OMFS should be a dual-degree specialty ONLY

[OMFS MASTER]

I recently read a 'summary' by the AMA on oral surgeons, basically outlining the ways that OMFS is an inferior specialty compared to ENT and Plastics. The article took aim not at dual-degreed surgeons, but only at 4 year tracks. The sad truth is there are too many piece-of-crap 4 year programs that only teach dentoalveolar and thus the article is partially correct.

If all OMFS had dental and medical licenses, the arguement wouldn't hold any water...but as the specialty now stands, it does.

---

Members don't see this ad.

 

[gary_ruska]

I recently read a 'summary' by the AMA on oral surgeons, basically outlining the ways that OMFS is an inferior specialty compared to ENT and Plastics. The article took aim not at dual-degreed surgeons, but only at 4 year tracks. The sad truth is there are too many piece-of-crap 4 year programs that only teach dentoalveolar and thus the article is partially correct.

If all OMFS had dental and medical licenses, the arguement wouldn't hold any water...but as the specialty now stands, it does.

Gary "What's the deal with this thread" Ruska here,

Why create this thread, when there is already a thread devoted to this topic? Is it just to fire up guys in four-year programs?

GR disagrees with your assessment of the document. Though they explicitly target 4-year programs, the majority of the document does not distinguish between single- and dual-degree surgeons. In fact, they even mention that 6-year guys can do plastics residencies after OMFS, which GR thought was a subtle hint that "we've even allowed these guys a pathway to do plastic surgery, but they'd rather cut corners..."

Also, there are plenty of 6-year programs that focus on dentoalveolar, implantology and do minimal major surgery (eg. Columbia)...For every Columbia, there is a Carle clinic and vice versa.

Kudos to you, however, for taking a stand on the issue.

 

[OMFS MASTER]

The point I am trying to make is that we as a specialty are "targets" because many of us are "only" dentists, by degree.

How much easier would it be to defend the specialty if EVERYONE had a dual-degree LICENSE, not just degree?? Sure there would still be battles to be fought, but there would be LESS battles and they would be MORE EASILY fought.

All of us who went to dual degree programs know that we'll always be referred to as the 'dentist', but the battles would be much easier. We're such a target when we're not unified by training and degree.

 

[1992Corolla]

One way to battle this misrepresentation by the 'geniuses' that run the AMA is to work your a** off during and after residency to prove to the MD colleagues that OMFS are worth more than the AMA implies in their statement. 4 or 6 year.

 

[OMFS MASTER]

While the above idea holds some merit, mine is better.

 

[6897round2]

I agree - everyone should be double degree in the future. Perhaps the powers that be can find a way to grandfather those single-degree guys into board certification, in the event that the double-degree becomes standard...Perception is a large part of the equation and the perception of the MD is that it is better - regardless of whether it actually makes you a better surgeon.

Will this happen? Probably not...Why? The higher ups in AAOMS are almost universally single-degree...

The two-track system has failed from a public-relations standpoint. It is confusing to the public, practitioners and our colleagues. This is no one's fault but our own and we've tried the "explain that the training is equivalent" strategy and it just isn't working. If, after 30 years, this isn't working, perhaps its time to call it a day and mandate for everyone having the same track, be it single- or dual-degree.

The April JOMS editorial touches upon this issue.

 

[2thguy82]

It's always an interesting topic....

My program director is a 4yr who does huge resections/reconstructions and is always willing to try new techniques with BMP/grafts/techniques

The other full time attendings here are all dual degree except one, and there's zero distinction made between them in terms of privileges, scope, or the treatment they choose for their patients. If anything, one of the 4yr guys is the most aggressive/"state of the art" here

Needless to say the 4 vs. 6 topic seems to be more of a public relations issue at this point than a topic of clinical relevance.

That said, too many 6yr and 4yr programs are committed to their track respectively. I would find it hard to imagine there will ever be a universally accepted program orientation at this point.

 

[schmack]

First off, the AMA sucks. Just ask most of your MD colleagues. That's why it has less than 50% participation amongst MD's, and it is the only physician-associated organization that actually supported this current health care reform bill piece of $#!#(another topic for another day). Second, OMS is and has ALWAYS been a DENTAL specialty. It is NOT a medical specialty, even for those who have the dual degree. The MD is a personal preference option at this point which has no merit as to types of procedures that can be performed in an office or hospital. Bottom line. This has been talked about in the other thread that GR mentioned.

For the AMA to try and describe our scope as OMS is fruitless, primarily because we are a dental specialty, and regulated in no way by the AMA. I do agree, however, that something needs to be done to educate these *****s about this fact, primarily so other organizations and associations cannot use this as potential litigation or for lawmakers to try and limit scope.

Choosing to pursue an MD initially was on OUR terms as OMS's, for the educational benefit, or to pursue additional training beyond the scope of OMS. As an organization, OMS's never intended for the MD to be a merit for scope of practice in our specialty. To have another organization suggest just that, is pretty disturbing. To suggest that the solution to this problem is to "give in" and make OMS a dual degree specialty only would be foolish. Because, as GR and others have stated, they'd first come after single degree OMS's, and then dual degree OMS's. Till it got to the point that any scope of ours encroaching on the turf of ENT or PRS would be limited as well. OMS needs to stand its ground, attempt to educate, and maintain our dental specialty roots.

-----Schmack's opinion

 

[OMFSZADE]

I am on OMFS resident in a four year program. I think that an MD is a beautiful option. There are absolutely no negatives with getting an MD as a part of OMFS training. One can only gain from it immensely. There are number of ways that MD can serve:
1. More education is always good.
2. It looks better next to your name...especially to people who are "OMFS confused"
3. One has more options when choosing national and international fellowships
4. American board of Cosmetic surgery only recognizes oral surgeons who have MD
5. In many states, such as CT, and MA, a single degree OMFS is not allowed to perform any cosmetic procedures on the face...they are not allowed to use BOTOX for cosmetic purposes, due to the fact that they are governed by the state's dental associations...THIS IS PAINFUL AND DEGRADING
6. Our MD colleagues in the community, are much more comfortable to refer patients to a dual degree surgeon, just because they foolishly think that MD makes one a better surgeon. This is true. and it sucks
7. ORAL AND MAXILLOFACIAL SURGERY as we know it in US is a MEDICAL SPECIALTY in many major countries, including UK...so it is easier to be eligible if one was to move, or operate outside the US.
8. MD can be potentially much more helpful in academics...its not necessary as seen so far...but who knows in the future
9. One has almost almost no chance of performing a cleft lip and palate surgery as a single degree OMFS guy in US...not to mention get a craniofacial fellowship. Of course you will tell that you know single degree guys who do it. And I will tell you that some i.e. Turvey...have been doing it forever, and have a nice setup and a reputation, and other guys live far from major centers...i.e. Hawaii and are doing those procedures there. Whether it is an important factor is up to the individual.
10. If one were to choose to extend his/her career beyond OMFS...i.e. plastics, microvascular...an MD is a must.


So...an MD is quite simply a very nice icing on the cake. Now for the defensive types...you notice that I didn't mention anything about who is a better surgeon.
That factor of course has nothing to do with degrees, and has everything to do with an individual, their wanting to be great, and continuous striving for perfection...just like anywhere else in life. I know single degree guys who graduated from "SMALL" programs in Brooklyn and Bronx and who became amazing surgeons and have tremendously advanced our field. I also know dual and singe degree guys who came out of amazing programs...that really gave one all the opportunity and experience to become great, and who can't operate.

At the end of the day, we have to keep some things in mind. DONT CREATE A DOUBLE STANDARD. Our field, OMFS, is a constantly evolving and growing field. We came very far from our exodontist origins in the 1950's. And of course as a result of our superior training and desire to do more procedures, we are encroaching on other fields.
One can argue that PERIO is also an evolving field that has in its own right advanced tremendously...and has been continuously encroaching on OMFS...in terms of procedures and an many cases anesthesia.

You will tell me: "You should see the complications periodontists have...they are not "Surgeons"...they are "gum gardeners", "Hygientists with balls" , they "should not be placing implants, or "getting into the sinuses, or taking out wisdom teeth". In reality its all bull****. I know periodontist who are amazing at what they do...have amazing hands and make great clinical decisions. They handle both hard and soft tissues well, and have a great understanding of restorative aspects. However, the truth is, that they ARE encroaching on OMFS turf...and of course it is unpleasant for us...especially because these are the $$$ procedures. Hey...this is the truth.
Now PLASTICS and some ENTS feel that we are the "PERIODONITSTS" who "SHOULD NOT" be "CUTTING SKIN ON THE FACE", we are not trained well enough, and we should work on the "LOWER JAW" and take out teeth. "HEY WE HAVE A CONSULT FOR YOU...WE HAVE A PATIENT ADMITTED FOR SEIZURE WORKUP AND WE NOTICED SHE HAS BAD TEETH, WE WANTED TO CALL THE DENTIST TO TAKE A LOOK AT HER."
Go google around, read the forums. Read what the MD's think of us. It is amazing how so many of them think that we are "PERIODONTISTS".
In reality it is very annoying.
In reality it is probably much better for someone just to go the traditional route to become a plastic and craniofacial surgeon and be recongized for it. Doing it through OMFS it possible but very painful and one has to constantly be on defensive and "explain" that "I am a facial surgeon who takes the posterior table out and allows the brain to fill in the frontal sinuses"...people in the community will always call us "dentists"...and its ok...if thats who you want. My point, is that a lot of OMF guys are really embarassed that they are dentists...when rounding in the morning or in the hospital they tell patients "I am a facial doctor". Its a defense mechanism. They want to be indistinguishable from facial plastic surgeons...and be treated the same, and it doesn't sit well with MD's. It never will. Just like it will never sit well with us that PERIOS go into the sinuses, take out wizzies, and do IV sedations.

The moral is this:
1. If you choose to be a super surgeon (facial cosmetics, cleft, microvascular), want to be equally treated by the plastics and ENT's...then be it...strive for it and fight for it...but remember...that you ARE taking a different and uncoinventional route...and they who have "done it the right way", will despise you for it.

2. If you really want to be Facial plastic surgeon, then you probably have enough desire and drive to do it...then become it the right way. Go to ENT...or PRS residency. That was you wont have to defend yourself.

3. Undersatnd this...if your loved one needed a 3rd molars out whould you sent him/her to? To a trauma center OMFS who does crazy trauma and who roughly takes out teeth in a community clinic, or to the PRIVATE PRACTICE OMFS, who ONLY takes out wizzies and does it quickly, gently and autramatically.
Now if you relative needed a nosejob, who would you sent him/her to? To an oral surgeon who in addition to 3rd molard, implants, sunus lifts, mandible fractures, several times a months does rhinoplasties in some well selected cases, or to a guy who only does nose jobs all day and nights such as Dr. Paul Nassif ?
You know the answer.

There is no solution. We, OMFSs should continue doing what we are doing despite all the people who are against us and the confusion of who we really are. We have been doing it well for a long while. But if we want to be treated with respect by our MD colleagues, we have to treat our own dental specialists (perios) with respect.
There is enough candy for everyone.

 

[280040]

I am on OMFS resident in a four year program. I think that an MD is a beautiful option. There are absolutely no negatives with getting an MD as a part of OMFS training. One can only gain from it immensely. There are number of ways that MD can serve:
1. More education is always good.
2. It looks better next to your name...especially to people who are "OMFS confused"
3. One has more options when choosing national and international fellowships
4. American board of Cosmetic surgery only recognizes oral surgeons who have MD
5. In many states, such as CT, and MA, a single degree OMFS is not allowed to perform any cosmetic procedures on the face...they are not allowed to use BOTOX for cosmetic purposes, due to the fact that they are governed by the state's dental associations...THIS IS PAINFUL AND DEGRADING
6. Our MD colleagues in the community, are much more comfortable to refer patients to a dual degree surgeon, just because they foolishly think that MD makes one a better surgeon. This is true. and it sucks
7. ORAL AND MAXILLOFACIAL SURGERY as we know it in US is a MEDICAL SPECIALTY in many major countries, including UK...so it is easier to be eligible if one was to move, or operate outside the US.
8. MD can be potentially much more helpful in academics...its not necessary as seen so far...but who knows in the future
9. One has almost almost no chance of performing a cleft lip and palate surgery as a single degree OMFS guy in US...not to mention get a craniofacial fellowship. Of course you will tell that you know single degree guys who do it. And I will tell you that some i.e. Turvey...have been doing it forever, and have a nice setup and a reputation, and other guys live far from major centers...i.e. Hawaii and are doing those procedures there. Whether it is an important factor is up to the individual.
10. If one were to choose to extend his/her career beyond OMFS...i.e. plastics, microvascular...an MD is a must.


So...an MD is quite simply a very nice icing on the cake. Now for the defensive types...you notice that I didn't mention anything about who is a better surgeon.
That factor of course has nothing to do with degrees, and has everything to do with an individual, their wanting to be great, and continuous striving for perfection...just like anywhere else in life. I know single degree guys who graduated from "SMALL" programs in Brooklyn and Bronx and who became amazing surgeons and have tremendously advanced our field. I also know dual and singe degree guys who came out of amazing programs...that really gave one all the opportunity and experience to become great, and who can't operate.

At the end of the day, we have to keep some things in mind. DONT CREATE A DOUBLE STANDARD. Our field, OMFS, is a constantly evolving and growing field. We came very far from our exodontist origins in the 1950's. And of course as a result of our superior training and desire to do more procedures, we are encroaching on other fields.
One can argue that PERIO is also an evolving field that has in its own right advanced tremendously...and has been continuously encroaching on OMFS...in terms of procedures and an many cases anesthesia.

You will tell me: "You should see the complications periodontists have...they are not "Surgeons"...they are "gum gardeners", "Hygientists with balls" , they "should not be placing implants, or "getting into the sinuses, or taking out wisdom teeth". In reality its all bull****. I know periodontist who are amazing at what they do...have amazing hands and make great clinical decisions. They handle both hard and soft tissues well, and have a great understanding of restorative aspects. However, the truth is, that they ARE encroaching on OMFS turf...and of course it is unpleasant for us...especially because these are the $$$ procedures. Hey...this is the truth.
Now PLASTICS and some ENTS feel that we are the "PERIODONITSTS" who "SHOULD NOT" be "CUTTING SKIN ON THE FACE", we are not trained well enough, and we should work on the "LOWER JAW" and take out teeth. "HEY WE HAVE A CONSULT FOR YOU...WE HAVE A PATIENT ADMITTED FOR SEIZURE WORKUP AND WE NOTICED SHE HAS BAD TEETH, WE WANTED TO CALL THE DENTIST TO TAKE A LOOK AT HER."
Go google around, read the forums. Read what the MD's think of us. It is amazing how so many of them think that we are "PERIODONTISTS".
In reality it is very annoying.
In reality it is probably much better for someone just to go the traditional route to become a plastic and craniofacial surgeon and be recongized for it. Doing it through OMFS it possible but very painful and one has to constantly be on defensive and "explain" that "I am a facial surgeon who takes the posterior table out and allows the brain to fill in the frontal sinuses"...people in the community will always call us "dentists"...and its ok...if thats who you want. My point, is that a lot of OMF guys are really embarassed that they are dentists...when rounding in the morning or in the hospital they tell patients "I am a facial doctor". Its a defense mechanism. They want to be indistinguishable from facial plastic surgeons...and be treated the same, and it doesn't sit well with MD's. It never will. Just like it will never sit well with us that PERIOS go into the sinuses, take out wizzies, and do IV sedations.

The moral is this:
1. If you choose to be a super surgeon (facial cosmetics, cleft, microvascular), want to be equally treated by the plastics and ENT's...then be it...strive for it and fight for it...but remember...that you ARE taking a different and uncoinventional route...and they who have "done it the right way", will despise you for it.

2. If you really want to be Facial plastic surgeon, then you probably have enough desire and drive to do it...then become it the right way. Go to ENT...or PRS residency. That was you wont have to defend yourself.

3. Undersatnd this...if your loved one needed a 3rd molars out whould you sent him/her to? To a trauma center OMFS who does crazy trauma and who roughly takes out teeth in a community clinic, or to the PRIVATE PRACTICE OMFS, who ONLY takes out wizzies and does it quickly, gently and autramatically.
Now if you relative needed a nosejob, who would you sent him/her to? To an oral surgeon who in addition to 3rd molard, implants, sunus lifts, mandible fractures, several times a months does rhinoplasties in some well selected cases, or to a guy who only does nose jobs all day and nights such as Dr. Paul Nassif ?
You know the answer.

There is no solution. We, OMFSs should continue doing what we are doing despite all the people who are against us and the confusion of who we really are. We have been doing it well for a long while. But if we want to be treated with respect by our MD colleagues, we have to treat our own dental specialists (perios) with respect.
There is enough candy for everyone.

I really like this post and you summed up my thoughts. I could go on and on why most of my classmates think periodontists are the true oral surgeons, and the OMS are the hospital dentists (not truly sure what they do).

I predict perio will rapidly become very competitive and sought after specialty the way they are headed. Most perio programs are now making research time mandatory and whomever is doing the research on a topic (implants, grafts, augmentation, etc) controls the field. I believe they all/most switched over to 3 year programs also to accommodate the research and surgical training time. Periodontists are also much more visible in our school, and I'm assuming most schools. They are nicer, more welcoming, and gentler than the oral surgeons to both students and the patients. That impacts dental students and ultimately referral patterns. Old school perio is dead...hemisections, long term hopeless maintenance (why is a DDS doing that anyway...hygiene should be. we let dental students do it), hopeless defect regeneration. Bring on implants, grafts, esthetic gum contouring, exodontia, sedation. It's exciting stuff, why wouldn't they want to do it. And they should. They are dentists and they are highly trained.

Could you make the argument that OMS is to broad? General surgery scope is being cut up into subspecialties. Can't be good at everything...

AND, I believe mid level providers for dentistry are coming and here to stay. They will initially be embraced by dentists because it means more $$$. Mid levels will do basic dental stuff and dentists will be further educating themselves on implant placement, 3rds, exodontia, in addition to the restorative aspect of implants, endo, perio, prosth, etc. The competition for bread and butter os procedures won't be just perio vs OMS. Bring on the thousands of US dentists.

Just a 4th year dental student perspective though...

 

[Xigris14]

I am in private practice with a DMD and MD. In my mind I have a advantage in the community in two ways:

1) Patients are for the most part clueless to single/dual degree OMFS and their scope/capabilities. For us we know there are few differences other then the dual degree guys knowing more medicine in my opinion but surgically it has no advantage. But for marketing to patients it helps because they think I know more and can do more than a single degree surgeon. Thats the facts in the private sector. I see it from my patients.

2) My colleagues such as Internal Medicine, ENT,Plastics, RadOnc guys I feel speak to me differently and have some higher level of respect when they consult me or when I consult them. I hear it on the phone or in person and it always comes up in the discussion about my MD degree. I think they look at single degree surgeons as dentist with some higher surgical capability rather than as a true surgeon. Or they think that the medical degree means that I can do cosmetics, head and neck cases or more complex types of cases but they are dead wrong and I inform them on this issue.

The point is if your a single degree or dual degree, we need to get more people to realize what our scope and training entails because most will continue to think we just chuck teeth and place implants And thats what most of private guys do so we are to blame in a way. We are isolating ourself from the hospital because trauma and other surgeries do not reimburse like thirds or implants. Just wait and see what happens when that cash cow fails to reimburse at the level they are currently. We are sometimes no different than a periodontist or a one year oral surgery intern year. The more we can show our scope through complex cases, research and involvement in the community and hospitals can we expect others to see what we are capable of doing and gain the respect we deserve.

 

[OMFSZADE]

Hey,

you have no idea of what you are talking about.
I think that you are confused about my previous post.
Please don't make me sound like a periodontist advocate (although I have a lot of perio friends). I just used them as an example.
It will never ever happen that perio will replace omfs. Even though some 10-15% of general dentists in US place implants doesn't make then oral surgeons.
Perio training doesn't even come close to even the most mediocre OMFS training. This is the truth. It is also true that some periodontists are great specialists in their own right and are great at placing implants, small bone grafts, some extractions, and soft tissue procedures...overall...all these procedures are a minor part of a true OMFS scope...they just happen to pay more.

My point in the previous post, which was addressed to my fellow colleagues oral surgeons...was that it is very difficult to DO EVERYTHING...and that it is easier to do a plastics residency to become a true plastic surgeon than to do it through the OMFS route.
I also said that we are all above, and we are all too good and too smart to say what one can and can't do, and what is within one's scope...that has no relevance on anything and doesn't make the situation any easier.
If perios want to place implants, do sinus lifts, etc...let them...it is not our problem. They are allowed by dental board...and WE...OMFS's...are allowed by our board to do what we USUALLY DO...i.e. head and neck surgery.

I really like this post and you summed up my thoughts. I could go on and on why most of my classmates think periodontists are the true oral surgeons, and the OMS are the hospital dentists (not truly sure what they do).

I predict perio will rapidly become very competitive and sought after specialty the way they are headed. Most perio programs are now making research time mandatory and whomever is doing the research on a topic (implants, grafts, augmentation, etc) controls the field. I believe they all/most switched over to 3 year programs also to accommodate the research and surgical training time. Periodontists are also much more visible in our school, and I'm assuming most schools. They are nicer, more welcoming, and gentler than the oral surgeons to both students and the patients. That impacts dental students and ultimately referral patterns. Old school perio is dead...hemisections, long term hopeless maintenance (why is a DDS doing that anyway...hygiene should be. we let dental students do it), hopeless defect regeneration. Bring on implants, grafts, esthetic gum contouring, exodontia, sedation. It's exciting stuff, why wouldn't they want to do it. And they should. They are dentists and they are highly trained.

Could you make the argument that OMS is to broad? General surgery scope is being cut up into subspecialties. Can't be good at everything...

AND, I believe mid level providers for dentistry are coming and here to stay. They will initially be embraced by dentists because it means more $$$. Mid levels will do basic dental stuff and dentists will be further educating themselves on implant placement, 3rds, exodontia, in addition to the restorative aspect of implants, endo, perio, prosth, etc. The competition for bread and butter os procedures won't be just perio vs OMS. Bring on the thousands of US dentists.

Just a 4th year dental student perspective though...

 

[og2]

I really like this post and you summed up my thoughts. I could go on and on why most of my classmates think periodontists are the true oral surgeons, and the OMS are the hospital dentists (not truly sure what they do).

I predict perio will rapidly become very competitive and sought after specialty the way they are headed. Most perio programs are now making research time mandatory and whomever is doing the research on a topic (implants, grafts, augmentation, etc) controls the field. I believe they all/most switched over to 3 year programs also to accommodate the research and surgical training time. Periodontists are also much more visible in our school, and I'm assuming most schools. They are nicer, more welcoming, and gentler than the oral surgeons to both students and the patients. That impacts dental students and ultimately referral patterns. Old school perio is dead...hemisections, long term hopeless maintenance (why is a DDS doing that anyway...hygiene should be. we let dental students do it), hopeless defect regeneration. Bring on implants, grafts, esthetic gum contouring, exodontia, sedation. It's exciting stuff, why wouldn't they want to do it. And they should. They are dentists and they are highly trained.

Could you make the argument that OMS is to broad? General surgery scope is being cut up into subspecialties. Can't be good at everything...

AND, I believe mid level providers for dentistry are coming and here to stay. They will initially be embraced by dentists because it means more $$$. Mid levels will do basic dental stuff and dentists will be further educating themselves on implant placement, 3rds, exodontia, in addition to the restorative aspect of implants, endo, perio, prosth, etc. The competition for bread and butter os procedures won't be just perio vs OMS. Bring on the thousands of US dentists.

Just a 4th year dental student perspective though...

just one question -- are you kidding?

 

[OMFSPrime]

I poop on perio!

I no keed, I no keed

There has always been a long running rivalry between perio and omfs. Gutter vs. Butter...respectively.

Let's see perio do high volume whizzies and atraumatic extractions...its like watching paint dry and/or Alex Trebec with the jeopardy tune...mmm, no thank you.

Perio doing IV Sedation? That is scary.

As for the original topic: Dual degree programs only...mmm, I dunno. Have to think more about it.

What about all the confusion between DDS and DMD?

 

[280040]

Hey,

you have no idea of what you are talking about.
I think that you are confused about my previous post.
Please don't make me sound like a periodontist advocate (although I have a lot of perio friends). I just used them as an example.
It will never ever happen that perio will replace omfs. Even though some 10-15% of general dentists in US place implants doesn't make then oral surgeons.
Perio training doesn't even come close to even the most mediocre OMFS training. This is the truth. It is also true that some periodontists are great specialists in their own right and are great at placing implants, small bone grafts, some extractions, and soft tissue procedures...overall...all these procedures are a minor part of a true OMFS scope...they just happen to pay more.

My point in the previous post, which was addressed to my fellow colleagues oral surgeons...was that it is very difficult to DO EVERYTHING...and that it is easier to do a plastics residency to become a true plastic surgeon than to do it through the OMFS route.
I also said that we are all above, and we are all too good and too smart to say what one can and can't do, and what is within one's scope...that has no relevance on anything and doesn't make the situation any easier.
If perios want to place implants, do sinus lifts, etc...let them...it is not our problem. They are allowed by dental board...and WE...OMFS's...are allowed by our board to do what we USUALLY DO...i.e. head and neck surgery.

Got it. Except oral surgeons USUALLY DO implants, sinus lifts, 3rds.....isn't that the honest truth? ENT does head and neck, hence the name change.

I just offered an opinion from one dental colleague to another, but thanks for the correction.

 

[OMFSZADE]

Dear Colleague,

you are correct. Most oral surgeons are in a private practice mostly performing wisdom teeth, implants, bone grafting, and other "small" procedures. Mostly because they pay well. to be honestly with you...and most of my OMFS colleagues will agree, this is very unfortunate, since most of us if sufficiently reimbursed, would rather do what were were really trained to do...is head and neck procedures, trauma, and orthognathics.
The saddest part of our field, is that arguably the "smallest" surgeries pay the most.

ENTS however, very often perform the same scope after residency that they have in the residency. Of course this varies with additional training, and locations.

So, to summarize, OMFSs are surgeons who very easily and professionally operate inside the oral cavity, the head, and neck regions. So we are all "the head and neck surgeons". Also please dont forget that "oral cavity" is a a part of the head. Its just ENTS want to be called that so they write that next to their name...we don't care...so we are called ORal and MAxillo-facial surgeons.

Please don;t confuse the extent of OMFS training with what they do in private practice.

Periodontists however are only trained to do what they do in their offices. It is not negative just the truth. They no more TREAT the perio disease...that has been abandoned

Got it. Except oral surgeons USUALLY DO implants, sinus lifts, 3rds.....isn't that the honest truth? ENT does head and neck, hence the name change.

I just offered an opinion from one dental colleague to another, but thanks for the correction.

 

[Count Orlok]

ENTS however, very often perform the same scope after residency that they have in the residency. Of course this varies with additional training, and locations.

Most ENT's do T&T (Tubes and Tonsils) just like most OMFS's do T&T. OMFS is not the only specialty where private practice guys focus on the bread and butter. Rarely do ENT's do major surgery (H/N cancer, big trauma, cranial base surg, etc.) out side of academic setting, just like the bigger OMFS procedures are usually kept in academic settings. Not saying it is right, just pointing it out.

 

[servitup]

Probably half of the posted openings for faculty right now specifically require an MD. What do you think will happen to the programs when 99% of the attendings nationwide are dual degree? 20 years from now, that will be the case. All of the leaders in our field who are single degree will be retiring over the next 10 years or so.

 

[JakeD]

I'd have to agree. All programs should be dual degree. I'm finishing my second year of medical school right now and I could not imagine going straight from dental school into an intern year or a 4 year program without some kind of medical background. Times are changing. People are living longer; and there are more patients presenting with multiple co-morbidities and drugs. These will certainly impact surgeries within our scope and those that we are currently expanding into. I certainly don't agree with being "shoved into a corner" by the AMA or the public's mis-perceptions of us, but these are the times we live in. Law/policy makers will be influenced by these branches when it comes time to determine what's "legally" in our scope and we should be ready for that. It's already been mentioned that the single degree guys will be phased out and I strongly agree with that statement due to the current environment; with so much focus on health care and everyone trying to stake a claim in "what's theirs". Never underestimate the influence of public opinion. Just my 0.02.

Also, being able to communicate openly and comfortably among healthcare providers is a very valuable asset. If the MD feels more comfortable talking openly with an MD trained surgeon (whether his reason for feeling comfortable is warranted or not), isn't that better for the patient? Again, just my 0.02

 

[Thunderdome23]

I'd have to agree. All programs should be dual degree. I'm finishing my second year of medical school right now and I could not imagine going straight from dental school into an intern year or a 4 year program without some kind of medical background. Times are changing. People are living longer; and there are more patients presenting with multiple co-morbidities and drugs. These will certainly impact surgeries within our scope and those that we are currently expanding into. I certainly don't agree with being "shoved into a corner" by the AMA or the public's mis-perceptions of us, but these are the times we live in. Law/policy makers will be influenced by these branches when it comes time to determine what's "legally" in our scope and we should be ready for that. It's already been mentioned that the single degree guys will be phased out and I strongly agree with that statement due to the current environment; with so much focus on health care and everyone trying to stake a claim in "what's theirs". Never underestimate the influence of public opinion. Just my 0.02.

Also, being able to communicate openly and comfortably among healthcare providers is a very valuable asset. If the MD feels more comfortable talking openly with an MD trained surgeon (whether his reason for feeling comfortable is warranted or not), isn't that better for the patient? Again, just my 0.02

I disagree with you, I highly doubt there will be a "phase-out" of a DMD/DDS practicing OMFS, which, let's not forget, is a dental specialty. Maybe it will be more difficult to practice cosmetic or head/neck cancer, but no other medical profession does orthognathics, implants, infections, TMJ, taht is ours no matter what. Also, all single year degree programs require about 6 months (at least) of general surgery rotation, where you're expected to perform at the level of an MD gen surg intern. Wait till you get to your third year of medical school and tell me you honestly learn more being and interns bitch then an actual intern. You learn a ton of medicine in gen surg. And give me a break with the complex medical conditions. Yes people have medical conditions but we are not managing them, most OMFS will call their PCP about it no matter how many degrees they have. We are not managing all of their medical conditions but just being aware of which ones effect the course of our treatment. Oh and btw, almost all 6 year programs have you start your intern year BEFORE medical school.

 

[schmack]

Ditto thunderdome. My thoughts exactly. If you wanted to be a "big doc" with all the respect of an equal MD medical professional, you should have gone to MEDICAL school to do a MEDICAL specialty. Not dental school and dental specialty. No matter which track you choose, you'll always be "the dentist" and until you are comfortable with that and proud of that DDS/DMD you worked so hard for, you're always going to be miserable trying to defend yourself constantly. Be comfortable with the decision you made to be OMFS as a dental specialty. Let your surgical skills and patient management practices defend you. Not the degree you attain. I worked hard for my DDS and I"m proud of it, not ashamed.

 

[JakeD]

1. Neither of us can predict the future so I can't comment any further the "phasing out", but like I said, it's just an opinion given the nature of things these days. My point is just to keep public opinion in mind when you consider the future of Oral Surgery Training Programs. Law/Policy makers and the public have no idea what we do so when it comes to limiting or expanding our scope through the laws, I feel they'd be more hesitant to limit us if there is MD involved in our training. Right or wrong, that's the way it is. You also have to consider how much medicine a dental student gets before they're let out into the world.
2. My point was that because of our profession's expansion into cosmetics, head/neck cancer, etc.. the MD comes more into play. Yes, orthognathics, infections,TMJ, etc.. will forever be ours - I couldn't agree with you more.
3. I can guarantee that you would learn more as a general surgery intern than a 3rd year medical student, but how much medicine do you know fresh out of dental school? Are you suggesting that training in medicine would not be beneficial before you did your general surgery rotation? Are you not interacting with these patients before your general surgery rotation? With dental school training becoming more watered down and the increasing medical complexities of the general population at large, that knowledge gap is certainly widening and mandatory dual degree programs would be a way to address that.
Which brings me to my next point. "almost all 6 year programs have you start intern year BEFORE medical school" "all"??? Really? I'll even spot you the ones that send you to medical school 6 months into your intern year. Just because it's happening doesn't make it a good idea. Otherwise literally "all" would do it. The places that still do it either do it for sake of state residency or they've just been doing it for a long time.
And no, we don't manage all of our patient's medical conditions, my statements were never made to imply that and MD gives you the advantage of managing your patients. You can't sit there and tell me that as an intern straight out of dental school there where things that scared the B/S out simply because you've never heard of them. Your patient is not going to ask you if you've been to general surgery yet. It's not going to happen. They're going to expect you to know about all of their medications and conditions before you pick up that periosteal elevator.

Again, my point in saying it should be dual degree training is for a) expansion of our scope b) public pacification (as wrong as this one is, we have to accept that the public will NEVER understand what we do as it stands) the unknown breeds fear and we all know how influential fear is in politics and c) better preparation during residency training. Dental school is now more watered down, NBDE I is becoming pass/fail and these residents should wait until general surgery to learn medicine?

Bringing up the past is almost irrelevant because as I posted previously, times are changing.

 

[JakeD]

So those who agree with dual degrees aren't proud to be dentists? Keep in mind before you can be a good oral surgeon you have to be a good dentist. I'm proud to have the opportunity to expand our scope. Again, as a DDS first.

 

[Thunderdome23]

If we are talking about the public opinion, I think if we become the only profession requiring two doctorates to practice people may become confused with our profession, perhaps moving it to become a medical profession all together. This idea is discouraging as it seems to undermine the importance of the DMD/DDS. With a DMD/DDS we are doctors, we are trained in pharmacology, basic medical sciences, and dentistry. We are legally allowed to prescribe any medication. My opinion is that if we give in to the public perception that we need an MD (which I believe is not true) we will lose respect for our field as a dental specialty. This is the time to stand strong and be confident that we are well trained to perform the procedures we do. There are both good and bad 4 and 6 year programs. The MD does not dictate the quality of our training and as long as 60% of the programs do not currently offer an MD it would be nearly impossible to phase them out. If you want an MD then do it, but it is not needed and I doubt it ever will be. The AMA are the only ones making a stink about our profession, and guess what, most physicians do respect us and most do not agree with the AMA to begin with. The public views us a competent dental specialist (most are even confused by those who have an MD along with their DDS/DMD).

 

[DREDAY]

If we are talking about the public opinion, I think if we become the only profession requiring two doctorates to practice people may become confused with our profession, perhaps moving it to become a medical profession all together. This idea is discouraging as it seems to undermine the importance of the DMD/DDS. With a DMD/DDS we are doctors, we are trained in pharmacology, basic medical sciences, and dentistry. We are legally allowed to prescribe any medication. My opinion is that if we give in to the public perception that we need an MD (which I believe is not true) we will lose respect for our field as a dental specialty. This is the time to stand strong and be confident that we are well trained to perform the procedures we do. There are both good and bad 4 and 6 year programs. The MD does not dictate the quality of our training and as long as 60% of the programs do not currently offer an MD it would be nearly impossible to phase them out. If you want an MD then do it, but it is not needed and I doubt it ever will be. The AMA are the only ones making a stink about our profession, and guess what, most physicians do respect us and most do not agree with the AMA to begin with. The public views us a competent dental specialist (most are even confused by those who have an MD along with their DDS/DMD).

I disagree. When you say "the MD does not dictate the quality of our training", you must be referring to the technical side of being a surgeon. Yes we don't need to understand the pathophysiology of a patient with a pheochromocytoma, systolic cardiomyopathy or reactive airway disease to perform a Bimax advancement. The surgical aspect of the treatment is technical stuff that even a mechanic can learn how to do. Around the structures that you are working on is a body, and to simply rely on MD's to pick up the slack for your lack of medical knowledge is not something a healthcare professional should strive for.
By saying that "most physicians do respect us and most do not agree with the AMA to begin with", are you suggesting that an MD would refer a mandillectomy, maxillectomy, cosmetic case, or craniofacial case to an omfs before an ENT/plastics? Who do you think they would trust more with managing their patients? Whether their concern is warranted or not, its debatable and dependant on the clinician treating the patient. It is the role of a medical school, to produce healthcare professionals that have a competent understanding of physiology, pathophysiology and pathopharmacology of the entire body. I am not 100% sure that dental school gives us that same understanding.
Saying that omfs dont need the medicine taught in medical shcool to manage their patients seems to suggest that 1. you minimize the 2 years of extra medical education that 6 year omfs do 2. that you are expecting other medical professionals to pick up the slack for you when you come across something that is outside your dental school education. Before coming to a 6 year omfs program, I used to think the same way..."Why do I need the extra medical education I went to a bad ass dental school and kicked ass on NBDE part 1? How much more medicine could there really be?" It wasn't until medical school that I realized how much stuff we don't learn in dental school specifically pathophysiologic and pharmacologic understanding of diseases that I doubt can be picked up in 6 months of general surgery. Can a single degree learn all that? Sure if they have the dedication to spend the time learning the medicine. Will most be that dedicated? i am not sure.

 

[shabu2]

I am not 100% sure that dental school gives us that same understanding.

I am 100% sure that DENTAL school does not provide the same understanding that medical school provides.

 

[OMFSZADE]

Nicely said. My thoughts exactly.
and this is coming from a resident in a 4 year program.

I disagree. When you say "the MD does not dictate the quality of our training", you must be referring to the technical side of being a surgeon. Yes we don't need to understand the pathophysiology of a patient with a pheochromocytoma, systolic cardiomyopathy or reactive airway disease to perform a Bimax advancement. The surgical aspect of the treatment is technical stuff that even a mechanic can learn how to do. Around the structures that you are working on is a body, and to simply rely on MD's to pick up the slack for your lack of medical knowledge is not something a healthcare professional should strive for.
By saying that "most physicians do respect us and most do not agree with the AMA to begin with", are you suggesting that an MD would refer a mandillectomy, maxillectomy, cosmetic case, or craniofacial case to an omfs before an ENT/plastics? Who do you think they would trust more with managing their patients? Whether their concern is warranted or not, its debatable and dependant on the clinician treating the patient. It is the role of a medical school, to produce healthcare professionals that have a competent understanding of physiology, pathophysiology and pathopharmacology of the entire body. I am not 100% sure that dental school gives us that same understanding.
Saying that omfs dont need the medicine taught in medical shcool to manage their patients seems to suggest that 1. you minimize the 2 years of extra medical education that 6 year omfs do 2. that you are expecting other medical professionals to pick up the slack for you when you come across something that is outside your dental school education. Before coming to a 6 year omfs program, I used to think the same way..."Why do I need the extra medical education I went to a bad ass dental school and kicked ass on NBDE part 1? How much more medicine could there really be?" It wasn't until medical school that I realized how much stuff we don't learn in dental school specifically pathophysiologic and pharmacologic understanding of diseases that I doubt can be picked up in 6 months of general surgery. Can a single degree learn all that? Sure if they have the dedication to spend the time learning the medicine. Will most be that dedicated? i am not sure.

 

[DREDAY]

I am 100% sure that DENTAL school does not provide the same understanding that medical school provides.

You are right. I was giving the benefit of the doubt to those who went schools like Harvard where dental students take same course as medical students.

 

[Thunderdome23]

You learn a lot more medicine during your general surgery training/ internal medicine training in OMFS residency than you do in 3rd and 4th year of med school. Some program,s give you a lot of this type of training and some not so much, THAT is why i do not think the MD dictates the quality of the program both in the surgical sense and in the medical sense.

I also think my opinion of needing an MD as an OMFS is skewed since my dental training comes from Harvard and I feel that I received plenty of medicine to supplement my surgical skills. I'm sure those who went to UConn and Columbia feel the same. But for those who have not completed half of med school already, an MD may help increase their knowledge of medicine so they can better understand their patients conditions.

 

[6897round2]

You learn a lot more medicine during your general surgery training/ internal medicine training in OMFS residency than you do in 3rd and 4th year of med school. Some program,s give you a lot of this type of training and some not so much, THAT is why i do not think the MD dictates the quality of the program both in the surgical sense and in the medical sense.

Have you actually gone to medical school? Have you even finished dental school (your status says dental student)...

I wholeheartedly disagree with the above statement. You absolutely do not learn more medicine during general surgery residency versus medical school. You may learn more, but what you're learning is not medicine. You're learning how to take care of surgical patients, evaluate patients for surgery, manage surgical emergencies and develop technical skills.

If you think that 6 months of general surgery is superior to medical school plus a year of general surgery, I assume that you think that NPs and PAs, many of who manage patients with the same level of responsibility that PGY-1 surgery residents do, are equivalent to MDs...

Just playing devil's advocate here, but what if, during your general surgery/off-service time, you never did any of the following:

1. Delivered or assisted in the delivery of a baby or took care of a pregnant patient.
2. Did a pediatrics rotation (not pediatric surgery, pediatrics)
3. Did a neurology rotation (not neurosurgery or neuroscience, neurology)

If you think that having gaps in these three areas still makes you equivalent to someone who went through medical school, then you need to go back to Harvard - none of this stuff is taught in the first two years.

As an OMFS you will:
1. Take care of a pregnant patient.
2. Take care of possibly many pediatric patients, some of whom will have syndromic problems requiring a basic knowledge of pediatrics
3. Take care of many facial trauma patients who will often concomitant neurologic injuries.

I am obviously biased, as a dual-degree guy, but I don't think that going to Harvard dental school and then doing a four-year program gives you equivalent knowledge to someone who went to a six-year program. Otherwise medical school would only be two years, followed by a 6 month general surgery/medicine rotation.

 

[servitup]

You learn a lot more medicine during your general surgery training/ internal medicine training in OMFS residency than you do in 3rd and 4th year of med school.

This is false and could only be honestly judged by someone who has actually done both. Medical/surgical interns are actually taught far less in my opinion. Intern year is a scut year for the most part which for OMFS residents, only serves to make us eligible for a medical license. It is the 3rd and 4th years of medical school where you actually learn medicine. 4 year guys who do 6 months of medical/surgical rotations at the intern level will only learn how to move the meat (which they should have learned their OMS intern year). For example, I am on general surgery right now as a third year med student along with a 4th year in my program who is the "intern." I attend lectures, assist with surgeries, read about surgery. The 4th year orders suppositories and pain meds, changes/orders diets, finds nursing homes/works on dispo, does D/C summaries, pre-rounds, etc. He works mostly side by side with two NP's who have been hired by the university to help with the service. He makes no decisions. He hardly sees the OR. I can only imagine how they must treat the "rotating dentist" from the 4 year programs.

Clearly, medical school is much more educational in fact than the "intern level rotation."

 

[JakeD]

"could only be honestly judged by someone who has actually done both"

- Probably the truest statement in this thread.

 

[CranioFacial]

If one considers 1) a strong broad-brushed 4yr program, 2) a weak medical school experience in a 6yr program, 3) 4yr guys that went through a strong GPR and/or a strong OMFS Internship, this discussion gets really blurry. Everyone has their opinions about their program gives the best training. As long as OMFS grads are producing legitimate case log numbers when they leave residency, they should not have issues with going to a hospital, submitting their case logs, and gaining priviledges. I feel recent (past 10yrs) OMFS grad, you should put in your dues participating in trauma, orthognathics, pathologies, etc (OR and Hospital cases). If you decide later in practice you want to throttle back to 3rds and more office-based procedures great, BUT we have to keep the standard up that OMFS grads are fully capable to manage the cranio maxillofacial complex.

 

[CranioFacial]

I agree with you Jake D. If someone had gone through a 4yr with the MD option at the end, I feel they would be most educated to speak to did the medical school add to what they had under his/her belt. I also agree that all patients should be managed by a team approach. If an OMFS is doing H&N or cosmetic and could team up with the Plastics or ENTs group...GREAT! Why do we really have to get into what one can/cannot do.
I personally would want for myself or my family, a surgeon that had performed the procedure I was going into multiple times with good success/outcomes... be it OMFS, ENT, Plastics. AND this can be very specific to where one is in the country.

 

[CranioFacial]

Got a consult just the other day from "MD-X" for endocarditis and extensive dental caries...get some extractions performed before proceeding with "other" medical treatment.
Pt had mild calculus on mandibular anteriors, minimal horizontal bone loss, no dental caries, no abscesses. I knew about infective endocarditis and its cause/effect from my DENTAL classes.
I know these may be debunked as random example, BUT it reminds us that it is not about the letters you have behind your name. It is about what you work to get out of your professional education. And, it can be about being open to educating each other (MD, DMD, etc.).

 

[FaceGuy]

Got a consult just the other day from "MD-X" for endocarditis and extensive dental caries...get some extractions performed before proceeding with "other" medical treatment.
Pt had mild calculus on mandibular anteriors, minimal horizontal bone loss, no dental caries, no abscesses. I knew about infective endocarditis and its cause/effect from my DENTAL classes.
I know these may be debunked as random example, BUT it reminds us that it is not about the letters you have behind your name. It is about what you work to get out of your professional education. And, it can be about being open to educating each other (MD, DMD, etc.).

How does proving physicians don't know dentistry help you argue that dentists DO know medicine? If he wanted to learn dentistry he would need dental school, not a few month rotation. If we want to learn medicine, we need medical school.

 

[brokeassdoc]

On a very superficial level, which is the perspective most people view us from, including patients and other healthcare providers, isn't it very unique that OMF surgeons can perform very major surgeries such as double jaw advancements near vital structures (airway, major vessels, etc.) that have arguably the most profound aesthetic effects, without the same medical training as our medical colleagues?

How many surgical specialties can you name which do not require an MD? (please don't say periodontist)

Your average orthopedic surgeon who doesn't specialize in neuro/spine does mostly ORIFs of extremities and hips and have a reputation of knowing less about antibiotics than a carpenter, yet they are still prepared with basic medical knowledge, because it is often relevant. Not to underestimate orthopedics, but the complications OMF surgeons deal with are equally, if not more impacting on a patient's life; which do you think is worse, not being able to feel your shin, or not being able to feel your lower lip?

Just because OMFS is a dental specialty does not mean we are not responsible for the same medical preparation as every other surgeon out there.

 

[Thunderdome23]

My point is that there are plenty of MD programs that wave the fact that they offer and MD as a way of hiding the fact that they do not offer as solid of an OMFS experience as others. An MD does not dictate the quality of the program, period. There's nothing wrong with it, but you don't have to deliver a baby to know how to manage a pregnant patient or assist in bypass surgery to know how to deal with a patient with a recent MI, or have done a psych rotation to screen for psych patients or pts w/ BDD etc.. It is an optional degree for a reason, IT IS NOT NECESSARY. If you want it, more power to you, no knowledge is wasted. But in reality if any specialty has questions regarding a patient they consult other specialties or the PCP as part of a team approach (and to cover their butt). At the end of the day you have to be able to provide sufficient surgical skills and manage your patient, both of which can be accomplished in a solid 4 or 6 year program. I know a lot of you 6-year guys feel like you have to defend the reason why you are doing a 6-year program, but you really don't. It's a personal choice and I greatly respect that. It's when you say that a 4 year surgeon has insufficient knowledge to adequately handle the medical conditions effecting the surgical outcome of his/her patients that I lose respect for you, because it is simply not true.

 

[LudwigsMangina]

I for one, am very thankful of the dual degree boys and girls out there advancing our specialty. It is prestigious for all of us, keeps us in an arena that some would consider on the outer edges of the specialty, etc. As a single degree surgeon, this is great because they keep on pressing the scope farther and farther, all the while I can stay in my office, working under dental referrals, doing mainly dental based procedures, and stay as far away as possible from managed care and/or Obamacare. I'm happy to let the studs do the big procedures, work 80 hrs per week, have their pager on all night long and lose sleep worrying about the anastomosis on the free flap they just did. Let me know how that worked out for you when I get back from my two week trip to Europe.

For me, I went to dental school for a reason. Dentistry is a great field with tons of autonomy, good hours, reasonable pay, etc. Just because I chose OMFS doesn't mean I have chosen to forego the life I initially chose. I will still take trauma call, albeit not at a level 1 trauma center. Market permitting still plan to do some osteomoties, etc. I feel we should all keep some representation in a hospital and honor those that worked so dilligently to help OMFS as a profession acquire and retain those privileges. But 12 years of school/training post high school, $300k in debt, many days/hours missed away from my kids, let the guys that want to do the big stuff do it.

As far as mandating the dual degree, well this issue has been discussed at length. Seeing how there are an incredible amount of single degree guys out there practicing, I just don't see the logistics in making it happen. You may start to see a gradual phasing out of the single degree surgeon, but it will not be in my lifetime, and I'm certainly not going to lose any sleep over it after a long day of wizzies.

 

[OMFS MASTER]

It's when you say that a 4 year surgeon has insufficient knowledge to adequately handle the medical conditions effecting the surgical outcome of his/her patients that I lose respect for you, because it is simply not true.

I agree with this. I also agree that pulling wizzies and making tons of money and working hardly any hours is great, as the above poster stated, as long as you still maintain hospital priviliges/take care of trauma/etc.

HOWEVER...

The bottom line is this:

THE SPECIALTY WOULD BE BETTER OFF AS A WHOLE IF ALL SURGEONS WERE DUAL DEGREE.

Laziness is the WRONG reason to not do the RIGHT thing for the specialty. If your wife/kids couldn't take the extra two years, then be a periodontist.

 

[LudwigsMangina]

Laziness is the WRONG reason to not do the RIGHT thing for the specialty. If your wife/kids couldn't take the extra two years, then be a periodontist.

This is ridiculous.

I take sincere offense to the notion that because I chose a 4 year program that I am somehow lazy. Check it out bucko - at my program there are no ENT or PRS taking face call. That's right. None. Zero. That means we get all facial trauma 24/7/365. I would compare my graduating #s of frontal sinus, NOE, LeFort, and mandible fxs to those of anybody in the country. How's about neck dissections? Need we go there?

My point is, just having an MD doesn't mean **** except for a few extra letters if you can't cut. I would much rather be a stud surgeon and be lacking in medical management then be an encyclopedia of medical knowledge and have two left hands in the OR. Many dual degree programs fit into the latter half of that statement. And truth be told, patients don't have a clue nor do they care what your educational training is. They go where they are referred. If they like you and your proposed treatmet plan, they go with it. If not, they get a second opinion. How many have asked to see your diploma? Finally, I want my referrals coming mainly from dentists. So if the medical community won't refer to me because I lack an MD, that is there problem not mine. They can explain to their patient whey they have to drive 80 miles instead of 8 to see somebody that can offer them the same treatment.

 

[280040]

I agree with this. I also agree that pulling wizzies and making tons of money and working hardly any hours is great, as the above poster stated, as long as you still maintain hospital priviliges/take care of trauma/etc.

Kudos to him for getting good at private practice stuff though. Establishing yourself as the leader in your community in office based dental surgical procedures is just as important as OMS having balls/stamina to fight it out in the hospital politics and maintaining scope there. Without him/her in the community, I stand by my arguement that perio will pick up that void. Both of you are maintaining scope for future surgeons. Just from different directions.

This doesn't have any 4 vs 6 arguements though....

 

[joefosho315]

Good info in this thread, as with the other one already posted a while back. The more responses/citations/references the better, because I'm hoping to write my masters in bioethics thesis and get published on the legitimacy/ethics of the AMA trying to limit the scope of OMFS. Maybe if I'm lucky enough, it'll do at least a little bit in legitimizing and defending the field of OMFS in the face of what I consider to be superficial/fallible arguments from the AMA.

 

[6897round2]

This is ridiculous.

I would compare my graduating #s of frontal sinus, NOE, LeFort, and mandible fxs to those of anybody in the country. How's about neck dissections? Need we go there?

I think one point here is the following: as a single-degree guy, there are many geopgrahic areas in which you will have to fight to do all of the procedures you just mentioned. If you think I'm wrong, ask Esclavo about the hurdles he faced when attempting to get privileges for head and neck procedures and an ENT at his hospital balked at a "dentist" doing these procedures.

Another, broader, point is that this really isn't about who is better, 6- or 4-year guys. This is about perception. The strategy of "both tracks are equivalent" isn't working with the public or our medical colleagues, regardless of AAOMS official position. If this is the case after 30+ years of a two-track system, perhaps a change needs to be made.

Why doesn't the two-track system make sense to the public and medical community? Because, if you think about it, it really doesn't make sense:

"Here's two practitioners who can do the same thing, but one has a DDS and an MD and one just has a DDS. But they're equivalent."

The public doesn't understand the basics of surgical training and falsely elevates the value of medical education and thus won't believe/understand this.

The medical community at large, almost all of whom went to medical school, will similarly fail to comprehend how the two providers could be equivalent, because people in medical school/medicine tend to think that the MD-degree is the epitome of educational achievement.

I think the AMA issue is timely, for it gives us an opportunity, as an Association, to revisit this controversy and figure out why the current PR approach is failing. Do we need to do more to educate the public and medical community? Do we need to create a uniform training pathway? We've tried the former, with limited success. Perhaps now is time to consider the latter.

 

[OMFS MASTER]

I think one point here is the following: as a single-degree guy, there are many geopgrahic areas in which you will have to fight to do all of the procedures you just mentioned. If you think I'm wrong, ask Esclavo about the hurdles he faced when attempting to get privileges for head and neck procedures and an ENT at his hospital balked at a "dentist" doing these procedures.

Another, broader, point is that this really isn't about who is better, 6- or 4-year guys. This is about perception. The strategy of "both tracks are equivalent" isn't working with the public or our medical colleagues, regardless of AAOMS official position. If this is the case after 30+ years of a two-track system, perhaps a change needs to be made.

Why doesn't the two-track system make sense to the public and medical community? Because, if you think about it, it really doesn't make sense:

"Here's two practitioners who can do the same thing, but one has a DDS and an MD and one just has a DDS. But they're equivalent."

The public doesn't understand the basics of surgical training and falsely elevates the value of medical education and thus won't believe/understand this.

The medical community at large, almost all of whom went to medical school, will similarly fail to comprehend how the two providers could be equivalent, because people in medical school/medicine tend to think that the MD-degree is the epitome of educational achievement.

I think the AMA issue is timely, for it gives us an opportunity, as an Association, to revisit this controversy and figure out why the current PR approach is failing. Do we need to do more to educate the public and medical community? Do we need to create a uniform training pathway? We've tried the former, with limited success. Perhaps now is time to consider the latter.

The above poster got it spot on. 'Ludwig' is missing the point. The arguement has nothing to do about whether 4 or 6 years are better surgically trained. Any good surgical resident with any common sense knows an MD with poor case load is worse off then a well trained 4 year guy with good volume/broad scope in training...BUT THAT'S NOT THE ISSUE!!

The issue is that...as a specialty...we would all be better off dual degree only, as the above poster explained.

 

[OMFSPrime]

The above poster got it spot on. 'Ludwig' is missing the point. The arguement has nothing to do about whether 4 or 6 years are better surgically trained. Any good surgical resident with any common sense knows an MD with poor case load is worse off then a well trained 4 year guy with good volume/broad scope in training...BUT THAT'S NOT THE ISSUE!!

The issue is that...as a specialty...we would all be better off dual degree only, as the above poster explained.

Alright, I understand clearly the point you are making, and want to move it along a little further.

Since we are all in understanding that 4 and 6 year are equivalent surgically, the real issue is the public & medical perception.

Let us entertain the dual degree thought.

What do we do for all the current and past 4 year program trained OMFS surgeons? Do we grandfather them in to DDS/MD, or do we make them take equivalency exams (USMLE)?

I am asking practically. I really want to entertain this dual degree thought process and see what we come with in order to better the public perception.

 

[aphistis]

The above poster got it spot on. 'Ludwig' is missing the point. The arguement has nothing to do about whether 4 or 6 years are better surgically trained. Any good surgical resident with any common sense knows an MD with poor case load is worse off then a well trained 4 year guy with good volume/broad scope in training...BUT THAT'S NOT THE ISSUE!!

The issue is that...as a specialty...we would all be better off dual degree only, as the above poster explained.

Then again, if esclavo won the fight for his hospital privileges, you could say HE was the one advancing the specialty, as a single-degree surgeon.

 

[Rube]

There is something I don't understand about these people advocating dual degree only. If OMS is expanding its scope so dramatically then there really isn't any way they can possibly practice everything in the speciality. I mean you cannot do everything well, you have to pick a few things and do them to the standard of care.

It seems with the way OMS is growing, the 4 year and the 6 year surgeons working together to cover such a broad scope seem to make sense.

Lastly, has any MD really said you were "just a dentist" when referring to a 4 year surgical residency? Really? or did you just perceive that because you have a chip on your shoulder about not applying to med school when you were younger? If I were an OMS I'd laugh and pity that and that would be a mark of poor judgement on the part of that particular MD.


Once you get out of bs academia for a while you realize:

1) the patients are not confused over dds vs dds, md. they actually don't care about your extra degree. They think you're smart enough or they wouldn't be in your chair. Now they want to see you as a "good doctor". You wouldn't believe the things they judge you on and its NEVER your degree.

2) respect is earned day in and day out in how you treat your patients and communicate with your colleagues. It is not granted by degree, it is earned. Why in the world would any good colleague grant you respect based on your degree. That person would be foolish to do so and their respect ultimately wouldn't be worth much.

3) Academia can be make you grow in some ways and can be toxic in others.

 

[gary_ruska]

There is something I don't understand about these people advocating dual degree only. If OMS is expanding its scope so dramatically then there really isn't any way they can possibly practice everything in the speciality. I mean you cannot do everything well, you have to pick a few things and do them to the standard of care.

It seems with the way OMS is growing, the 4 year and the 6 year surgeons working together to cover such a broad scope seem to make sense.

Lastly, has any MD really said you were "just a dentist" when referring to a 4 year surgical residency? Really? or did you just perceive that because you have a chip on your shoulder about not applying to med school when you were younger? If I were an OMS I'd laugh and pity that and that would be a mark of poor judgement on the part of that particular MD.


Once you get out of bs academia for a while you realize:

1) the patients are not confused over dds vs dds, md. they actually don't care about your extra degree. They think you're smart enough or they wouldn't be in your chair. Now they want to see you as a "good doctor". You wouldn't believe the things they judge you on and its NEVER your degree.

2) respect is earned day in and day out in how you treat your patients and communicate with your colleagues. It is not granted by degree, it is earned. Why in the world would any good colleague grant you respect based on your degree. That person would be foolish to do so and their respect ultimately wouldn't be worth much.

3) Academia can be make you grow in some ways and can be toxic in others.

Gary "confusion abounds" Ruska here,

With regard to your points above:

1. True - most patients aren't that discriminating and certainly don't judge the practitioner on the basis of academic pedigree. However, one key point is this - in the "buyer beware" market of elective/cosmetic surgery, GR has seen both of the following occur:

Plastic Surgeon, talking to a cosmetic surgery patient: Why do you want to go to him? He's just a dentist. Would you let your dentist do a facelift?

Cosmetic Surgery patient: "He's a terrific surgeon - he went to Columbia for medical school"

Again, the proof is in the pudding and, in general, if you do good work, you will not have a tough time with referrals, regardless of degree. Just ask Joseph Niamtu.

2. Disagree in part. This may be true in some pockets of the private practice world, but for those practitioners who work in or are affiliated with a hospital, respect is, often, based on these exact superficialities. GR is certain that there are a number of OMFSers on this board who can attest to the fact that sometimes patients come to see an attending who may not be the best at a particular procedure, just because they have a certain title or are a "big name".

3. There is little to no argument against further education, provided that it is sought after for the pursuit of knowledge, rather than to massage the ego. A lot of the previous posters have denigrated the knowledge acquired in medical school, though none have actually gone to medical school. GR contends that most OMFS residents who get an MD do so knowing that it will be the most expensive degree they ever get (>$500,000). Most are smart enough to know that doing this for your ego is a terrible idea. On the flip side, given that they have sacrificed a ton to get the MD, most 6-year OMFSers will be the first to defend the MD as a tool that improves the quality of care that they provide. Keep this in mind 4-year guys - the 6-years, in general, make a much bigger financial and time sacrifice.

GR echoes the thoughts of the previous poster who said that this isn't about the 4- vs. 6-year and who is better. This is about a public relations nightmare that has existed for 30+ years, with no improvement in the status quo. A uniform double-degree is one possible solution to this problem, though not the only solution. GR sees no need for everyone to get all up in arms about this, as the OP was only expressing their support for one potential solution. An alternative solution is to discontinue all of the 6-year programs.

 

[brokeassdoc]

4-year guys often claim that a medical education is not necessary.

Ask yourself this question. From whom do you obtain your MEDICAL knowledge from during your 4 month MEDICINE rotation, which is required for all omfs residents? From whom do you obtain your MEDICAL knowledge from during your 6 month surgical rotation?

The answer is from MEDICAL doctors employed by teaching institutions of MEDICAL school.

The fact is, medical education is absolutely necessary for OMFS and we rely heavily on our medical colleagues to prepare us, nobody can argue that. I think the AMA and 6 year OMFSer's are realizing that 4 year guys are jumping through a huge loop hole to practice surgery by selectively choosing the rotations they feel are relevant to them, instead of being exposed to all of medicine, like an orthopedic surgeon having to go through psychiatry, ob/gyn, family medicine.

It's simply a luxury to practice surgery without going through medical school, and the more the public and medical world learn about our profession, the more they will hate, and try to strip us of this luxury.