Difference between "Practice limited to endo" and endodontist?

[DrTacoElf]

Hey guys i was wondering what you thougth about this. Quite a clever way to bypass residency if you have the skill no?

Is it really true that a general dentist can do perio, endo, ortho, oral surgery if they want! (assuming you dealt with easier cases which didn't require general anesthesia if you didn't want to deal with that certification.

Do you think this will ever change?

It seems like you can pick the cases which are the cream of the crop and refer out the tougher stuff you'd rather not touch, a liberty the specialist doesn't have..

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[aphistis]

Hey guys i was wondering what you thougth about this. Quite a clever way to bypass residency if you have the skill no?

Is it really true that a general dentist can do perio, endo, ortho, oral surgery if they want! (assuming you dealt with easier cases which didn't require general anesthesia if you didn't want to deal with that certification.

Do you think this will ever change?

It seems like you can pick the cases which are the cream of the crop and refer out the tougher stuff you'd rather not touch, a liberty the specialist doesn't have..

You've just gone and hit one of the best parts of being a general dentist square on the nose. As long as you can perform it to the standard of care (and don't misunderstand, that's an important qualifier), you can do any work in your office you feel like doing, and refer the crap you don't want to mess with to the specialist, who really doesn't have much choice if he wants to retain you within his referral base. 😀

 

[dane4695]

I would be slightly wary of trying to do something along those lines -- easy cases a general dentist can and are supposed to solve. However, if you get a difficult root canal and run into problems, good luck defending yourself in court. You have to know when you can get the best care to the patient... at least that's what i've heard. I suppose though that if you did something like that exclusively, you could probably still get away with doing one aspect of dentistry without a cert.

Ear Nose and Throat Dr.'s are frequently found to be doing plastic surgery... and then they get a lawsuit and lose their liscence 🙂 Slightly different but I still think I'd be wary.

 

[DrTacoElf]

I would be slightly wary of trying to do something along those lines -- easy cases a general dentist can and are supposed to solve. However, if you get a difficult root canal and run into problems, good luck defending yourself in court. You have to know when you can get the best care to the patient... at least that's what i've heard. I suppose though that if you did something like that exclusively, you could probably still get away with doing one aspect of dentistry without a cert.

Ear Nose and Throat Dr.'s are frequently found to be doing plastic surgery... and then they get a lawsuit and lose their liscence 🙂 Slightly different but I still think I'd be wary.

well you could refer out tough cases. Clearly you are taking a risk doing what i mentioned above, but not really much more so that an endo that screws up i wouldn't think.

 

[aphistis]

I would be slightly wary of trying to do something along those lines -- easy cases a general dentist can and are supposed to solve. However, if you get a difficult root canal and run into problems, good luck defending yourself in court. You have to know when you can get the best care to the patient... at least that's what i've heard. I suppose though that if you did something like that exclusively, you could probably still get away with doing one aspect of dentistry without a cert.

Ear Nose and Throat Dr.'s are frequently found to be doing plastic surgery... and then they get a lawsuit and lose their liscence 🙂 Slightly different but I still think I'd be wary.

Actually, if you go over to DentalTown, you'll find a regular poster who is exactly what the OP has described here: a GP who voluntarily limits his practice to endodontics, and he's thriving. As I've already stated, the only obligation is the one in place for any dental procedure: it has to meet standard of care, regardless of who performs it. Furthermore, a general dentist is under no obligation to perform ANY type of procedure s/he is uncomfortable with. My dentist hates endo with a passion, so all RCTs are referred regardless of location or presumed difficulty. Your perception of scope of practice seems to be a little off the mark.

 

[ItsGavinC]

The difference, for the OP, is that the endodontist gets stuck with anything and everything while the GP who has a "practice limited to endodontics" gets to choose the cases and scope he wishes to do. Further, he can also legally perform other dental procedures should he wish to do so. The endodontist cannot.

 

[c132]

The difference, for the OP, is that the endodontist gets stuck with anything and everything while the GP who has a "practice limited to endodontics" gets to choose the cases and scope he wishes to do. Further, he can also legally perform other dental procedures should he wish to do so. The endodontist cannot.

HIT THE NAIL ON THE HEAD GAVIN!!!!


Both ways have Ups and Downs, but you had better be confident in endo, which I probably will NEVER be!!

 

[no2thdk999]

The difference, for the OP, is that the endodontist gets stuck with anything and everything while the GP who has a "practice limited to endodontics" gets to choose the cases and scope he wishes to do. Further, he can also legally perform other dental procedures should he wish to do so. The endodontist cannot.

I think you're mostly right. But even if you are a GP voluntarily limited to endo you will still be a mostly referral based practice. You can only send the patient back to the referrer for being too difficult so many times before your referrals dry up and just go straight to the real endodontist. Also the two guys that I know that have pulled this off pretty much have a deal that they won't do any restorative. Dentists are sketchy people and if they fear losing their patient to the GP-endo for routine care they'll just send them to the real endo who can't steal them.

JMHO
Rob

 

[DrTacoElf]

The difference, for the OP, is that the endodontist gets stuck with anything and everything while the GP who has a "practice limited to endodontics" gets to choose the cases and scope he wishes to do. Further, he can also legally perform other dental procedures should he wish to do so. The endodontist cannot.

so an endo can not practice general dentistry legally?

can a general dentist do ortho or implants legally?

 

[TX OMFS]

you can do any work in your office you feel like doing, and refer the crap you don't want to mess with to the specialist, who really doesn't have much choice if he wants to retain you within his referral base. 😀

I'd take you out of my referral base and tell you to get lost when you call me crying b/c you've ****ed-up and gotten in too deep. Most GP's who think they are junior specialists tend to piss off the true specialists and it comes back to bite the GP in the ass.

 

[UBTom]

so an endo can not practice general dentistry legally?

can a general dentist do ortho or implants legally?

Yes, if you are a specialist, you are not allowed to do procedures outside your specialty.

And yes, a general dentist can do ortho and implants as long as the GP can do it to the same standard of care as a specialist.

HTH!

 

[toothcaries]

so an endo can not practice general dentistry legally?

can a general dentist do ortho or implants legally?

you'll have a dds (or dmd)
you can practice whatever procedures defined under your local dental act as long as you are meeting the standard of care.

generally..
if u are "limited to endodontics" then that is what u practice...
your local state dental board will give u all the nitty gritty detail stuff...

..

i will say...
i'm interested in family dentistry.
which means i enjoy all aspects of dentistry so far...and i'd like to be about to offer comprehensive treatment plans to my patients.
..i'd like you'd be doing a service if u could keep everything under one roof.

concerning endo..
my experiences are limited...but it seems like a large percentage of GPs are now doing their own RCT..and just punt on the pita's and the impossible cases..
with rotary files and the new materials....it is an efficient procedure.

 

[toothcaries]

i'd hope u are in a small town...and you are the only specialist in the area...
otherwise the moment that i'd feel like i was not your "grade a" referer....
you'd never see a patient from me again. and i will make sure i mention to my buddies (that also happen refer to you) about my experiences..



hypothetically speaking
😉

I'd take you out of my referral base and tell you to get lost when you call me crying b/c you've ****ed-up and gotten in too deep. Most GP's who think they are junior specialists tend to piss off the true specialists and it comes back to bite the GP in the ass.

 

[Dr.SpongeBobDDS]

We were given a number in a treatment planning class that 70% of endo is done by GPs. Still, endodontists seem not to be starving on that 30%.

 

[ItsGavinC]

We were given a number in a treatment planning class that 70% of endo is done by GPs. Still, endodontists seem not to be starving on that 30%.

We were given that same number, so it must be true. 😀

 

[bcDDS]

There is no law that states that you are not allowed to practice outside of your specialty. No law whatsoever. So legally, it's not an issue. What becomes an issue is losing your referral base. If you are an endodontist doing crown and bridge, good luck getting referrals from general dentists. Why would they want to send endo patients to someone that is their competition for lucrative restorative work? Limiting your practice as a specialist is not a legal move, it; it's a professional courtesy. By limiting your practice, you are demonstrating good faith to the general dentists and are more likely to develop a referral base from them.

 

[toothcaries]

..after a quick google search..
this is the kentucky board policy..
http://www.lrc.state.ky.us/KRS/313-00/445.PDF


" No specialty license shall be issued unless the applicant presents proof satisfactory to
the board that he will limit his practice to that specialty from date of receipt of such
license. Upon the failure of a specialty licensee to limit his practice to the specialty in
which he is licensed, the board shall recall his specialty license and revoke the
privilege of announcing to the public that he is especially qualified in, or is limiting
his practice to, such specialty. The specialty license and the privileges attached
thereto shall be restored to the dentist when satisfactory proof has been presented
that such dentist is limiting his practice to the specialty in which he was licensed."


..again, this is something you'd need to check with your state dental board.

There is no law that states that you are not allowed to practice outside of your specialty. No law whatsoever. So legally, it's not an issue. What becomes an issue is losing your referral base. If you are an endodontist doing crown and bridge, good luck getting referrals from general dentists. Why would they want to send endo patients to someone that is their competition for lucrative restorative work? Limiting your practice as a specialist is not a legal move, it; it's a professional courtesy. By limiting your practice, you are demonstrating good faith to the general dentists and are more likely to develop a referral base from them.

 

[bcDDS]

..after a quick google search..
this is the kentucky board policy..
http://www.lrc.state.ky.us/KRS/313-00/445.PDF


" No specialty license shall be issued unless the applicant presents proof satisfactory to
the board that he will limit his practice to that specialty from date of receipt of such
license. Upon the failure of a specialty licensee to limit his practice to the specialty in
which he is licensed, the board shall recall his specialty license and revoke the
privilege of announcing to the public that he is especially qualified in, or is limiting
his practice to, such specialty. The specialty license and the privileges attached
thereto shall be restored to the dentist when satisfactory proof has been presented
that such dentist is limiting his practice to the specialty in which he was licensed."


..again, this is something you'd need to check with your state dental board.

You are talking about the privelage to announce and advertise as a practice that is limited to the specialty. If you announce that you are going to 'limit your practice, that's what you need to do. But it isn't 'illegal' to practice general dentistry as a specialist. You just can't advertise as a practice 'limited to'. The prosthodontists are doing it all the time - practicing general dentistry with the added expertise in their discpline. Just because a state is not going to allow someone to state that they are limiting a practice to the chosen specialty doesn't make it illegal to practice outside it's confines. You just can't announce a limited scope practice unless you do it. Your privelage to announce it as well as specialty status in the state may be revoked, but to practice general detnistry with specialty training is NOT illegal and you won't lose your right to practice dentistry. Just as the general dentist can legally attempt any root canal that they choose, the endodontist can legally attempt to extract any tooth that they choose. The Kentucky board policy stated really speaks about it's rules and actions against false advertising, not laws against practicing general dentistry as a specialist.

 

[DrTacoElf]

Upon the failure of a specialty licensee to limit his practice to the specialty in
which he is licensed, the board shall recall his specialty license

so your no longer a specialist you are now a General

 

[aphistis]

Upon the failure of a specialty licensee to limit his practice to the specialty in
which he is licensed, the board shall recall his specialty license

so your no longer a specialist you are now a General

What's your source on that, Taco?

 

[bcDDS]

Upon the failure of a specialty licensee to limit his practice to the specialty in
which he is licensed, the board shall recall his specialty license

so your no longer a specialist you are now a General

The board of what? Are you referring to a state board? Again, this is an advertising issue. Your right to specialize and advertise as such is granted to you when you recieve a certificate from an accredited program. Whether or not you choose to limit your practice is your decision, no one else's. You simply can't advertise or register as a specialist if you haven't completed a program or in the case that was stated above, you aren't limiting your practice. If that means that you have to register with the state licensing commission or whatever board requires it, as a general dentist, then so be it. But as a graduate of an accredited program, you can always go back and limit your practice and state that you are doing so as a specialist. It may mean paying a different liability premium and maybe even changing to a different classification within the state (I suppose it depends on what state). Maybe I'm off about the details, but the point is that it is YOUR right as the practitioner to do as you choose, specialty trained or not. There is nothing illegal about corssing lines in practice and you CANNOT be sued of disciplined for it just because you are a trained specialist. Are you telling me that the GP on dental town in Florida (no names) can legally state that he is limiting his practice to endodontics even though he never got a post graduate certificate at an accredited program (and yes, he legally can do so...just can't state he's a specialist), while the endodontist can no longer legally do amalgams??? So are you going to say that a post placement or a core buildup by the endodontist is grounds for specialty license revocation since it crosses lines with the restorative aspect of general practice? That makes little common sense. If I'm wrong about this, then a number of my friends and colleagues with established practices are doing things 'illegally'. Let's go one step further. Logistically, if you think about it, if you were an endodontist that decided to do an amalgam on a friend as a courtesy, are you going to tell me that because you are a specialist, you are going to 'lose your specialty license' because you no longer have the right to do a filling, despite having the same DDS degree as everybody else? Please....without even citing quotes or examples, this is just silly and I'd be shocked if this were the case.

 

[ItsGavinC]

Logistically, if you think about it, if you were an endodontist that decided to do an amalgam on a friend as a courtesy, are you going to tell me that because you are a specialist, you are going to 'lose your specialty license' because you no longer have the right to do a filling, despite having the same DDS degree as everybody else? Please....without even citing quotes or examples, this is just silly and I'd be shocked if this were the case.

The question isn't a legal one, but an ethical one. Would the endodontist who does an amalgam on a friend by operating under illegal means? Not by the law of the land, but certainly by the ADA guidlines, and certainly in an unethical manner.

 

[ItsGavinC]

By the way, the section of the ADA Code of Ethics and Professional Conduct that deals with this is section 5, and can be accessed here: http://www.ada.org/prof/prac/law/code/principles_05.asp#5h

 

[bcDDS]

The question isn't a legal one, but an ethical one. Would the endodontist who does an amalgam on a friend by operating under illegal means? Not by the law of the land, but certainly by the ADA guidlines, and certainly in an unethical manner.

IMHO, I don't believe so. An endodontist is just as competent as any other practitioner, and this being the case, what is unethical about it? Why should the patient have to pay a stranger to do a simple filling when their endodontic friend can do it as a courtesy? What if the patient if more comfortable being treated by their friend? Seriously, most endodontists practiced as general dentists for several years before specialty training. As in the post placement, or core buildup case that I presented, is there a difference between that and doing a filling? Endodontic referral slips often have boxes with check marks that ask if the dentist wants the post placed or a buildup done before the patient is sent back to the GP's office. In addition, it is actually better practice to have the endodontist do this immediately after the endo is completed because the majority of endodontic failure is due to coronal leakage.

Don't get me wrong. I think that an endodontist or any specialist for that matter shouldn't be routinely performing procedures outside of their specialty. It's not only professional suicide as far as referrals go, but if someone wants to practice as a specialist, his time and services would be best utilized treating those cases that GP's have trouble doing. In this manner, everybody wins, most importantly the patient. But I don't see any basis for questioning the ethics of such actions. To stretch it into an ethical gray area, I would think that it would have to be shown that the patient is not getting treated up to the standard of care.

Gavin, after reading the specialty section that you referred me to, I'm still not sure what line you're referring to. The only ethical comments that I see are made about announcing a specialty practice when that specialty practitioner has non specialists in the office performing those specific procudures. Other than that, I don't see what the dilemma is. The only stipulation I see is that if you decide to announce limitation of your practice to the general public, that's what you are to do.

I'm sure we could go back and forth on this issue until we're blue in the face, because a lot of it just depends on perspectives, but my post was meant to enlighten what I felt were some inaccurate comments on earlier posts, specifically the comments that made blanket statements that specialists were not allowed to do anything outside of their discipline.

BTW, here's a fire starter for anybody that wants to dwell on it...there are some programs that are teaching their endo residents to place implants. That kind of baffles me, but if you want to discuss gray areas this has to fall into that category.

Cheers

 

[Lila08]

I read the above discussions about endodontists practicing general dentistry, and was just thinking about the reverse of this situation....I always thought that ONLY endodontists could advertise their practices as "limited to endodontics." My understanding was that gp's could do as much endo as they wanted as long as it was up to the standard of care but could NOT advertise their practices to the public as "limited to endodontics." Is this correct?

 

[ItsGavinC]

IMHO, I don't believe so. An endodontist is just as competent as any other practitioner, and this being the case, what is unethical about it?

Ask the ADA--it's their code of ethics and professionalism that says it is unethical to do so. I don't make the rules, but I do know that our profession has thrived with them in place. 😀

 

[ItsGavinC]

Gavin, after reading the specialty section that you referred me to, I'm still not sure what line you're referring to.

From the ADA code of ethics:

"Dentists who choose to announce specialization should use "specialist in" or "practice limited to" and shall limit their practice exclusively to the announced special area(s) of dental practice"

 

[bcDDS]

From the ADA code of ethics:

"Dentists who choose to announce specialization should use "specialist in" or "practice limited to" and shall limit their practice exclusively to the announced special area(s) of dental practice"

Once again this deals with the issue of 'false advertising'. If you want to get nitty gritty about the details, then let's put the statement in its proper context. It falls under the section of Veracity or truthfulness (Section 5) and the main point of the entire section is to not deceive or misrepresent. Doing the courtesy filling on your friend isn't going to violate the veracity principle if no one is being deceived. As a specialist, you still have a DDS or DMD license, and you are STILL afforded the privelage to practice DENTISTRY if need be. If you announce as a specialist that is limiting practice and base your practice on procedures that fall outside the realm of your specialty, that would be deceptive to not only referring dentists, but to the public and that would generally be regarded as false advertising. This in turn WOULD be a violation of veractiy and a violation of ethics.

The above statement is a guideline under section 5 to prevent misrepresentation of services. Keep in mind that it falls under the veracity section. If it was a hard and fast rule that fell out of context, it would make it unethical for an announced endodontic specialist to even volunteer his time to the community at a non profit organization doing free dentistry (fillings, caries control, extractions...i.e. non endodontic services) to help underprivelaged children. I hate to get so technical about this topic, (section 5, blah blah) but it seems that common sense along with sound professional and ethical judgement have been thrown out the window in this thread. If I'm wrong, then I'm wrong, but I'm done commenting about it. If you want clarification on this topic, maybe you should ask someone that has been out there with practice experience, such as faculty or local dentists. Good luck..

 

[aphistis]

Once again this deals with the issue of 'false advertising'. If you want to get nitty gritty about the details, then let's put the statement in its proper context. It falls under the section of Veracity or truthfulness (Section 5) and the main point of the entire section is to not deceive or misrepresent. Doing the courtesy filling on your friend isn't going to violate the veracity principle if no one is being deceived. As a specialist, you still have a DDS or DMD license, and you are STILL afforded the privelage to practice DENTISTRY if need be. If you announce as a specialist that is limiting practice and base your practice on procedures that fall outside the realm of your specialty, that would be deceptive to not only referring dentists, but to the public and that would generally be regarded as false advertising. This in turn WOULD be a violation of veractiy and a violation of ethics.

The above statement is a guideline under section 5 to prevent misrepresentation of services. Keep in mind that it falls under the veracity section. If it was a hard and fast rule that fell out of context, it would make it unethical for an announced endodontic specialist to even volunteer his time to the community at a non profit organization doing free dentistry (fillings, caries control, extractions...i.e. non endodontic services) to help underprivelaged children. I hate to get so technical about this topic, (section 5, blah blah) but it seems that common sense along with sound professional and ethical judgement have been thrown out the window in this thread. If I'm wrong, then I'm wrong, but I'm done commenting about it. If you want clarification on this topic, maybe you should ask someone that has been out there with practice experience, such as faculty or local dentists. Good luck..

That's funny, my idea of a common-sense conclusion to Section 5 would be to assume that "restricting practice exclusively to one's area of licensed specialty" means exactly what it says.

 

[ItsGavinC]

If I'm wrong, then I'm wrong, but I'm done commenting about it. If you want clarification on this topic, maybe you should ask someone that has been out there with practice experience, such as faculty or local dentists. Good luck..

Multiple practicing dentists have already commented on this topic. It means what it means. If you are a specialist and announce yourself as such, then you are limited to practicing that specialty. Nothing more. If you don't announce yourself as a specialist then you can do as you please, but you aren't going to get strong referrals from general dentists without the acknowledgement on your behalf that you are a specialist.

 

[ItsGavinC]

If it was a hard and fast rule that fell out of context, it would make it unethical for an announced endodontic specialist to even volunteer his time to the community at a non profit organization doing free dentistry (fillings, caries control, extractions...i.e. non endodontic services) to help underprivelaged children.

In all honesty I don't know that an established endodontist would even touch those basic restorative procedures.

 

[c132]

Multiple practicing dentists have already commented on this topic. It means what it means. If you are a specialist and announce yourself as such, then you are limited to practicing that specialty. Nothing more. If you don't announce yourself as a specialist then you can do as you please, but you aren't going to get strong referrals from general dentists without the acknowledgement on your behalf that you are a specialist.

Gavin you are wrong! I asked our dean today and he said that only in some states are specialist commited only to that scope of practice. Other states, you can call yourself a specialist, but do other aspects of dentistry (his example was a periodontist, he was one, but did fillings etc....)
It is a state by state law, which is unclear/blurred in many states according to him.

 

[ItsGavinC]

Gavin you are wrong! I asked our dean today and he said that only in some states are specialist commited only to that scope of practice. Other states, you can call yourself a specialist, but do other aspects of dentistry (his example was a periodontist, he was one, but did fillings etc....)
It is a state by state law, which is unclear/blurred in many states according to him.

Remember, I'm not talking about LEGAL stipulations, only ETHICAL ones laid out by the American Dental Association. Legally there may or may not be ramifications for a specialist providing treatments outside the score of his specialty. This has nothing to do with state laws, and everything to do with a dentist's relationship with his peers and colleagues. It is an ethical violation, according to our governing body.

Here is a message I posted a year ago that pertains exactly to your question:

"The ADA states that it is unethical for an announced specialist to do GP work. So, if you are an endodontist, and announce to customers that you are an endodontist, then you CANNOT do GP work.

However, if you are an endodontist but NEVER announce yourself as such, then you can do all the GP you want AND all the endo you want. In this case, your endo specialty would serve like a great big hunk of CE.

There are strict rules and guildines in place for specialists, and one way to really tick off the ADA, the dental community, and your referral system is for a specialist to do GP work. This is probably what your endo is referring to.

It's got to be one or the other (at least publicly announced as such), but it cannot be both."

And the response from one of our practicing dentists, Dr. Jeff:

"ItsGavinC is exactly right, if you advertise yourself as a specialist, then your practice is limited too only that field of dentistry, so even if my wife, an orthodontist, wanted to pick up the handpiece and prep that interproximal lesion that occurred under the molar band, technically she couldn't."

This thread, which is pretty interesting, is here: http://forums.studentdoctor.net/showthread.php?s=&threadid=74670