Paradigm shift in OMFS or I should say oral surgeons

[recovering OMFS]

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is it me or we are going back 50 years in OMFS practice;
new grads opting to become slaves to dental mills, no hospital privileges, no trauma, orthognathic ??!!! are you kidding me, it doesn't pay, send it to the county hospital where the residents can work it up or the craniofacial surgeon at the university.
AMA comparing us to mid level healthcare providers " Oral surgeon, aka oral and maxillofacial surgeons".
ACS dropping OMFS from Trauma centers requirements.
You wanna do cosmetic surgery, are you kidding, you are a dentist who is out of control. You need to get a special permit from the dental board to allow you to do that, your credentials will be reviewed by three MDs to verify your competence; Yes this is the law in California.
soon enough we won't be allowed to do our own H&Ps; I heard it is already happening in some parts of the country.
I think after all it is all good. It is time to follow our european friends. If you wanna do trauma, orthognathics, head and neck, craniofacial and cosmetics, you are called a Maxillofacial surgeon, you qualify in medicine and dentistry.
You wanna do teeth, implants, and biposies you qualify in dentistry only, you are called oral surgeon.

With socialized medicine, corporate healthcare models, that's going to be the way. Unfortunately we can't double dip anymore.

Please this thread is not a pissing match between single and double degree candidates, residents or surgeons, just my thoughts I wanted to share and get some feedback.

 

[DrReo]

is it me or we are going back 50 years in OMFS practice;
new grads opting to become slaves to dental mills, no hospital privileges, no trauma, orthognathic ??!!! are you kidding me, it doesn't pay, send it to the county hospital where the residents can work it up or the craniofacial surgeon at the university.
AMA comparing us to mid level healthcare providers " Oral surgeon, aka oral and maxillofacial surgeons".
ACS dropping OMFS from Trauma centers requirements.
You wanna do cosmetic surgery, are you kidding, you are a dentist who is out of control. You need to get a special permit from the dental board to allow you to do that, your credentials will be reviewed by three MDs to verify your competence; Yes this is the law in California.
soon enough we won't be allowed to do our own H&Ps; I heard it is already happening in some parts of the country.
I think after all it is all good. It is time to follow our european friends. If you wanna do trauma, orthognathics, head and neck, craniofacial and cosmetics, you are called a Maxillofacial surgeon, you qualify in medicine and dentistry.
You wanna do teeth, implants, and biposies you qualify in dentistry only, you are called oral surgeon.

With socialized medicine, corporate healthcare models, that's going to be the way. Unfortunately we can't double dip anymore.

Please this thread is not a pissing match between single and double degree candidates, residents or surgeons, just my thoughts I wanted to share and get some feedback.

Are you saying your colleagues are becoming periodontists that are trained in sedation?

 

[GTFOOMICT]

is it me or we are going back 50 years in OMFS practice;
new grads opting to become slaves to dental mills, no hospital privileges, no trauma, orthognathic ??!!! are you kidding me, it doesn't pay, send it to the county hospital where the residents can work it up or the craniofacial surgeon at the university.
AMA comparing us to mid level healthcare providers " Oral surgeon, aka oral and maxillofacial surgeons".
ACS dropping OMFS from Trauma centers requirements.
You wanna do cosmetic surgery, are you kidding, you are a dentist who is out of control. You need to get a special permit from the dental board to allow you to do that, your credentials will be reviewed by three MDs to verify your competence; Yes this is the law in California.
soon enough we won't be allowed to do our own H&Ps; I heard it is already happening in some parts of the country.
I think after all it is all good. It is time to follow our european friends. If you wanna do trauma, orthognathics, head and neck, craniofacial and cosmetics, you are called a Maxillofacial surgeon, you qualify in medicine and dentistry.
You wanna do teeth, implants, and biposies you qualify in dentistry only, you are called oral surgeon.

With socialized medicine, corporate healthcare models, that's going to be the way. Unfortunately we can't double dip anymore.

Please this thread is not a pissing match between single and double degree candidates, residents or surgeons, just my thoughts I wanted to share and get some feedback.

wait wait wait....you're telling me I can limit myself to just teeth?!

Can OS and MFS exist as separate setups financially, politically, training, etc? I'd argue no. Double dipping keeps this specialty alive. The fact that your local OMS is the go to man in the area for implants is just as important as having your local hospital staffed by OMS for trauma cases.

OMS isn't the only surgical specialty that wants out of the hospital and into the private practice really bad. The loans require payment, children require clothes, and ex wives require their stipend.

 

[flapaTron]

ACS dropping OMFS from Trauma centers requirements.
You wanna do cosmetic surgery, are you kidding, you are a dentist who is out of control. You need to get a special permit from the dental board to allow you to do that, your credentials will be reviewed by three MDs to verify your competence; Yes this is the law in California.
soon enough we won't be allowed to do our own H&Ps; I heard it is already happening in some parts of the country.

really? is california the only state where this is happening? and what would be the exact implications if ACS did drop OMS from trauma centers req's?

 

[DREDAY]

I think we can avoid splitting the specialty into Maxillofacial surgeons and Oral surgeons by weeding out and eliminating the greedy OMS applicants who are just gonna do teeth and titanium and not take trauma call.


The issue is multifactorial:

#1 The most attractive aspects of dentistry are lifestyle and ability to be your own boss.

50.7% of dental applicants anticipated working 35-40 hours a week;
27% of dental applicants anticipated working 30-35 hours a week;
91.2% of dental applicants said the business side of dentistry excited them
96.4% of dental applicants aid they want to be their own boss.

Given that most dental students pursued dentistry for lifestyle and business reasons, it is likely that a large part of the OMS applicant pool will have those same ideals. Likewise, most dental applicants do not pursue dentistry with expectations of taking call, working in a hospital, doing long surgeries or dealing with sick patients. OMS programs likely pick from a pool of applicants that embody the same expectations.

We need to adjust our selection criteria for both dental school and OMS residency as to better screen for applicants who are pursuing a lifestyle taking call, working in hospital and doing complicated surgeries. We also need to weed out the self-serving applicants.

#2 Complicated surgeries don't pay much
The reimbursement quotas needs to change. There needs to be a decrease in the repayment disparity between orthognathic/cancer and dental alveolar. This will help minimize the incentive to pursue a pure dental alveolar practice.

#3 Most predental/premedical students are not aware of the scope of OMS
In order to attract the "right" people into our profession we need to make sure that predental/premed students also understand the scope of our profession. We need more OMS participation at the undergraduate level giving OMS presentations to premed/predental clubs.

#4 Our AAOMS recruitment video is an embarassment
Our current OMS recruitment video paints a very private practice/family friendly picture of our profession. We need to change that ASAP.

Statistics were taken from:

Predental Students' Attitudes Toward and Perceptions of the Dental Profession
Nathan J. Hawley, B.A.; Marcia M. Ditmyer, Ph.D., M.B.A., M.S.; Victor A. Sandoval, D.D.S., M.P.H.

 

[ObviousGuy]

is it me or we are going back 50 years in OMFS practice;
new grads opting to become slaves to dental mills, no hospital privileges, no trauma, orthognathic ??!!! are you kidding me, it doesn't pay, send it to the county hospital where the residents can work it up or the craniofacial surgeon at the university.
AMA comparing us to mid level healthcare providers " Oral surgeon, aka oral and maxillofacial surgeons".
ACS dropping OMFS from Trauma centers requirements.
You wanna do cosmetic surgery, are you kidding, you are a dentist who is out of control. You need to get a special permit from the dental board to allow you to do that, your credentials will be reviewed by three MDs to verify your competence; Yes this is the law in California.
soon enough we won't be allowed to do our own H&Ps; I heard it is already happening in some parts of the country.
I think after all it is all good. It is time to follow our european friends. If you wanna do trauma, orthognathics, head and neck, craniofacial and cosmetics, you are called a Maxillofacial surgeon, you qualify in medicine and dentistry.
You wanna do teeth, implants, and biposies you qualify in dentistry only, you are called oral surgeon.

With socialized medicine, corporate healthcare models, that's going to be the way. Unfortunately we can't double dip anymore.

Please this thread is not a pissing match between single and double degree candidates, residents or surgeons, just my thoughts I wanted to share and get some feedback.

The fibular free flap is the work horse flap for the face. Chew on that topic for a while.

 

[CranioFacial]

"The fibular free flap is the work horse flap for the face. Chew on that topic for a while."

I'm not sure what to do with this. There is an ever-increasing belief out there that all reconstruction can be done with:
-Some framework: Bone Bank Grafts (big cases) or allograft (smaller cases)
-Bone Marrow Aspirate
-rhBMP
Limiting the continued need for AICBG, fibula, radius, calvarial grafts in the future.

Something to chew on.

 

[servitup]

Like it or not, our specialty will continue to provide the services the public value until their values change. Currently, that is mainly anesthesia and dentoalveolar surgery. There is really no good reason nor need to train 190 surgeons per year in our specialty to do head and neck cancer or craniofacial surgery. Aferall, there are only 35,000 new cases of head and neck cancer per year in the whole country. Most ENT's do very little to none in prCtice because these patients tend to be treated at academic hospitals by surgeons who do a lot of this type of surgery and have resident support as it is very manpower intensive. Also, there are more craniofacial surgeons than there are patients in the US.

Should we take trauma call? I think most of us will as long as the hospital wants to pay us. If the public doesn't value my services as a trauma surgeon, I am not going to do it just to show how smart or cool I am. Same premise applies to orthognathic surgery.

 

[Localnative]

Graduated from a very academic, head and neck onc heavy program last July. My one concern I had would be that certain skills would atrophy after I left residency.

Now, having been several months out, I realize your postrez life is what you make of it. The big cases are out there, and in some cases yes, you have to fight for them. They aren't limited to those who are fellowship trained and stay in academics. The orthognathics are out there in the community, the salivary gland stuff is out there, the larger reconstructive cases are out there. A new grad just has to work a little harder to pinpoint those private practices that do those things.

There will always be those who just want to focus on TNT... there is very little one can do to weed those applicants out before the selection process is finalized. It's up to you to chart your own course. The broad scope of our specialty is what sets it apart from any other medical and dental specialty. It's up to the individual though to preserve that variety, which is the beauty of OMFS.

 

[The Dawgfather]

I think we can avoid splitting the specialty into Maxillofacial surgeons and Oral surgeons by weeding out and eliminating the greedy OMS applicants who are just gonna do teeth and titanium and not take trauma call.

This seems kind of presumptuous. I am going to guess that a very high percentage of practicing OMFS do not take trauma call. I am also going to guess that a high percentage of current OMFS residents will end up doing the same. There is no law that states that if you go to OMFS residency than you have to take trauma call. A comparable example I can think of is women in dental school. How many women practice for more than 10 years after finishing dental school? Not many. Is this a bad thing? Again, no law that states that this is wrong. People are entitled to do whatever they want after their training and I think they should be able to do so without being labeled greedy.

 

[servitup]

This seems kind of presumptuous. I am going to guess that a very high percentage of practicing OMFS do not take trauma call. I am also going to guess that a high percentage of current OMFS residents will end up doing the same. There is no law that states that if you go to OMFS residency than you have to take trauma call. A comparable example I can think of is women in dental school. How many women practice for more than 10 years after finishing dental school? Not many. Is this a bad thing? Again, no law that states that this is wrong. People are entitled to do whatever they want after their training and I think they should be able to do so without being labeled greedy.

99% of the private plastic and ENT surgeons in this town do NOT take trauma call by the way. Time to take the dental chip off of our shoulders. No need to apologize for having the best specialty in healthcare, period.

 

[recovering OMFS]

Like it or not, our specialty will continue to provide the services the public value until their values change. Currently, that is mainly anesthesia and dentoalveolar surgery. There is really no good reason nor need to train 190 surgeons per year in our specialty to do head and neck cancer or craniofacial surgery. Aferall, there are only 35,000 new cases of head and neck cancer per year in the whole country. Most ENT's do very little to none in prCtice because these patients tend to be treated at academic hospitals by surgeons who do a lot of this type of surgery and have resident support as it is very manpower intensive. Also, there are more craniofacial surgeons than there are patients in the US.

Should we take trauma call? I think most of us will as long as the hospital wants to pay us. If the public doesn't value my services as a trauma surgeon, I am not going to do it just to show how smart or cool I am. Same premise applies to orthognathic surgery.

It is all about fighting for recreating a value for what we do, why take $750 per Jaw for Orthognathic from insurance while they pay higher dollar amount for a less invasive surgery which requires no preop preparation. Our organization AAOMS, which is a joke when it comes to fighting and lobbying, needs to grow a pair and stand up for these issues.

 

[DREDAY]

.

 

[ObviousGuy]

It is all about fighting for recreating a value for what we do, why take $750 per Jaw for Orthognathic from insurance while they pay higher dollar amount for a less invasive surgery which requires no preop preparation. Our organization AAOMS, which is a joke when it comes to fighting and lobbying, needs to grow a pair and stand up for these issues.

Or collect your fee from the patient and have them get reimbursed from their insurance company. The beauty of our profession.

If you have a problem with AAOMS lobbying, and also assuming you are not already growing a pair, ie lobbying yourself, why not lobby yourself or take on a position to fight for something important to you.

 

[Xigris14]

Another great topic for discussion. Yes there are OMFS that come out well trained in full scope but just do TNT. Thats fine, that pays the bill and affords a comfortable lifestyle. Sometimes I dont blame them because in order to do the full scope you have too:

1) Get on most medical insurance plans and accept crap in return. It is a crime. I just did a nerve case and got 700 dollars.
2) Hire a biller that knows medical insurance billing because if you dont know how to bill your f-cked. More money lost.
3) Accept time away from your office to do cases in the hospital. In this case, leaving the office means lost income during that time and unhappy referrals that cant get their patient to your office ASAP for that tooth that brooke off while they tried to take it out themself. Bastards!!
4) Be ready to appeal, appeal and appeal for TMJ and Ortho Surg cases. Insurance companies love to deny these cases. You need time and patience. I hate insurance companies, they are the devil.
5) Fight political battles such as, plastics vs. OMFS or ENT vs. OMFS for trauma and cosmetic/cranio cases. Again more bull-sh-t

I choose to do full scope and deal with all of these headaches because I love it and cant just do TNT. Might as well be a periodontist if I did in my mind.

A Xigris thought.
Thank you

 

[armorshell]

So, to play the devil's advocate, why is this a bad thing, and why do we spend so much time griping about it?

There's around 300-500 OMS in the country (Yes, OMS, I like that rogue 'F' I see all the time buried in the middle of the word it belongs in) doing 'full scope'. Then there's the other 6200-6400 who do 'traditional scope'. I wonder if they, the vast majority of our specialty, the majority represented by our lobbying organizations, would be happy with being called periodontists or 'just' oral surgeons.

These 92-95% of OMS serve as a vital and essential foil to those of us that pursue full scope surgery. They provide a financial anchor to the lobbying and professional organizations that fight our scope battles. They fight an almost unmentioned (on this board) scope battle on the dental front for implants, dentoalveolar surgery and anesthesia. They clearly provide an essential service to the dental community and it's patients in the areas I mentioned above, as well as in trauma, orthognathic and TMJ surgery. Remember, despite having a paucity of academics and fewer surgeons, OMS provide more facial trauma services per capita than any of the other specialties providing facial trauma services and a sizable portion of that is provided by the private sector.

Are there problems that exist within this specialty? I think so, and I still have quite a bit more to learn. But as always, there are two sides to every story, and the other side deserves to be heard. Why do we, as a profession, consistently flagellate ourselves for enjoying an excellent paying and rewarding career?

 

[recovering OMFS]

Or collect your fee from the patient and have them get reimbursed from their insurance company. The beauty of our profession.

If you have a problem with AAOMS lobbying, and also assuming you are not already growing a pair, ie lobbying yourself, why not lobby yourself or take on a position to fight for something important to you.

I pay membership every year to AAOMS and OMSPAC, they are responsible for lobbying for the specialty, just like other organizations.

In regard to collecting from patients, that's what I have been doing, since I value my work and its dollar value, however orthognathic, TMJ, reconstruction used to be reimbursed top dollar at some point, its reimbursement/RVU value dropped, who is responsible for that? lack of lobbying.

I do lobby and fight insurance companies every single day, I was able to negotiate good reimbursement for some procedures from some companies.

 

[recovering OMFS]

Another great topic for discussion. Yes there are OMFS that come out well trained in full scope but just do TNT. Thats fine, that pays the bill and affords a comfortable lifestyle. Sometimes I dont blame them because in order to do the full scope you have too:

1) Get on most medical insurance plans and accept crap in return. It is a crime. I just did a nerve case and got 700 dollars.
2) Hire a biller that knows medical insurance billing because if you dont know how to bill your f-cked. More money lost.
3) Accept time away from your office to do cases in the hospital. In this case, leaving the office means lost income during that time and unhappy referrals that cant get their patient to your office ASAP for that tooth that brooke off while they tried to take it out themself. Bastards!!
4) Be ready to appeal, appeal and appeal for TMJ and Ortho Surg cases. Insurance companies love to deny these cases. You need time and patience. I hate insurance companies, they are the devil.
5) Fight political battles such as, plastics vs. OMFS or ENT vs. OMFS for trauma and cosmetic/cranio cases. Again more bull-sh-t

I choose to do full scope and deal with all of these headaches because I love it and cant just do TNT. Might as well be a periodontist if I did in my mind.

A Xigris thought.
Thank you

Kudos to you

 

[DrReo]

I choose to do full scope and deal with all of these headaches because I love it and cant just do TNT. Might as well be a periodontist if I did in my mind.

A Xigris thought.
Thank you

👍 Bad ass.

 

[Kundalini]

I pay membership every year to AAOMS and OMSPAC, they are responsible for lobbying for the specialty, just like other organizations.

In regard to collecting from patients, that's what I have been doing, since I value my work and its dollar value, however orthognathic, TMJ, reconstruction used to be reimbursed top dollar at some point, its reimbursement/RVU value dropped, who is responsible for that? lack of lobbying.

I do lobby and fight insurance companies every single day, I was able to negotiate good reimbursement for some procedures from some companies.

Paying dues and making a tax deductable contribution to OMSPAC is great. All OMSs should follow the same.
Bad mouthing what the leadership is trying to do is so unwarranted. If you feel that AAOMS lobbying isnt effective and your issues and complaints are falling on deaf ears, there is always the option of participating in the Day on the Hill yearly and speaking to your district trustee about the issues that bother you most.
What are the chances that AAOMS leadership will ever see anything written on this forum?
You are chasing windmills here, my friend.

 

[Kundalini]

I pay membership every year to AAOMS and OMSPAC, they are responsible for lobbying for the specialty, just like other organizations.

In regard to collecting from patients, that's what I have been doing, since I value my work and its dollar value, however orthognathic, TMJ, reconstruction used to be reimbursed top dollar at some point, its reimbursement/RVU value dropped, who is responsible for that? lack of lobbying.

I do lobby and fight insurance companies every single day, I was able to negotiate good reimbursement for some procedures from some companies.

Paying dues and making a tax deductable contribution to OMSPAC is great. All OMSs should follow the same.
Bad mouthing what the leadership is trying to do is so unwarranted. If you feel that AAOMS lobbying isnt effective and your issues and complaints are falling on deaf ears, there is always the option of participating in the Day on the Hill yearly and speaking to your district trustee about the issues that bother you most.
What are the chances that AAOMS leadership will ever see anything written on this forum?
You are chasing windmills here, my friend.

 

[BenignDMD]

Time to take the dental chip off of our shoulders. No need to apologize for having the best specialty in healthcare, period.

👍👍👍