Jul 6, 2010
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I'm not arguing about 4 vs 6 here. But I do see a flaw in our argument base. Please let me know what you think. This has come up with discussions with physicians who get all excited when they find out some OMS do cosmetics.

I view the general dentist as the core of the dental care team. They make all the decisions and ask for help from specialists as needed. We have specialists to help bridge the gap between what a general dentist wants to accomplish and where their own personal training lies. Think about every specialty, and it fits this quite well. Ortho, perio, prosth, endo, oral surgery.

Now how can we make the argument that an oral surgeon is operating under their dental license when they are doing cosmetic surgery. Or even trauma surgery for that matter. This is not an argument of training. I believe with proper case exposure, an OMS can lead quite a successful practice in cosmetics.

Does anyone else see this as a hole in our argument or is it just me?

PLEASE, NO ONE START ARGUING 4 VS 6.
 

CanuckDDS

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Dec 3, 2004
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I'm not arguing about 4 vs 6 here. But I do see a flaw in our argument base. Please let me know what you think. This has come up with discussions with physicians who get all excited when they find out some OMS do cosmetics.

I view the general dentist as the core of the dental care team. They make all the decisions and ask for help from specialists as needed. We have specialists to help bridge the gap between what a general dentist wants to accomplish and where their own personal training lies. Think about every specialty, and it fits this quite well. Ortho, perio, prosth, endo, oral surgery.

Now how can we make the argument that an oral surgeon is operating under their dental license when they are doing cosmetic surgery. Or even trauma surgery for that matter. This is not an argument of training. I believe with proper case exposure, an OMS can lead quite a successful practice in cosmetics.

Does anyone else see this as a hole in our argument or is it just me?

PLEASE, NO ONE START ARGUING 4 VS 6.

I do not see it as a hole in our argument.

We are a self regulated profession. As is medicine. We can choose to do what we want (if properly trained). Why does having a medical licence mean that you have exclusivity over anything? Who made that rule?

I think that if the public trusts us, our colleagues trust us, we are properly trained, and we are confident in our ability to complete a procedure to the standard of care then a licence is just something you hang on the wall...

Maxillofacial surgery blurs the lines between medicine and dentistry to such a degree that this is a non-issue.

Some might even suggest that we are more apt to operate on the face than our medical colleagues (gasp!), since we have spent way more time looking at, and analyzing the face and facial anatomy than ANY medical specialist. This is what we did through dental school, plus intern year, plus 6 years of balls-to-the-walls OMF training.

At our hospital, if a physician or their family member sustains facial trauma or has a baby with a cleft they request our service treat them. Period.

Good question though.:thumbup:
 
OP
G
Jul 6, 2010
329
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I do not see it as a hole in our argument.

We are a self regulated profession. As is medicine. We can choose to do what we want (if properly trained). Why does having a medical licence mean that you have exclusivity over anything? Who made that rule?

I think that if the public trusts us, our colleagues trust us, we are properly trained, and we are confident in our ability to complete a procedure to the standard of care then a licence is just something you hang on the wall...

Maxillofacial surgery blurs the lines between medicine and dentistry to such a degree that this is a non-issue.

Some might even suggest that we are more apt to operate on the face than our medical colleagues (gasp!), since we have spent way more time looking at, and analyzing the face and facial anatomy than ANY medical specialist. This is what we did through dental school, plus intern year, plus 6 years of balls-to-the-walls OMF training.

At our hospital, if a physician or their family member sustains facial trauma or has a baby with a cleft they request our service treat them. Period.

Good question though.:thumbup:
Great response. As a general dentist, you are allowed to do 'specialist' procedures as long as you reach the elusive concept of 'as good as the specialist'. Braces, root canals, implants, EVERYTHING. Yet a general dentist has no hope of the surgical procedures in maxillofacial surgery. So as a specialist/extension of the gp, I am not a dentist when I do trauma, cosmetics, etc. That was the source of my question/disconnect.

You make a great point in regards to oms training being so different that it's not an issue.
 
Mar 9, 2010
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This discrepancy is essentially what makes OMS such an amazing field.

I agree with you that there is a disconnect with the traditional thinking when pertaining to OMS. There is no doubt that maxillofacial trauma/cosmetics etc. is well out of the realm of a general dentist and this is where the disconnect lies.

This disconnect could no doubt get OMS into trouble (see AMA article). I think it is actually real important to keep OMS as an obscurity. Its perfect little niche between medicine and dentistry is ideal, but certainly won't stay that way if too much attention is drawn to the profession. People (especially MD's) are competitive (and jealous) by nature and don't want to be outdone by "dentists." That's why it is so important that they continue to feel like they are not being outdone by OMS.

If OMS can stay in its little niche and stay out of the MD spotlight then the profession will continue to be gravy.

But to address your point... you're right, there is a definite discrepancy.
 

armorshell

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You could easily say the same thing of medicine: That the PCP (Family med, internal medicine) is the quarterback of the MD team, and the goal of the medical specialist is to augment their treatment planning with specialty training. Therefore, if a specialist does something a PCP could not hope to do with their training, it isn't medicine.

Obviously the conclusion doesn't follow. The reason this argument doesn't work is that legal aspects of medicine, just like dentistry, are not defined around what general practitioners do. Just because the care delivery system is organized around a GP "quarterbacking" care, doesn't mean the legal definition of dentistry has to be "everything a GP dentist can do."

Trauma and cosmetics being a part of dentistry makes sense because historically, these are things that OMFS were doing. OMFS are dentists, therefore it has to be a part of dentistry's legal structure. I'm not arguing the point that when you do trauma surgery or a facelift you aren't really doing dentistry; you aren't in the traditional sense. But because of the training path, the history and advancement of the specialty, it makes sense these procedures are part of "dentistry" legally.
 
OP
G
Jul 6, 2010
329
5
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You could easily say the same thing of medicine: That the PCP (Family med, internal medicine) is the quarterback of the MD team, and the goal of the medical specialist is to augment their treatment planning with specialty training. Therefore, if a specialist does something a PCP could not hope to do with their training, it isn't medicine.

Obviously the conclusion doesn't follow. The reason this argument doesn't work is that legal aspects of medicine, just like dentistry, are not defined around what general practitioners do. Just because the care delivery system is organized around a GP "quarterbacking" care, doesn't mean the legal definition of dentistry has to be "everything a GP dentist can do."

Trauma and cosmetics being a part of dentistry makes sense because historically, these are things that OMFS were doing. OMFS are dentists, therefore it has to be a part of dentistry's legal structure. I'm not arguing the point that when you do trauma surgery or a facelift you aren't really doing dentistry; you aren't in the traditional sense. But because of the training path, the history and advancement of the specialty, it makes sense these procedures are part of "dentistry" legally.

I agree with some of that. At the end of the day WE are the underdogs though. So I'd rather ask questions internally than let someone outside the profession answer them for me. Your theory and logic can be correct, but that doesn't always win. And if dentistry loses their cohesiveness due to drop in incomes, quality of life, midlevels, etc. oms may lose their general dentist audience and their voting and $$$ power.

Historically surgeon's scope has been restricted by privileges. With ambulatory surgical care centers this is a non issue. So I do believe this is an important topic for us. The haters can restrict inside the hospital walls. So laws are their option outside the hospital. Now most legislative attempts have fallen flat on their face except for Cali's odd law. And lucky for us, case law rules the land. Still, I'm not convinced that we aren't using dental licenses on the edge. But then where does anesthesia lie in all of this? I have no idea. That is practicing medicine in the monopoly world of MDs.
 
Mar 9, 2010
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I agree with some of that. At the end of the day WE are the underdogs though. So I'd rather ask questions internally than let someone outside the profession answer them for me. Your theory and logic can be correct, but that doesn't always win. And if dentistry loses their cohesiveness due to drop in incomes, quality of life, midlevels, etc. oms may lose their general dentist audience and their voting and $$$ power.

Historically surgeon's scope has been restricted by privileges. With ambulatory surgical care centers this is a non issue. So I do believe this is an important topic for us. The haters can restrict inside the hospital walls. So laws are their option outside the hospital. Now most legislative attempts have fallen flat on their face except for Cali's odd law. And lucky for us, case law rules the land. Still, I'm not convinced that we aren't using dental licenses on the edge. But then where does anesthesia lie in all of this? I have no idea. That is practicing medicine in the monopoly world of MDs.
Can't you just call eachother, or better yet just speak at school?
 

Bifid Uvula

My Superior Wang...
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Aug 16, 2005
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I'm not arguing about 4 vs 6 here. But I do see a flaw in our argument base. Please let me know what you think. This has come up with discussions with physicians who get all excited when they find out some OMS do cosmetics.

I view the general dentist as the core of the dental care team. They make all the decisions and ask for help from specialists as needed. We have specialists to help bridge the gap between what a general dentist wants to accomplish and where their own personal training lies. Think about every specialty, and it fits this quite well. Ortho, perio, prosth, endo, oral surgery.

Now how can we make the argument that an oral surgeon is operating under their dental license when they are doing cosmetic surgery. Or even trauma surgery for that matter. This is not an argument of training. I believe with proper case exposure, an OMS can lead quite a successful practice in cosmetics.

Does anyone else see this as a hole in our argument or is it just me?

PLEASE, NO ONE START ARGUING 4 VS 6.
- Why argue about cosmetics? There is no more invasive "cosmetic" procedure than Orthognathic Surgery... If you can do a BSSO/Genioplasty/LF then why argue about a blepharoplasty?

- Why argue about trauma? Most PRS and ENT don't want to do facial trauma call. Its been our traditional standpoint given our background in Dentistry and better understanding of Occlusion and the TMJs as a basis for re-establishing the facial framework.

-Why argue about anesthesia? We essentially pioneered and set the standards for ambulatory anesthesia. Our morbidity/mortality rates are are about 1 in every 800-900,000 cases.

All of these fall under our dental license. The dual degree guys/gals technically are practicing OMFS under their dental license, not their medical license...
 

Phidippides

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Apr 27, 2010
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And lucky for us, case law rules the land. Still, I'm not convinced that we aren't using dental licenses on the edge. But then where does anesthesia lie in all of this? I have no idea. That is practicing medicine in the monopoly world of MDs.
The anesthesia part of our training has been looked at heavily as well. I am guessing that training programs are going from 4 to 5 months of anesthesia training due to the attention it is getting. I would not be surprised if OMS's ability to run anesthesia and operate simultaneously ceases in the future. It is a very unique situation that OMS has in that arena. I know that at least one insurance company is starting to deny claims for any claim with the operation and sedation being performed by the same doctor.
 

Phidippides

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Which one?
This was reported to me by an attending somewhere in the middle of the interview trail, not sure where (it is all a blur). I was not given a name of the insurance company, but the attending's point was that if one ins co starts to head in that direction others might follow. And if it does not become a law that prohibits the operator/anesthetist it might become less common due to patients not wanting to pay for it out of pocket.

But this is a different concern than scope of practice for OMS.
 

Bifid Uvula

My Superior Wang...
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Aug 16, 2005
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The anesthesia part of our training has been looked at heavily as well. I am guessing that training programs are going from 4 to 5 months of anesthesia training due to the attention it is getting. I would not be surprised if OMS's ability to run anesthesia and operate simultaneously ceases in the future. It is a very unique situation that OMS has in that arena. I know that at least one insurance company is starting to deny claims for any claim with the operation and sedation being performed by the same doctor.
I doubt insurance companies will take that stance. They would rather pay our lower anesthesia fees than have to pay a higher anesthesiologist fee.
 

DREDAY

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Jul 13, 2004
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The anesthesia part of our training has been looked at heavily as well. I am guessing that training programs are going from 4 to 5 months of anesthesia training due to the attention it is getting. I would not be surprised if OMS's ability to run anesthesia and operate simultaneously ceases in the future. It is a very unique situation that OMS has in that arena. I know that at least one insurance company is starting to deny claims for any claim with the operation and sedation being performed by the same doctor.
I started a thread about this. The FDA has already made a statement against the use of propofol by the person doing the procedure.... i wonder if they will begin adding other anesthetics to that list.