Dentist performing facelifts and MD's are pissed

[3rdMolarRoller]

From the NY Times. So that you will not have to register:

A Nip and Tuck With That Crown?
By ALEX KUCZYNSKI

Published: May 16, 2004


Californians concerned that their favorite plastic surgeon might be too busy to see them for a nip or a tuck may one day be able to call upon another professional to minister to their sagging faces and drooping eyelids: their dentist.

Tomorrow, a subcommittee of the California State Legislature is expected to approve Senate Bill 1336, which if enacted would make it legal for dentists with training in oral surgery to perform cosmetic surgery on the face.

Plastic surgeons are, of course, apoplectic.

"The whole thing is so audacious that I have trouble controlling myself," said Dr. Harvey A. Zarem, the president of the California Society of Plastic Surgeons (and occasional guest surgeon on "Extreme Makeover" on ABC). "That anyone would even pretend to want to do this is just, just, just, I mean, it's offensive, incredible. Did I say absolutely audacious?"

Tomorrow's expected approval does not mean the bill is law; it simply moves it one step closer to Gov. Arnold Schwarzenegger's desk for possible approval later this year. But it comes at a time when plastic surgeons are in a ferocious turf battle, fighting off any number of would-be competitors for coveted patients.

As the population ages and more Americans seek out cosmetic surgery, doctors of every stripe ? dermatologists, gastroenterologists, gynecologists ? are cashing in and performing cosmetic surgery. There are about 6,600 plastic surgeons certified by the American Board of Plastic Surgery; most estimates suggest that there are three to four times that number of practitioners performing cosmetic surgery without board certification. In the United States, anyone with an M.D. degree and some surgical training can hang out a shingle and announce that they are open for business as a cosmetic surgeon.

This, the plastic surgeons have to deal with. But they say they cannot deal with the idea that dentists ? well trained perhaps, but without medical degrees ? could perform cosmetic plastic surgery.

Dr. Jack G. Bruner, a former president of the California Society of Plastic Surgeons, made a comparison to the legal profession.

"It's like a paralegal saying, O.K., I've been watching how you do this, and I think I will take the next case into court," Dr. Bruner said. "And win."

The dentists seeking the new privileges are oral and maxillofacial surgeons, who are traditionally considered expert in repairing fractured jaws, improperly aligned teeth, cleft palates and related abnormalities and trauma. But even though their title includes the word "surgeon," they typically hold dental, not medical, licenses.

Still, the oral surgeons argue that because of their training repairing bones and structures of the jaw and face, they should be allowed to perform the procedures that physicians do, said Dr. P. Thomas Hiser, president of the California Association of Oral and Maxillofacial Surgeons.

"The bottom line is oral and maxillofacial surgeons do work around the head and the neck all the time," Dr. Hiser said. "We are the ones called to the emergency rooms in the middle of the night to handle severe trauma. And we deal with all the complex structures we would be dealing with in daylight hours if we were doing cosmetic procedures."

Dr. Larry J. Moore, an oral surgeon who testified before the California Legislature, said that the heart of the issue is that oral surgeons are treated unfairly, considering their level of training and skill.

"Let's say you are in a horrible accident and half of your face is torn off," Dr. Moore said in an interview. "I can reattach it and then do all the follow-up surgeries to make sure it looks perfect. But I can't do that if you're born with an imperfect face. I can go in and reattach someone's nose in the middle of the night. But if somebody came in and their nose had grown that way, we are prohibited from doing the same thing. That isn't fair."

Another key issue is financial, Dr. Moore said.

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[3rdMolarRoller]

When you operate on a trauma patient in a Class 1 trauma center, maybe the patient has no insurance," Dr. Moore said. "You sometimes don't get paid for it. And when you do get reimbursed for it, it is about 30 percent of your actual fee."

Dr. Jack C. Lewin, a family practitioner who is the chief executive of the California Medical Association, said that the key issue is, indeed, financial.

"We think this particular proposal is all about the money and not about improving health care," Dr. Lewin said. "Look. There are dentists out there who have gone through the full residency training to become plastic surgeons and we support their involvement here. But this becomes an area in which it's too easy to go after noninsurance money. We don't believe it improves quality of care. We believe it would go in the other direction."

Plastic surgeons insist that only they can assure the highest quality of care. Their education includes four years of medical school, in which two years are spent studying diagnosis and management of the entire patient, and seven or eight years of residency ? before they can be board certified.

An oral surgeon, by comparison, has a D.D.S. or a D.M.D. degree, which is conferred after a four-year course of study limited to oral health, followed by another four-year period of study in dental surgery, of which only 18 months are usually spent in surgical rotation. This second four-year period does not lead to a medical degree; it is considered advanced training in dentistry. (The abbreviations D.D.S., or Doctor of Dental Surgery, and D.M.D., Doctor of Medical Dentistry, are essentially synonymous, and do not mean the dentist is an M.D.)

Dr. Steven A. Teitelbaum, a plastic surgeon in Los Angeles, argued that the education of an oral surgeon generally does not include adequate training in all the areas essential to the treatment of a patient undergoing elective surgery.

"The procedures are different," Dr. Teitelbaum said. "When you deal with a broken nose, you deal with bone. When you do a cosmetic rhinoplasty you deal with cartilage. Their bread and butter are wisdom teeth and young trauma patients with broken jaws. But do they know how to deal with IV fluids, EKG's, patients with hypertension, stroke or blood clots? When you're talking about a 66-year-old woman about to go under for a four-hour facelift, you're talking about a patient these doctors don't usually see."

Plastic surgeons say they are frightened that the reputation of their profession ? tarnished recently by deaths related to cosmetic surgery, including that of the novelist Olivia Goldsmith ? may be further sullied, Dr. Teitelbaum said.

"There have been several well-publicized deaths, and the public is demanding higher levels of safety," he said. "By lowering the bar substantially, I am concerned there will be more problems."

Dr. Jonathan S. Jacobs, who is both an oral surgeon and a plastic surgeon in Virginia, said that oral surgery training is inadequate preparation for a doctor who wants to perform cosmetic surgical procedures.

"They are not well trained enough to do the kinds of cosmetic procedures that they say they have expertise in," Dr. Jacobs said. A former acting head of the oral surgery training program at Vanderbilt University Medical Center in Nashville, he added that just because an oral surgeon can move a chin forward, that does not mean he or she can do a facelift.

The current bill, which would need the approval of both houses of the California Legislature and the governor, would not instantly open the floodgates to any oral or maxillofacial surgeon who wants to install cheek implants. Candidates would have to apply for a permit and be approved by a panel of medical experts that would include a plastic surgeon.

More than a dozen states ? including Virginia, West Virginia, Illinois, Ohio, Tennessee and Mississippi ? have in recent years adopted an expanded definition of dentistry put forth by the American Dental Association in 1990. In those states, a nonphysican dental practitioner can interpret the language to permit him or her to perform some cosmetic surgical procedures.

The California legislative initiative is more alarming, plastic surgeons say, because there are many more prospective patients in the California marketplace who could be affected.

But oral surgeons are prepared for a fight. Dr. Hiser, the California Association of Oral and Maxillofacial Surgeons president, said that oral surgeons have always been considered the poor relations of plastic surgeons. And to hear him tell it, they are sick and tired of it.

"They all say, `Oh yeah, oral surgeons are great guys, but all they know how to do is take out teeth and treat lower jaw fractures,' " Dr. Hiser said. "Well, I trained at Georgetown in the early 1970's, and in those days we learned orthognathic surgery. We learned how to separate the upper jaw from the skull and move it around and cut it into small pieces. And we did procedures up inside the nose, and we did zygomatic procedures, and we treated orbital fractures, upper jaw fractures, mandible fractures. We learned to treat all those things. We know our way around the head."

Dr. Rod J. Rohrich, a Dallas plastic surgeon who is the president of the American Society of Plastic Surgeons, said he was prepared for a fight, too. "I am sorry," he said, sounding not sorry at all. "But I would not go to my dentist and ask him for a facelift. Just as I would not expect my dentist to come to me and ask me to pull some teeth."

 

[MacGyver]

This is a money grab, pure and simple. There are plenty of plastic surgeons operating in California, so the usual claim that people cant get healthcare is crap.

If you want to be a plastic surgeon, go to medical school and complete a plastics residency. BTW, I think this should apply to ALL MDs too. OB/gyns and FPs should not be allowed to do plastic surg. ONLY those who have completed a plastic surg residency should be able to do these procedures.

 

[Yah-E]

As a dental student and a future OMFS hopeful, I personally do not believe that OMFS surgeons should perform Plastics U N L E S S they are trained for it, meaning getting the MD degree and do a Plastics residency or fellowship.

For a non-double degree OMFS with no Plastics training to do Plastics, that's crazy! I'm sure they are competent after enough procedures under their belts, but I still think that is crazy!

I know that rhinoplasty, genioplasty and blepharoplasty is in the scope of OMFS practice, but face lifts and other Plastics procedures....I don't know...

I'll be interesting to see how this debate turns out!

 

[redicon1]

it is really uncool thatthe article does not mention that a lot of oral surgery programs aalso lead to an MD and the fact that some schools like UCONN and Harvard have essentially the same didactic coursework for medical and dental classes.

 

[Yah-E]

I'm sure the Plastic Surgeons are well aware of that some of the OMFS surgeons are double degree guys. Just as mentioned in the article by a double degree OMFS who also believe that OMFS residencies do not train the OMFS residents well enough to do Plastics.

Again, we'll have to see how it pans out when the Bill is "fought" out between the OMFS surgeons and the Plastic surgeons. I personally believe the Bill will not go into law. If you're a double degree OMFS surgeons with Plastics residency/fellowship under your belt, then fine, but if your a single degree OMFS, then you need the proper training to do Plastics!

Think of it this way:

OMFS surgeons with no MD and Plastics training wanting to do Plastics to Plastic Surgeons

is just like

Dental Hygenist wanting to open their own offices without a dentist around to Dentists

You should not do what you are not properly trained for, no matter how related the procedures and the scope of practice between the two Professions are!

 

[MacGyver]

it is really uncool thatthe article does not mention that a lot of oral surgery programs aalso lead to an MD and the fact that some schools like UCONN and Harvard have essentially the same didactic coursework for medical and dental classes.

Irrelevant. NOBODY should be doing plastic surgery unless they completed a plastic surg residency. That goes for MDs as well as dentists.

 

[honestpredent]

This is a turf war; plain and simple. Plastic surgeons have been hit hard in the last decade as dermatolgists stole a lot of their procedures, and now family practice physicians can administer botox and many other minor procedures. Can dermatologists perform face lifts? I'll ask someone in the dermatology forum. That would be interesting to know because dermatologists aren't surgeons let alone cosmetic surgeons. I would think an oral maxilofacial surgeon is much more qualified to perform a face lift than a dermatologist?

I agree with the others here. I don't think anyone should be able to perform plastic surgery without getting training in a plastics fellowship. Cartilage and bone are two different things. I think this debate is rather silly because most people won't go to an oral surgeon to have a facelift performed. Oral surgeons have a hard enough time attracting clients who want cosmetic procedures as it is. I think what will happen is that patients seeking "budget" face lifts will have it done by the oral surgeon as opposed to the hot shot plastic surgeon. And I don't mean to rag on my own people but I would be scared to have a face lift performed by an oral surgeon. I think some patients could potentially be harmed by an oral surgeon who gets ambitious and attempts a face lift on some desperate patient. This isn't like learning about orthodontistry in a weekend course. Like Yah-E said, it's not that I think oral surgeons lack the capability to perform a facelift but they should get some extensive training in it before they perform it. I have no problem getting a facelift from an oral surgeon who completed a 2 year fellowship in plastic surgery.

 

[honestpredent]

it is really uncool thatthe article does not mention that a lot of oral surgery programs aalso lead to an MD and the fact that some schools like UCONN and Harvard have essentially the same didactic coursework for medical and dental classes.

Yes, I have heard this argument many times and I agreed with it in the past until a physician made an excellent point. Dentists and Physicians may share the same didactic coursework but only physicians do hospital rotations in every medical field during their 3rd and 4th years and an intern year before training in their specialized field of interest. That is why dentists can't fairly claim they are physicians who specialize in the oral cavity. Even a radiologist that only looks at X-rays still did every medical rotation during his third and fourth years in addition to an internal medicine internship for a year prior to focusing only on radiology.

 

[ecdoesit]

Another point is general dentists could do the specialty procedure if they could achieve the same standard. I think oral surgeons should be allowed to perform plastic surgery if and only if they can do just as well as plastic surgeons do. As far as i know, they will experience the same amount of being sue if not greater. I doubt many omfs surgeons will risk their license to do soemthing they are not trained well enough. Though, I can see a problem when general dentists trying to do plastic surgery. This is somewhat a long stretch, but who knows.

 

[Calculus1]

All of the oral surgeons I've talked to and a few guys getting ready to go to an OMFS residency next year have told me that they wouldn't even want to bother with plastic surgery. There is equal if not more money(I mention the money because that's what most plastic surgery is about) in pulling wisdom teeth and drilling for implants without even going into many other procedures they are qualified to handle.

 

[MacGyver]

Another point is general dentists could do the specialty procedure if they could achieve the same standard. I think oral surgeons should be allowed to perform plastic surgery if and only if they can do just as well as plastic surgeons do. As far as i know, they will experience the same amount of being sue if not greater. I doubt many omfs surgeons will risk their license to do soemthing they are not trained well enough. Though, I can see a problem when general dentists trying to do plastic surgery. This is somewhat a long stretch, but who knows.

Uhhh....no. You dont expose patients to undue risk simply to facilitate a money grab.

what if I proposed a trial to determine if dental hygienists could perform the same as dentists? You'd go for that right? and if my results concluded that dental hygienists could do just as well as dentists, you'd step aside and allow them to take on your turf? Yeah right. 🙄

NOBODY should be doing plastic surg, unless they completed a proper residency/fellowship. I'll say it again, this goes for MDs as well as OMFS as well as regular dentists.

 

[MacGyver]

All of the oral surgeons I've talked to and a few guys getting ready to go to an OMFS residency next year have told me that they wouldn't even want to bother with plastic surgery. There is equal if not more money(I mention the money because that's what most plastic surgery is about) in pulling wisdom teeth and drilling for implants without even going into many other procedures they are qualified to handle.

This only supports my point that they should not be allowed to do it. Why expand access if nobody wants to participate?

 

[ItsGavinC]

Irrelevant. NOBODY should be doing plastic surgery unless they completed a plastic surg residency. That goes for MDs as well as dentists.

You do understand that plastic surgery has nothing to do with plastic, right? Surgeons trained in plastics, as well as oral surgeons and ENTs are all required to do plastic surgery on any given night in the ER. Trauma victims don't care who works on them, and at many (if not most all) hospitals, these 3 areas rotate trauma call.

 

[MacGyver]

You do understand that plastic surgery has nothing to do with plastic, right? Surgeons trained in plastics, as well as oral surgeons and ENTs are all required to do plastic surgery on any given night in the ER. Trauma victims don't care who works on them, and at many (if not most all) hospitals, these 3 areas rotate trauma call.

You know I was referring specifically to the original post which was talking about cosmetic plastic surgery. Dont sit there and lie and claim that OMFS residents get the same plastics training as plastic surg residents do.

Also, I dispute your notion that trauma victims "dont care" who works on them. Usually they arent aware of who works on them, but if you give them the choice between a board certified plastic/recon surgeon, and other surgeons who have no such training, they will pick the former.

 

[Energon]

I think this article left out a lot of information needed to get a full picture of the situation. There was a full discussion panel set up in our school last monday to discuss the upcoming California bill. Most of the OMFS doing plastics in the state of California are dual degree holders and most of the younger practioners have completed the one year craniofacial plastics fellowships (considering most of them are based at the UC system). The single degree OS people are more than happy to stick to their exodontia, dentoalveolar and occasional orthognathic surgeries. Remember CA is one of the most conservative states when it comes to practicing medicine and the fact that this bill is even getting serious attention means that there is a lot of validity to the practioners who are pushing it.
And yes it is about finances. A lot of the OMFS/craniofacial plastics share the burden with ENT/facial plastics and Plastics of doing facial reconstructive work may it be trauma related, oncological or congenital anomalies. A lot of these procedures are extremely time consuming and the reimbursements have dropped severely. If they are willing to split this responsibility with ENT and plastics, they too should be allowed to reap the benefits of cosmetic procedures, something they are equally trained to do.

 

[UBTom]

A Nip and Tuck With That Crown?
By ALEX KUCZYNSKI

Published: May 16, 2004


Californians concerned that their favorite plastic surgeon might be too busy to see them for a nip or a tuck may one day be able to call upon another professional to minister to their sagging faces and drooping eyelids: their dentist.

I think the article is guilty of misrepresentation.

From what I highlighted above, the article is implying that any GP dentist might do a facelift, and that is simply not true. Any sane general dentist wouldn't even think about doing plastic surgery in their practice, let alone attempt it.

Leave us GP's out of the argument. We want no part of it. 😛

 

[Yah-E]

Obivously the Plastic Surgeons are refering OMFS Surgeons as "Dentists". Of course OMFS Surgeons are "dentists", but they're also "surgeons"!

 

[MacGyver]

uhhh... you guys didnt read the article very carefully... it said "dentists with training in oral surgery" not just "dentists"

Thats the best way to describe them. Not all oral surgeons have MD degrees.

 

[Yah-E]

UBTOM was refering to the first sentence of the article....."their dentist"

 

[UBTom]

uhhh... you guys didnt read the article very carefully... it said "dentists with training in oral surgery" not just "dentists"

uhhh... you didn't read the article very carefully...

Did you even bother to read the TITLE of the article? "A Nip and Tuck with that Crown?"

Oral surgeons DO NOT do crowns, only restorative/general dentists do. The article from the get-go is insinuating that all dentists might do plastic surgery, which is patently false.

A Nip and Tuck With That Crown?
By ALEX KUCZYNSKI

Published: May 16, 2004


Californians concerned that their favorite plastic surgeon might be too busy to see them for a nip or a tuck may one day be able to call upon another professional to minister to their sagging faces and drooping eyelids: their dentist.

With such an opening statement, Mr. Kuczynski is dragging all dentists into the argument and IS guilty of misrepresentation.

And while even you must acknowledge that it is common for oral surgeons to also have MD's, the article did NOT. More sloppy writing.

 

[MacGyver]

Most of the OMFS doing plastics in the state of California are dual degree holders

Link please.

and most of the younger practioners have completed the one year craniofacial plastics fellowships (considering most of them are based at the UC system).

and these fellowships do cosmetic procedures like face lifts? Thats still not the same as a plastic surg residency. If they want cosmetics, then let them complete a plastic surg residency just like everybody else. BTW, ENTs should also have to complete a plastic surg residency if they want cosmetics.

The single degree OS people are more than happy to stick to their exodontia, dentoalveolar and occasional orthognathic surgeries.

So why does the bill allow ALL oral surgeons to do it? Why not specifically state that ONLY dual degree oral surgeons can do the procedures?

That indicates to me that this is a bad bill. It doesnt distinguish between dual degree and "dentist" oral surgeons.

Remember CA is one of the most conservative states when it comes to practicing medicine

Assumes facts not in evidence. You need some backup for a statement like this.

and the fact that this bill is even getting serious attention means that there is a lot of validity to the practioners who are pushing it.

Oh, bull****. Validity and politics have NOTHING to do with each other.

And yes it is about finances. A lot of the OMFS/craniofacial plastics share the burden with ENT/facial plastics and Plastics of doing facial reconstructive work may it be trauma related, oncological or congenital anomalies. A lot of these procedures are extremely time consuming and the reimbursements have dropped severely. If they are willing to split this responsibility with ENT and plastics

what in god's name are you talking about? that is absolutely irrelevant to the debate.

they too should be allowed to reap the benefits of cosmetic procedures, something they are equally trained to do.

OMFS are NOT equally trained in cosmetic plastic surg as the plastic surgeons are. ENTs should not be doing cosmetic plastic work either. If they want to do cosmetics, then tell them to complete a plastic surg residency. Dont sit there and lie and tell me that the training is the same for all of them.

 

[maxheadroom]

<gasp> I'm . . . <choke> agreeing with MacGyver <sob, wail> . . . must get air . . .

The ABPS and ASPS are hard at work . . . lots of educational campaigns for the public about going to BC/BE PRS trained surgeons for cosmetic and reconstructive surgery.

 

[Yah-E]

Here's the actual Bill from the CA Senate:

http://info.sen.ca.gov/pub/bill/sen/sb_1301-1350/sb_1336_bill_20040504_amended_sen.html

 

[dudelove]

I think some of us should answer the question of whether an OMFS should be allowed to do facelifts, breast augmentation,etc,etc by asking, "If I needed a facelift, would I go to the MD who has his training specifically geared towards plastic surgery with a residency and board certification in it, or would I rather go to the general surgeon, ENT or OMFS?" I know that I would rather go the plastic surgeon with the MD and board certification. I would also rather go to the OMFS if I needed jaw surgery, impacted tooth removal,etc,etc. I would never go to an MD for such procedures.

 

[msummar_smc]

That article is dragging all dentists into the argument and IS guilty of misrepresentation.

And while even you must acknowledge that it is common for oral surgeons to also have MD's, the article did NOT. More sloppy writing.

I agree UBTom. This is the kind of misinformed writing that gets everyone in an uproar. The media has to sell their products and newspapers.

I have a relative that is a CRNA (nurse anesthetist). When the MDAs and the ASA publish papers or articles, they call them anesthesia nurses like they are nurses that just so happen to get jobs in the OR, when in fact they attend 2 year master's courses in anesthesia beyond a nursing degree.

Everything today has spin ... and it stinks.

 

[ItsGavinC]

You know I was referring specifically to the original post which was talking about cosmetic plastic surgery. Dont sit there and lie and claim that OMFS residents get the same plastics training as plastic surg residents do.

Also, I dispute your notion that trauma victims "dont care" who works on them. Usually they arent aware of who works on them, but if you give them the choice between a board certified plastic/recon surgeon, and other surgeons who have no such training, they will pick the former.

I didn't say ANYTHING about OMFS residents getting the same plastics training as plastic surgery residents. I'd like you to show me where I said that.

And how can you dispute the notion that trauma victims don't care who works on them? My point is that hospital chiefs spread the schedule evenly among those they have on staff. I agree that they aren't going to choose a gastroenterologist to do their facial reconstructions, but OMS, ENTs, and plastics all DO have surgical training in facial reconstruction. Those are ALL viable choices according to the medical world.

 

[River13]

If the surgeon has been trained in the procedure correctly and has done an adequate number of them during training, on healthy and medically compromised patients, he should be able to do them, regardless of his title ie. ENT/OMFS/Plastics/Derm.

There are many OMFS residencies that give plenty of this prerequisite experience for many procedures, even without an official fellowship afterwards. It really varies by residency.

TITLE DOESN'T EQUATE WITH SURGICAL SKILL! Take Univ. Nebraska for example...one of the current Plastics residents who did OMFS before his residency there said he did way more facelifts/blephs/ etc. during his OMFS residency than in his plastics one...

 

[ToothMonkey]

Well, I don't think anyone should be performing plastic surgery without the proper training. But my favorite part of the article was this little gem:

they cannot deal with the idea that dentists &#8212; well trained perhaps, but without medical degrees &#8212; could perform cosmetic plastic surgery.

"Perhaps?!?!" Whoah...hold on a second there, Mr. Kuczynski. Let's not give those dentists *too* much credit...

 

[groundhog]

honestpredent is correct. This is a truf war. The bad news is that global economics and biotech advances will result in ever increasing anxiety for those who are not prepared to adapt to the future. I would advise future dentists to look into GPRs and continuing education rather than specialization unless they are interested in an academic research career. As a future dental practitioner you will not want to lock yourself out of any markets which may become more viable for a wider range of service providers due to a combination of oral health care access political pressures and advances in biotech. The one exception is academia where the specialists will be highly valued and needed to carry on the leading edge research that results in the biotech advances.

 

[Yah-E]

The Bill passed yesterday at the California Senate level and it will now go to the "Governator's" desk to become law, IF HE SIGNS IT. Here's the status as of yesterday's debate:

http://info.sen.ca.gov/pub/bill/sen/sb_1301-1350/sb_1336_bill_20040517_status.html

 

[cbc]

To ToothMonkey: The "perhaps" is the frightening word used to indicate one thing: risky procedures that can cause permanent anesthetic damage to one's face are now opened to a different field. Keep in mind that there are always foreign dentists/OMS who will acquire their oral surgical training elsewhere and then immigrate to the US to work. AMA will have no power to regulate their activities. The word "perhaps" refers to these particular dentist specialists who are allowed to perform plastics because they are supposed to have had the training but actually did not.

To Yah-E: It is proper and not downgrading to call an oral surgeon a "dentist" and a plastic surgeon a "physician." Oral surgeons are dentists, and plastic surgeons are physicians/doctors. I would also forgive the article author simply because with so many articles floating around on the web, authors often use exaggerations as grabbers.

To ItsGavinC: You seem to like to imply that plastic surgeons, ENT, and oral surgeons all have the same training or do the same procedures. If they are the same, why do they exist distinctively? Why is there an ENT AND plastic residencies for medical students to choose from? Do they just randomly create two terms/residency for the same specialty? No, ENT and plastic surgeons are trained differently and do different procedures. OMS is also different from the three. No matter how "skilled" or how many psychiatry rotations a particular internist did, without doing a psychiatry residency and receiving licensure in psychiatry, the internist must refer a psychiatric patient to a psychiatrist. This "ensures" patients receives top quality of care only from experts in their fields and needs. The field of psychiatry should remain outside of the control of internists regardless of skill, and the field of plastics should remain outside of the control of non-MD OMS regardless of skill.

To all of you, I would like to present this to you by turning the situation. What would you say if ENT, plastic surgeons, and neurosurgeons propose a bill that they are allowed to fix/rebuild teeth, mandible, and even put on braces?

Plastic surgery is already a highly risky procedure, with permanent damages inflicted by plastic surgery experts you see on Oprah every day. Patients and this area of medicine are already hurting. The argument that non-MD OMS doing this procedure for lower cost is even scarier, as ill-informed destitute patients will risk permanent marks by seeing the surgeon less trained in that area. The field of dentistry is one respected, localized in the oral cavity (at least it should be, http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=dentist). Neurosurgery is also a well-respected field, localized in the CNS. When these specialties begin probing into areas not of their expertise, (drooping eyelids???) it will be the patients and colleagues who will be angered and hurt.

Well, I don't think anyone should be performing plastic surgery without the proper training. But my favorite part of the article was this little gem:

"Perhaps?!?!" Whoah...hold on a second there, Mr. Kuczynski. Let's not give those dentists *too* much credit...

 

[oms fan]

To ToothMonkey: The "perhaps" is the frightening word used to indicate one thing: risky procedures that can cause permanent anesthetic damage to one's face are now opened to a different field. Keep in mind that there are always foreign dentists/OMS who will acquire their oral surgical training elsewhere and then immigrate to the US to work. AMA will have no power to regulate their activities. The word "perhaps" refers to these particular dentist specialists who are allowed to perform plastics because they are supposed to have had the training but actually did not.

I think your theory is pretty optimistic...it is far more likely that the physician was taking a precisely placed jab at dental training in order to plant in the minds of the readers that dental training is inferior to medical training and the two should not be viewed to hold equal ground. Therefore, how could a "dentist"/OMS even begin to think their skills could be equal to those of an MD.

...and plastic surgeons are physicians/doctors..

We are all doctors. To reserve that title for only physicians belittles our profession and training. Dentists, Optometrists, Physicians, Podiatrists...are all doctors.

To all of you, I would like to present this to you by turning the situation. What would you say if ENT, plastic surgeons, and neurosurgeons propose a bill that they are allowed to fix/rebuild teeth, mandible, and even put on braces?...The field of dentistry is one respected, localized in the oral cavity (at least it should be, http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=dentist).

I see no problem with it as long as the physician has received proper training in dentistry, occlusion, and orthodontics. I think this is the theme that this whole thread has presented. No one in here is endorsing someone untrained to perform procedures outside their field of practice.

I think it is crazy to think that dentistry is limited to the oral cavity (although the physical work occurs within the oral cavity). Think of all the oral manifestations of systemic diseases there are...To focus solely on the oral cavity and not consider the patient as a whole is bad dentistry. There is more to dentistry than cutting preps and doing endo all day.

 

[cbc]

To OMS Fan: What the heck are you talking about? Yes, all those professionals hold doctorates and are Dr. Smiths, but in general society the word doctor refers to physicians. When commercials say, "ask your doctor about levitra," is the general population thinking I should go see my dentist about this new drug? Or if someone says, I'm going to see the doctor, who in the right mind would think this person is having a toothache and going to see a dentist or wants to talk to his PhD friend. In the general population, if one ever said, I have a toothache so I am going to go see my doctor, it would confuse everyone. It's not downplaying the doctorate of these experts; it's just the lingo of the general population. If this ego boost is so important to you that you need to bring it up for discussion here of being called a dentist rather than doctor bothers you, you shouldnt have selected this profession. To me the titles dentist, doctor, physician, attorney, what the hell is the difference and who the hell cares? Your thoughts are pretty pessismitic, not only are you misinterpreting the quote from the article but mine as well. Not one word in my posts implied that DDS is any superior or inferior than any other doctorates. It's so sickening that some dentists/students always play the victim role regarding inferiorities.

I didnt say or imply dentistry should be limited to the oral cavity. As a matter of fact, that's why I brought in neurosurgery in my discussion. Neither oral or neuro surgeries are "limited" to those areas, but my argument is that they should be "focused" in those areas. Regarding receiving proper training, that is the entire purpose of the bill. The bill is redefining the scope of proper training of cosmetic surgery, and this post is the discussion of what is adequate training for such a procedure. To repeat, my argument is to increase strict regulations and training of experts who perform this already risky procedure, not broadening the practice. Please keep in mind that any ENT who wants to install braces (cosmetic reasons or not) are required to start their training from first year dental school, and I support that notion as well.

 

[oms fan]

Listen, I don't know what your problem is but don't start accusing me of an ego problem. My discussion of titles has nothing to do with ego. Of course title has some importance. "Doctor" implies a significant level of knowledge not attained by other members of a given field. I don't think it is arrogant to feel this way. If the general population wants to refer to physicians as doctor, exclusively...that is fine...I could care less. I do think it is rediculous when other health professionals refer to them as doctors. That is what I was refering to.
You are correct in that I misinterpreted the article. I stated that a physician made the comment about "perhaps" when in fact it was the author of the article. My interpretation remains the same however. And it is just that...an interpretation. We are all entitled to them, Chief. Maybe it is your ego that won't let you understand that your interpretation of the article isn't necessarily correct. It was nice to see how you could extract such a profound meaning from such a limited passage in the article.
I don't recall where in your post you refered to dentistry being "focused" on the oral cavity. I think you said "localized". Can you point that out??
I never stated that you thought dentistry was either inferior or superior to any other profession. I feel that the author was implying that. And I am sorry you are so "sickened" by ..."some dentists/students always play the victim role regarding inferiorities". Maybe you should see a "doctor" about that...

 

[cbc]

Health professionals are part of the general population. I would never mislead my wife or health professional colleagues by saying I have a doctor's appointment when I have a meeting with a PhD friend or lawyer, both of whom hold doctorates. I don't see how anyone can think that is ridiculous.

I apologize for accusing you of misinterpretation or the word localize. You are right, there is no way I can extract such meaning from the one word "perhaps," but neither should toothmonkey. I was just trying to give the other side of the usage of word "perhaps" in the statement. Also, I did mean the word "focus", but typed down the word "localized." I am no national acclaimed author writing a book editted 15 times. As I take a break from my daily activities by visiting this site, I type as fast as possible with the first words that come to mind. I hope that you can at least understand my main argument.

Listen, I don't know what your problem is but don't start accusing me of an ego problem. My discussion of titles has nothing to do with ego. Of course title has some importance. "Doctor" implies a significant level of knowledge not attained by other members of a given field. I don't think it is arrogant to feel this way. If the general population wants to refer to physicians as doctor, exclusively...that is fine...I could care less. I do think it is rediculous when other health professionals refer to them as doctors. That is what I was refering to.
You are correct in that I misinterpreted the article. I stated that a physician made the comment about "perhaps" when in fact it was the author of the article. My interpretation remains the same however. And it is just that...an interpretation. We are all entitled to them, Chief. Maybe it is your ego that won't let you understand that your interpretation of the article isn't necessarily correct. It was nice to see how you could extract such a profound meaning from such a limited passage in the article.
I don't recall where in your post you refered to dentistry being "focused" on the oral cavity. I think you said "localized". Can you point that out??
I never stated that you thought dentistry was either inferior or superior to any other profession. I feel that the author was implying that. And I am sorry you are so "sickened" by ..."some dentists/students always play the victim role regarding inferiorities". Maybe you should see a "doctor" about that...

 

[ToothMonkey]

Keep in mind that there are always foreign dentists/OMS who will acquire their oral surgical training elsewhere and then immigrate to the US to work. AMA will have no power to regulate their activities. The word "perhaps" refers to these particular dentist specialists who are allowed to perform plastics because they are supposed to have had the training but actually did not.

What makes you think the author was knocking the training of foreign-trained dentists *only*? There's no reason whatsoever to believe that the author was concerned with the professional qualifications of "foreign dentists/OMS" specifically. You're really reaching with that interpretation.

The "perhaps" is the frightening word used to indicate one thing: risky procedures that can cause permanent anesthetic damage to one's face are now opened to a different field.

The phrase "well trained" clearly refers to the dentists' training in traditional dental procedures (i.e. oral surgery), *not* plastic surgery. So it follows that the qualifier "perhaps" is intended to call into question the dentists' level of training in oral surgery and *only* oral surgery. It's simply a cheap shot that has nothing to do with article's supposed main topic.

Let's be honest here...the sentence I quoted in my first post works just fine without "perhaps" (try it and see). In fact, if the author really felt the need to pad his already bloated sentence with a qualifier then something respectful like "yes", "certainly", or "to be sure" would have been appropriate in light of the level of training necessary to obtain a DDS/DMD. Instead Mr. Kuczynski chose the incredibly patronizing word "perhaps", and the only possible explanation for that particular selection is that he wanted to take a not-so-subtle dig at the professionalism of dentistry as a whole.

Anyway, I really never meant to make a big stink out of one measly word. I only brought it up in the first place as a light-hearted joke--because seeing a childish potshot like that in a supposedly professional piece of journalism made me LOL and I thought others might find it amusing as well. Sorry if my intentions were not clear.

 

[cbc]

The foreign trained dentist was only an example. My point is a medical specialty opening up its doors to a field overseen by dentistry with different regulations and criteria also opens up to all kinds of possibilities and conditions. Medical and plastic surgery panels have no control over the training and regulation of OMS in the next 10 years, and who knows how this field will change in this timespan. "Perhaps" is a word that implies unknown possibilities and conditions right? My poor choice of 1 word, "localized," caused my true meaning to be misinterpreted. I agree with OMS Fan that one should not extract from the one word "perhaps" such profound meaning, even as to take a jab at a health profession. I sincerely encourage you not to look so deeply at one modifier especially in text (we are also ignoring the tone of voice, facial expression, and the interrogations by the author).

 

[Yah-E]

Alright guys, since the recent CA Senate Bill 1865 (allowing dentists to practice in CA with WREB) passed and signed by the "Governator", it provoked me to follow up on the CA Senate Bill 1336 (allowing OMFS without MD degree and/or without proper plastic surgery training to perform facial plastic surgeries).

Well, on August 17, 2004 the Senate passed this bill 29 ayes and 0 noes and onto the "Governator's" desk. The "Governator" vetoed it on August 27, 2004. Now it's back to the Senate floor as "unfinished business" as of September 10, 2004.

Here's the official web site for the Bill status:

http://www.leginfo.ca.gov/pub/bill/sen/sb_1301-1350/sb_1336_bill_20040910_history.html

What do you guys think? Will this Bill be discarded? I don't think it's looking so good.

 

[River13]

Alright guys, since the recent CA Senate Bill 1865 (allowing dentists to practice in CA with WREB) passed and signed by the "Governator", it provoked me to follow up on the CA Senate Bill 1336 (allowing OMFS without MD degree and/or without proper plastic surgery training to perform facial plastic surgeries).

Well, on August 17, 2004 the Senate passed this bill 29 ayes and 0 noes and onto the "Governator's" desk. The "Governator" vetoed it on August 27, 2004. Now it's back to the Senate floor as "unfinished business" as of September 10, 2004.

Here's the official web site for the Bill status:

http://www.leginfo.ca.gov/pub/bill/sen/sb_1301-1350/sb_1336_bill_20040910_history.html

What do you guys think? Will this Bill be discarded? I don't think it's looking so good.

This is another good reason to go to a 6 year OMFS residency that includes enough post-MD training to actually get a medical license vs. a 4 year residency if you're interested in performing cosmetic facial surgery as an OMFS...then all this legislation wouldn't limit you.

 

[toofache32]

I still don't see what the MD has to do with it. I wouldn't have said that before I finished my MD, but after going through medical school I realize how irrelevant it is to OMFS. Med students do nothing but stand around and watch residents work. In a team of 12 people, you are #12. You don't learn facial osteotomies, etc. in med or dental school...you learn it in your residency. My time would have been better spent on OMFS than med student.

Yah-E....I don't follow your logic that blephs and rhinos are within our scope, but not facelifts. Have you seen a TMJ replacement? A coronal flap? These (and other) procedures involve the same incisions, techniques, dissection, and closure as facelifts.

I agree this is about money. Money is also the reason why the Plastics guys never complained about OMFS doing trauma involving reconstructing these same parts of the face...because you often don't get paid.

 

[Yah-E]

Yah-E....I don't follow your logic that blephs and rhinos are within our scope, but not facelifts.

Did I say that? 😕

I believe facelifts are within OMFS's scope of practice given that you're trained and certified to perform the procedure for esthetic reasons. During my externship I assisted a full face rejuevination case where the patient had a full facelift. The attending the performed the surgery was amazing and he did a year face comestic fellowship in Texas.

So I definitely believe that facelifts can be within an OMFS practice scope.

[addition]

Ahhh, I see what you're saying......you meant from my first post in this thread. Let me clarify, what I meant was that if an OMFS is not trained in Plastics (residency or fellowship), doing facelifts for esthetics from a non-trained plastics OMFS is questionable! If an OMFS is trained, then of course facelifts are game!

[Disclaimer: actually I don't really know anything, I'm only a 3rd year dental student 😀 ]

 

[River13]

This is another good reason to go to a 6 year OMFS residency that includes enough post-MD training to actually get a medical license vs. a 4 year residency if you're interested in performing cosmetic facial surgery as an OMFS...then all this legislation wouldn't limit you.

I should have added that you'll be as good a surgeon if you do a good 4 year vs. 6...its just the politics around practicing can be easier. At VCU I watched more cosmetic cases than many 6 yr programs will ever have.

 

[OzDDS]

So are you saying that California will allow OMFS A who went to a 5-year training program that included an M4 year of med school to do facial cosmetic procedures, but not OMFS B who did a 4-year training program that did not included a year of med school. Even both did just as much residency training?

It doesn't matter whether you have 1 degree or 2. Having the MD has no effect on your scope of practice as an OMFS.

 

[River13]

So are you saying that California will allow OMFS A who went to a 5-year training program that included an M4 year of med school to do facial cosmetic procedures, but not OMFS B who did a 4-year training program that did not included a year of med school. Even both did just as much residency training?

It doesn't matter whether you have 1 degree or 2. Having the MD has no effect on your scope of practice as an OMFS.

Yes, that is what I am saying...assuming "OMFS A" also completed enough ACGME accredited years of post-MD training to also get a medical license. Thus you are mistaken, HAVING THE MD CAN HAVE AN EFFECT ON YOUR SCOPE OF PRACTICE AS AN OMFS depending on which state you live in. Is it ethical? No, not in my opinion. But is it reality? Yes. From my experience, there is more cosmetic surgery taught at 6 year residencies than at 4 year ones, GENERALLY speaking as well.

 

[daelroy]

I agree this is about money. Money is also the reason why the Plastics guys never complained about OMFS doing trauma involving reconstructing these same parts of the face...because you often don't get paid.

This logic can be applied to every facet of medicine. Do you really think internists can't perform colonoscopies that GI's do or putting in catheters like cardiologists do? Do you think family practice docs can't do botox, remove veins, prescribe acne medication, perform microderm skin abrasian, or collagen lip enhancements like a dermatologist? Do you think an optometrist can't program the numbers on a Lasik machine like an opthalmologist? Do you really think a psychologist lacks the ability to prescribe drugs like a psychiatrist? Do you think a radiology tech who has been reading scans for 20 years can't be trained to be a radiologist? Hell, do you really think a Physician Assistant is incapable of seeing patients on their own without the supervision of a physician?

Do you think a dental hygienist couldn't do most procedures as a general dentist if that person spent a year in a fellowship just learning hands on procedures. In a hypoethical world, if the ADA suddenly granted one year fellowship programs to dental hygienists that would grant them the right to perform most general dentistry procedures on their own, the dental community would be livid. And it wouldn't be because general dentists were concerned about patients; it would be due to the fear of hygenists taking potential income away from them.

This territorial aspect is a part of life. Those who are extensively trained seek to protect their territory from those that are not. At some point, you have to accept that life is competitive and a hiearchy. At some point, you have to reward those who attained addition training through merit. I think it's bogus that general surgeons can get a 1 year fellowship in "cosmetic surgery" and perform plastic surgery. If you can't get into a PRS fellowship then you don't deserve to practice that form of surgery or refer to yourself as a plastic/cosmetic anything.

 

[toofache32]

Another post by an obviously uninformed poster on this subject.

This logic can be applied to every facet of medicine. Do you really think internists can't perform colonoscopies that GI's do or putting in catheters like cardiologists do? Do you think family practice docs can't do botox, remove veins, prescribe acne medication, perform microderm skin abrasian, or collagen lip enhancements like a dermatologist? Do you think an optometrist can't program the numbers on a Lasik machine like an opthalmologist? Do you really think a psychologist lacks the ability to prescribe drugs like a psychiatrist? Do you think a radiology tech who has been reading scans for 20 years can't be trained to be a radiologist? Hell, do you really think a Physician Assistant is incapable of seeing patients on their own without the supervision of a physician?

Do you think a dental hygienist couldn't do most procedures as a general dentist if that person spent a year in a fellowship just learning hands on procedures. In a hypoethical world, if the ADA suddenly granted one year fellowship programs to dental hygienists that would grant them the right to perform most general dentistry procedures on their own, the dental community would be livid. And it wouldn't be because general dentists were concerned about patients; it would be due to the fear of hygenists taking potential income away from them.

I have seen most of these situations you've described. You can teach a monkey to do most of these procedures. We're really just glorified carpenters. The point that is missing is how do you manage patients when something goes wrong? That's when you need an appropriate background when you get NMS from the drug your psychologist prescribed, etc.

Those who are extensively trained seek to protect their territory from those that are not. At some point, you have to reward those who attained addition training through merit. I think it's bogus that general surgeons can get a 1 year fellowship in "cosmetic surgery" and perform plastic surgery. If you can't get into a PRS fellowship then you don't deserve to practice that form of surgery or refer to yourself as a plastic/cosmetic anything.

There is no basis for this idea. The bottom line in this thread is that OMFS guys in most programs are trained to do facial plastics as good if not better than Plastics. During the entire 2-year Plastics residency at my institution, they only spend a 3-month period on cosmetics. 10 or 20 years ago this didn't matter because that was the best there was. It's only logical that specialties with more experience in one anatomical location will eventually incorporate all procedures in that area.

I'm not all that interested in cosmetics, but it's not because I'm not trained.