Regarding your statement on orthognathic... not sure if you’ve used digital planning before but doesn’t this make the issue of occlusion a moot point with the orthodontics and digital splints involved?
Nothing is ever a moot point when it comes to surgery. And with orthognathic surgery, the occlusion is what it's all about. It is the only reason we are there for the surgery. I was being glib saying the surgery is easiest part. I guess a better thing to say is that the most important thing is the thing you are doing right then.
With respect to orthognathic surgery, it is one of the areas of OMS at which I am best. I first scrubbed on these cases with my father in 1982. This was before the advent of rigid fixation. I probably got to see 50 orthognathic osteotomies before I even got to dental school. So I have been fortunate to have mentors who worked well in dentistry, and especially orthodontists.
After dental school, I had an internship year where one surgeon performed mostly orthognathic and TMJ surgery. Then, I had my full residency training at Mayo in Rochester, MN, where we were doing 300+ osteotomies a year in the late 1980s-early1990s. We worked very closely with the orthodontists, both pre and post-surgery.
Now, I see the orthognathic patients multiple times preop and postop. I do not worry about the reimbursement (at least not too much). It is poor across the board. The orthodontists appreciate the care we give to their patients. It is not a one-and-done situation for me at all.
Most of my career I have done stone model surgery, and I still do it for a single-jaw case. I do hyper-accurate measuring of these models and take those to the OR to replicate the measurements on the patient. I check the occlusion after placement of fixation, and if it isn't right, I take out the fixation and do it again.
I also do the computer planning, and it is very nice with double jaws cases, and especially with a maxillary asymmetry case. However, I still set the occlusion myself on models. On a segmental case, it helps me to see where the intra-operative cuts will be. I'll also get the orthodontist to check the final occlusion before splint fabrication to make sure that it is what they want.
This is what I do, it's my profession, and I am not going to assign that responsibility to a technician at the plating company, good as they may be. Otherwise, it's just a trade, not a profession.