that MD only plastic surgeons can't?

[UGAChemDawg]

Are there any procedures that an Oral/Maxillofacial surgeon trained in plastic surgery can do that a regular plastic surgeon without a DDS/DMD degree can't? (I'm not asking if they're better at it, I mean are there any legal prohibitions or malpractice/hospital privledge regulations that would prevent a regular MD only plastic surgeon from attempting it)?

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[OzDDS]

Are there any procedures that an Oral/Maxillofacial surgeon trained in plastic surgery can do that a regular plastic surgeon without a DDS/DMD degree can't? (I'm not asking if they're better at it, I mean are there any legal prohibitions or malpractice/hospital privledge regulations that would prevent a regular MD only plastic surgeon from attempting it)?

Is this a troll/flame post? looks suspect.. but I'll answer your question anyhow.

Dental implants, pretty much all dentoalvelor surgery, and I suppose removable of cysts and tumours of the jaws. I think that's probably about it really.
Both can do orthgnathic surgery I believe, although its usually plastic surgeons who have completed a craniomaxillofacial fellowship that log any real number of orthognathic cases. also I dont think I've heard of many plastic guys attempting TMJ replacement/repair.

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http://www.baoms.org.uk/CD-ROM/profile/relation.html

 

[gary_ruska]

Are there any procedures that an Oral/Maxillofacial surgeon trained in plastic surgery can do that a regular plastic surgeon without a DDS/DMD degree can't? (I'm not asking if they're better at it, I mean are there any legal prohibitions or malpractice/hospital privledge regulations that would prevent a regular MD only plastic surgeon from attempting it)?

Gary Ruska here...There are very few procedures that overlap between the two specialties in the real world. GR knows of no plastic surgeons at his program nor anywhere else who do orthognathic surgery on a regular basis - it simply doesn't pay well enough for them to justify spending the time and effort...Academic plastic surgeons may tinker a bit with orthognathics, but even then, it's slim to none. The vast majority of orthognathic surgery done in this day and age is by academic OMFS (private practice OMFS don't want orthognathics either).

GR also agrees with the previous poster - plastics guys can't put in dental implants or do any dentoalveolar surgery...but then again, why would they want to? Point is that everyone has their own procedures that make $$$$$.

 

[toofache32]

There's a plastic surgeon in town here who's started putting in some dental implants. I've wondered what dentists would refer to him, but when I realized his brother is a dentist it all made sense.

 

[CrispRice]

There's a plastic surgeon in town here who's started putting in some dental implants. I've wondered what dentists would refer to him, but when I realized his brother is a dentist it all made sense.

Wow? Is he a DDS/MD with a Texas dental license? If not, I'm wondering why the Texas Dental Board hasn't looked into this...

 

[toofache32]

Wow? Is he a DDS/MD with a Texas dental license? If not, I'm wondering why the Texas Dental Board hasn't looked into this...

Nope.

 

[UGAChemDawg]

Nope.

As I understand it, as long as he's telling his patients he's not a dentist and isn't board certified to be able to do the procedure, there isn't much they can do about it as far as disciplinary action goes.

Once you've done your internship year after medical school and get your license to practice medicine, you can pretty much do whatever you want as long as you have the informed consent of the patient.

For example, if a family practice doctor tried to do neurosurgery on someone, even though he hasn't been trained in neurosurgery, his license still allows him to do it. He might be sued for the farm if he messes up because malpractice most likely will not cover him doing that procedure, and no hospital in their right mind would allow him to do it in the first place, but he could not be prosecuted criminally for it.

 

[toofache32]

For example, if a family practice doctor tried to do neurosurgery on someone, even though he hasn't been trained in neurosurgery, his license still allows him to do it. He might be sued for the farm if he messes up because malpractice most likely will not cover him doing that procedure, and no hospital in their right mind would allow him to do it in the first place, but he could not be prosecuted criminally for it.

This isn't really correct. I think you're confused about how the legal system works with professions such as health care. There aren't really any "criminal" actions to be dealt with, unless you perform a procedure without consent (assault & battery). The issue you're asking about is really "Standard of Care." Of course a generalist can do a procedure normally done by a specialist...it's done all the time in both dentistry and medicine. The important part to understand is that a generalist is held to the same standard as a specialist. In other words, it's not a valid defense to say "well I wasn't trained as a specialist so you shouldn't expect my results to be the same." If you're a generalist who can't provide care to the same standards as a specialist (notice I didn't say "get the same results as a specialist"), you should have referred it to someone who could.

 

[OzDDS]

There's a plastic surgeon in town here who's started putting in some dental implants. I've wondered what dentists would refer to him, but when I realized his brother is a dentist it all made sense.

Interesting.. The PRS people complain about OMFS (and ENT) doing Facial cosmetics, (even though we are actually trained to do the procedures in our residency programs and usually log equal if not greater number of elective cosmetic face cases than PRS residents). At the same time now this PRS guy is attempting dental implants (without any previous experience). Did he just sit in some dental CE courses with his brother or something?

Again.. Most implants placed by surgeons are by referrals from general dentists. I wonder how he recruits patients for this procedure (I'm assuming his brother is the only one sending him patients). hmm.

 

[Pilot Doc]

This isn't really correct. I think you're confused about how the legal system works with professions such as health care. There aren't really any "criminal" actions to be dealt with, unless you perform a procedure without consent (assault & battery). The issue you're asking about is really "Standard of Care." Of course a generalist can do a procedure normally done by a specialist...it's done all the time in both dentistry and medicine. The important part to understand is that a generalist is held to the same standard as a specialist. In other words, it's not a valid defense to say "well I wasn't trained as a specialist so you shouldn't expect my results to be the same." If you're a generalist who can't provide care to the same standards as a specialist (notice I didn't say "get the same results as a specialist"), you should have referred it to someone who could.

I think you're a bit confused too. Practicing medicine without a license is a crime. If a beautician starts giving botox, he/she could be prosecuted criminally. The prior poster was making the point that there's no legal impediment to a doc doing dental implants. The degree of overlap between medicine and dentistry is not a subject I know much about - other than it's occasionally controversial nature, but it's certainly possible that a DA could consider dentistry/medicine without a license charges against envelope pushing practicioners.

 

[toofache32]

I think you're a bit confused too. Practicing medicine without a license is a crime. If a beautician starts giving botox, he/she could be prosecuted criminally. The prior poster was making the point that there's no legal impediment to a doc doing dental implants. The degree of overlap between medicine and dentistry is not a subject I know much about - other than it's occasionally controversial nature, but it's certainly possible that a DA could consider dentistry/medicine without a license charges against envelope pushing practicioners.

Practicing medicine without a license? I'm not sure what you're referring to in this thread that is outside the scope of OMFS.

 

[DelAGator]

I think you're a bit confused too. Practicing medicine without a license is a crime. If a beautician starts giving botox, he/she could be prosecuted criminally. The prior poster was making the point that there's no legal impediment to a doc doing dental implants. The degree of overlap between medicine and dentistry is not a subject I know much about - other than it's occasionally controversial nature, but it's certainly possible that a DA could consider dentistry/medicine without a license charges against envelope pushing practicioners.

Can an OFMS residency be used as a requisite for a plastic surgery fellowship

 

[OzDDS]

Can an OFMS residency be used as a requisite for a plastic surgery fellowship

Yes.. so can ENT, Orthopedic, GenSurg, and UrologicalSurg residencies.

 

[Mediculous]

Gary Ruska here...There are very few procedures that overlap between the two specialties in the real world. GR knows of no plastic surgeons at his program nor anywhere else who do orthognathic surgery on a regular basis - it simply doesn't pay well enough for them to justify spending the time and effort...Academic plastic surgeons may tinker a bit with orthognathics, but even then, it's slim to none. The vast majority of orthognathic surgery done in this day and age is by academic OMFS (private practice OMFS don't want orthognathics either).

GR also agrees with the previous poster - plastics guys can't put in dental implants or do any dentoalveolar surgery...but then again, why would they want to? Point is that everyone has their own procedures that make $$$$$.

Mediculous appreciates Gary Ruska's prolific referring of himself in 3rd person

 

[PDT4CNV]

Yes.. so can ENT, Orthopedic, GenSurg, and UrologicalSurg residencies.

Dont forget ophthalmology.

 

[toofache32]

Dont forget ophthalmology.

Huh?

http://www.abplsurg.org/training_requirements.html

 

[maxheadroom]

Occuloplastics is a fellowship done after Ophtho, but it is not Plastic Surgery.

 

[esclavo]

I think you're a bit confused too. Practicing medicine without a license is a crime. If a beautician starts giving botox, he/she could be prosecuted criminally. The prior poster was making the point that there's no legal impediment to a doc doing dental implants. The degree of overlap between medicine and dentistry is not a subject I know much about - other than it's occasionally controversial nature, but it's certainly possible that a DA could consider dentistry/medicine without a license charges against envelope pushing practicioners.

There is definitely some confusion here...and toofache isn't the confused/confusing one...

 

[PDT4CNV]

Occuloplastics is a fellowship done after Ophtho, but it is not Plastic Surgery.

Then maybe you are confused what plastic surgery is. The ophthalmologists I know of who do plastics do blephs, midface and face lifts (SMAS), brow lifts, entropion and ectropion repairs, ptosis repairs, telecanthus repairs, post-mohs reconstructions, fix facial fractures, remove tumors of the face and orbit. They harvest tissue from the ear, mouth, nose, abdomen, fascia lata, use cranioplast, medpore etc.. Some do laser hair removal, some chemical peels and resurfacing, restylane injection, botox, tattooing. This qualifies as facial plastic surgery in my book. Then there are of course the lacrimal procedures that are more specialized to ophthalmic plastics.

And BTW, not all ophthalmologists who do plastics do oculoplastic fellowships, plastics is part of ophthalmology residency training.

Some have gone on after oculoplastics to do craniofacial or general plastics fellowships, so my original point, is that plastics is not limited to the specialties named previously. Remember, applying for plastic surgery fellowship is different (better in my opinion) than plastic surgery residency.

 

[maxheadroom]

1. I am not confused about what Plastic Surgery is. As a resident in Plastic Surgery and a member of the Residents Section of the American Society of Plastic Surgeons I am very clear on who is a Plastic Surgeon and who is not.

2. There is no such thing as a plastic surgery fellowship. Plastic Surgery is a residency. Some people do it after completing training in another field (Gen Surg, OTO-HNS, Ortho, more rarely NSG or Uro).

3. I have tremendous respect for the Occuloplastics guys with whom I have worked. Their knowledge of anatomy and skill is impressive.

Below you can find the ABPS description of the INDEPENDENT model of Plastic Surgery training. This is the often (incorrectly) described fellowship model.

This is copied from the ABPS website: http://www.abplsurg.org/training_requirements.html# INDEPENDENT MODEL

INDEPENDENT MODEL

This model includes programs with two or three years of plastic surgery training. The Independent Model has two options. The first option has two variations. Each of the pathways described satisfy the requirements of the Board for entry into the certification process.

Option 1, variation A requires at least three years of ACGME-approved clinical general surgery residency training in the same institution with progressive responsibility to complete the PREREQUISITE requirements of the Board. Residents must complete a minimum requirement of 36 months of training including specific rotations, which are noted later in this Booklet of Information. This requirement of the Board stipulates that a minimum of three years of clinical training in general surgery, with progressive responsibility, in the same program must be completed before the resident enters a plastic surgery residency.

Option 1, variation B is the “combined” or “coordinated” residency. This option is the same as option #1A, with the exception that medical students are matched into an ACGME-approved general surgery training program with a non-contractual understanding that they will become plastic surgery residents at the same institution after satisfactorily completing the three-year minimum PREREQUISITE requirement in general surgery. During this time they are considered residents in general surgery with an “expressed interest” in plastic surgery, but are not considered plastic surgery residents by the RRC-PS, AACPS, or ABPS until completing the PREREQUISITE training program and entering the requisite training years. These programs are not differentiated in the ACGME’s Graduate Medical Education Directory (the “Green Book”), but rather are found listed among general surgery and independent plastic surgery programs. PREREQUISITE AND REQUISITE requirements are completed at the same institution in this model.

Option 2 is available for residents who have satisfactorily completed a formal training program (and are board admissible or certified) in general surgery, neurological surgery, orthopedic surgery, otolaryngology, urology, or oral and maxillofacial surgery (the latter requiring two years of clinical general surgery training in addition to an M.D./D.D.S. or D.M.D.). Successful completion of these ACGME or ADA accredited programs fulfills the PREREQUISITE training requirement.

Yes, Occuloplastics do all of the things that you stated, but Ophtho is not a defined pathway into Plastic Surgery

 

[PDT4CNV]

1. I am not confused about what Plastic Surgery is. As a resident in Plastic Surgery and a member of the Residents Section of the American Society of Plastic Surgeons I am very clear on who is a Plastic Surgeon and who is not.

2. There is no such thing as a plastic surgery fellowship. Plastic Surgery is a residency. Some people do it after completing training in another field (Gen Surg, OTO-HNS, Ortho, more rarely NSG or Uro).

3. I have tremendous respect for the Occuloplastics guys with whom I have worked. Their knowledge of anatomy and skill is impressive.
Yes, Occuloplastics do all of the things that you stated, but Ophtho is not a defined pathway into Plastic Surgery

There are plastic surgery fellowships in various aspects such as facial plastics, hand, etc...

It is true that Ophtho is not the typical pathway into plastics, but to say that the "plastics" done by them is not plastic surgery is ridiculous.

 

[toofache32]

You guys are talking about 2 different things. "Plastic surgery" as a ABMS-recognized specialty requires the prerequisites set out by the ABPS as quoted above. Note that Ophthalmology is not part of the pathway. Ophthalmologists can do it, but they have to complete the same prerequisites as everyone else, and time spent doing Ophthalmology contributes nothing to these prereqs.

"Plastic surgery" as a technique is done by anyone who performs surgery. There is no monopoly on 6-0 prolene and wound eversion like some ABPS surgeons would like people to believe.