AMA trying to limit OMFS scope

[DREDAY]

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I am sure most of you OMFS residents received the following email from our president. Does anyone have access to the actual copy of the report? I have been trying to find it online for the past hour and haven't found it. I hope this motivates my fellow omfs residents to pursue careers beyond teeth and titanium and to expand their scope of practice as to protect the headway our forefathers have made for us. I hope that we can protect our turf. Anyone have any insight on this?



February 22, 2010

Dear Colleagues:

As some of you may be aware, the American Medical Association (AMA) has targeted the scope of practice of a number of healthcare professionals. In mid-October of last year, AAOMS received a letter from American Medical Association Executive Vice President Dr. Michael Maves accompanied by a draft document entitled "AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons."

To be frank, we were more than a little surprised that the AMA had the temerity to develop such a document regarding a specialty of dentistry. A careful and systematic examination of the publication, including a background search, and internal and external clinical and legal reviews of the contents uncovered numerous errors, inaccuracies, and some very basic misrepresentations about the OMS scope of practice.

On November 17, I wrote to Dr. Maves and the AMA, pointing out the many problems we noted in their publication and expressing our surprise and concern that the AMA would produce a document of this nature that addresses a specialty over which organized medicine has no official responsibility, authority or first-hand knowledge. I further stressed the important role that oral and maxillofacial surgeons serve in health care and the tremendous support we provide to our dental and medical colleagues. I concluded the letter with an invitation to the leadership of the AMA to meet with the AAOMS to discuss our concerns in greater detail. The AMA responded to this invitation in January, and expressed interest in a face-to-face meeting. We are presently working with the AMA to arrange the meeting.

Meanwhile, AAOMS continues to review available information about the AMA Scope of Practice Data Series. Oral and maxillofacial surgery is one of 10 healthcare professions and specialties addressed by the American Medical Association's Scope of Practice Partnership (SOPP) project. The other health professionals included in the AMA's review are audiologists, naturopaths, nurse anesthetists, nurse practitioners, optometrists, pharmacists, physical therapists, podiatrists and psychologists.

We will carefully consider our next steps. I can assure you the AAOMS views this document and the purported purposes for its use very seriously, and we are prepared to take whatever additional actions are deemed appropriate. We will keep you informed as we move forward, and I thank you for your continued support of the AAOMS.

Sincerely,

Ira D. Cheifetz, DMD
President, AAOMS

 

[6897round2]

I am sure most of you OMFS residents received the following email from our president. Does anyone have access to the actual copy of the report? I have been trying to find it online for the past hour and haven't found it. I hope this motivates my fellow omfs residents to pursue careers beyond teeth and titanium and to expand their scope of practice as to protect the headway our forefathers have made for us. I hope that we can protect our turf. Anyone have any insight on this?



February 22, 2010

Dear Colleagues:

As some of you may be aware, the American Medical Association (AMA) has targeted the scope of practice of a number of healthcare professionals. In mid-October of last year, AAOMS received a letter from American Medical Association Executive Vice President Dr. Michael Maves accompanied by a draft document entitled "AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons."

To be frank, we were more than a little surprised that the AMA had the temerity to develop such a document regarding a specialty of dentistry. A careful and systematic examination of the publication, including a background search, and internal and external clinical and legal reviews of the contents uncovered numerous errors, inaccuracies, and some very basic misrepresentations about the OMS scope of practice.

On November 17, I wrote to Dr. Maves and the AMA, pointing out the many problems we noted in their publication and expressing our surprise and concern that the AMA would produce a document of this nature that addresses a specialty over which organized medicine has no official responsibility, authority or first-hand knowledge. I further stressed the important role that oral and maxillofacial surgeons serve in health care and the tremendous support we provide to our dental and medical colleagues. I concluded the letter with an invitation to the leadership of the AMA to meet with the AAOMS to discuss our concerns in greater detail. The AMA responded to this invitation in January, and expressed interest in a face-to-face meeting. We are presently working with the AMA to arrange the meeting.

Meanwhile, AAOMS continues to review available information about the AMA Scope of Practice Data Series. Oral and maxillofacial surgery is one of 10 healthcare professions and specialties addressed by the American Medical Association's Scope of Practice Partnership (SOPP) project. The other health professionals included in the AMA's review are audiologists, naturopaths, nurse anesthetists, nurse practitioners, optometrists, pharmacists, physical therapists, podiatrists and psychologists.

We will carefully consider our next steps. I can assure you the AAOMS views this document and the purported purposes for its use very seriously, and we are prepared to take whatever additional actions are deemed appropriate. We will keep you informed as we move forward, and I thank you for your continued support of the AAOMS.

Sincerely,

Ira D. Cheifetz, DMD
President, AAOMS

Yeah - I spoke with a few of our attendings (both single- and double-degree) about this. They had read the report (I have not). Here's what they said...

1. The report was apparently generated by some disgruntled folks in anesthesia, ENT/head and neck oncology and plastics who are claiming (with no evidence whatsoever) that OMFS are practicing dangerous medicine and "encroaching" on medical specialties. The document is apparently very poorly researched and contains assertions with no supporting evidence of any significant quality.

2. The section on anesthesia is, in particular, quite appaling because there is significant evidence to suggest the OMFS anesthesia practice is quite safe.

3. Given that the AMA is generally toothless and has absolutely zero jurisdiction over a dental specialty whose scope of practice is governed by the state's dental practice act, the report will likely be of little actual consequence. However, I agree that this should be a warning to those complacent OMFS who are shirking hospital call and larger cases.

This is nothing new -the AMA and state medical associations have been trying to limit the scope of practice for single-degree OMS for decades. If one wants to see how successful they have been, you only need to look at what most OMFS can do in practically every state (i.e. full-scope). The AMA has also been battling nurse anesthetists for years - they don't seem to be suffering either.

 

[ChillinVillain]

I was expecting a letter from AAOMS to AMA expressing concerns over medical graduates entering OMFS residencies, and obtaining their DDS in 2 years (Harvard); keeping in mind that it is only their DDS that makes them qualified to practice OMFS. We get the MD in 2-4 years, and don't even need it. At any rate, the medical community has been playing political calisthenics with OMFS specialty for a while now and this new stunt only serves as a wake up call, like DREDAY said.

 

[DREDAY]

Sounds like they are going hard. This is from the AMA website.

Scope Of Practice

Some non-physician health care provider groups have become increasingly aggressive in efforts to expand their scopes of practice to include treatments, procedures, and authority inconsistent with their education and training. These providers seek to expand their scopes of practice through legislative, regulatory, and administrative means. Scope of practice debates have serious implications for patient care. If scope of practice expansions are inconsistent with the education and training a provider group receives, or are not coupled with safeguards, such as practice protocol arrangements with a physician who provides oversight of the care provided, the safety and quality of health care delivered to patients is compromised.

Numerous bills expanding the scope of practice for nonphysician providers are introduced each legislative session in state houses across the country. Nonphysician provider groups also frequently circumvent the legislative process by expanding their scopes of practice via the rulemaking authority of their state regulatory boards. Commonly seen scope of practice expansions include independent prescriptive authority, independent practice, diagnostic and/or surgical authority, and other care privileges for which a nonphysician provider may not be educated or trained to safely and effectively provide.

As nonphysician provider groups seek to expand the care they deliver into the traditional practice of medicine, patients may become confused as to the credentials of their health care providers. Many nonphysician provider groups now advocate a "clinical doctorate" degree as the minimum qualification for entry-level practice, enabling these providers to be called "doctor" in the health care setting. A recent survey demonstrated such confusion among patients as to the qualifications of their health care providers.

Advocacy tools and resources related to nonphysician scope of practice issues are listed below.

For further information, please contact the following ARC staff: Daniel Blaney-Koen, Legislative Attorney at (312) 464-4126.

Scope of Practice Partnership
The SOPP was formed to focus organized medicine's resources when disputing expansions by non-physicinan practitioners that threaten the health and saftey of patients.

AMA Geo Mapping Initiative: Where are healthcare providers practicing in your state?
This interactive advocacy tool provides visual documentation of the practice locations of all MDs and DOs for any given state.

State-based Scope of Practice coalitions
This interactive advocacy tool provides a visual documentation of states that have created formal cross-specialty scope of practice coalitions. As you consider creating your own state-based coalition, please link to any of the states and access the core documents related to each states' respective coalitions. Scope of Practice Partnership core documents are available, as well.

State-based Scope of Practice review committees
How to create a state-level scope of practice review committee that assesses scope of practice initiatives prior to their introduction at the legislative or regulatory rule-making level.

Truth in Advertising
The Truth in Advertising campaign will be launched in 2010 to highlight the qualifications of non-physician providers and provide medical societies with resources to help enact Truth in Adverting legislation.

 

[joefosho315]

What is the implication of such news on non-MD oral surgeons vs. MD oral surgeons? Does the AMA recognize MD oral surgeons as physicians, and thus is trying to limit the scope of just the DDS/DMD oral surgeons? Or does this news apply to all oral surgeons regardless of training? Interesting news for sure.

 

[FTW OMFS]

Does the AMA recognize MD oral surgeons as physicians...

I get about 3 mailers a week asking me to join/give $ so, yes, I think they recognize my degree when it's convenient.

I will NEVER EVER join the AMA. Those *******s wonder why their membership is so low. They are mostly a group of primary care docs who don't make money anyway so they don't care if medicine is socialized.

I am considering joining the Association of American Physicians and Surgeons. I've been trying to read everything on their website, slowly, before I join just to be sure there's nothing too crazy. I want a medical group that represents me and it's not the AMA asshats.

I second the opinion we should do more than tooth and titanium. I'm in private practice and still make plenty of time to go to the OR.

 

[DREDAY]

I am not sure someone please correct me if I am wrong, but I am under the impression that when you get your MD you have all the same rights and and privileges of all MDs. Therefore, I don't think it would be legal for them to limit a dual degree's scope. What I think they are trying to do is put all health field professions under the AMA jurisdiction so that the AMA can dictate each field's scope of practice. I think its similar to the battle dentists have with dental hygienist where dentists try to limit the hygienist's scope of practice.

What is the implication of such news on non-MD oral surgeons vs. MD oral surgeons? Does the AMA recognize MD oral surgeons as physicians, and thus is trying to limit the scope of just the DDS/DMD oral surgeons? Or does this news apply to all oral surgeons regardless of training? Interesting news for sure.

 

[Yahtzee]

What is the implication of such news on non-MD oral surgeons vs. MD oral surgeons? Does the AMA recognize MD oral surgeons as physicians, and thus is trying to limit the scope of just the DDS/DMD oral surgeons? Or does this news apply to all oral surgeons regardless of training? Interesting news for sure.

There is no implication about it as far as the AMA is concerned. In the introductory section they come right out and say that the focus of the document is single degree OMS and not those with a medical degree. As far as any practical or legal implications go, I see absolutely none at this point other than the AMA's political maneuvering.

 

[servitup]

This post explains one reason why getting an MD is worthwhile. Political insulation from the argument being made. Is it right? No. Is it fair? No. Is it a REAL threat? Absolutely.

Again, just one of MANY reasons to pursue a 6 year program.

 

[OMS MaVen]

Here is a copy of the report for those interested...

 

[280040]

Here is a copy of the report for those interested...

Ha, that's it?? Hope they didn't waste too much money on it..... They could have done a better job upselling the ENT and PRS section for sure! What is their accreditation standards for esthetic cases by the way? They attacked OMS accred standards. I couldn't find ENT and PRS ACGME standards like the CODA ones during a 10 second google search.

Glad I'm heading into a dual degree program but I still believe it's the residency that trains the OMS, not the medical degree.

And why no mention of issues with trauma, pathology, head and neck cancer, orthognathics......all MAJOR surgeries with MAJOR positive and negative potential outcomes. Cuz that doesn't pay $$$$$....and thus no turf war.

But hey....oral surgeons get all upset when periodontists take out 3rd molars, so there!

 

[armorshell]

Some fun quotes from the article

Oral surgeons total post graduate residency experience is less than a medical student earns before obtaining their MD

4 year program, only 18 months medical/surgical rotations
30 months clinical oral health

 

[armorshell]

Also of concern is the fact that these standards provide only a maximum of 6 months of general surgery experience;4 months if the OMS trainee does not opt for 2 additional months of general surgery training

Interesting, nice to know I'll have an extra 6 months on "Clinical oral health" my 4th year.

 

[armorshell]

What is the implication of such news on non-MD oral surgeons vs. MD oral surgeons? Does the AMA recognize MD oral surgeons as physicians, and thus is trying to limit the scope of just the DDS/DMD oral surgeons? Or does this news apply to all oral surgeons regardless of training? Interesting news for sure.

Here's the quote from the article:

While all oral surgeons attend dental school, some additionally pursue a medical degree. In fact, a significant proportion of accredited training programs in oral and maxillofacial surgery require their trainees to attend medical school after graduating from dental school. This module focuses on those oral surgeons who do not pursue the medical degree

Funny, because the focus of the article seems to be that to be an accredited OMFS you need 10 cosmetic procedures during residency, but somehow that's made up for by going to medical school?

 

[CanuckDDS]

This is an f'n joke. The AMA should be ashamed to put out this smut. What a disgrace. I'm gonna start treating burns and hands just out of spite now...f'n losers.

 

[armorshell]

This is an f'n joke. The AMA should be ashamed to put out this smut. What a disgrace. I'm gonna start treating burns and hands just out of spite now...f'n losers.

Personally, I think it's very reassuring to know that the best foot they could put forward is simply laughable.

 

[Bifid Uvula]

I can't believe they totally forgot to give us credit for some other fundamental dental school classes like...

Tooth whitening 101...
Evidence based dentistry, flavored gloves vs regular gloves...
Sharp pokey things u can stick in the mouth 101 and 102...

And yet I have to go work with a bunch of ***** MD's that recently consulted our service INSISTENT that there was some sort of abnormal Nasal/Oral communication because their NG/Dobhoff tube keeps coming out through the mouth! The consult read "Evaluate for hole from nose to mouth, dobhoff keeps coming out of mouth."

My report read... "The area of concern was determined to be an anatomically normal naso-pharynx. Please cancel pending facial CT Scan. Should you require assistance in placing the NG tube please re-consult OMFS."

 

[Truedat]

I can't believe they totally forgot to give us credit for some other fundamental dental school classes like...

Tooth whitening 101...
Evidence based dentistry, flavored gloves vs regular gloves...
Sharp pokey things u can stick in the mouth 101 and 102...

And yet I have to go work with a bunch of ***** MD's that recently consulted our service INSISTENT that there was some sort of abnormal Nasal/Oral communication because their NG/Dobhoff tube keeps coming out through the mouth! The consult read "Evaluate for hole from nose to mouth, dobhoff keeps coming out of mouth."

My report read... "The area of concern was determined to be an anatomically normal naso-pharynx. Please cancel pending facial CT Scan. Should you require assistance in placing the NG tube please re-consult OMFS."

That is great!!! I almost pissed my pants from laughing so hard.

 

[DrTacoElf]

This whole report is a joke. It’s a futile attempt to have legislatures use this document to make decisions regarding scope of practice. First they will come for single degree OMS guys and then dual degree. Its very evident that this is their intention especially when one closely looks at the language towards the end of the document. It basically says that OMS training on a whole isn't equivalent to plastics or ENT regardless of single or dual degree. I will never join the AMA or AMSA now and will actively campaign against them at each and every opportunity throughout my career.

 

[schmack]

Can we proposition the ADA to come out with a statement against PRS & ENT to limit their scope of practice to anything that does not involve the teeth? That means no trauma to either jaw, no jaw whacks/reconstruction, and definitely no orthognathic surgery. After all, moving a patient's mandible and maxilla does nothing for their cosmetic appearance, right? Come on...IMO orthognathics is really the ultimate plastic surgery, and way more life changing than tit-jobs or facelifts.

 

[DrTacoElf]

I totally agree that anything which has the potential to alter occlusion should be fully off limits to anyone but OMFS as plastics and ENT have not had formal training in these areas. Such training can only be obtained by 3rd and 4th years of dental school.

 

[shabu2]

The report was pretty good. I am going to keep it in my bathroom for reading material, and just in case I run out of TP, wipe my ***** with it.

 

[ChillinVillain]

I just like how plastic surgery clinic director at Stanford is an OMFS.

 

[rlee99p]

Thanks for posting this Dreday.

 

[280040]

Does anyone believe that the mere existence of dual degree options and resulting surgeons undermines the fact that single degree OMS are capable of the same procedures? Do you think the MD provides credibility to the profession or sheds negative light on those who are single degree pursuing procedures traditionally done by physicians? Those are just 2 of my thoughts when I was interviewing a couple months ago.

 

[DREDAY]

If there have been previous attempts by the AMA to limit our scope, why hasn't AAOMS done more to teach dental colleagues, medical colleagues, and the public about our scope???? What is most appalling to me is that most dentists have no idea about the full scope of OMFS. I think AAOMS should hire a marketing company to really drive home what our scope entails. The fact that no one knows what we do is no one's fault but our own.

 

[Xigris14]

We are at fault in a slight way for this AMA crap. We dont have a big presence as Plastics/ENt have in the hospital setting and community. You average oral surgeon is described below:

1) Lots of us leave residency and go into private practice to only do extractions, implants, bone grafts, etc.. Occasional cyst or TMJ case. MAYBE a frenectomy or expose/bond, wow..Dont know if I have enough time.
Therefore no presence in the Hospital doing big cases. All the nurses and docs and AMA people, then see a oral surgeon doing face lifts or craniofacial stuff and say ...Wait a second...You dont do these cases and should not be doing these cases this is for Plastics and ENT, or SURGEONS WITH A M.D. Now I have my MD, but I am not trying to offend those who do not go the 6 year route. These people don't realize that doing psych and obgyn rotations does not make you a better surgeon as it pertains to the scope of our speciality.

2) We stoped taking call trauma call because it pays crap and most of those patients are thugs that are litigation nightmares. Why do a mandible in the middle of the night for pennies on the dollars. Does not make sense. The lack of reimbursement and litigation has caused this problem.

3) Also surgeons have refrained from big cases because medical insurance sucks as it pertains to reimbursement. I make more taking out three simple teeth under local then I do doing a bilateral arthroscopic surgery in the OR. ???See the problem. How about that Lefort 1 orth/surg Aetna Reimbursement...Couple Hundred Bucks. ???Work up, films, models, splints, OR time, rounding post op if needed, follow up, and liability. No sense!!!

So in conclusion we are at fault in a way but not completly, and I agree that AAOMS needs to market the hell out of our speciality. These people need to know what our scope is and not allow the ignorance of the AMA to prevail.

 

[EuroOMFS]

I particularly like the section where they try to make the reader believe OMS training is insufficient in critical areas, because of faulty CODA standards:

"While these CODA standards provide detailed requirements for the structure of the OMS training program, they fail to establish specific requirements in certain critical areas. The standards do not establish a minimal requirement of cases to perform for outpatient OMS procedures. Similarly, while the emergency care standard specifies that the OMS student must assume major responsibilty for the care of oral and maxillofacial injuries, it does not eastablish a minimum number of cases or minimum length of rotation."

I like it because when they tell us how great a training ENTs get during their recidency they do so by quoting the ACGME Program Requirements for Graduate Medical Education in Otolaryingology, where it says that:

"Otolaryngology residents should perform a sufficient number and variety of surgical procedures to ensure education in the entire scope of the specialty. There must be adequate distribution and sufficient complexity of cases within the principal categories of the specialty."

And this is of course very specific and not ambiguous at all.

 

[rlee99p]

This is nothing new -the AMA and state medical associations have been trying to limit the scope of practice for single-degree OMS for decades. If one wants to see how successful they have been, you only need to look at what most OMFS can do in practically every state (i.e. full-scope). The AMA has also been battling nurse anesthetists for years - they don't seem to be suffering either.

Can you cite the AMA's previous attempts to limit the scope of OMFS? Just asking out of curiosity.

 

[6897round2]

Can you cite the AMA's previous attempts to limit the scope of OMFS? Just asking out of curiosity.

Plastic surgeons/ENT, often via the AMA, have tried to limit the scope of OMFS. Follow the timeline closely and you'll see a somewhat ridiculous pattern of inconsistency:

1960s-1970s: Plastic surgeons make the argument that Oral Surgeons should not do orthognathic surgery/facial trauma because it is too complicated for them and that they don't understand occlusion as well as the PRS folks (granted many PRS at the time were DDS and MD, but this is still silly). Of note, orthognathic/trauma procedures paid mucho $$$$ back then. Some hospitals, bending to this pressure, would not allow non-MD OMFS to admit to hospitals. This was part of the reason for the rise of the 6-year MD/OMFS programs during this time period.

1980s: As cosmetic surgery began to come into the vogue, including cosmetic orthognathic surgery, PRS and ENT again made the argument that OMFS shouldn't do orthognathics and that this should be done by PRS/ENT folks. Some ENT folks claimed at this time that OMFS shouldn't do TMJ procedures as well. Orthognathics still paying big bucks, as does trauma.

1990s: Insurers start reducing the payments for orthognathic surgery and facial trauma recons. All of the sudden, no arguments from PRS and ENT about OMFS doing orthognathic/mandibular/midfacial/orbital trauma surgery. I use this as an argument any time a PRS/ENT person suggests that OMFS doing cosmetic surgery is a "blatant money grab" (despite the fact that you could make more doing T+T, with much less stress). History suggests that PRS/ENT have tried to prevent OMFS from doing orthognathics only when it was a paying procedure and didn't care once the reimbursement sucked...

1990s-2000s: The last remaining bastion of fee-for-service surgery becomes a grisly battle...As OMFS programs incorporate more head and neck surgery and facial cosmetics surgery, more graduates start including these procedures in their daily practices. As medical reimbursements fall through the floor, OMFS still doing well with implants, office sedations and thirds, don't need to be affiliated with a hospital, aren't taking as much trauma call, etc. PRS/ENT mainly have cosmetics as a fee-for-service practice and are upset that "the dentists" are "stealing" their procedures. You'll notice that there is little to no argument being made that OMFS can't do facial reconstruction after trauma or orthognathic surgery, both of which require many of the same skill sets as cosmetic surgery and can be, in their own right, exceedingly challenging and complicated with respect to patient management.

Like I said before, this will likely be of minimal consequence. In the community where I practice, everyone seems to get along quite well. That being said, I'm happy to have spent the time in medical school.

 

[joefosho315]

Plastic surgeons/ENT, often via the AMA, have tried to limit the scope of OMFS. Follow the timeline closely and you'll see a somewhat ridiculous pattern of inconsistency:

1960s-1970s: Plastic surgeons make the argument that Oral Surgeons should not do orthognathic surgery/facial trauma because it is too complicated for them and that they don't understand occlusion as well as the PRS folks (granted many PRS at the time were DDS and MD, but this is still silly). Of note, orthognathic/trauma procedures paid mucho $$$$ back then. Some hospitals, bending to this pressure, would not allow non-MD OMFS to admit to hospitals. This was part of the reason for the rise of the 6-year MD/OMFS programs during this time period.

1980s: As cosmetic surgery began to come into the vogue, including cosmetic orthognathic surgery, PRS and ENT again made the argument that OMFS shouldn't do orthognathics and that this should be done by PRS/ENT folks. Some ENT folks claimed at this time that OMFS shouldn't do TMJ procedures as well. Orthognathics still paying big bucks, as does trauma.

1990s: Insurers start reducing the payments for orthognathic surgery and facial trauma recons. All of the sudden, no arguments from PRS and ENT about OMFS doing orthognathic/mandibular/midfacial/orbital trauma surgery. I use this as an argument any time a PRS/ENT person suggests that OMFS doing cosmetic surgery is a "blatant money grab" (despite the fact that you could make more doing T+T, with much less stress). History suggests that PRS/ENT have tried to prevent OMFS from doing orthognathics only when it was a paying procedure and didn't care once the reimbursement sucked...

1990s-2000s: The last remaining bastion of fee-for-service surgery becomes a grisly battle...As OMFS programs incorporate more head and neck surgery and facial cosmetics surgery, more graduates start including these procedures in their daily practices. As medical reimbursements fall through the floor, OMFS still doing well with implants, office sedations and thirds, don't need to be affiliated with a hospital, aren't taking as much trauma call, etc. PRS/ENT mainly have cosmetics as a fee-for-service practice and are upset that "the dentists" are "stealing" their procedures. You'll notice that there is little to no argument being made that OMFS can't do facial reconstruction after trauma or orthognathic surgery, both of which require many of the same skill sets as cosmetic surgery and can be, in their own right, exceedingly challenging and complicated with respect to patient management.

Like I said before, this will likely be of minimal consequence. In the community where I practice, everyone seems to get along quite well. That being said, I'm happy to have spent the time in medical school.

Wow, thank you for the extremely informative response. May I ask where you were able to obtain such details on the history of oral surgery? It certainly is something important to consider when dealing with such arguments from the medical community.

 

[Xigris14]

you are correct and described it well:

Plastics/ENT are discovering more and more what we are capable of doing surgically as our scope increases. The days of not incorporating cosmetcs/oncology/craniofacial are over and this is now a part of our scope. They need to deal with it and stop using the AMA to limit our surgical ability.
Where I practice, the craniofacial team is all plastics. No oral surgeons. The plastic surgeons do primary, secondary repair, bone grafting, and all ortho surg. They dont want a oral surgeon unless there are teeth that need to be removed. I asked the orthodontist how the outcomes were, and he says not well. He told me they get lots of relapse and occlusion problems. No joke. They should not be doing orth surg unless properly trained and the same goes for us doing cosmetics. The only difference is that we are properly trained for cosmetics while I dont know too many plastic residencies doing ortho surg.
You are also seeing no trauam battle mainly because the plastics/ent want to get paid. Most of trauma is medicaid or no insurance. Why fight for that. Now that ortho surg makes no money unless you dont take insurance and quote your own price, plastic surgeons dont want any part of it.
As we cross boundaries of surgical specialities this problem will always be around. My response.... The AMA can suck it.

 

[bobby6]

If you look over the pond in the UK, the scope of OMFS is very broad with significant amount of head & neck oncology and microvascular surgery.

However, it is interesting to note that in the UK, OMFS is a medical specialty not dental and requires both a dental and medical degrees before beginning training. Oral surgery and oral & maxillofacial surgery are separate specialties in the UK, one under dental specialties, and other under medical specialties.

If anything, having only one pathway into OMFS and requiring an M.D. would help the specialty in terms of scope of practice.

you are correct and described it well:

Plastics/ENT are discovering more and more what we are capable of doing surgically as our scope increases. The days of not incorporating cosmetcs/oncology/craniofacial are over and this is now a part of our scope. They need to deal with it and stop using the AMA to limit our surgical ability.
Where I practice, the craniofacial team is all plastics. No oral surgeons. The plastic surgeons do primary, secondary repair, bone grafting, and all ortho surg. They dont want a oral surgeon unless there are teeth that need to be removed. I asked the orthodontist how the outcomes were, and he says not well. He told me they get lots of relapse and occlusion problems. No joke. They should not be doing orth surg unless properly trained and the same goes for us doing cosmetics. The only difference is that we are properly trained for cosmetics while I dont know too many plastic residencies doing ortho surg.
You are also seeing no trauam battle mainly because the plastics/ent want to get paid. Most of trauma is medicaid or no insurance. Why fight for that. Now that ortho surg makes no money unless you dont take insurance and quote your own price, plastic surgeons dont want any part of it.
As we cross boundaries of surgical specialities this problem will always be around. My response.... The AMA can suck it.

 

[CanuckDDS]

you are correct and described it well:

Plastics/ENT are discovering more and more what we are capable of doing surgically as our scope increases. The days of not incorporating cosmetcs/oncology/craniofacial are over and this is now a part of our scope. They need to deal with it and stop using the AMA to limit our surgical ability.
Where I practice, the craniofacial team is all plastics. No oral surgeons. The plastic surgeons do primary, secondary repair, bone grafting, and all ortho surg. They dont want a oral surgeon unless there are teeth that need to be removed. I asked the orthodontist how the outcomes were, and he says not well. He told me they get lots of relapse and occlusion problems. No joke. They should not be doing orth surg unless properly trained and the same goes for us doing cosmetics. The only difference is that we are properly trained for cosmetics while I dont know too many plastic residencies doing ortho surg.
You are also seeing no trauam battle mainly because the plastics/ent want to get paid. Most of trauma is medicaid or no insurance. Why fight for that. Now that ortho surg makes no money unless you dont take insurance and quote your own price, plastic surgeons dont want any part of it.
As we cross boundaries of surgical specialities this problem will always be around. My response.... The AMA can suck it.

I bet they do it well too...🙄

 

[EuroOMFS]

If you look over the pond in the UK, the scope of OMFS is very broad with significant amount of head & neck oncology and microvascular surgery.

However, it is interesting to note that in the UK, OMFS is a medical specialty not dental and requires both a dental and medical degrees before beginning training. Oral surgery and oral & maxillofacial surgery are separate specialties in the UK, one under dental specialties, and other under medical specialties.

If anything, having only one pathway into OMFS and requiring an M.D. would help the specialty in terms of scope of practice.

Knowing a little bit about OMFS in Europe I can tell you that many, if not most, oral and maxilliofacial surgeons in countries like Germany and UK consider themselves medical doctors rather then dentists. In these countries, OMS is a medical speciality. There are usually strong ties to dentistry and dental schools and most countries in Europe require some kind of formal training in dentistry before entering OMS recidency, but, OMS is a medical speciality.

And because OMS is a medical speciality no one doubts that OMSs are fully able to do whatever they want. Be it ablative surgery, microvascular surgery, trauma reconstuction, orthognathic surgery etc. No one questions their ability. Which is why they´re doing all this fun cool stuff.

However, OMS in Europe has moved somewhat away from it´s dental roots. As an example the EAMS (European Assiciation of Medical Specialties) is figthing to keep formal dental training as a required part of OMS training. And in Spain, Portugal and Greece, OMSs don´t need any dental training at all.

I think what you have the US is quite worth holding onto, ie. OMS being a dental specialty with an MD option. In the end it´s a political question whether to go all the way with MD being required or to keep things as they are. Whatever you do, it´s very important not to forget that OMS has its roots in dentistry and that OMS should be a dental specialty. Any ENT/PRS do othognathics and trauma reconstruction, but what makes us so eminently better at it, is our dental training.

Documents like this piece of toiletpaper from the AMA are first and foremost political documents, made to invoke fear in the OMS community, and to push for an obligatory MD for OMSs.

 

[DREDAY]

Does anyone know when the meeting with the AMA will take place? Also does anyone know if a ROAAOMS representative will attend the meeting? What about a 6year md omfs? The entire aaoms board consists of 4 year omfs. It would be good to have at least one 6 year guy on board so that the aaoms as a whole is more acurately represented.

 

[GTFOOMICT]

Anyone hear anything new about this?

 

[servitup]

The meeting took place a couple of months ago. Rumor has it the meeting did not go well and things were not resolved amicably (which is not surprising). For what it's worth, most physicians are not in the AMA.

 

[flapaTron]

The meeting took place a couple of months ago. Rumor has it the meeting did not go well and things were not resolved amicably (which is not surprising). For what it's worth, most physicians are not in the AMA.

no kidding? well, maybe the AMA will publish another fun read in another month or so 🙄

 

[LeFortsBeWithU]

Evidently, the meeting between AAOMS and the AMA was relatively purposeless. The AMA did not believe that the SOP document was available to the public. The AAOMS board opened up their laptops and googled it. Sure enough, each of the SOP documents came right up. When asked for a response, the AMA board president said "I only have 4 months left in my term, so I have no response." Seriously. And, for historical perspective, this is similar to a scope of practice attack in the 80's by the AMA, which we took to the FTC, and they sided with AAOMS. Looks like we have a precedent in our favor.

 

[GTFOOMICT]

AMA House to consider Resolution 217 to retract Data Series on OMS

On February 22, April 5, and May 19, 2010, AAOMS alerted you to the AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons, a publication prepared by the American Medical Association that questions the education, training, skills and competence of oral and maxillofacial surgeons and the validity of the specialty's scope of practice. As we have told you, AAOMS has met with the AMA in an attempt to amicably have the document retracted. At the AAOMS Annual Meeting last month, our House of Delegates approved funds for use in responding to the AMA publication and authorized the Board of Trustees to use these funds should a referral to the Federal Trade Commission be deemed appropriate. In a new development, the American Academy of Cosmetic Surgery has promulgated a resolution for consideration by the AMA House of Delegates at the AMA Interim Meeting this weekend in San Diego. Resolution 217 resolves that "the AMA House of Delegates direct the immediate retraction of the AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons." As always, we will keep you advised of the developments concerning this important issue.

 

[DREDAY]

Looks like someone in the AMA is on our side.


Introduced by: American Academy of Cosmetic Surgery

Subject: Retract the AMA Scope of Practice Data Series: Oral and Maxillofacial
Surgeons

Referred to: Reference Committee B
(Alethia E. Morgan, MD, Chair)


Whereas, In November 2005, the AMA House of Delegates approved Resolution 814, which
called for the study, qualifications, education, academic requirements, licensure, certification,
independent governance, ethical standards, disciplinary processes, and peer review of non-
physician healthcare providers; and

Whereas, By surveying the type and frequency of bills introduced in state legislatures, and in
consultation with state medical associations and national medical specialty societies, the AMA
identified 10 distinct non-physician professions currently seeking scope of practice expansions
that AMA interpreted as potentially harmful to the public; and

Whereas, The AMA Advocacy Resource Center published an information module on oral and
maxillofacial surgeons entitled: AMA Scope of Practice Data Series: Oral and Maxillofacial
Surgeons ("OMS Scope Document") in September 2009; and

Whereas, The American Academy of Cosmetic Surgery (AACS) was informed that no oral
maxillofacial surgeon participated in researching or drafting the OMS Scope Document, and that
the AMA did not consult with the American Association of Oral and Maxillofacial Surgeons
(AAOMS) in creating the OMS Scope Document. It would be prudent, diligent, and seemingly
necessary to consult with AAOMS and/or the American Board of Oral and Maxillofacial Surgery
(ABOMS) to obtain information about a board certified oral and maxillofacial surgeon's
education, training, and experience regarding cosmetic surgery. For example, AACS is
informed that facial cosmetic surgery is among the core curriculum in oral and maxillofacial
surgery residency programs, and is tested on both the written and oral examinations for board
certification by the ABOMS; and

Whereas, Although the OMS Scope Document involves cosmetic surgery and the education,
training, and experience that underlies cosmetic surgery procedures, the AMA did not consult
with AACS regarding AMA's research, investigation, and preparation of the OMS Scope
Document. Had the AMA consulted AACS, AACS would have provided the AMA with
documentation evidencing, among other things, that: (i) the OMS Scope Document contains
incomplete and incorrect information regarding cosmetic surgery and those who are qualified to
perform it; and (ii) patient safety is jeopardized by restricting the practice of cosmetic surgery
based on one's underlying certification; and

Whereas, Cosmetic surgery is a specialty that has been, and continues to be, developed by
physicians from various specialties. The multiple procedures encompassing cosmetic surgery
are primarily learned through post-residency education and training. Whether one is qualified to
perform cosmetic surgery depends on his/her education, training, experience, and proven
competence; not his/her underlying board or societal affiliation; and Resolution: 217 (I-10)
Page 2 of 3

Whereas, AMA's policy on "Board Certification and Discrimination" specifically opposes
discrimination against physicians based solely on lack of ABMS or equivalent American
Osteopathic Board certification (AMA Policies H-275.944 and H-275.950); and

Whereas, Any attempt to define competency in cosmetic surgery based on the presence of a
board certification or membership in a specific specialty society and/or prohibition of the practice
of cosmetic surgery by oral and maxillofacial surgeons improperly reduces patient choice and
jeopardizes patient safety. In doing so, the OMS Scope Document is at odds with patient
safety; thus, inconsistent with an overarching goal of the AMA and its members; and

Whereas, The OMS Scope Document improperly influences public and private sector entities
responsible for making decisions that directly affect physician practice, payment for physician
services, and access to and delivery of medical care; and

Whereas, Many AMA members are oral and maxillofacial surgeons. By publishing the OMS
Scope Document, the AMA ignored the interests of these members, and harmed many of them.
Many of these members will likely discontinue their AMA membership if the OMS Scope
Document is not retracted; and

Whereas, AACS was informed the AMA and the AAOMS have engaged legal counsel to
represent them concerning the content, distribution, further dissemination, and utilization of the
OMS Scope Document. Unless the OMS Scope Document is retracted, this matter is likely to
result in litigation. Based on the fact that the OMS Scope Document proffers incomplete and
incorrect information, and jeopardizes patient safety, there can be no rational basis for the AMA
to incur the expenses associated with its continued promotion, where those funds could be
utilized on matters that will benefit AMA members and their patients, not harm them; therefore
be it

RESOLVED, That our American Medical Association House of Delegates direct the immediate
retraction of the AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons, including
any current and/or pending revised version thereof. (Directive to Take Action)

 

[servitup]

very nice. thanks for posting.

 

[GTFOOMICT]

Wow. I thought we were just at the point of requesting redaction of the material. Didn't realize it is already past that point.

Makes the AMA look really weak and non-cohesive.

However, this is not a small deal. I believe it's a big deal. If you look closely at public documents where a dental and/or medical board was involved in investigating an OMS related cosmetic procedure, credentialing, law suit, etc, the AMA scope of practice series is listed under the 'external documents' section of the cases. So it was used in all likelihood against the OMS practitioner.

Where do I send my check to AAOMS for being bad ass and sticking up for our future? They also need to start saving up for 2030 when the ASNS (american society of nurse surgeons of course) tries to limit our scope.

 

[GTFOOMICT]

On a side note, how does the AACS have any official pull within AMA?

It is not one of the official core specialty boards.

 

[armorshell]

On a side note, how does the AACS have any official pull within AMA?

It is not one of the official core specialty boards.

Yeah but the overwhelming majority of their members are MD's and they're a special interest group within the AMA.

For them, I don't think this is an issue about OMFS, it's an issue about actual training being more important than a certain specialty membership or board certification in regards to being able to competently perform cosmetic surgery. They repeated as much several times in their measure.

The overwhelming majority of AACS members are NOT PRS, so this is a platform to get their issues out to the AMA.

 

[GTFOOMICT]

Yeah but the overwhelming majority of their members are MD's and they're a special interest group within the AMA.

For them, I don't think this is an issue about OMFS, it's an issue about actual training being more important than a certain specialty membership or board certification in regards to being able to competently perform cosmetic surgery. They repeated as much several times in their measure.

The overwhelming majority of AACS members are NOT PRS, so this is a platform to get their issues out to the AMA.

http://www.ama-assn.org/ama/pub/abo...ates/the-delegates/member-organizations.shtml

Here is their official ticket in to the AMA vote. So although not an official board, they do have a voice and are listed the same.

I wonder if AAOMS has anything to gain from a direct voice in the AMA. It appears that your power is linked to the number of members in the AMA though. So that would be terrible to pay dues to them. I'd think those dues would be better spent going straight to AAOMS and other OMS societies and powers. Although every society gets 1 seat regardless of their number of members. As an example, the PRS only have 2 seats. Family Physicians have the most.

 

[joefosho315]

Looks like someone in the AMA is on our side.


Introduced by: American Academy of Cosmetic Surgery

Subject: Retract the AMA Scope of Practice Data Series: Oral and Maxillofacial
Surgeons

Referred to: Reference Committee B
(Alethia E. Morgan, MD, Chair)


Whereas, In November 2005, the AMA House of Delegates approved Resolution 814, which
called for the study, qualifications, education, academic requirements, licensure, certification,
independent governance, ethical standards, disciplinary processes, and peer review of non-
physician healthcare providers; and

Whereas, By surveying the type and frequency of bills introduced in state legislatures, and in
consultation with state medical associations and national medical specialty societies, the AMA
identified 10 distinct non-physician professions currently seeking scope of practice expansions
that AMA interpreted as potentially harmful to the public; and

Whereas, The AMA Advocacy Resource Center published an information module on oral and
maxillofacial surgeons entitled: AMA Scope of Practice Data Series: Oral and Maxillofacial
Surgeons (“OMS Scope Document”) in September 2009; and

Whereas, The American Academy of Cosmetic Surgery (AACS) was informed that no oral
maxillofacial surgeon participated in researching or drafting the OMS Scope Document, and that
the AMA did not consult with the American Association of Oral and Maxillofacial Surgeons
(AAOMS) in creating the OMS Scope Document. It would be prudent, diligent, and seemingly
necessary to consult with AAOMS and/or the American Board of Oral and Maxillofacial Surgery
(ABOMS) to obtain information about a board certified oral and maxillofacial surgeon’s
education, training, and experience regarding cosmetic surgery. For example, AACS is
informed that facial cosmetic surgery is among the core curriculum in oral and maxillofacial
surgery residency programs, and is tested on both the written and oral examinations for board
certification by the ABOMS; and

Whereas, Although the OMS Scope Document involves cosmetic surgery and the education,
training, and experience that underlies cosmetic surgery procedures, the AMA did not consult
with AACS regarding AMA’s research, investigation, and preparation of the OMS Scope
Document. Had the AMA consulted AACS, AACS would have provided the AMA with
documentation evidencing, among other things, that: (i) the OMS Scope Document contains
incomplete and incorrect information regarding cosmetic surgery and those who are qualified to
perform it; and (ii) patient safety is jeopardized by restricting the practice of cosmetic surgery
based on one’s underlying certification; and

Whereas, Cosmetic surgery is a specialty that has been, and continues to be, developed by
physicians from various specialties. The multiple procedures encompassing cosmetic surgery
are primarily learned through post-residency education and training. Whether one is qualified to
perform cosmetic surgery depends on his/her education, training, experience, and proven
competence; not his/her underlying board or societal affiliation; and Resolution: 217 (I-10)
Page 2 of 3

Whereas, AMA’s policy on “Board Certification and Discrimination” specifically opposes
discrimination against physicians based solely on lack of ABMS or equivalent American
Osteopathic Board certification (AMA Policies H-275.944 and H-275.950); and

Whereas, Any attempt to define competency in cosmetic surgery based on the presence of a
board certification or membership in a specific specialty society and/or prohibition of the practice
of cosmetic surgery by oral and maxillofacial surgeons improperly reduces patient choice and
jeopardizes patient safety. In doing so, the OMS Scope Document is at odds with patient
safety; thus, inconsistent with an overarching goal of the AMA and its members; and

Whereas, The OMS Scope Document improperly influences public and private sector entities
responsible for making decisions that directly affect physician practice, payment for physician
services, and access to and delivery of medical care; and

Whereas, Many AMA members are oral and maxillofacial surgeons. By publishing the OMS
Scope Document, the AMA ignored the interests of these members, and harmed many of them.
Many of these members will likely discontinue their AMA membership if the OMS Scope
Document is not retracted; and

Whereas, AACS was informed the AMA and the AAOMS have engaged legal counsel to
represent them concerning the content, distribution, further dissemination, and utilization of the
OMS Scope Document. Unless the OMS Scope Document is retracted, this matter is likely to
result in litigation. Based on the fact that the OMS Scope Document proffers incomplete and
incorrect information, and jeopardizes patient safety, there can be no rational basis for the AMA
to incur the expenses associated with its continued promotion, where those funds could be
utilized on matters that will benefit AMA members and their patients, not harm them; therefore
be it

RESOLVED, That our American Medical Association House of Delegates direct the immediate
retraction of the AMA Scope of Practice Data Series: Oral and Maxillofacial Surgeons, including
any current and/or pending revised version thereof. (Directive to Take Action)

Sorry for bringing up such an old thread, but does anyone know where I can get this actual document from that DREDAY cited? I'm not talking about the AMA scope of practice data series on OMS, but the AACS's response to the document. Thanks.