Oral Surgery & Reconstructive Surgery

[ArtinDent]

Dear fellow SDN dentists/dental students,

I am about to begin dental school in the fall and had a question that I've not been able to find answers to online and from other dentists...

I am highly interested in pursuing oral surgery specialty following completion of my pre-doctoral education. My question is this: which states allow oral surgeons (who have also completed their MD requirements) allow them to perform all types of facial reconstructive surgery (therapeutic as well as elective)? I recently read that Gov Schwartzenager veto'ed the bill allowing CA oral surgeons to perform elective surgeries. I cannot seem to find any info on the AA of Plastic Surgeons and AA Oral Surgeons website regarding this.

Any and all help would be awesome! Thanks and good luck to you all...

Artin

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[tx oms]

If you have an MD there are no restrictions. Schwartzenager veto'ed a bill allowing 4 year (non-MD) OMFS guys from doing cosmetic surgery.

 

[Fullosseousflap]

If you have an MD there are no restrictions. Schwartzenager veto'ed a bill allowing 4 year (non-MD) OMFS guys from doing cosmetic surgery.

Yeah it is so hard to inject that Botox!

 

[ArtinDent]

Thanks TX OMS for your reply...

That sounds more like it, because it is completely unfair to deprive OMS's with MD's from doing the work they have been trained to perform (i.e. having gone through g-surg and many other speciality rotations during residency). I will probably do rhinoplasty as the only elective surgery and focus mainly on pediatric reconstructive surgery (e.g. cleft palates and such).

Here's the link to regarding bill SB1336 that Schwartzeneger veto'ed if others are interested about it: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/08/31/BAG928H38P1.DTL

 

[toofache32]

The MD helps in that situation, but the Plastics and ENT guys still consider you a dentist because the turf battle will always exist.

The irony is that your scope of practice is dictated by your oral surgery training, not by your degree. You learn oral surgery during your residency, not during dental or medical school. My med school classmates had never even heard of the problems we treat and the procedures we do. The irony is that people assume you are better trained as an oral surgeon because you did a 6-week psychiatry rotation and a 6-week OB/GYN rotation. I realize now that med school was a huge waste of time as far as training, but the public doesn't realize that.

 

[UNLV OMS GUNNABE]

The MD helps in that situation, but the Plastics and ENT guys still consider you a dentist because the turf battle will always exist.

The irony is that your scope of practice is dictated by your oral surgery training, not by your degree. You learn oral surgery during your residency, not during dental or medical school. My med school classmates had never even heard of the problems we treat and the procedures we do. The irony is that people assume you are better trained as an oral surgeon because you did a 6-week psychiatry rotation and a 6-week OB/GYN rotation. I realize now that med school was a huge waste of time as far as training, but the public doesn't realize that.

Knowing what you know now, if you had to apply again would you prefer a 6-year program that only did 2 years of med school as opposed to the three you are doing now?

 

[tx oms]

Yeah it is so hard to inject that Botox!

I had a prosthedontics prof that said he could teach a monkey to fill a tooth...

 

[toofache32]

I had a prosthedontics prof that said he could teach a monkey to fill a tooth...

And he was teaching you?

I have to take my cheap shots when I see them.

 

[toofache32]

Knowing what you know now, if you had to apply again would you prefer a 6-year program that only did 2 years of med school as opposed to the three you are doing now?

That's a really good question. I've that about that and had this conversation with some of the other residents here. On one hand, it's nice to have at least part of the 2nd year of med school so that you can review all that stuff to take the medical boards. However, this means less time rotating on oral surgery. On the other hand, time spent on oral surgery as a first-year residentis usually spent being everyone's b!tch. It's not like you're actually operating that much, but it's variable from program to program.

In my opinion, the 6-year programs I would be wary of are ones where you only do oral surgery during your 1st and 6th years. You can probably identify these as the one's that have you on general surgery during the 5th year.

 

[Fullosseousflap]

And he was teaching you?

I have to take my cheap shots when I see them.

Sorry guys but tx oms was:

 

[toofache32]

Why don't we keep this thread open this time...

 

[Fullosseousflap]

Why don't we keep this thread open this time...

Really all in good fun!

 

[ArtinDent]

I second toofache's motion...

I had never heard of those programs with 1st year and 6th year residency years, that sounds way awkward. I have only seen OMS programs with the medical school completion first, followed by oral surgery residency years (6 years). I guess its a good point though about getting part of MS2 in prior to taking the boards, but then again don't they teach the same medical ed to dentists, so essentially they would be able to pass USLME Part 1 as well as NDBE?

I'd like to hear more about job outlook of OMS and the lifestyle of oral surgeons, i.e. do they live more of the lifestyle that medical practitioners do, or one that is more flexible and realistic than the former (sorry for the bitter tone heh).

Also, in a previous post somebody mentioned that and MD helps in doing elective cosmetic procedures as on OMS, but does this also indicate that there are restrictions in certain/all states regarding scope of practice for OMS's? Thanks again everyone, very interesting and humorous thread going...

 

[LSR1979]

I second toofache's motion...

I had never heard of those programs with 1st year and 6th year residency years, that sounds way awkward. I have only seen OMS programs with the medical school completion first, followed by oral surgery residency years (6 years). I guess its a good point though about getting part of MS2 in prior to taking the boards, but then again don't they teach the same medical ed to dentists, so essentially they would be able to pass USLME Part 1 as well as NDBE?

I'd like to hear more about job outlook of OMS and the lifestyle of oral surgeons, i.e. do they live more of the lifestyle that medical practitioners do, or one that is more flexible and realistic than the former (sorry for the bitter tone heh).

Also, in a previous post somebody mentioned that and MD helps in doing elective cosmetic procedures as on OMS, but does this also indicate that there are restrictions in certain/all states regarding scope of practice for OMS's? Thanks again everyone, very interesting and humorous thread going...

I appreciate your enthusiasm for OMFS as an undergraduate. However, I think you may be getting ahead of yourself. IMHO, you should retain your passion for OMFS but instead of looking this far down the road, focus your enthusiasm on dental school and in doing well in the courses that will allow you to pursue your desires of going into residency. You will have PLENTY of time to expand your knowledge on the scope of OMFS as you go through dental school. You will also learn a great deal when you complete externships. However if you are only going to dental school to become an OMFS, you might be setting yourself up for a big letdown. I'm not trying to discourage you, but keep in mind that it is very competitive to get into an OMFS residency, and if you don't think you could be happy doing general dentistry, perhaps you should reconsider your career choice. I say the previous not to be an a**hole or anything. I am really only trying to help. Good luck.

 

[lunguv]

I appreciate your enthusiasm for OMFS as an undergraduate. However, I think you may be getting ahead of yourself. IMHO, you should retain your passion for OMFS but instead of looking this far down the road, focus your enthusiasm on dental school and in doing well in the courses that will allow you to pursue your desires of going into residency. You will have PLENTY of time to expand your knowledge on the scope of OMFS as you go through dental school. You will also learn a great deal when you complete externships. However if you are only going to dental school to become an OMFS, you might be setting yourself up for a big letdown. I'm not trying to discourage you, but keep in mind that it is very competitive to get into an OMFS residency, and if you don't think you could be happy doing general dentistry, perhaps you should reconsider your career choice. I say the previous not to be an a**hole or anything. I am really only trying to help. Good luck.

I used to be very interested in oral surgery from my shadowing experiences. But after being on this board for a while and learning how competitive OMFS programs are...I have realized it is probably not going to happen. So thanks to people like LSR1979 my dreams are shattered! Haha . On a side note, I hear some people referring to oral surgeons as OMS while others call it OMFS, what’s the difference?

 

[SPBest]

The way I understand it is they are the same. The more correct term however is OMFS because they treat the whole oral cavity and all maxillofacial structures, not just the maxilla.

 

[ArtinDent]

Thanks for those very humbling words LSR1979. I know I always have a tendency to overcook my ideas in my own head, lol. I would NOT mind at all doing general dentistry actually, I find the entire field of oral health care to be of extreme value and importance to the practitioner and to the community as a whole. With oral surgery I feel that I can give a "bigger" gift to those I treat. I have always been eager for all the challenges relating to knowledge and education, so that is why I feel I can tackle dental school and become an OMFS. I have also done a lot of surgical work in the past as an undergraduate researcher, on those tiny mice! So there's no challenge out there I'm not willing to face, but I do respect your caution in planning too much and then realizing that it's not feasible. You guys are the best, always watching each other's back, God bless you all and the SDN folks

 

[USC2003]

I find it interesting to hear dental students and even pre-dental students talk about how they want to go into OMFS and do elective facial cosmetic procedures. If you really have a strong interest in this you should drop out of dental school and get your ass in medical school, do very well on your boards so you can get into a plastics residency. There are several reasons I say this. First there are only a handful of residencies that I know of that a resident might feel comfortable doing rhinoplasties, facelifts, and so on directly out of residency without doing a fellowship in plastics (So you would save yourself time going to med school and then plastics instead of dental school, OMFS and then a fellowship). Secondly, you have to think about where you want to practice. If you want to live somewhere where there are already MD plastic surgeons good luck getting patients. The lay public will not choose a DDS, MD over a plastics MD for a facelift, because in their eyes you are still a dentist. Third, the truth of the matter is that the majority of 6 year OMFS are doing the bread and butter wisdom teeth and implants after residency. One of the main reason's for this is financial. Last keep in mind that it is very difficult to have a mixed practice. That is having one office where you are seeing cosmetic patients and patients who come in to have their wisdom teeth our implants placed. The two types of patient populations don't mix in the same office. I strongly believe that going through dental school gives OMFS residents great hand skills and that we as a profession can perform these procedures just as well if not better than our colleagues after receiving the proper training. The point is that it is not as simple as one might think because there are a lot of hurdles to get through for a OMFS to have a successful cosmetic practice.

 

[egpndoc]

I find it interesting to hear dental students and even pre-dental students talk about how they want to go into OMFS and do elective facial cosmetic procedures. If you really have a strong interest in this you should drop out of dental school and get your ass in medical school, do very well on your boards so you can get into a plastics residency. There are several reasons I say this. First there are only a handful of residencies that I know of that a resident might feel comfortable doing rhinoplasties, facelifts, and so on directly out of residency without doing a fellowship in plastics (So you would save yourself time going to med school and then plastics instead of dental school, OMFS and then a fellowship). Secondly, you have to think about where you want to practice. If you want to live somewhere where there are already MD plastic surgeons good luck getting patients. The lay public will not choose a DDS, MD over a plastics MD for a facelift, because in their eyes you are still a dentist. Third, the truth of the matter is that the majority of 6 year OMFS are doing the bread and butter wisdom teeth and implants after residency. One of the main reason's for this is financial. Last keep in mind that it is very difficult to have a mixed practice. That is having one office where you are seeing cosmetic patients and patients who come in to have their wisdom teeth our implants placed. The two types of patient populations don't mix in the same office. I strongly believe that going through dental school gives OMFS residents great hand skills and that we as a profession can perform these procedures just as well if not better than our colleagues after receiving the proper training. The point is that it is not as simple as one might think because there are a lot of hurdles to get through for a OMFS to have a successful cosmetic practice.

USC2003, You are 100% correct. Some people that want to do this are not thinking rationally. It kind of seems that they want to be MD's but via the DDS route. Thats kinda weird.

 

[ArtinDent]

So then what is the point of going through the 6-year program to even get the MD degree if it has no relevance to future scope of practice. It seems that the med schools are using the dental graduates as a source of income (tuition costs). This is very saddening to me. I initially wanted to go into medical school but in all actuality I have no faith in today's medical training programs and curriculums in America. I would rather have gone to study medicine in England or something. In any case, I thought by going into an OMFS-MD program I would be able to do more than just implants and wisdom teeth (which can get boring after a while).

Maybe some practicing OMFS's who have MD's can reflect on their practice and tell us more about the pro's of this option.

 

[KY2007]

The way I understand it is they are the same. The more correct term however is OMFS because they treat the whole oral cavity and all maxillofacial structures, not just the maxilla.

The reason some say OMS is because maxillofacial is one word.

 

[USC2003]

Artindent,

You can do more than just implants and wisdom teeth. There are dual degree OMFS that do perform cosmetic procedures routinely. I was just pointing out that it is not as easy a path as some think. Besides personal gratification there are other advantages to obtaining an MD. If you have a strong interest in academics the more letters you have behind your name the better. If you truely have an interest in head and neck cancer or pursuing plastics having an MD will open more doors for you. You have a long way to go so just enjoy where you are at and see what your interests are as you progress through dental school.

 

[OzDDS]

Artindent,

You can do more than just implants and wisdom teeth. There are dual degree OMFS that do perform cosmetic procedures routinely. I was just pointing out that it is not as easy a path as some think. Besides personal gratification there are other advantages to obtaining an MD. If you have a strong interest in academics the more letters you have behind your name the better. If you truely have an interest in head and neck cancer or pursuing plastics having an MD will open more doors for you. You have a long way to go so just enjoy where you are at and see what your interests are as you progress through dental school.

You don't have to be an OMS to do implants and wisdom teeth. Any general dentist can do this. Plus a general dentist can even take a course and do IV sedation in office as well.

 

[USC2003]

Another thing I find interesting is when I hear how gp's can do IV Sedation when they take a class and get a permit. Let me clarify that there is a huge difference between IV Sedation and General Anesthesia (GA). When GP's do IV Sedation they give a whiff of diazepam or midazolam. GP's cannot perform deep sedation using propofol or ketamine and they cannot administer fentanyl like OMFS can. OMFS receive a General Anesthesia permit which allows them to use these drugs. By definition the use of propofol is deemed general anesthesia. I don't know how many of you have seen GP's trying to take full bonies out under light IV sedation but it is not pretty. How many GP's do you know that feel comfortable maintaining a patient's airway. Would they know what to do if a patient had a laryngospasm, do they have the right equipment to handle unforseen complications associated with sedation. Always keep in mind that whatever procedures you perform you shouldn't do so unless you feel comfortable handling the complications.

 

[tx oms]

If you really have a strong interest in this you should drop out of dental school and get your ass in medical school, do very well on your boards so you can get into a plastics residency. There are several reasons I say this. First there are only a handful of residencies that I know of that a resident might feel comfortable doing rhinoplasties, facelifts, and so on directly out of residency without doing a fellowship in plastics (So you would save yourself time going to med school and then plastics instead of dental school, OMFS and then a fellowship).

Or go to dental school, do very well on your boards, and go to a residency that will let you feel comfortable doing cosmetics upon completion. OMFS guys who do a lot of cosmetics often advertise as "head and neck" or "facial" surgeons. BTW, most people don't go from med school to plastics. The majority of plastics programs are a three year stent following 5-6yrs of general surgery.

Despite all this, I agree with your premise. If you want a heavy cosmetic focus your best bet is probably the medical route b/c of public perception. In reality, I think an oral surgeon has potential to be the best facial cosmetic surgeon secondary to our dental and orthognathic backgrounds.

 

[OzDDS]

Another thing I find interesting is when I hear how gp's can do IV Sedation when they take a class and get a permit. Let me clarify that there is a huge difference between IV Sedation and General Anesthesia (GA). When GP's do IV Sedation they give a whiff of diazepam or midazolam. GP's cannot perform deep sedation using propofol or ketamine and they cannot administer fentanyl like OMFS can. OMFS receive a General Anesthesia permit which allows them to use these drugs. By definition the use of propofol is deemed general anesthesia. I don't know how many of you have seen GP's trying to take full bonies out under light IV sedation but it is not pretty. How many GP's do you know that feel comfortable maintaining a patient's airway. Would they know what to do if a patient had a laryngospasm, do they have the right equipment to handle unforseen complications associated with sedation. Always keep in mind that whatever procedures you perform you shouldn't do so unless you feel comfortable handling the complications.

So how about instead of doing OMFS. How about you do a GPR that trains in implants and oral surgery. Then do an Anesthesiology residency. Then you can do in office or hospital General Anesthesia and surgically removed impacted 3rd molars and do implants. That would be an interesting pathway and prob easier than doing OMFS.

OMFS can do craniofacial trauma and head/neck cancer removal, but many who go into this do it for a while right after residency while they are young, but then still go back and end up limiting their practice to just implants and 3rds in-office even though they are licensed to do so much more because it pays better.

 

[rocknightmare]

is it me or does a DDS open a crazy amount of doors?

 

[ArtinDent]

Thanks USC2003, OzDDS and tx oms for your guys' inputs....

Wow it seems like there are quite a bit of ways to go about what I am interested in doing... I have learned a great deal these past couple days from all of you... I will just have to take it one step at a time and get through dental school with nice marks and skills-development first...

As far as making oneself look attractive to these OMFS programs that give MD degree and focus heavily on facial reconstruction.... what types of activities are out there for pre-doctoral dental students that I *should* engage in, in order to increase my attractiveness to these programs? (besides scoring above 90th percentile on NBDE I/II and ranking top 10% of my class, )

Thanks again all...

 

[USC2003]

Tx OMS,

As far as I know the people who do plastics after general surgery are those who were not able to get into a plastics residency right out of medical school. Plastic surgery programs are not three years, its just that those who have done general surgery don't have to repeat these years. This is what I was told by our plastic colleagues.


OzDDS,
Which GPR program places implants? I am unaware of any GPR program where you spend all your time doing oral surgery. By definition you should be performing general dentistry as well. I don't believe that someone coming out of a GPR is as competent as an OMFS in extracting wisdom teeth. Any OMFS will tell you that a difficult third can humble the most experienced oral surgeon.

 

[toofache32]

Any OMFS will tell you that a difficult third can humble the most experienced oral surgeon.

My program director is known around the world as guru when it comes to trauma and reconstruction, but he has said many times that "3rd molars are the most difficult surgery we do as oral surgeons."

 

[ItsGavinC]

My program director is known around the world as guru when it comes to trauma and reconstruction, but he has said many times that "3rd molars are the most difficult surgery we do as oral surgeons."

Good info, and probably overlooked quite often.

 

[kato999]

From what I have read, many plastic residencies right after med school are usually 5 years. So if nose jobs are what spark your interest you are better off saving yourself 2 years and just doing med school in stead of the 6+1 OMFS plastics fellowship after the DDS.

That being said one of our part time faculty did the 6 year OMFS and the plastics fellowship. He does the bread and butter wizzies, but also does boob jobs and rhinoplasties a few days a week.

When a patient calls to get implants he has to ask them where

 

[jiggapigga]

Have a personality and a life.

Thanks USC2003, OzDDS and tx oms for your guys' inputs....

Wow it seems like there are quite a bit of ways to go about what I am interested in doing... I have learned a great deal these past couple days from all of you... I will just have to take it one step at a time and get through dental school with nice marks and skills-development first...

As far as making oneself look attractive to these OMFS programs that give MD degree and focus heavily on facial reconstruction.... what types of activities are out there for pre-doctoral dental students that I *should* engage in, in order to increase my attractiveness to these programs? (besides scoring above 90th percentile on NBDE I/II and ranking top 10% of my class, )

Thanks again all...

 

[tx oms]

Tx OMS,

As far as I know the people who do plastics after general surgery are those who were not able to get into a plastics residency right out of medical school. Plastic surgery programs are not three years, its just that those who have done general surgery don't have to repeat these years. This is what I was told by our plastic colleagues.

Plastics is three years with a minimum of two years of general surgery as a prereq, in most cases. Some people enter integrated programs in which they complete two years of general surgery followed by three years of plastics, others finish gen surgery before proceding to plastics. I think you are confusing the two different tracts as one.

 

[burton117]

Another thing I find interesting is when I hear how gp's can do IV Sedation when they take a class and get a permit. Let me clarify that there is a huge difference between IV Sedation and General Anesthesia (GA). When GP's do IV Sedation they give a whiff of diazepam or midazolam. GP's cannot perform deep sedation using propofol or ketamine and they cannot administer fentanyl like OMFS can. OMFS receive a General Anesthesia permit which allows them to use these drugs. By definition the use of propofol is deemed general anesthesia. I don't know how many of you have seen GP's trying to take full bonies out under light IV sedation but it is not pretty. How many GP's do you know that feel comfortable maintaining a patient's airway. Would they know what to do if a patient had a laryngospasm, do they have the right equipment to handle unforseen complications associated with sedation. Always keep in mind that whatever procedures you perform you shouldn't do so unless you feel comfortable handling the complications.

Don't General Dentists have the same prescribing rights as Specialists? (and MD's for that matter)

 

[burton117]

From what I have read, many plastic residencies right after med school are usually 5 years. So if nose jobs are what spark your interest you are better off saving yourself 2 years and just doing med school in stead of the 6+1 OMFS plastics fellowship after the DDS.

That being said one of our part time faculty did the 6 year OMFS and the plastics fellowship. He does the bread and butter wizzies, but also does boob jobs and rhinoplasties a few days a week.

When a patient calls to get implants he has to ask them where

Good one!!

 

[aphistis]

Don't General Dentists have the same prescribing rights as Specialists? (and MD's for that matter)

It's not a matter of prescribing rights, it's one of patient management. General dentists don't typically have the training to handle a patient under general anesthesia. You could write for the drugs, sure; just make sure you tell the patient they stand a good chance of not waking back up after you're done with their exos.

 

[burton117]

It's not a matter of prescribing rights, it's one of patient management. General dentists don't typically have the training to handle a patient under general anesthesia. You could write for the drugs, sure; just make sure you tell the patient they stand a good chance of not waking back up after you're done with their exos.

That makes more sense now..

 

[KY2007]

Don't General Dentists have the same prescribing rights as Specialists? (and MD's for that matter)

They might have the same rights but pharmacists will refuse to fill if they think it is out of your scope. Case in point: One of the oms attendings (has no M.D.) at my school prescribed eye drops to a patient after dealing with a zygoma fracture and the pharmacist refused to fill the prescription. He had to get one of his residents (has M.D.) to write another prescription. Even though the resident is only halfway through his training and has 20 years less experience than the attending it didn't matter.

 

[toofache32]

They might have the same rights but pharmacists will refuse to fill if they think it is out of your scope. Case in point: One of the oms attendings (has no M.D.) at my school prescribed eye drops to a patient after dealing with a zygoma fracture and the pharmacist refused to fill the prescription. He had to get one of his residents (has M.D.) to write another prescription. Even though the resident is only halfway through his training and has 20 years less experience than the attending it didn't matter.

You gotta be kidding. And he didn't push the issue with the pharmacist? Since when does a pharmacist determine another practitioners scope? I could undestand questioning it if it was some kind of foot cream, but there is no question that eyedrops can be prescribed after a ZMC fracture by the guy who repaired the fracture.

 

[KY2007]

You gotta be kidding. And he didn't push the issue with the pharmacist? Since when does a pharmacist determine another practitioners scope? I could undestand questioning it if it was some kind of foot cream, but there is no question that eyedrops can be prescribed after a ZMC fracture by the guy who repaired the fracture.

I'm not kidding. He did push the issue with the pharmacist and tried to educate him to the fact that M.D. or not it is within his scope of practice. The pharmacist still refused.

 

[tjb]

I'm not kidding. He did push the issue with the pharmacist and tried to educate him to the fact that M.D. or not it is within his scope of practice. The pharmacist still refused.

I witnessed the same thing at one of my externships. The OMS chair (4yr)wasn't allowed to prescribe eye drops and steroid cream for pts lips. He had to have a pediatric resident write it instead. It was the hospital policy.

tjb

 

[VancouverDoc2b]

Is this the case in private practice too if u perform these procedures and want to prescribe the subsequent drugs??

 

[KY2007]

A pharmacist always has the right to refuse to fill a prescription. It doesn't matter if you are in private practice or not. With that being said, are there pharmacists that would fill this same presciption for a non M.D. OMS, I'm sure of it. According to the attending that this happened to it's not an everyday occurrance but it does happen. This is one of the benefits of having an M.D. in front of your name. Nobody questions what you are writting prescriptions for. This is one of the reasons I want to go to a 6 year oms program.

 

[aphistis]

A pharmacist refusing to recognize a prescription for OMS' post-op eyedrops is bad enough, but rejecting ANY dentist's authority to prescribe topical lip meds is patently ridiculous.

 

[kwakster928]

pharmacists are required to ask these question upon themselves everytime they receive a prescription. in case of this, i believe this particular pharmacist went little too far. pharmacists usually question the prescriber what were precriber's intends were. if pharmacist feels that what the prescriber indended to do with the medication with the scope of the prescriber's practice is reasonable, pharmacist will fill the prescription as ordered. next time anyone encounter such an event, please explain the pharmacist your intentions. chances are pharmacist will say "ok".

 

[aphistis]

pharmacists are required to ask these question upon themselves everytime they receive a prescription. in case of this, i believe this particular pharmacist went little too far. pharmacists usually question the prescriber what were precriber's intends were. if pharmacist feels that what the prescriber indended to do with the medication with the scope of the prescriber's practice is reasonable, pharmacist will fill the prescription as ordered. next time anyone encounter such an event, please explain the pharmacist your intentions. chances are pharmacist will say "ok".

That's all well and good, except for one significant oversight--when did pharmacy receive regulatory authority over other doctors to define their scopes of practice? I must've missed the e-mail.

 

[kwakster928]

there is no written law stating that this doctor cannot prescribe this or that. refusing such a precription also depends on individual pharmacist and his/her confidence or familiartiy of that particualr medication. i have no problem with filling any precription if i can verify that this medication is used for what is intended to use for. this is an extremem example but if a dentists writes methotrexate i have to say i will not fill it until i get some verification.

in that case above, i would have not questioned it. i dont know that's because i was in the dental field before i went to pharmacy.

 

[aphistis]

there is no written law stating that this doctor cannot prescribe this or that. refusing such a precription also depends on individual pharmacist and his/her confidence or familiartiy of that particualr medication. i have no problem with filling any precription if i can verify that this medication is used for what is intended to use for. this is an extremem example but if a dentists writes methotrexate i have to say i will not fill it until i get some verification.

in that case above, i would have not questioned it. i dont know that's because i was in the dental field before i went to pharmacy.

OK, I'll run with your hypothetical example. You call for verification, and the dentist is renewing a long-standing prescription for the patient's severe psoriasis because, say, the patient's dermatologist is on a three-month vacation (for the sake of realism ). Now, since in your own words, "i have no problem with filling any precription if i can verify that this medication is used for what is intended to use for," do you fill it?

(Note: I would never write a patient for a chemotherapeutic the way I glibly suggested here. It's a hypothetical, folks; call off the dogs.)

 

[28657]

That's all well and good, except for one significant oversight--when did pharmacy receive regulatory authority over other doctors to define their scopes of practice? I must've missed the e-mail.

I don't want to sound flippant, but pharmacists "receive" regulatory authority when we graduate and it also becomes our license on the line if something goes wrong. We are all professionals, thereby allowing us professional judgement. These two examples are poor examples of a pharmacist pushing his or her judgement. Sometimes dentists like to prescribe for meds out of their scope of practice and it is in those instances when pharmacists should refuse to fill (but of course calling the dentist first). It is by no means an "MD" / "non MD" issue....if a pathologist was writing Rxs for warfarin, you can bet any pharmacist would be calling that path doc right away.

And to answer your question about filling the dentist's script for psoriasis...Nope, there's no way I'd fill that.