SDN Edition: OMFS vs Plastics

[Yah-E]

What is your view? Should OMFS surgeons be able to perform plastic surgery of the face and neck legally?

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[MacGyver]

when you say "proper plastics training" I am assuming you are talking about becoming a board certified plastic surgeon after completion of a plastic surgery residency?

 

[Yah-E]

True that, word!

 

[Energon]

Yes provided they complete the ADA recognized appropriate craniofacial plastics fellowship and are BC. The listing of the fellowships are on the AAOMS website. These fellowships provide good training for any OMFS or ENT clinicians who complete it.

 

[Yah-E]

I just noticed that choices in the poll and listed below is equivalent:

Yes, if a MD degree OMFS surgeon has the proper plastics training
No, no MD degree and no plastics training => no plastics PERIOD

Sorry for the poor construction of the poll, but I believe it serve its purpose.

 

[MacGyver]

Yes provided they complete the ADA recognized appropriate craniofacial plastics fellowship and are BC. The listing of the fellowships are on the AAOMS website. These fellowships provide good training for any OMFS or ENT clinicians who complete it.

Thats not the same as completing a plastic surgery residency. Only those who complete plastic surg residencies should be allowed to do cosmetic plastic surg.

ENTs and other MD surgeons shouldnt be allowed to do it either unless they complete the plastics residency.

 

[Biogirl361]

Yes, omf surgeons without an MD degree should be allowed to do it if they want, if they complete some type of additional training in plastics. like the guy in the article said, if he can put your face back together after a car accident, etc., then it shouldn't be too hard to figure out how to insert plastic.

 

[MacGyver]

Yes, omf surgeons without an MD degree should be allowed to do it if they want, if they complete some type of additional training in plastics. like the guy in the article said, if he can put your face back together after a car accident, etc., then it shouldn't be too hard to figure out how to insert plastic.

Shouldnt be too hard to complete a plastic surg residency either.

 

[Biogirl361]

i agree with the plastic surgery residency or other special training part, just not the needing an MD.

 

[USC2003]

MacGyver,

I guess you are also against those who do Gen. Surg Residencies and then go on to do a plastics fellowship practicing cosmetics as well. From your standpoint I guess ENT and plastics shouldn't be handling mandible Fx's either unless they are properly trained in dental occlusion.

 

[aphistis]

MacGyver,

I guess you are also against those who do Gen. Surg Residencies and then go on to do a plastics fellowship practicing cosmetics as well. From your standpoint I guess ENT and plastics shouldn't be handling mandible Fx's either unless they are properly trained in dental occlusion.

Touche.

 

[ItsGavinC]

ENTs and other MD surgeons shouldnt be allowed to do it either unless they complete the plastics residency.

Why? The LAW allows them to do it. Hospitals allow them to do it. In fact, it's a mandatory part of their jobs (trauma reconstruction).

Why should ENTs not be able to operate on the area of the body that they specialize in?

I understand that facial trauma reconstruction might be a bit far off from breast augmentation, but it certainly is the same ballpark as rhinoplasty.

 

[River13]

If the surgeon has been trained in the procedure correctly and has done an adequate number of them during training, he should be able to do them, regardless of his title ie. ENT/OMFS/Plastics/Derm.

There are many OMFS residencies that give plenty of this prerequisite experience for many procedures, even without an official fellowship afterwards. It really varies by residency.

 

[redicon1]

Just because something can be done, does not necessarily mean that it should be pursued. As an issue, I think that poor oral health care in the US is a greater concern than botox shots for enhancing the body image. Maybe the dentists as a whole can decide to take the higher road and restrict their work to REALLY making a difference in the millions of kids that are without any oral care whatsoever. I am not against someone with the training going ahead and doing plastics coz I could give a rat's ass, but sure makes me sad when I see OMFS aspirants get hung up on whether they can do plastics or not. if you want to do it, just go ahead and do it. But don't assume that there is no other, larger void where they are unable to make a difference.

 

[Doggie]

Just because something can be done, does not necessarily mean that it should be pursued. As an issue, I think that poor oral health care in the US is a greater concern than botox shots for enhancing the body image. Maybe the dentists as a whole can decide to take the higher road and restrict their work to REALLY making a difference in the millions of kids that are without any oral care whatsoever. I am not against someone with the training going ahead and doing plastics coz I could give a rat's ass, but sure makes me sad when I see OMFS aspirants get hung up on whether they can do plastics or not. if you want to do it, just go ahead and do it. But don't assume that there is no other, larger void where they are unable to make a difference.

I kinda agree with Red....

"No, leave to the Plastic Surgeons, even for a MD degree OMFS surgeon and proper plastics training"

I am going through dental school and hopefully specialize in something pertaining to dentistry. If I wanted to to be able to do plastics on the oral-facial region, I would have tried to enter med school the "traditional" way. Leave plastics to plastic surgeons, even if a chimpanzee was to ever be accredited for such a procedure. An oral surgeon has enough to worry about.

 

[Energon]

If an OMFS practioner limits his/ her practice above the clavicle, then the facioplastics fellowship should be more than enough. There is no reason to do another 4 years of training to learn breast augmentation, tummy tucks, microvascular extremety procedures etc. to do facial cosmetic procedures. Upon completion of an OMFS residency and facial plastics fellowship the practioner has all the experience/ training needed to do facial cosmetic procedures. MacGyver is undoubtedly clueless about OMFS training and its scope. Yah-e can you please insert links to the AAOMS fellowship site and maybe a couple of actual fellowship center sites (University of Pitt, U of Iowa i think and the one in Maryland); I dont know how to do it (my project for tomorrow)

 

[MacGyver]

Upon completion of an OMFS residency and facial plastics fellowship the practioner has all the experience/ training needed to do facial cosmetic procedures.

Thats NOT what the California bill says. It says NOTHING about a plastics fellowship, it gives away cosmetic surg privileges to straight OMFS with no extra training.

 

[c132]

OMFS = bunch of a holes that think they can do it all!!! Why would they even try to do this? Finally MD's refer to dentists now for path and other issues, but I think this is going to ruin that newly formed trust. Plastics is plastics, go to MD, get your surgery residency done, then do your fellowship in plastics.

We at DDS do not learn nearly as much stuff as MD's. I know this is going to start a big hole down here, but its true, I have many MD's in my family. They are 10,000 times more in tune with the body, just not the mouth.

The only plastics that should be done by a dentist is oral-max prosthodontics, done by a prosthodontist.

Who do those oral surgeons think they are?

 

[MacGyver]

Why? The LAW allows them to do it. Hospitals allow them to do it. In fact, it's a mandatory part of their jobs (trauma reconstruction).

Why should ENTs not be able to operate on the area of the body that they specialize in?

I understand that facial trauma reconstruction might be a bit far off from breast augmentation, but it certainly is the same ballpark as rhinoplasty.

What are you talking about? I'm talking about cosmetic procedures. If you want to do face lifts, you need to do a plastic surg residency.

Cosmetic procedures ARE NOT a mandatory part of their jobs, and the law doesnt take a stance one way or the other. Only those who complete a plastic surg residency (whether they be MDs or OMFS) should be allowed to do cosmetic plastic surg.

 

[MacGyver]

Looking at the poll, it appears that most people agree with me that nobody should be doing cosmetics unless they completed a plastic surg residency.

 

[USC2003]

I do agree that proper training is needing to perform plastics as part of your everyday practice, but I don't believe a full plastics residency is needed. An ENT or OMFS with 2 to 3 years of plastics fellowship is qualification. As far as c132 comments, there really is nothing to say to ignorant comments. Obviously c132 has no idea what type of training is received in an OMFS residency and I don't have the time to explain it.
The way the questions in the poll are written does not take into account those who do 4 year OMFS residencies and go on to do a craniofacial or facial plastics fellowship. In all reality an MD is needed if you want to just do plastics in your office because no lay person will go for a plastics procedure to someone who does not have their MD, but there is no difference in clinical training between the 4 and 6 year tracts. Sure some programs may do more plastics than others, just like some programs do more Trauma or TMJ surgeries than others, but if 2 individuals, one who did the 4 year and the other the 6, did a plastics fellowship they would be equally trained. Spending those extra two years completing your clerkships in psychiatry, pedo, family practice... will not make you a more qualified surgeon, just more of a politically correct one in the eyes of the public.

 

[River13]

What are you talking about? I'm talking about cosmetic procedures. If you want to do face lifts, you need to do a plastic surg residency.

Cosmetic procedures ARE NOT a mandatory part of their jobs, and the law doesnt take a stance one way or the other. Only those who complete a plastic surg residency (whether they be MDs or OMFS) should be allowed to do cosmetic plastic surg.

Why do you need to do a plastic surg residency? I've yet to see any concrete reasons with studies/examples to back them up.

The poll was constructed poorly. I voted #1 because in my opinion, cosmetic training during residency is included in 'proper plastics training.'

 

[c132]

I do agree that proper training is needing to perform plastics as part of your everyday practice, but I don't believe a full plastics residency is needed. An ENT or OMFS with 2 to 3 years of plastics fellowship is qualification. As far as c132 comments, there really is nothing to say to ignorant comments. Obviously c132 has no idea what type of training is received in an OMFS residency and I don't have the time to explain it.
The way the questions in the poll are written does not take into account those who do 4 year OMFS residencies and go on to do a craniofacial or facial plastics fellowship. In all reality an MD is needed if you want to just do plastics in your office because no lay person will go for a plastics procedure to someone who does not have their MD, but there is no difference in clinical training between the 4 and 6 year tracts. Sure some programs may do more plastics than others, just like some programs do more Trauma or TMJ surgeries than others, but if 2 individuals, one who did the 4 year and the other the 6, did a plastics fellowship they would be equally trained. Spending those extra two years completing your clerkships in psychiatry, pedo, family practice... will not make you a more qualified surgeon, just more of a politically correct one in the eyes of the public.

WHAT IN THE? there is no difference in the 4 and 6 year tracts of what? Obviously you have no idea what an MD is. It is a MEDICAL DOCTOR!!! YOU need to go look up what training an MD would go into for plastics. Starting with the 4 year MED, not DENT. Then the surgery residency, not OMFS. Then the plastics fellow. OMFS is a hard job, don't get me wrong. But they DO not do the surgery training as a MD surgeon gets. Pulling teeth and cutting 3rds most of the day is no where near doing neuro surgery, surge oncology, ENT surgery etc.... Therefore you being the ignorant one, need to look at what an OMFS residency consists of. Plastics SHOULD remain where it is, in the hands of a PLASTIC SURGEON!

 

[USC2003]

c132,

I was talking about the difference in the 4 and 6 year tracts of OMFS. Let me try and share a little bit of knowledge with you. First of all extracting 3rd molars is not all you do in an OMFS residency. The 4 year tract includes 6 months of General Surgery training, three of these months in the program I attend consists of Neurosurgy, two months of General Surgery, and one month in the Surgical Intensive Care Unit. During all of our rotations we function at the intern level sharing the same responsibilites as the first year residents in that program. We also do 2 months of Plastics training where we are actually doing the surgery along side the Plastics staff, performing such procedures as breast augmentations, rhinoplasties... We spend two months on Medicine one of which is on the Cardiology service treating heart failure patients. Again we are functioning at the intern level where we help med students on the service write orders and co-sign their orders. We do 4 months of Anesthesia where after 6 weeks of training are given our own rooms to run at the main hospital. We function as first year anesthesia residents. Most programs share these same rotations with a couple of differences. I know that at some programs they also do a month or two of ENT surgery. I hope this provides you with more knowledge on OMFS training. Your comments about not having Neuro surgery, Plastics or ENT surgery training are obviously incorrect. I also am not sure what you meant by premed and predent, is there a difference. My understanding is that these are terms used at the undergraduate level, meaning both are undergraduates aiming either towards medical or dental school. Also your timeline of getting into a plastics residency is a little incorrect. If you are competitive enough you can match to a plastics residency right after medical school. The other way to go is to first do general surgery then get into plastics. You shouldn't use the term MD surgeons either, because there are many different types of surgeons with many different backgrounds of training and by saying MD surgeon you are saying they all receive the same training.
C132 If you wouldn't mind sharing what level of training you are at so I can have a better understanding of where you are coming from I would appreciate it.

 

[River13]

c132- Similiar to USC's program, mine includes an MD after completing the second 2 years of med school, a whole year of gen surg. for a medical license, including surgical oncology, 3-4 months of neurosurg, functioning at the neuro resident level, etc. Please limit your comments to things you understand.

 

[Yah-E]

You know what gentlemen, no matter how we feel or where we stand on this OMFS scope of practice expansion issue, it's truly in the hands of the House of Representatives, the Senate and the "Governator" of California!

As the news paper article have stated, many states have already allowed the facial plastic surgeries be in the scope of practice of OMFS, I guess it's up to the patients to see who they wish to treat their desired facial procedures.

There is no point debating which OMFS residency trains what or who understands what in an OMFS residency, the bottom line is that obviously the new expansion of OMFS scope of practice is stepping on some toes.

Just as CRNAs with Anesthesiologists and Hygenists wanting to open their own practice without Dentists around, if I was a Plastic Surgeon, I could see their perspective as well!

 

[Col Sanders]

I know a kid who was jumped and beat up pretty bad and they asked his fam at the trauma center who do you want to take care of this an ENT, Plastic, or OMFS? Naturally they chose plastic because it sounds the best to the public. The plastic did fine on the nose and eye but jacked up the occlusion so bad the kid couldnt eat or function properly. An OMFS had to go back in a month later and break things just to put it back together properly so the kid could eat.

 

[gryffindor]

I know a kid who was jumped and beat up pretty bad and they asked his fam at the trauma center who do you want to take care of this an ENT, Plastic, or OMFS? Naturally they chose plastic because it sounds the best to the public. The plastic did fine on the nose and eye but jacked up the occlusion so bad the kid couldnt eat or function properly. An OMFS had to go back in a month later and break things just to put it back together properly so the kid could eat.

We were lectured in our Oral Surgery class about some cases where exactly this happened. I know they made the family pick, but what's wrong with a team approach to treating this kid, so that he would have had a nice nose and could chew properly the first time around when you broke his face? Costs too much money? Or is it a pride issue among these three specialties?

c132 - River & USC2003 know much more about this than me, but there are also OMS/MD programs where 2 years of general surgery are required to finish the program. UConn is the first program that comes to mind here. From the UConn website: "The first year consists of clinical oral and maxillofacial surgery and an anesthesiology rotation. The next 20 months are committed to the mandatory and elective School of Medicine third- and fourth-year clerkships after which the medical degree is awarded. The fourth year and part of the fifth year are accredited by the General Surgery Department and the final one and a half years are in oral and maxillofacial surgery. "

 

[River13]

Griff is right--there are several residencies that require 2 years Gen Surg., usually to fulfill those states requirement of ACGME PGY years to get a medical license.

 

[MacGyver]

c132- Similiar to USC's program, mine includes an MD after completing the second 2 years of med school, a whole year of gen surg. for a medical license, including surgical oncology, 3-4 months of neurosurg, functioning at the neuro resident level, etc. Please limit your comments to things you understand.

I guess the next thing you are going to tell me is that OMFS should be allowed to do neurosurgery, because they had 3-4 months of training. What a joke.

 

[Col Sanders]

I know they made the family pick, but what's wrong with a team approach to treating this kid, so that he would have had a nice nose and could chew properly the first time around when you broke his face? Costs too much money? Or is it a pride issue among these three specialties?

"

Its a little pride but alot of liability. An OMFS friend of mine who also has his JD said in those cases that require more than one specialist you can both be held accountable for mistakes made by the other specialist. He said its better for both the patient and the system if one specialist handles the case (if they are adequately trained in all of the areas). He specifically referred to the cases that sometimes are split between the ENT's, Plastics, and OMFS.
I know in the above example that I would have chosen an OMFS because I am already married it doesn't matter what I look like anymore more, but I dont know what I would do if I couldnt eat, (dont tell my wife I said that)

 

[Mo007]

Its a little pride but alot of liability. An OMFS friend of mine who also has his JD said in those cases that require more than one specialist you can both be held accountable for mistakes made by the other specialist. He said its better for both the patient and the system if one specialist handles the case (if they are adequately trained in all of the areas). He specifically referred to the cases that sometimes are split between the ENT's, Plastics, and OMFS.
I know in the above example that I would have chosen an OMFS because I am already married it doesn't matter what I look like anymore more, but I dont know what I would do if I couldnt eat, (dont tell my wife I said that)

I guess OMFS has limited previleges if there is no MD title on the credentials against ENT and Plastics. But who cares, as long as there is a shortage, cases will be in OMFS hands as much as ENT or Plastics in many areas where the competition is not severe.

 

[c132]

c132,

4 year tract includes 6 months of General Surgery training, three of these months in the program I attend consists of Neurosurgy, two months of General Surgery, and one month in the Surgical Intensive Care Unit. QUOTE]


For one thing if someone can't even spell neurosurgery, I do not want them doing brain surgery on me!!!!!

Just another little tid bit. You are no where near a MD resident level on these surgeries. Would you care to tell what exactly you did during these surgeries? Here let me. If you worked with a medical resident or a 3rd or 4th year student, then you watched the surgery, same thing I do on the learning channel!!! If you were fortunate to do it without a med resident helping or student in there, then you may and I repeat MAY get to hold the suction. That is if you were VERY LUCKY. They are NOT going to let an OMFS do neurosurgery, you can watch or maybe assist.

I have 2 doctors in my family and both told me that on surgery when an OMFS is in there, they are lost. The chief surgeon has even made comments on why they are over there in the surgery!!!

Now let us take the MD surgeon. They do 5 straight years in surgery, where they actually DO hands on surgery, not assist after 2-3 years and MANY times watching it / assisting. Then they go into a 3 year fellowship in plastics, where again they watch/assist for a long time, then do it.

An OMFS is a great thing. Like the guy said, he was in a wreck and the OMFS fixed his occlusion. That is what they are for. They have that training. It is an intense residency that teaches them that training. They know about the mouth/jaws.

Please do a little more research when trying to say that OMFS has the same surgery rotation as an MD surgeon. 3 months is NOT enough time to do surgery, even someone as hard headed as you should see that. OMFS can't do everything, hence the reasons for periodontists, prosthos, endos, GPs, etc.....

Obviously you may know about Dental School, but as uneducated as you are on Medical School, why did you even post here?

 

[UNLV OMS GUNNABE]

c132 - I don't understand why you are so upset about this whole thing. These guys obviously know more about the specialty than you do. Based on your other posts it seems like you are just a second year dental student. I am sure that an OMS would know what he is capable of doing and what he isn't. If a guy that has gone through that much training feels comfortable doing a little cosmetic surgery (and it's legal for him to do it) then go for it. If he didn't feel good about it or thought it was beyond his training there are very few who would just do it anyways for the money or whatever other reason.

 

[USC2003]

c132,

Look, I am not here to upset you or continue arguing with you. I am sorry but you have your facts wrong. I am not here to change your mind or try and convince you of something. I am just stating the facts. The fact is I never stated that we receive the same surgical training as Neurosurgeons or General Surgery residents. I was merely correcting your statement that we don't receive training in these areas. Another fact is that we do perform procedures when we are on Neurosurgery under the supervision of either the chief resident or staff. We do bur holes, trachs, coronal flaps... The fact is simply that we treat more than just the mouth/jaws as you stated. We routinely handle trauma to the head and neck, including orbital fractures. It is not uncommon for OMFS to perform coronal flaps to get access to some orbital fractures. I encourage you to talk to OMFS residents where you are at and ask them questions regarding their residency. I am sorry this topic has upset you as much as it has, but your comments make me think that you are either a 1st year dental student or undergaduate. Like I asked before why don't you share your level of training with us so we can understand your background.

 

[Sveet07]

I don't think OMFS being allowed to do plastics is new news on the East Coast where I live. My brother in-law is one and has been doing plastics for years now. He even advertises on TV in those informercial for plastic surgery along with other plastic surgeons all the time too. He graduated at the top of his dental school and went on to become chief resident. I always thought they are allowed to do this even before I got to medical school.

In the hospital I see DDS/MD get consulted all the time in the OR for breast reconstructions and face/head traumas so I don't see why there should be any objections for them doing other plastic procedures. The attending I saw is very skillful and can tie a knot faster than I can blink

 

[RaiderNation]

Wow, MacGyver (or is it God, I'm confused). You must feel good about yourself.

 

[c132]

Well, I know I will probably not ever need plastic surgery, If I ever do, then I will go to a plastic surgeon. I am a 3rd year dental student. I talked with an OMFS today as a matter of fact and they did in deed tell me what the residency was. He also mentioned that he felt that plastic cosmetic surgery was out of the ?, but using plastics in reconstruction was OK. I feel the same on the matter.

I dunno why I sound upset, I think its quite funny!!!

 

[ShawnOne]

here is a new article on this topic:

http://story.news.yahoo.com/news?tm...chicagotrib/oralsurgeonswanttocutinonfaceneck

 

[marshall]

This thread is really good! Thanks everyone!