OMFS & Hospital Privilege

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DREDAY

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It is under the scope of OMFS to perform surgeries on cases pertaining to craniofacial anomalies, pathology, and cosmetics. Some programs give you "enough" experience in the above to make you "competent" in doing "straight forward" cases. However, some OMFS say that they have "difficulty" getting hospital privileges to performing such procedures.

1. How do hospitals determine what procedures that you are are competent in doing?


2. If its based on your OR logs, how many 1st assist surgeries are required to make you "competent" in a specific procedure?


3. Do they take into account OR logs/ experiences abroad, such as mission trips or fellowships in other countries? (I've heard that some OMFS programs go on mission trips where their residents perform primary cleft surgeries)
 
DREDAY said:
It is under the scope of OMFS to perform surgeries on cases pertaining to craniofacial anomalies, pathology, and cosmetics. Some programs give you "enough" experience in the above to make you "competent" in doing "straight forward" cases. However, some OMFS say that they have "difficulty" getting hospital privileges to performing such procedures.

1. How do hospitals determine what procedures that you are are competent in doing?


2. If its based on your OR logs, how many 1st assist surgeries are required to make you "competent" in a specific procedure?


3. Do they take into account OR logs/ experiences abroad, such as mission trips or fellowships in other countries? (I've heard that some OMFS programs go on mission trips where their residents perform primary cleft surgeries)
Click to expand...

This is a very complex issue and different hospitals handle it differently, but a few general principles apply:

1. Most hospitals utilize core credentialing criteria by specialty. Where it gets murky is what is included in the core procedures of any given specialty. If the hospital's credentialing board utilizes the credentialing guide provided by AAOMS, then you can be assured of being considered for privileges including craniofacial, cosmetic and tumor surgery. However, if the credentialing board defers to expertise from other practitioners or related specialties, your scope may be more limited. Finally, the board, in general, will be hesitant to credential someone for something they're not familiar with or are not familiar with that particular specialty performing. For example, some hospitals may not have OMFS on staff and may even have hesitations about granting privileges for trauma, since they're not familiar with what we do.

2. Credentialing can be based on OR logs for procedures that are not considered within scope. Usually, however, board certification or board eligibility will allow for credentialing for most "core" procedures in your specialty. This is how young surgeons get privileges.

3. Additional training or experiences are certainly considered in evaluating your application for credentials for a certain procedure. However, oftentimes politics plays a role in determining who can do what, especially in areas where overlap is costly to related specialties (i.e. cosmetics).

Fortunately, there is a formal appeals process and AAOMS is quite proactive in helping young surgeons provide the necessary information to hospital boards to assist with credentialing.

Talking with some of our recent grads, it seems as though they have not had trouble getting privileges for things that OMFS are known to do (orthognathic, TMJ, trauma, dentoalveolar), but have had sometimes uphill battles for cosmetics, craniofacial and tumor surgery.

Perhaps a recent grad can chime in about their experience with this process?
 
111 views and only 1 reply?? More inputs please.
 
Thank you for your reply. More specifically, how is hospital privilege granted? Suppose you are a new OMFS and you apply to "City of Hope" hospital saying "I have a patient and I would like to do craniofacial surgery in your OR." Who specifically grants you the right to do the surgery? is it a committee? How does the process work?


mms0805 said:
This is a very complex issue and different hospitals handle it differently, but a few general principles apply:

1. Most hospitals utilize core credentialing criteria by specialty. Where it gets murky is what is included in the core procedures of any given specialty. If the hospital's credentialing board utilizes the credentialing guide provided by AAOMS, then you can be assured of being considered for privileges including craniofacial, cosmetic and tumor surgery. However, if the credentialing board defers to expertise from other practitioners or related specialties, your scope may be more limited. Finally, the board, in general, will be hesitant to credential someone for something they're not familiar with or are not familiar with that particular specialty performing. For example, some hospitals may not have OMFS on staff and may even have hesitations about granting privileges for trauma, since they're not familiar with what we do.

2. Credentialing can be based on OR logs for procedures that are not considered within scope. Usually, however, board certification or board eligibility will allow for credentialing for most "core" procedures in your specialty. This is how young surgeons get privileges.

3. Additional training or experiences are certainly considered in evaluating your application for credentials for a certain procedure. However, oftentimes politics plays a role in determining who can do what, especially in areas where overlap is costly to related specialties (i.e. cosmetics).

Fortunately, there is a formal appeals process and AAOMS is quite proactive in helping young surgeons provide the necessary information to hospital boards to assist with credentialing.

Talking with some of our recent grads, it seems as though they have not had trouble getting privileges for things that OMFS are known to do (orthognathic, TMJ, trauma, dentoalveolar), but have had sometimes uphill battles for cosmetics, craniofacial and tumor surgery.

Perhaps a recent grad can chime in about their experience with this process?
Click to expand...
 
I received an e-mail back from my former chief, who currently practices in the Pittsburgh area. Keep in mind - completed a 6 year OMFS resident w/o fellowship.

Here's the list of procedures that he's credentialed for under "Core Credentialing" at his hospital:

Alveolectomy/Alve-oplasty
Alveolar & gingival and mucogingival surgical procedures
Antrotomy, Antrostomy
Apicoectomy
Arthrectomy, Arthroscopy, Arthrotomy for TMJ
Arthrocentesis- aspiration, TMJ
Arthroplasty, TMJ
Arthroscopic & Endoscopic procedures
Biopsy, All
Blepharoplasty
Caldwell Luc
Catheterization of salivary duct (sialography)
Closure of laceration and fistula
Condylectomy
Coronoidectomy
Corticotomy of maxilla or mandible
Crown and bridge preparation
Decompression of nerves
Dental and dentoalveolar surgical procedures
Dilation of mouth
Electrosurgical or cryosurgical excision of lesions of the oral mucosa
Eminectomy
Endodontics
Excision (enucleation) or marsupialization of cysts, lesions, exostoses, mucoceles, tumors and tuberosities
Extraction of teeth, impacted
Extraction of teeth, complex
Fracture treatment (open and closed), mandible, maxilla, zygoma, orbital bones, frontal bone
Frenectomy
Grafting procedures including bone, skin, gingival,inlay, and pedicle
Hemisection of tooth
Immobilization of jaws
Implant procedures, dental
Incision & drainage of abscesses and infections
Lavage maxillary sinus
Ligation of salivary duct
Lip, palatal cleft, & tongue surgery (including shave and wedge resection)
Mandibulectomy
Maxillectomy including radical w/ orbital exenteration
Mentoplasty
Nasal Septoplasty
Oral prosthesis for malformation of face, jaw, mouth including congenital, pathological & traumatic
Oral & Maxillofacial trauma surgery (mandible, maxilla, zygoma, orbit, frontal bone)
Oral & Maxillofacial reconstructive surgery (including pathologic)
Oral & Maxillofacial orthognathic surgery
Oral & Maxillofacial extirpative surgery for pathology
Osseous surgery (including flap entry, closure)
Osteotomy, inferior border symphasis
Osteotomy-including maxillary, subcondylar, and Lefort I,II,III
-With/without palatal split or bone graft
Otoplasty
Palatoplasty
Partial glossectomy for orthognathic surgery considerations
Periodontal surgical procedures
Placement of nasal balloon to control hemorrhage
Reanastomosis of nerves
Removal of foreign body, glands, calculi, tori, lesions and tumors
Repair of traumatic oroantral, oronasal communication associated w/ facial skeletal fractures
Repositioning of muscles, nerves, and ducts
Restorative dentistry
Rhytidectomy
Sequestration & saucerization
Surgical procedures of salivary gland/duct
Tracheostomy and/or Tracheotomy
Vestibuloplasty

ANESTHESIA
Moderate Sedation

He said the process was relatively painless. He had to provide evidence of having completed an ADA program in Oral and Maxillofacial Surgery and had an interview with a few members of the credentialing board. He said that the board was composed of 2 general surgeons (one of whom was the chief of surgery), 1 anesthesiologist, 1 plastic surgeon, 1 ENT and 1 OMFS, in addition to hospital administrators and a "lay member".

Curiously, you'll notice some random general/restorative dental procedures on the core credentialing list - like crown and bridge preparation!
 
Wow. Not bad at all. Sounds like a very fair list. Do you think the list would be as extensive if the OMFS was not on the credentialing board?


mms0805 said:
I received an e-mail back from my former chief, who currently practices in the Pittsburgh area. Keep in mind - completed a 6 year OMFS resident w/o fellowship.

Here's the list of procedures that he's credentialed for under "Core Credentialing" at his hospital:

Alveolectomy/Alve-oplasty
Alveolar & gingival and mucogingival surgical procedures
Antrotomy, Antrostomy
Apicoectomy
Arthrectomy, Arthroscopy, Arthrotomy for TMJ
Arthrocentesis- aspiration, TMJ
Arthroplasty, TMJ
Arthroscopic & Endoscopic procedures
Biopsy, All
Blepharoplasty
Caldwell Luc
Catheterization of salivary duct (sialography)
Closure of laceration and fistula
Condylectomy
Coronoidectomy
Corticotomy of maxilla or mandible
Crown and bridge preparation
Decompression of nerves
Dental and dentoalveolar surgical procedures
Dilation of mouth
Electrosurgical or cryosurgical excision of lesions of the oral mucosa
Eminectomy
Endodontics
Excision (enucleation) or marsupialization of cysts, lesions, exostoses, mucoceles, tumors and tuberosities
Extraction of teeth, impacted
Extraction of teeth, complex
Fracture treatment (open and closed), mandible, maxilla, zygoma, orbital bones, frontal bone
Frenectomy
Grafting procedures including bone, skin, gingival,inlay, and pedicle
Hemisection of tooth
Immobilization of jaws
Implant procedures, dental
Incision & drainage of abscesses and infections
Lavage maxillary sinus
Ligation of salivary duct
Lip, palatal cleft, & tongue surgery (including shave and wedge resection)
Mandibulectomy
Maxillectomy including radical w/ orbital exenteration
Mentoplasty
Nasal Septoplasty
Oral prosthesis for malformation of face, jaw, mouth including congenital, pathological & traumatic
Oral & Maxillofacial trauma surgery (mandible, maxilla, zygoma, orbit, frontal bone)
Oral & Maxillofacial reconstructive surgery (including pathologic)
Oral & Maxillofacial orthognathic surgery
Oral & Maxillofacial extirpative surgery for pathology
Osseous surgery (including flap entry, closure)
Osteotomy, inferior border symphasis
Osteotomy-including maxillary, subcondylar, and Lefort I,II,III
-With/without palatal split or bone graft
Otoplasty
Palatoplasty
Partial glossectomy for orthognathic surgery considerations
Periodontal surgical procedures
Placement of nasal balloon to control hemorrhage
Reanastomosis of nerves
Removal of foreign body, glands, calculi, tori, lesions and tumors
Repair of traumatic oroantral, oronasal communication associated w/ facial skeletal fractures
Repositioning of muscles, nerves, and ducts
Restorative dentistry
Rhytidectomy
Sequestration & saucerization
Surgical procedures of salivary gland/duct
Tracheostomy and/or Tracheotomy
Vestibuloplasty

ANESTHESIA
Moderate Sedation

He said the process was relatively painless. He had to provide evidence of having completed an ADA program in Oral and Maxillofacial Surgery and had an interview with a few members of the credentialing board. He said that the board was composed of 2 general surgeons (one of whom was the chief of surgery), 1 anesthesiologist, 1 plastic surgeon, 1 ENT and 1 OMFS, in addition to hospital administrators and a "lay member".

Curiously, you'll notice some random general/restorative dental procedures on the core credentialing list - like crown and bridge preparation!
Click to expand...
 
I better hurry up and do some crown and bridge for experience. Haven't done any since school! 😱
 
dilation of mouth = brisement procedure
 
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