With the seemingly growing tensions between dual degree and single degree OMS tracts (ie recent AMA Scope of Practice attack etc) there seems that one day there may come an OMS armageddon/civil war. I have already heard talk about the future generations of OMS splitting into oral surgeons (restricted to dentoalveolar and single degree) and maxillofacial surgeons (full scope and double degree). This dissolution of the specialty would be disasterous in my opinion and I have a hard time believing that AAOMS would stand by and let that happen. But a certain reality remains that there is a growing number of dual degree OMS and dwindling number of single degree OMS. Currently dual degree surgeons are the minority, but what will happen when they become closer to a majority? On the other side of the coin, going back to the tensions 2/2 competitions, is there any reality that the AMA will ever campaign to their medical schools to stop privileging OMS residents to advanced standing to take the USMLE I and essentially skip 2 of the 4 years of med school? This would essentially kill the fast tract to an MD. Any thoughts?
Gary "Armageddon was a terrible moive and that Aerosmith song has been played at too many weddings" Ruska here,
GR can see why those aspiring to be an OMFS would be concerned about the current political rumblings - it is only natural to be worried about what, externally, appears to be an uncertain future.
As always, reassurance can be, to some measure, found in history.
Two giants in OMFS come to mind when thinking about this debate (though there are many others): Daniel Laskin and Walter Guralnick.
Dan Laskin has, historically, been a proponent of the single-degree surgeon as full-scope practitioner. Walter Guralnick, who designed the first MD-integrated program, is at the opposite end of the spectrum. Interestingly, Guralnick is giving a keynote address on this very topic at the 2010 AAOMS meeting in Chicago.
When the concept was first introduced in the 1970s, there was significant resistance to the MD-integrated format. OMFS of the time were stating that the dual-degree concept would sever ties with dentistry, lessen OMFS and dental education in the eyes of medical counterparts and, functionally, serve as "armageddon" for the specialty. Sound like anything you've heard recently?
Fast forward 40 years and nothing has changed. Both types of surgeons exist and thrive in their communities. Trainees have a multitude of options for training pathways and flexibility in pursuing career options. There are practices with both single- and degree-surgeons under the same roof, the sun still rises in the East and settles out West.
The strength of OMFS has always been in its dental roots and that's where the $$$$ is. Unless this changes, OMFS will never turn its back on dentistry.
Read for yourself (just a handful of the dozens of articles and letters on the subject, key articles in bold):
1970s:
Guralnick WC. The combined oral surgery-MD program: the Harvard plan. J Oral Surg. 1973 Apr;31(4):271-6.
Hall HD. Current tracks in advanced educational programs in oral surgery. J Oral Surg. 1973 Apr;31(4):260-5.
Hillenbrand H. The past, present, and future status of oral surgery in the United States. J Oral Surg. 1973 Apr;31(4):290-4.
Eisenbud L. An analysis of the potential impact of oral surgery-MD programs. J Oral Surg. 1973 Apr;31(4):277-82.
The double-degree dilemma. J Oral Surg. 1977 May;35(5):347, 430.
Alling CC. Defense of MD option. J Oral Surg. 1977 Aug;35(8):619.
1980s:
Barber HD, Sejud P. Double-degree oral and maxillofacial surgeons: was it worth it? J Oral Maxillofac Surg. 1988 Oct;46(10):872-4.
To what degree can we change our future? J Oral Maxillofac Surg. 1989 Oct;47(10):1124-6.
The double-degree debate continues. J Oral Maxillofac Surg. 1989 Oct;47(10):1123-4.
1990s:
Punjabi AP, Haug RH. The development of the dual-degree controversy in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1990 Jun;48(6):612-6.
Bailey WK. Medical training for oral and maxillofacial surgeons: a resident's perspective. J Oral Maxillofac Surg. 1990 Jun;48(6):667.
Laskin DM. The MD degree: a panacea or a problem? J Oral Maxillofac Surg. 1997 Mar;55(3):209.
Laskin DM. Double degree members and their importance to AAOMS. American Association of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 1997
Sep;55(9):911.
Leonard MS. The MD degree: problem or solution? J Oral Maxillofac Surg. 1997 Aug;55(8):899-900.
2000s:
Kaban LB, Guralnick WC. Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery Program. J Oral Maxillofac Surg. 2005 Aug;63(8):1069-72
Dodson TB, Guralnick WC, Donoff RB, Kaban LB. Massachusetts General Hospital/Harvard Medical School MD oral and maxillofacial surgery program: a
30-year review. J Oral Maxillofac Surg. 2004 Jan;62(1):62-5.
Herford AS. Integration of the medical degree in oral and maxillofacial surgery: a 10-year follow-up. J Oral Maxillofac Surg. 2002 Jul;60(7):844.
Mettner J. To MD or not to MD? Minn Med. 2005 Aug;88(8):8-9.
2010:
Assael LA. The view from the third rail. J Oral Maxillofac Surg. 2010 Apr;68(4):713-4.
Take home points:
1. Not a new controversy and certainly not one that hasn't been dissected from every viewpoint.
2. OMFS scope of practice is determined by Dental Practice Acts -- State Dental Associations are powerful entities, often more powerful than their medical counterparts and have been successful at ensuring that ALL OMFS have the same practice privileges. The last time this debate ramped up was in response to a NYTimes article on OMFS doing cosmetic surgery.
3. Many will maintain that the MD does add some degree of security. GR would just point out the following: if everyone in OMFS had a medical degree, PRS/ENT would still try to limit scope of practice, just via a different mechanism (e.g. Board Certification by an ABMS-certified board). If OMFS became a member of the ABMS, they would try something else - do not underestimate one's creativity when their livelihood is threatened.
4. PRS/ENT look at OMFS the way that OMFS look at perio. Think about that the next time you rag on a periodontist for taking out thirds.
