OMFS should be a dual-degree specialty ONLY

[Thunderdome23]

If you look at this problem objectively, the most likely solution is what Ruska said, to do away with the dual degree programs all together. This would work for several reasons:

1) It would not in any way limit or add a hint of inferiority to any currently practicing OMFS (whether they be a single or double degree surgeon)

2) It would actually be feasible, as opposed to requesting that all programs add a costly MD component to the curriculum which is not always possible as not all programs have a relationship to a medical school which allows this to happen

3) The MD degree, as it is, is a costly degree that takes up a coveted spot in the medical school that could be better used for someone who, without this degree, could not even become a doctor, let a lone a surgeon who wants 2 degrees.

4) It would keep this coveted specialty in the dental profession. More and more medical students are applying to OMFS and if we go dual degree all together, there may be even more med students taking up spots in this dental specialty. And god-forbid it ever become a sole medical specialty requiring that you go through all of medical school first!

---

Members don't see this ad.

 

[gary_ruska]

If you look at this problem objectively, the most likely solution is what Ruska said, to do away with the dual degree programs all together.

Gary "easy there MadMax" Ruska here,

Just to clarify, GR was not advocating for doing away with 6-year programs. If that was how you read the post, you are incorrect in your interpretation.

Also, getting rid of six-year programs is not "the most likely" solution. The most likely "solution" is that ABSOLUTELY NOTHING will change. If you know about the history of this, you will see that every ten years or so, this becomes a hot topic. Take a look at some of Dan Laskin's JOMS editorials from the early 90s - you'll find them eerily prophetic.

The AAOMS-AMA meeting will likely be of little consequence, as will be the AMA document. Everyone will keep doing what they're doing and the scope of the specialty will be determined by its practitioners, be they single- or dual-degree.

Too many people have stakes in both sides and entreached ideology. Suggesting that abandoning six-year programs would be a simple solution than making all programs six-years overlooks many of the logistic issues of such a transition and the value of such education. In the 70s-90s, OMFS has largely been advanced by practitioners from both tracks. In the last two decades, the specialty has achieved greater strides moreso because of dual-degree surgeons.

Read Assael's April JOMS editorial - interesting - not in the least because he is a single-degree guy who is potentially advocating for uniform training - in the form of a 6-year program.

For the record, GR is an advocate of the six-year path, but feels that it is a personal decision and that applicants should have the option for the four-year path. Though, this does beg the question - at one point OMFS training was two years, then three years and subsequently four years. It is conceivable that, at some future point, the training for single-degree surgeons will be five-years.

 

[Thunderdome23]

I suggest we end this discussion with this final thought:

If you want to do 4 years, do it, you will get all the training you need. If you want to do 6-years, do it you'll have more medical knowledge. In the end, both programs produce terrific surgeons who know enough medical knowledge to manage their patients (unless there are any studies I don't know about showing showing single degree surgeons getting sued more than dual degree surgeons).

This debate can get beaten to death and still not budge an inch. It is a choice, and a preference. It will never be mandatory that you do one way or the other, nor should it be. We are a dental specialty, so for all you physician-one-a-be's be loud and proud that you are an ORAL and maxillofacial surgeon as a dentist first and foremost. We are unique in that we bring knowledge to the operating room that no physician is equipped with and can do procedures that no other physician is trained to do, don't ever forget that.

Respect one another regardless of degrees, because at the end of the day the things that matter are this:

1) Do you treat your patients well? Do you treat your colleagues well?
2) Are you a good surgeon in the technical sense?
3) Can you manage the medical conditions that effect your surgery?

Done and done!

 

[Rube]

Gary "confusion abounds" Ruska here,



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"

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. .

Perhaps the problem is only a nightmare for the OS who pushes the limits of the scope of practice by doing cosmetic cases. I can almost promise if that surgeon was doing mouths and jaws there wouldn't be a problem. But try and take away a cosmetic surgeon's cases and he's going to pull that "dentist" card. It is BS, but that's life with some guys.

Maybe the solution is for the AAOMS to launch a vigourous promotion of the dental educated, surgically trained OMS. I know I look at the facial 1/3rds just as much as I look at teeth and got training in d school that promoted esthetics. Can your average physician say the same? I say that we promote dental education without apologizing for it. just my .02

 

[brokeassdoc]

I suggest we end this discussion with this final thought:

If you want to do 4 years, do it, you will get all the training you need. If you want to do 6-years, do it you'll have more medical knowledge. In the end, both programs produce terrific surgeons who know enough medical knowledge to manage their patients (unless there are any studies I don't know about showing showing single degree surgeons getting sued more than dual degree surgeons).

This debate can get beaten to death and still not budge an inch. It is a choice, and a preference. It will never be mandatory that you do one way or the other, nor should it be. We are a dental specialty, so for all you physician-one-a-be's be loud and proud that you are an ORAL and maxillofacial surgeon as a dentist first and foremost. We are unique in that we bring knowledge to the operating room that no physician is equipped with and can do procedures that no other physician is trained to do, don't ever forget that.

Respect one another regardless of degrees, because at the end of the day the things that matter are this:

1) Do you treat your patients well? Do you treat your colleagues well?
2) Are you a good surgeon in the technical sense?
3) Can you manage the medical conditions that effect your surgery?

Done and done!

You're either a dental student or a 4 year guy because you completely disregard the other half of the picture. Nobody is arguing that OMFS is a dental specialty, yet that's all 4 year guys harp about. Lay it to rest, we all agree it's a dental specialty.

The other half of the picture is that being an OMFS requires as much medical knowledge as being a general surgeon, orthopedic surgeon, ENT surgeon, plastic surgeon. Are you catching on? Our medical colleagues feel that we should have the same level of preparation as every other surgeon on this planet and that we should not be given a free pass to sidestep medical school when a substantial portion of our residency training IS actual medical training.

ESPECIALLY, in today's age of OMFS with our intention to "expand our scope." Expanding our scope has allowed us to perform procedures, such as neck dissections, cosmetic surgeries, craniofacial surgery, which are traditionally performed by medically trained surgeons. And don't say OMFS has traditionally performed these surgeries, because if they have, then the phrase "expansion of scope" would be unnecessary. Our scope is expanding onto the territory of our medical colleagues, and just as we blow smoke when other dentists learned implants, wisdom teeth, etc. these md's are trying to protect their territory.

Look at your 4 year schedule and realize how much of the knowledge you obtain from MDs. 4 months of medicine, 6 months, minimum of general surgery, 4 months of anesthesia (which i forgot to mention in my previous post) in addition to ENT, ER and whatever else you guys do equals to more than half of your residency training being provided by MEDICAL doctors, not only by Doctors of Dental Surgery and Doctors of Medical Dentistry.

 

[Thunderdome23]

You're either a dental student or a 4 year guy because you completely disregard the other half of the picture. Nobody is arguing that OMFS is a dental specialty, yet that's all 4 year guys harp about. Lay it to rest, we all agree it's a dental specialty.

The other half of the picture is that being an OMFS requires as much medical knowledge as being a general surgeon, orthopedic surgeon, ENT surgeon, plastic surgeon. Are you catching on? Our medical colleagues feel that we should have the same level of preparation as every other surgeon on this planet and that we should not be given a free pass to sidestep medical school when a substantial portion of our residency training IS actual medical training.

ESPECIALLY, in today's age of OMFS with our intention to "expand our scope." Expanding our scope has allowed us to perform procedures, such as neck dissections, cosmetic surgeries, craniofacial surgery, which are traditionally performed by medically trained surgeons. And don't say OMFS has traditionally performed these surgeries, because if they have, then the phrase "expansion of scope" would be unnecessary. Our scope is expanding onto the territory of our medical colleagues, and just as we blow smoke when other dentists learned implants, wisdom teeth, etc. these md's are trying to protect their territory.

Look at your 4 year schedule and realize how much of the knowledge you obtain from MDs. 4 months of medicine, 6 months, minimum of general surgery, 4 months of anesthesia (which i forgot to mention in my previous post) in addition to ENT, ER and whatever else you guys do equals to more than half of your residency training being provided by MEDICAL doctors, not only by Doctors of Dental Surgery and Doctors of Medical Dentistry.

There you go then, we get plenty of medical training within our residency, so why start delivering babies and writing pt notes as a 3rd year medical student (aka intern secretary) for our medical knowledge? Part of the reason med students do what the do is to expose them to all fields, as they don't yet know where their interest lies yet. We do though, we are oral surgeons, so why not have a more tailored medical education focused on the surgical management of patients, since that is what we're doing (aka, 4-year programs with rotations in medicine, gen surg...etc..)? A bit more practical ain't it?

 

[brokeassdoc]

There you go then, we get plenty of medical training within our residency, so why start delivering babies and writing pt notes as a 3rd year medical student (aka intern secretary) for our medical knowledge? Part of the reason med students do what the do is to expose them to all fields, as they don't yet know where their interest lies yet. We do though, we are oral surgeons, so why not have a more tailored medical education focused on the surgical management of patients, since that is what we're doing (aka, 4-year programs with rotations in medicine, gen surg...etc..)? A bit more practical ain't it?

Very practical, and very efficient. However, people who know they are going to do ortho or OMFS still have to go through dental school and people who know they are going to do orthopedics still have to go through medical school. It is a luxury that we have the option of skipping medical school while still practicing surgery. No other doctor can have a "tailored medical education focused on" whatever their primary interest is. They are required to be exposed to it whether they're interested or not.

 

[PAJain]

Very interesting discourse! Many valid points, but we all must remember that if any changes are to take place it will be DECADES before anything like this takes affect. While there are a few OMFS out there with practices limited to cosmetics and head/neck onc/recon the reality is we are a dental specialty under the provision of CODA, ADA, and AAOMS which last time I checked is run by DDS/DMD. For the ADA to endorse such a move to eliminate single degree programs is counter productive. It undermines the dental degree. We all know that single degree programs will be phased out eventually. But this is not going to happen over night. As most single degree chairmen retire their replacements will most likely be dual degreed surgeons who will try to push for dual degree programs or at least an MD optional program.

While this AMA report was a slap in the face, lets face it everyone is pissed because we got called out and who likes that. Much bigger battles that we face in our specialty are those with the ASA to continue doing our own anesthesia, and APHA who want to say that prophylactic removal of 3M is not indicated even though all the literature coming out says it is indicated in certain age groups. If anything we should focus our efforts on supporting all the research coming out of institutions like UNC and Harvard who are burning both ends of the candle for us to do what's right for our patients. See while people in this forum think that the OMFS out there doing neck dissections and free flaps are "Gods," the people that are keeping this specialty afloat are individuals like White, Dodson, etc...with quality research for us to defend our treatment options. The President and every one in Washington is calling for more "evidence based practices" in medicine. This will include third molars, scoping knees, doing cardiac caths, etc...Guess what if the data isn't there neither will be the check. This is why even residents should contribute to supporting research and those who are doing the research.

Lets face it, its great that we have our hands in craniofacial, cosmetics, and onc/micro but if we stopped doing these procedures, rural communities aside, there will still be enough PRS/ENT to serve this patient population. However, our role will always be to manage infections, benign jaw pathology, exodontia, bone grafting, mandible fractures, TMJ, and orthognathics.

All these debates lead no where. Because the decision is not going to come from residents, it is going to come from the top people at ADA and AAOMS. Who will keep OMFS as a dental specialty which it should be a dental specialty, and will not undermine the dental degree by getting rid of single degree programs.

Lastly, lets not keep insulting programs on this forum. I am in no way affiliated with Columbia's program but its gets knocked around on here a little too much. I know of many Columbia grads who take full face call and are doing lots of orthognathics. So for those who wanted to train at a knife and gun club type of programs don't knock people who wanted to be in the OR doing more TMJ/orthognathics. The reality is we should all be proud to have our specialty represented in the top medical centers in the country. What do you think AAOMS is going to do when it meets with the AMA? I'm certain that they will proudly report that the Chairmen of Michigan, Columbia, and Cornell are single degree surgeons, which the AMA considers these institutions as the leading medical centers. Stop bashing and hating your own specialty! By the way while we knock perio on here...I guarantee you more of your referrals will come from perio than from "MDs"

 

[cyrano]

.

 

[shamrock2006]

What about those interested in OMFS who like the idea of the private practice world? Does this "having the MD" vs "not having the MD" really matter? I guess if there is reason to believe the MD/DDS guys will overrun the private practice world...then we can say the **** will hit the fan.

 

[JakeD]

This thread has gotten waaaaaay out of hand.

 

[ToldYouSo]

This thread has gotten waaaaaay out of hand.

I think this thread has some great info, it's hard to find a long one that has useful info and input from residents =)

 

[cyrano]

This thread has gotten waaaaaay out of hand.

Huh?

 

[DREDAY]

Here is the difference:

Of 109 articles in JOMS in 2009 from OMFS programs:
93 (85%) articles from 6 year MD-integrated programs
16 (15%) articles from 4 year programs.

Of top 10 programs producing papers in 2009:
9 were MD-integrated
1 was 4 year program

Of 1027 residents enrolled in 100 programs:
491 civilian MD-integrated residents
469 civilian 4 year residents
67 Armed forces 4 year residents

The question is... who is not contributing their fair share?


This was taken from the JOMS April Editorial.

 

[280040]

Here is the difference:

Of 109 articles in JOMS in 2009 from OMFS programs:
93 (85%) articles from 6 year MD-integrated programs
16 (15%) articles from 4 year programs.

Of top 10 programs producing papers in 2009:
9 were MD-integrated
1 was 4 year program

Of 1027 residents enrolled in 100 programs:
491 civilian MD-integrated residents
469 civilian 4 year residents
67 Armed forces 4 year residents

The question is... who is not contributing their fair share?


This was taken from the JOMS April Editorial.

How many of those 93 md integrated had 4 year programs as part of them but credit was only given to the 6year track?

I have no easy way of getting the full article, so maybe that was addressed.

Interesting argument though. What about at aaoms conferences? Do you see that same bias? Are the current faculty in the US simply biased themselves? Those who like research may be at larger institutions or self select at the md integrated for some unknown reason? Maybe the availability of the residents during med school years for pushing papers or the type of resident in a 6vs4? Maybe the tenure requirements of those faculty who are employed by the med school or dental school vs those undo hospital employment?

It just seems odd that the pure existence of the dual track at your program makes you more likely to produce peer acceptable research. What do you think? Any faculty talk about this at your own journal clubs?

Was this editorial a random author in the US or is it the editor himself? No access at the moment.

 

[DREDAY]

How many of those 93 md integrated had 4 year programs as part of them but credit was only given to the 6year track?

I have no easy way of getting the full article, so maybe that was addressed.

Interesting argument though. What about at aaoms conferences? Do you see that same bias? Are the current faculty in the US simply biased themselves? Those who like research may be at larger institutions or self select at the md integrated for some unknown reason? Maybe the availability of the residents during med school years for pushing papers or the type of resident in a 6vs4? Maybe the tenure requirements of those faculty who are employed by the med school or dental school vs those undo hospital employment?

It just seems odd that the pure existence of the dual track at your program makes you more likely to produce peer acceptable research. What do you think? Any faculty talk about this at your own journal clubs?

Was this editorial a random author in the US or is it the editor himself? No access at the moment.

Leon Asael himself wrote it.

As far a the 4 year programs being at "smaller medical centers institutions":
As quoted in the Editorial, "Of the 536 residents in 4-year programs, 336 (64%) are residents in programs with a medical school housed directly on their campus/housing complex. Just 24 (5%) of the current 4-year omfs residents are enrolled in program that are part of institutions not directly affiliated with medical school."

 

[280040]

Leon Asael himself wrote it.

As far a the 4 year programs being at "smaller medical centers institutions":
As quoted in the Editorial, "Of the 536 residents in 4-year programs, 336 (64%) are residents in programs with a medical school housed directly on their campus/housing complex. Just 24 (5%) of the current 4-year omfs residents are enrolled in program that are part of institutions not directly affiliated with medical school."

Sounds like I need to grab the PDF on campus today. He probably addressed all of my random thoughts/questions. Still intrigueing that such a difference exists. Thanks.

 

[Kabek]

Sounds like I need to grab the PDF on campus today. He probably addressed all of my random thoughts/questions. Still intrigueing that such a difference exists. Thanks.

DM,

Here is the editorial in question:



JOMS, Volume 68, Issue 4, Pages 713-714 (April 2010)
The View From the Third Rail
Leon A. Assael, DMD

Article Outline

• Lack of Meaningful Discourse
• The Engine: Our Residency Programs
• Reaching a Fork in the Track
• Looking Down the Track
• Copyright

Politicians, with their continuous need to be re-elected, have characterized so many issues as third rail issues that they encompass much of the mainstream of American life. Social Security, Medicare, agricultural subsidy, family planning, sex education, banking regulation, health care reform, the tax code, funding of public education, among others, are believed to promote so much controversy, such entrenched opinion, that attempts to achieve a meaningful discourse, a general consensus, and resolute action have resulted in paralysis. Failure to act on these issues has not solved these problems but simply left them as open wounds to generate further controversy and strife. The consequences of failing to address these third rail issues that are emerging will diminish our ability to move forward as a society and stifle our success in the global economy.
Could oral and maxillofacial surgery have its own "third rail?" In the United States, the answer is obvious. It is the issue of the medical degree.
For our specialty, entrenched opinion continues to stifle meaningful discourse, thwart spirited debate, prevent a general consensus, and obviate resolute action on the fundamentals of how we are to educate the future members of our specialty and subsequently what their role will be in the fabric of American health care.
Lack of Meaningful Discourse

Since the meetings in Tenerife and Bermuda decades ago, no analysis of how or whether the medical degree could be integrated into American oral and maxillofacial surgery education has occurred. The current state of affairs is confusing to the public, to prospective applicants, and to policy makers. The educational rationale for 4-year or 6-year MD integrated programs is not coherently presented to dental students. The casual observer is left to imagine what the differences in education and practice might be. Advocates continue to loudly proclaim the advantages to 4 or 6-year education while the position of our specialty remains that there is no difference.
Leaders within OMS struggle to find the words to adequately describe who we are while continuing to meet the needs of all of the members of the specialty. It is difficult to provide a rationale for our dichotomous nature, because no rationale based upon standard educational values can be applied. Failure to present a rationale for understanding our dichotomous specialty in the US creates problems for all. While issues of licensure and scope of practice continue for the specialty, addressing those issues is made more complex by the dichotomous groups within it.
Most countries with active specialties of oral and maxillofacial surgery made a decision regarding the character of specialty education decades ago, before opinion became entrenched. While Britain, France, Germany, Italy, Japan, and China (among others) still struggle with the aftermath of their choice (for example, British surgeons are facing a nascent oral surgery specialty, the French do not maintain an identity within dentistry, and the Germans lead in oncology but struggle for identity in cleft and esthetic surgery), they have charted a single course for their specialty, a course that can serve as a basis for their advancement and serve a specialty's coherent identity.
No other medical, surgical, or dental specialty in the United States rests with this dichotomy in education. While multiple pathways exist in other medical surgical specialties, they all culminate in the same qualification. While ABOMS eligibility and achievement of ADA-recognized specialty status is the same for 4-6 year programs, as a practical matter, a divergence of qualifications has evolved. Membership in surgical organizations, de facto access to some fellowships, access to payers, and access to categories of patients are certainly influenced by the degree issue. The continued inability of the Commission on Dental Accreditation to understand the needs of OMS programs as well as the lack of oversight of the MD component and general surgery year continues.

The Engine: Our Residency Programs

Program directors of 6-year programs have not had the issues particular to their training ideals addressed in a comprehensive fashion. This may be due to the fear of appearing divisive. After 3 decades of integrated MD/OMS education, it is time to assess the impact of these programs, take actions to further enhance their quality, and measure their effect. This will help guide our specialty toward a decision on this vital issue.
To begin this debate, consider how MD-integrated programs are advancing our specialty. Here briefly is an assessment of our dichotomous education as seen in the pages of JOMS.
Medical degree integrated programs have an exceptional outsized effect on the specialty as it appears in JOMS. For example, 109 articles appeared in JOMS in 2009 from 45 American oral and maxillofacial surgery programs. Just 16 of these articles were from 4-year programs, while 93 (85%) were from MD-integrated programs. Of the 45 represented programs in JOMS 2009, 37 are integrated MD programs.
In addition, of the top 10 programs each producing 4 or more papers in 2009, all but one is MD integrated. They are:

Harvard-Massachusetts General Hospital
Loma Linda University
Oregon Health & Science University
University of California, San Francisco
University of Florida, Gainesville
University of Michigan
University of Minnesota
University of North Carolina
University of Texas, Southwestern Medical School
University of Texas, Houston



These papers have focused upon the broad range of the specialty including office-based and hospital-based procedures. They are especially focused on emerging technology and new skills to improve the specialty.

Reaching a Fork in the Track

Our programs are now cleanly divided between MD-integrated programs and 4-year programs. Currently, 1,027 residents are enrolled in 100 programs, 89 civilian programs and 11 US Armed Forces programs. Of these 1,027 future oral and maxillofacial surgeons, 491 are in civilian MD-integrated programs, 469 are in civilian 4-year programs and 67 are in Armed Forces 4-year programs. Forty-nine percent of the current enrollees will complete an MD-integrated residency.
Of note is to consider the position of the 536 residents now enrolled in 4-year programs. Of these 536, 334 (64%) are residents in programs with a medical school housed directly on their campus/hospital complex. Additionally, 168 residents (31% including all 67 of the Armed Forces enrollees) have direct access to a medical school through their sponsoring institutions affiliations. Just 24 (5%) of the current 4-year OMS residents are enrolled in programs that are part of institutions not directly affiliated with a medical school. Clearly, our specialty is at a fork in the track, with two clear and available options towards the future.

Looking Down the Track

It is hoped that this editorial will provoke a vigorous response, as it should. Now is the time for meaningful discourse on this issue which is the most critical one affecting the future of our specialty. But that response should not prevent a reasoned debate and eventual decision on this issue.
Looking down the track and sitting on the third rail can get your attention, but worrying about the voltage does not help you to see what's coming. Health care education is racing down the track. It's time to get on board the OMS train and figure out where we are going.



PII: S0278-2391(10)00165-5
doi:10.1016/j.joms.2010.02.006
© 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

 

[armorshell]

In addition, of the top 10 programs each producing 4 or more papers in 2009, all but one is MD integrated. They are:

Harvard-Massachusetts General Hospital
Loma Linda University
Oregon Health & Science University
University of California, San Francisco
University of Florida, Gainesville
University of Michigan
University of Minnesota
University of North Carolina
University of Texas, Southwestern Medical School
University of Texas, Houston

Don't all of these programs have a MD integrated AND 4 year track?

 

[armorshell]

It's time to get on board the OMS train and figure out where we are going.

Choochoo!

 

[Yahtzee]

You gotta love "the OMS train."

 

[1992Corolla]

Choochoo!

Is that you in the front armor? LOL.

Get on it everyone!

 

[1992Corolla]

 

[armorshell]

Also, you'll see with my magic mod powers (of complaining), I have resurrected posting in the dental residency forums.

Huzzah!

 

[armorshell]

Is that you in the front armor? LOL.

Get on it everyone!

It does look eerily like me now that you mention...

 

[6897round2]

It does look eerily like me now that you mention...

 

[armorshell]

 

[MRSA]

god bless sdn.

 

[280040]

Also, you'll see with my magic mod powers (of complaining), I have resurrected posting in the dental residency forums.

Huzzah![/QUOTE]

2 weeks and i bet it's gone

 

[280040]

hahaha

 

[DREDAY]

Did anyone think that Assael discretely suggested that we would be better off picking the 6 year MD integrated program as the only route to omfs because they contribute more to the advancement of the profession?

 

[armorshell]

Did anyone think that Assael discretely suggested that we would be better off picking the 6 year MD integrated program as the only route to omfs because they contribute more to the advancement of the profession?

I don't think he was discrete about it at all, and it's nice to see someone advocating for an open discourse about it.

 

[servitup]

It is time to accept that there really is a difference b/t the two tracks. The specialty will be better off when we all go MD integrated and according to Assael, this will only be a major problem for 5% of programs which have no medical school affiliate.

 

[NoMoScalin]

So now we have to start defending ourselves to our own specialty? Pretty lame. Yes I do think POLITICALLY having the "MD" can prove beneficial, I in know way agree that just because you did a couple more rotations through derm, radiology, OB and IM that makes you a better SURGEON than the 4 yr guys. Guess what, when you finnish your residency you will still go to jail if you continue to do vag checks in your office

As far as what Dr. Assael he makes a great point as to the research, but why would the MD make you more likely to due research? One reason maybe because you have more TIME!! If the point of integrating to the MD route is to increase the number of papers produced than why not integrate PhD? Just some thoughts from the other side, and for servitup, I hope you are enjoying medical school standing in the corner of the room holding the clipboard

 

[DrReo]

Are you referring to Perio managing the soft tissue that the OMFS couldn't manage?
'
Periodontist: "Look at this soft tissue another dual degree surgeon **** up. Freaking train wreck"

OMFS: "What? We can manage hard, I mean soft tissue . I gots my MD"

 

[DREDAY]

So now we have to start defending ourselves to our own specialty? Pretty lame. Yes I do think POLITICALLY having the "MD" can prove beneficial, I in know way agree that just because you did a couple more rotations through derm, radiology, OB and IM that makes you a better SURGEON than the 4 yr guys. Guess what, when you finnish your residency you will still go to jail if you continue to do vag checks in your office

As far as what Dr. Assael he makes a great point as to the research, but why would the MD make you more likely to due research? One reason maybe because you have more TIME!! If the point of integrating to the MD route is to increase the number of papers produced than why not integrate PhD? Just some thoughts from the other side, and for servitup, I hope you are enjoying medical school standing in the corner of the room holding the clipboard

Just to clarify, we do much more than just a "couple more rotations". But I am sure you were being facetious.

I don't think the reason 6 year omfs programs publish more papers has to do with the fact that they have more time. The residents at my program do research and publish when they are on service not when they are in medical school or general surgery. I think it has more to do with the type of people the program attracts. As evidenced by this thread many 4 year residents chose their route because "they don't want to acquire more loans. they want to spend time with family. they want to go into private practice and start making money." If you notice the trend, those are self satisfying motives. These motives outweigh their desire to learn more medicine. I could be wrong but, I think MOST 4 year residents don't consider academics as an option (notice i said most not all).
I think the people who choose the 6 year program are motivated by factors beyond their financial security and family.i.e. doing research, progressing the profession, having a stronger medical background. While many will end up in private practice, MOST consider going into academics.

 

[southomfs]

If I have to hear about one more periodontist make some comment about OMFS and soft tissue I'll puke. It takes you "surgeons" 15 mins to lay a flap, 20 mins to "debride" a pocket and 25 mins to circle jerk to figure out how to close. Keep in mind you do this while "sedating" your pt with 50 mics of fentanyl and 2 mg of versed over the hour.

In response to "yes I gots my MD." Yes, I will have mine. Yes, I will place more implants than any perio residency I've heard of. Yes, I will do a few hundred (or more) cases in the OR. Yes, I will close numerous soft tissue lack in the ED. I think between that, I'll be able to handle "soft tissue" in the mouth....and elsewhere.

 

[armorshell]

If I have to hear about one more periodontist make some comment about OMFS and soft tissue I'll puke. It takes you "surgeons" 15 mins to lay a flap, 20 mins to "debride" a pocket and 25 mins to circle jerk to figure out how to close. Keep in mind you do this while "sedating" your pt with 50 mics of fentanyl and 2 mg of versed over the hour.

In response to "yes I gots my MD." Yes, I will have mine. Yes, I will place more implants than any perio residency I've heard of. Yes, I will do a few hundred (or more) cases in the OR. Yes, I will close numerous soft tissue lack in the ED. I think between that, I'll be able to handle "soft tissue" in the mouth....and elsewhere.

I'm with you, but I'm pretty sure Reo was kidding.

 

[buggzzen]

It is time to accept that there really is a difference b/t the two tracks. The specialty will be better off when we all go MD integrated and according to Assael, this will only be a major problem for 5% of programs which have no medical school affiliate.

So do you propose that as a specialty we go the route of Europe where they have oral surgeons(relegated to DA stuff)-->equivalent to "4yr guys" here and oral-maxillofacial surgeons(everything else including DA)-->equivalent to "6yr guys" here?? If we go the strict MD route I fear we will lose what makes our specialty so unique. A beautiful blend of Medicine and Dentistry, which is made possible by OMFS being governed by the dental board which allows for certain freedoms that makes our specialty so unique. If we go the medical route we will come under the banner of formal medical regulation, rather than governed by CODA. This could prove to be disastrous, financially and professionally. Now halfway through my training I hate to think that I will have spent an additional (hard)4yrs of my life to be relegated to strict DA procedures. Will us “4 year” guys who are currently in training be grandfathered in when this new OMFS train comes through?? Or will we be left scrambling for our right to practice what we have trained for???

 

[servitup]

So do you propose that as a specialty we go the route of Europe where they have oral surgeons(relegated to DA stuff)

No. We already have periodontists. Most OMFS grads, MD or not, graduate to basically be very overtrained periodontists. I think we need to remain committed to what makes the specialty more interesting and prestigious than any other in dentistry which is the "medical" treatment we provide which in my opinion is trauma, pathology, orthognathic surgery, cosmetic surgery, oncology, and pediatric craniofacial/cleft lip and palate. I believe that these treatments should be mainstream in our specialty instead of relegated to the few who are fellowship trained and the first step to advancing our specialty in that direction is to require the MD.

I understand I am in the minority and that most OMFS residents want to do some cool stuff during residency then just make money and work nice hours. I don't think you can have your cake and eat it too forever though. Our medical colleagues who only know of us outside of the few outstanding training programs nationwide think all we do is teeth because that is what most of us do outside of training. If they saw us getting equivalent training by degree at every program, they would have to back off when they see us doing big cases.

I do agree we must be careful not to alienate the dental boards who provide us shelter from oversight of the medical boards who for the above stated reason are scared when they see us doing big cases.

PS I understand orthognathics belongs to us mainly even though I classified it as medical in this post. Most of us fight to do as many cases in residency as possible only to graduate and do a few per year because T&T pays better.

 

[DREDAY]

No. We already have periodontists. Most OMFS grads, MD or not, graduate to basically be very overtrained periodontists. I think we need to remain committed to what makes the specialty more interesting and prestigious than any other in dentistry which is the "medical" treatment we provide which in my opinion is trauma, pathology, orthognathic surgery, cosmetic surgery, oncology, and pediatric craniofacial/cleft lip and palate. I believe that these treatments should be mainstream in our specialty instead of relegated to the few who are fellowship trained and the first step to advancing our specialty in that direction is to require the MD.

I understand I am in the minority and that most OMFS residents want to do some cool stuff during residency then just make money and work nice hours. I don't think you can have your cake and eat it too forever though. Our medical colleagues who only know of us outside of the few outstanding training programs nationwide think all we do is teeth because that is what most of us do outside of training. If they saw us getting equivalent training by degree at every program, they would have to back off when they see us doing big cases.

I do agree we must be careful not to alienate the dental boards who provide us shelter from oversight of the medical boards who for the above stated reason are scared when they see us doing big cases.

PS I understand orthognathics belongs to us mainly even though I classified it as medical in this post. Most of us fight to do as many cases in residency as possible only to graduate and do a few per year because T&T pays better.

I agree. Too many omfs residents get greedy and just end up doing t&t. What a waste of 4-6 years. In any case are there any statistics showing the proportion of 4 vs 6 year omfs that perform big surgeries, have affiliation w/ a hospital (take trauma call), or go into academics?

 

[buggzzen]

No. We already have periodontists.

I agree with your above post for the most part. You still do not answer my question...what happens to the current residents who are in 4yr OMFS programs if the field moves to all 6yr integrated tracts? In 10-15 yrs will ABOMS continue to support my right to perform "full scope OMFS" procedures which I am being trained in??

I postulate that even if the duel degree becomes standard there will be little change from the day to day practices of most OMFSers in the future.

Perhaps when faced with the proposed mandated additional years of training(and debt) the field of OMFS will become less competitive as candate numbers drop.

 

[Kabek]

You still do not answer my question...what happens to the current residents who are in 4yr OMFS programs if the field moves to all 6yr integrated tracts? In 10-15 yrs will ABOMS continue to support my right to perform "full scope OMFS" procedures which I am being trained in??

Bugg,

Hypothetical questions can't be answered with factual information...

 

[CranioFacial]

The CRET of AAOMS has done fine in the past to make sure residents are getting a minimal standard of training across the country. There is a reason AAOMS is around. The AMA should not be the governing body/final say of the training of OMFS. OMFS is a dental specialty. If a resident would so choose to have a medical degree, great! I just do not feel it should be required. I feel past OMFSs programs started it all by offering only a 6yr program. There is no question the procedures performed overlap with other specialites in medicine. It should come back to case log and exposure to whatever the procedure is at hand.

 

[gary_ruska]

The CRET of AAOMS has done fine in the past to make sure residents are getting a minimal standard of training across the country. There is a reason AAOMS is around. The AMA should not be the governing body/final say of the training of OMFS. OMFS is a dental specialty. If a resident would so choose to have a medical degree, great! I just do not feel it should be required. I feel past OMFSs programs started it all by offering only a 6yr program. There is no question the procedures performed overlap with other specialites in medicine. It should come back to case log and exposure to whatever the procedure is at hand.

Gary "MD stands for Mostly Dental" Ruska here,

Excellent points all around. However, those who think that mandating the MD degree as part of OMFS training may be a little shortsighted as far as considering this a solution to turf battles, etc. If all OMFS programs granted the MD degree, and if there was some way to grandfather the existing four year guys into the fold (likely via the board certification process), there may still be hurdles placed before OMFS...

Consider this - many states now require more than 1 year of post-graduate ACGME training. Even if all OMFS graduates obtained MD degrees, the vast majority only do 1 year of ACGME general surgery prior to returning to OMFS. As government oversight and involvement in statewide health law increases, GR would not be surprised if more states required 2+ years of ACGME training. This would, undoubtedly be a significant obstacle for OMFS programs, unless all were accredited by the ACGME (the disadvantage, of course, being that this would effectively sever many ties to dentistry)...

To put it simply - the ADA and the dental community has supported OMFS for decades and will continue to do so. The same cannot be said for the AMA and the medical community and it is unrealistic to think that attitudes will change solely on the basis of everyone getting the MD degree.

While GR is a strong proponent of the 6-year track, mandating it does not solve the problems described above.

 

[buggzzen]

Gary "MD stands for Mostly Dental" Ruska here,

Excellent points all around. However, those who think that mandating the MD degree as part of OMFS training may be a little shortsighted as far as considering this a solution to turf battles, etc. If all OMFS programs granted the MD degree, and if there was some way to grandfather the existing four year guys into the fold (likely via the board certification process), there may still be hurdles placed before OMFS...

Consider this - many states now require more than 1 year of post-graduate ACGME training. Even if all OMFS graduates obtained MD degrees, the vast majority only do 1 year of ACGME general surgery prior to returning to OMFS. As government oversight and involvement in statewide health law increases, GR would not be surprised if more states required 2+ years of ACGME training. This would, undoubtedly be a significant obstacle for OMFS programs, unless all were accredited by the ACGME (the disadvantage, of course, being that this would effectively sever many ties to dentistry)...

To put it simply - the ADA and the dental community has supported OMFS for decades and will continue to do so. he same cannot be said for the AMA and the medical community and it is unrealistic to think that attitudes will change solely on the basis of everyone getting the MD degree.

While GR is a strong proponent of the 6-year track, mandating it does not solve the problems described above.

I love this guy. Gary seems to always have the voice of reason(not jokin). Do say Dr. Ruska...How do you see things playing out for the OMFS community over th next 15-20yrs??Do you think all this new uproar for change today is just part of a cyclical debate that will ultimatly lead to little change?

 

[servitup]

As long as oral and maxillofacial surgeons set the ACGME standards for oral and maxillofacial surgery, just like ENTs set ENT standards, PRSs set PRS standards, etc. then I think we SHOULD join ACGME. As long as OMFSers are steering our specialty, ACGME accreditation would be much better for us than CODA.

 

[280040]

As long as oral and maxillofacial surgeons set the ACGME standards for oral and maxillofacial surgery, just like ENTs set ENT standards, PRSs set PRS standards, etc. then I think we SHOULD join ACGME. As long as OMFSers are steering our specialty, ACGME accreditation would be much better for us than CODA.

That would have rippling effects. Totaly alienate dental colleagues.....

I know so little that I can't offer an opinion. It just feels wrong though.

Then again. I subscribe to the idea that oms is the only surgeons that can skip med school and still perform awesome surgeries. Seems like a short cut to outsiders.

I still tend towards the 6 year track though.

If oms leaves coda, perio will go nuts over it.

 

[MRSA]

If oms leaves coda, perio will go nuts over it.

why do you say that?

 

[PAJain]

I agree with "serveitup" OMFS should join ACGME. I wouldn't call what OMFS is going through now as a change, I would say it is going through a major revolution.

The reason I say this is that 30 years ago orthognathics and TMJ were the new big thing. As we all know at that time the program that was leading the way in orthognathic surgery was Parkland. So many of its graduates went on to become the current leaders of OMFS (i.e., Turvey, Fonseca, Schendel, Epker, Bell Sr.). If you think about it >90% of current chairmen specialize in orthognathics or TMJ, which kept us closer to our dental roots.

However, in 20 years the chairmen in OMFS will not be orthognathic surgeons. We all know this is a slowly dying art. The demand is much less today with the advent of mini-implants, anchorage devices, and facial implants. So in 20 years most of the chairmen will be micro/oncology surgeons. If you don't believe take a look at all the current young all-stars in OMFS (i.e., Bailey, Fernandes, Schmidt, Ward, Bell Jr., Hirsch, etc...). In order to seriously do Micro/Oncology you will need an MD, and General Surgery training. Also, many of these guys are pushing for ACGME for these areas of surgery are purely medical and have very little to do with dentistry.

This is why to all current applicants don't let this discussion discourage you. Just realize where the specialty is heading, and make sure you select a program that will keep you at the top. Make sure that mandibles and BSSO are not the only things you know how to do coming out of residency. This advice is more for people interested in becoming faculty.

To those interested in private practice, think cosmetics, cosmetics, cosmetics. Take a look at the big private practices out there today, they are all building surgery centers and hiring cosmetic trained surgeons. You may ask why? Well just like academic practices are doing less orthognathics, private practices are placing less implants. Implants are becoming much easier today, and with implant specialists, periodontists, general dentists, prosthodontics placing them there is much less to go around. With the increasing pressure by society for people to look young and beautiful the interest in cosmetic surgery is rapidly increasing. Private practice guys know this, and are doing everything they can to get into it. So if your interested in private practice I would recommend to all the current applicants make sure you go to a program where you will gain a lot of exposure to cosmetics. The reality is you will not be doing mandibles and BSSOs in private practice especially with compensation for medical procedures decreasing by the hour.