OMS in Australia and New Zealand

[Axle88]

Australia and New Zealand used to offer both dual and single degree OMS programs. Then they went through a period (the last 10-20 years) of only offering the dual degree track for OMS.


Now the two countries are currently in a period of re-introducing the single degree OMS option.

Does this happen everywhere?

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[Silent Cool]

Australia and New Zealand used to offer both dual and single degree OMS programs. Then they went through a period (the last 10-20 years) of only offering the dual degree track for OMS.


Now the two countries are currently in a period of re-introducing the single degree OMS option.

Does this happen everywhere?

Axle,

That's an interesting question and I don't know the answer. I think that many European countries offered only double-degree for many years.

As an addendum to your question: does anyone know about practicing in these two countries specifically if you were trained in the U.S.?

 

[Axle88]

Axle,

That's an interesting question and I don't know the answer. I think that many European countries offered only double-degree for many years.

As an addendum to your question: does anyone know about practicing in these two countries specifically if you were trained in the U.S.?

Do you mean practicing as an OMS? Have you completed a US OMS program?

 

[Silent Cool]

Do you mean practicing as an OMS? Have you completed a US OMS program?

Yea and No. I'm just wondering if anyone knows about practicing abroad.

 

[Axle88]

Yea and No. I'm just wondering if anyone knows about practicing abroad.

Australia and NZ do accept US and Canadian OMS specialty training as equivalent to ours. So, if you completed your residency training in North America you should be eligible to apply for specialty registration here. However, anyone applying for specialty registration must first obtain general dental registration/license from the Australian Dental Council or New Zealand Dental Council.

Australia and New Zealand signed a reciprocal agreement with Canada in 2010 which means that anyone who graduated after 2010 from either place can work in the other country (and are not considered foreign grads). Therefore obtaining a general license is pretty easy in this instance.

CODA (USA) has not signed the agreement so that means that at the moment all US dental grads are considered foreign (non-accredited) in Aus and NZ.
In order for US grads to get a general license/registration you either need to pass a series of exams (written, oral, and hands on) or alternatively you can apply to an accredited dental school here for advance standing (I think the University of Adelaide used to have an advanced standing program for overseas graduates). So that's the catch.

However, once you have general dental registration. You can then submit your application to have your specialty training recognized.

 

[Axle88]

Since Australia and NZ only offered dual degree OMS programs for the past 10 years, there have been a few AU/NZ dental graduates who have completed North American OMS training (without medical degrees) and then returned to register and work as OMS. However, they already had general dental registration so it was easier for them I think.

 

[Silent Cool]

Australia and NZ do accept US and Canadian OMS specialty training as equivalent to ours. So, if you completed your residency training in North America you should be eligible to apply for specialty registration here. However, anyone applying for specialty registration must first obtain general dental registration/license from the Australian Dental Council or New Zealand Dental Council.

Australia and New Zealand signed a reciprocal agreement with Canada in 2010 which means that anyone who graduated after 2010 from either place can work in the other country (is not considered a foreign grad). Therefore obtaining a general license is pretty easy in this instance.

CODA (USA) has not signed the agreement so that means that at the moment all US dental grads are considered foreign (non-accredited) and would first need to apply for a general dental license/registration
to the Australian (ADC) or New Zealand (NZDC) Dental Councils. In order to get a license/registration you either need to pass a series of exams (written, oral, and hands on) or alternatively you can apply to an accredited dental school here for advance standing (I think the University of Adelaide used to have an advanced standing program for overseas graduates). So that's the catch.

Axle,

Thanks for the great info. I appreciate it!
Do you expect the US to establish reciprocity with NZ/AU?
Also, do you know if medical (not dental) specialties have reciprocity with NZ/AU?

I've long thought that working in NZ/AU as a doctor would be cool for perhaps a period of a few years.

thanx

 

[Axle88]

Axle,

Thanks for the great info. I appreciate it!
Do you expect the US to establish reciprocity with NZ/AU?
Also, do you know if medical (not dental) specialties have reciprocity with NZ/AU?

I've long thought that working in NZ/AU as a doctor would be cool for perhaps a period of a few years.

thanx

In regards to any future US and AU/NZ agreements you'll have to contact CODA and the ADC/NZDC.

I have heard about some reciprocity agreements with some med specialties, but which ones I'm not sure. Sorry

 

[Axle88]

I know that some North American OMS programs offer medical degrees, but is it actually required to have a medical degree in any US state or Canadian province? I was under the impression that it wasn't.

There are many issues/politics with this specialty and I know this has been an issue debated back and forth for the past 50 years.

 

[Silent Cool]

I know that some North American OMS programs offer medical degrees, but is it actually required to have a medical degree in any US state or Canadian province? I was under the impression that it wasn't.

There are many issues/politics with this specialty and I know this has been an issue debated back and forth for the past 50 years.

In the U.S. you absolutely do *NOT* need a medical degree. My OMS was a single degree surgeon, and I believe ~50% of current OMS programs in the states are single degree.

Looking at the surgeons in Vancouver, BC, it looks like you do not need an MD to practice in Canada.

http://www.vancouveroralsurgerygroup.com/meetdrleung.html

http://www.drkennethchow.com/index.html

 

[Mordecai]

I'm an OMS2 in Australia. It's news to me that OMS in AUS/NZ is considering offering a single degree pathway.
Training has changed since I started in the old dual path system (Get one degree- apply to OMS- do the second degree- Finish OMS). The last of the old "dual pathway" folks will be filtering out of the system within the next 3-4 years.We now have "seamless" training where in order to apply for OMS selection one has to have the following:

• Dental degree
• Medical degree + full registration(internship year)
• 1 year of surgical residency (with recommended rotations including ICU/Emergency/Gen surg/plastics/ENT/Neurosurg)

It is also recommended that one has done the appropriate research, unaccredited residency work etc to puff up the CV with appropriate points before passing the hurdle that allows one to gain a selection interview. I have not heard even a peep about a plan to allow either single degree (Dental or Medical) being allowed to pursue OMS training in the future. I would be very interested as to where this info has come from.

 

[Mordecai]

Axle,

That's an interesting question and I don't know the answer. I think that many European countries offered only double-degree for many years.

As an addendum to your question: does anyone know about practicing in these two countries specifically if you were trained in the U.S.?

My supervisor in OMS1 was trained in Seattle under Egbert. As an Australian he had no problem returning to work, but had to in effect redo his final residency year here before practice as a specialist. I am not sure about whether he had to sit the FRACDS (OMS) board exam or not.

 

[Axle88]

My supervisor in OMS1 was trained in Seattle under Egbert. As an Australian he had no problem returning to work, but had to in effect redo his final residency year here before practice as a specialist. I am not sure about whether he had to sit the FRACDS (OMS) board exam or not.

Redoing 1 year of residency is not too bad.

BTW: The Dental Board of Australia does not require FRACDS (OMS) to obtain registration in Australia as an OMS (at the end of the day it is the dental board not the RACDS that registers dental specialists). FRACDS (OMS) is like board certification by ABOMS. Nice to have, but not absolutely required.

Australia is the ONLY country in the entire world that has required applicants to enrol in and complete medical school on their own accord and without financial support (before they even know if they are accepted to the OMS program). Most people who complete both degrees in Australia do not go on to complete OMS training. Additionally OMS is a dental specialty in Australia, not a medical specialty (even though they have been forcing everyone to complete medical degrees prior to being accepted). Australia is the only country in the world with this strange structure.

As a matter of fact the International Association of Oral and Maxillofacial Surgeons (IAOMS) even states:
The maximum length of training following completion of the first degree should not be greater than eight years. Careful attention should be given to integrating components of dental, medical and clinical education so that an oral and maxillofacial surgeon may complete their training at an age which allows for a long and productive career.

The Australian RACDS training program is in clear violation of this international recommendation as their current program is:
Dental (BDS/DMD): 5-8 years
Medical (MBBS/MD): 3-5 years
Internship: 1 year
Gen Surg year: 1 year
OMS training: 4 years
Total time: 14-19 years!

As a result of the RACDS (OMS) Australia now suffers from a major surplus of dual qualified graduates (most are now either general dentists with medical degrees or medical specialists in other fields who have dental degrees). Every year a couple hundred dual qualified graduates go on to pursue other fields. This is very poor way to structure a training program and is a major waste of people's time and taxpayers money.

Because of this poorly structured OMS training program in Australia many dental graduates are now going overseas to train as OMS surgeons where a medical degree is not required.


Most countries offer oms training as a 3-4 year residency post dental school. Some include 2 extra years to complete a medical degree. However, it is never required nor does it affect scope of practice in 98% of the world.

 

[Axle88]

Read for yourself (just a handful of the dozens of articles and letters on the subject, key articles in bold):

1970s:
Guralnick WC. The combined oral surgery-MD program: the Harvard plan. J Oral Surg. 1973 Apr;31(4):271-6.

Hall HD. Current tracks in advanced educational programs in oral surgery. J Oral Surg. 1973 Apr;31(4):260-5.

Hillenbrand H. The past, present, and future status of oral surgery in the United States. J Oral Surg. 1973 Apr;31(4):290-4.

Eisenbud L. An analysis of the potential impact of oral surgery-MD programs. J Oral Surg. 1973 Apr;31(4):277-82.

The double-degree dilemma. J Oral Surg. 1977 May;35(5):347, 430.

Alling CC. Defense of MD option. J Oral Surg. 1977 Aug;35(8):619.

1980s:

Barber HD, Sejud P. Double-degree oral and maxillofacial surgeons: was it worth it? J Oral Maxillofac Surg. 1988 Oct;46(10):872-4.

To what degree can we change our future? J Oral Maxillofac Surg. 1989 Oct;47(10):1124-6.

The double-degree debate continues. J Oral Maxillofac Surg. 1989 Oct;47(10):1123-4.

1990s:

Punjabi AP, Haug RH. The development of the dual-degree controversy in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1990 Jun;48(6):612-6.

Bailey WK. Medical training for oral and maxillofacial surgeons: a resident's perspective. J Oral Maxillofac Surg. 1990 Jun;48(6):667.

Laskin DM. The MD degree: a panacea or a problem? J Oral Maxillofac Surg. 1997 Mar;55(3):209.

Laskin DM. Double degree members and their importance to AAOMS. American Association of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 1997
Sep;55(9):911.

Leonard MS. The MD degree: problem or solution? J Oral Maxillofac Surg. 1997 Aug;55(8):899-900.

2000s:
Kaban LB, Guralnick WC. Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery Program. J Oral Maxillofac Surg. 2005 Aug;63(8):1069-72

Dodson TB, Guralnick WC, Donoff RB, Kaban LB. Massachusetts General Hospital/Harvard Medical School MD oral and maxillofacial surgery program: a
30-year review. J Oral Maxillofac Surg. 2004 Jan;62(1):62-5.

Herford AS. Integration of the medical degree in oral and maxillofacial surgery: a 10-year follow-up. J Oral Maxillofac Surg. 2002 Jul;60(7):844.

Mettner J. To MD or not to MD? Minn Med. 2005 Aug;88(8):8-9.

2010:

Assael LA. The view from the third rail. J Oral Maxillofac Surg. 2010 Apr;68(4):713-4.

Take home points:
1. Not a new controversy and certainly not one that hasn't been dissected from every viewpoint.
2. OMFS scope of practice is determined by Dental Practice Acts -- Dental Associations are powerful entities, often more powerful than their medical counterparts and have been successful at ensuring that ALL OMFS have the same practice privileges.
3. Many will maintain that the MD does add some degree of security. Just be aware that: if everyone in OMFS had a medical degree, PRS/ENT would still try to limit scope of practice of dual qualified OMS guys, just via a different mechanism. If OMFS became a member of the College of Surgeons (RACS), they would try something else - do not underestimate one's creativity when their livelihood is threatened.
4. PRS/ENT look at OMFS (dual degree or not… doesn't matter) the way that OMFS look at perio. Think about that the next time you rag on a periodontist for taking out 8s.

 

[Mordecai]

Speaking from the perspective of OMS in Aus/Nz- no there are no plans I have heard of to allow single degree training.
Though OMS is a dental specialty, the dental board recognizes people are OM surgeons only if they satisfy the RACDS (Royal Australasian college of dental surgeons) who are quite adamant that we are dual degree holders.
In addition, OMS are also recognized by the medical board of Australia which grants us access to Medicare payments.

During my brief stint in England I came across a few people who had put themselves through med school after dentistry without being accepted into formal OMS training. So , no Australia is not unique.

NZ had until recently through their dental board recognized single degree trainees who had completed a masters in Otago as OM surgeons , but that door has now been closed.

And no I don't rag on perio, I don't feel the need to. In our centre we do more trauma than plastics and almost as much cancer as ENT( with better results in our joint audits ). The trauma chair is the director of OMS and the head and neck chairman is an OMS. It has been stated clearly by plastics /ENT that the medical degree was a key component in defusing the previous resistance. We leave the nasopharyngeal ca to ENT and they leave us free reign over whatever else comes our way.

 

[Mordecai]

We are looking after sicker, fatter and older people. Our last neck dissections were aged 80, 90 and 76. Their care involved ICU, trache monitoring and constant liason with high risk anaesthesia clinic. These wheels are well greased by the fact that all residents have rotated through ICU as doctors prior to OMS. I don't envision the medical degree aspect being sidelined anytime soon in Aus.

 

[Mordecai]

Now the Aus/NZ training pathway might be long.... But we picked it up from the Brits.
http://www.surgeryrecruitment.nhs.u.../files/OMFS for CT Applicants 2011-12 (2).pdf

The French and Germans are convoluted too methinks.

 

[Mordecai]

And lastly , I don't think the powers that be much care about prospective OMS trainees who go abroad. Intake is low. In my selection year only 11 matched in Aus/NZ. This year it was 12.
Fewer grads = more wizzies for everyone.

 

[Silent Cool]

The best gang for the buck is still probably CWRU's 5-YEAR double degree OMS program:

http://dental.case.edu/omfs/residency/curriculum/

 

[Axle88]

I'm an OMS2 in Australia. It's news to me that OMS in AUS/NZ is considering offering a single degree pathway.

I simply heard that because there is a surplus of dual qualified graduates and that many have complained about the structure of the current OMS training program in Australia many dental graduates are now going overseas to train as OMS surgeons where a medical degree is not required.

Some return and get registered in Au/Nz, and some don't.

Specifically, now that Australia has a reciprocal accreditation agreement with Canada I know at least 4 or 5 people who have submitted applications to Canadian OMS programs (no MD required).

Speaking from the perspective of OMS in Aus/Nz- no there are no plans I have heard of to allow single degree training.
Though OMS is a dental specialty, the dental board recognizes people are OM surgeons only if they satisfy the RACDS (Royal Australasian college of dental surgeons) who are quite adamant that we are dual degree holders.
In addition, OMS are also recognized by the medical board of Australia which grants us access to Medicare payments.

During my brief stint in England I came across a few people who had put themselves through med school after dentistry without being accepted into formal OMS training. So , no Australia is not unique.

In the UK, OMS is a medical specialty and the final exam is with the college of surgeons not dental, so this makes more sense than in Australia where OMS is a dental specialty like the rest of the world. Additionally, in the UK where OMS is now a medical specialty there is still a single degree pathway (oral surgery) because the scope of practice of OMS in the UK is slightly different.

So, yes. Australia is unique in requiring their applicants to OMS (dental) to have completed a medical degree on their own prior to admission to a dental training program without offering a single degree pathway.

And no I don't rag on perio, I don't feel the need to. In our centre we do more trauma than plastics and almost as much cancer as ENT( with better results in our joint audits ). The trauma chair is the director of OMS and the head and neck chairman is an OMS. It has been stated clearly by plastics /ENT that the medical degree was a key component in defusing the previous resistance. We leave the nasopharyngeal ca to ENT and they leave us free reign over whatever else comes our way.

I apologies about the last post. That was actually a copied response from a previous thread about the same topic. I didn't write that reply someone else did and I thought I had included the reference. sorry

 

[Axle88]

Now the Aus/NZ training pathway might be long.... But we picked it up from the Brits.
http://www.surgeryrecruitment.nhs.uk/sites/surgeryrecruitment/files/OMFS for CT Applicants 2011-12 (2).pdf

The French and Germans are convoluted too methinks.

I agree. I just wanted to point out that unlike the Brits OMS is not a medical specialty in Australia and additionally the scope of practice for OMS in the UK is a bit wider as well and has more focus on H/N procedures (ablative, reconstructive/free-flaps) than in Australia.

I'd also like to point out that in North America people are usually fatter and sicker than Australians, and their OMS trainees manage a wider scope of practice and see more trauma there overall than in Australia and there a medical degree is optional.

 

[Axle88]

And lastly , I don't think the powers that be much care about prospective OMS trainees who go abroad. Intake is low. In my selection year only 11 matched in Aus/NZ. This year it was 12.

Fewer grads = more wizzies for everyone.

That is exactly my point!

Most dual qualified OMS grads in Australia spend more time postgraduation doing oral/dento-alveolar (T/T) surgery than H/N surgery. Which is something that many general dentists are capable of doing and does not require completing of a medical degree, internship year, and general surgery year.

However, that is very understandable. By the time that Aussie graduates complete the RACDS OMS training they are usually old, in debt, have families, and are trying to buy a home in Australia (very hard to do these days). So no wonder all they want to do is open a private practice and shuck 3rds all day.