Should OMFS be recognized as an ACGME specialty?

[lOuDMoUTH]

Wanted to create this post to spark a friendly discussion about our speciality and get some thoughts on the posts I've listed below. I personally am a part of a MD integrated program, and will be starting my gen surg year soon so was hoping to see what others take on this is. It was huge when our speciality became recognized by the American College of Surgeons and it seems there's a push to make ABOMS a part of ABMS and to make OMFS a ACGME accredited specialty, which could dramatically change the landscape of our programs (for the good imo). This is regardless of whether you are part of a MD/non-MD program, as being accredited by ACGME and being a member of ABMS would consider both paths legitimate, I would imagine.

Not that anyone asked, but my personal opinion is that we should be recognized by ABMS. As far as ACGME goes, I'm unsure of the ramifications, especially because we wear both the anesthesia and surgery hats. On the one side, I feel like it could allow our specialty to access other fellowships more readily, and be considered competitive when applying with our ENT or Plastics colleagues, but on the flip side, we could plunge ourselves into a hole when it comes to being able to provide anesthesia (not that they're mutually exclusive).

Posting two things:
1. An article from JOMS talking about the future of OMS

https://www.joms.org/article/S0278-2391(21)01330-6/fulltext

2. An interesting, public, letter from the prior president of ASPS. Not posting this to shame this guy or his view, rather spark a discussion.

https://www.plasticsurgery.org/documents/Advocacy/ASPS-Comments_ABOMS-Application-ABMS_01-02-2023.pdf

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[dogecointothemoon]

Not a fan. It just creates more bureaucracy over our specialty and opens us up to more scrutiny. In my opinion we should have never caved to a dual degree system in the first place. Hospitals need us and they know that. If you wanted to do fellowships that are heavily dominated by ENT or plastics you probably should have just gone to medical school and done one of those specialties. I’m not saying OMFS isn't qualified to do craniofacial, head and neck oncology, etc but the reality of it is that if you are an OMFS at a hospital where only ENT or plastics does those cases you are probably cooked wether we are recognized or not. On the other hand if you work at a hospital where OMFS dominates in that aspect then you will probably do those surgeries regardless of recognition or dual degree status.

 

[dogecointothemoon]

At the hospital I am at we have a craniofacial trained ENT who couldn’t do craniofacial procedures for 15 years because there was someone ahead of her that did them all. Just because you are plastics or ENT with the correct fellowship doesn’t mean you will do craniofacial surgeries. There just aren’t that many of these cases to go around and they are the “feel good” cases that nobody is willing to give up. There are plenty of craniofacial teams in the nation that have a couple OMFS providers associated with them. I know I’m using the availability heuristic and my sample size is 1 but it’s still food for thought.

 

[deleted923283]

We truly have it better than everyone else, and so my initial gut reaction is to be very skeptical of changes like this.

 

[OrphanageCaretaker]

More admin = more bull**** policies

 

[D1Bound]

More admin = more bull**** policies

That’s a good. If you can do your private practice with anesthesia, why try to change anything?

 

[Van Der Woude]

We will never be ACGME recognized IMO. CODA keeps a lot of our programs accredited to provide a service necessary for tertiary care referral centers: stabilization of acute facial trauma, handling larger odontogenic deep head/neck space infections, and dealing with benign pathology.

ACGME wouldn't recognize maybe 50% of our programs. The difference between ACGME and CODA standards are night and day.

 

[LegendaryPanda]

“ABOMS only require 220 cases in trauma, pathology (TMJ), orthognathics, and reconstruction/aesthetics while ABPS require 1150 cases.”

Ah, yes that those plastic guys are so much more experienced than us lowly OMFS in matters regarding TMJ, orthognathic, and occlusion.

I urge all of my GP and orthodontist companions to refer all those TMJ cases to plastic surgeons and especially this Gregory Greco, DO guy.

 

[D1Bound]

“ABOMS only require 220 cases in trauma, pathology (TMJ), orthognathics, and reconstruction/aesthetics while ABPS require 1150 cases.”

Ah, yes that those plastic guys are so much more experienced than us lowly OMFS in matters regarding TMJ, orthognathic, and occlusion.

I urge all of my GP and orthodontist companions to refer all those TMJ cases to plastic surgeons and especially this Gregory Greco, DO guy.

The whole letter made it sound as if Oral and Maxillofacial Surgeons are incompetent and they are “just dentists.” Why is it in healthcare no one respects each other?

 

[HockeyDocOMFS]

Not sure why everyone is getting butt hurt over what this dude says. Don’t really see the benefit for us to leave our lane - we are a dental specialty in the end and all are dentists (not all of us are physicians).

Realistically, some of the points he does make are valid. The CODA requirements are a complete joke. There are a handful of programs who hardly do anything in the OR and strictly do teeth and titanium in their clinic. All of our medical colleagues respect the hell out of us and our training, so who even cares about this letter to the board that this dude typed up.

 

[Van Der Woude]

People who do microvascular well in OMFS are rare. Especially in competitive areas. With how $$$ flows a significant portion of new OMFS grads are forgoing fellowships. Regardless, graduating from a dental school, even one with medical school classes, does not make you the equivalent of an MD in this country even if you are brighter than they are.

The only thing people will look at when they meet you are your titles, how nice you are, and an accurate record of good outcomes and reocmmendations.

 

[LegendaryPanda]

Not sure why everyone is getting butt hurt over what this dude says. Don’t really see the benefit for us to leave our lane - we are a dental specialty in the end and all are dentists (not all of us are physicians).

Realistically, some of the points he does make are valid. The CODA requirements are a complete joke. There are a handful of programs who hardly do anything in the OR and strictly do teeth and titanium in their clinic. All of our medical colleagues respect the hell out of us and our training, so who even cares about this letter to the board that this dude typed up.

I don’t care if we stay in or out of the list of medical specialties. I do care that someone is belittling our training with some misleading and out of context numbers. Leaving out aesthetics, this bloke is insinuating we’re not qualified with trauma, orthognathic, and TMJ because our total numbers are 5 times less than theirs when their actual specialty average for these procedures is probably like 20, 0, and 0 respectively.

 

[Wisetoothshucker]

As others said it may have negative impacts on our requirements, anesthesia, etc. Also even if we became an ABMS specialty, I don’t think it’d significantly make us more competitive if we wanted competitive ENT or Plastics fellowships. If it’s already competitive within their specialty, why would they open doors for an outside specialty, regardless of ABMS status.

I think many ENT and Plastics would like to do what we do if it was open to them. No harm in keeping us the best kept secret

 

[HockeyDocOMFS]

I don’t care if we stay in or out of the list of medical specialties. I do care that someone is belittling our training with some misleading and out of context numbers. Leaving out aesthetics, this bloke is insinuating we’re not qualified with trauma, orthognathic, and TMJ because our total numbers are 5 times less than theirs when their actual specialty average for these procedures is probably like 20, 0, and 0 respectively.

He didn’t even really bad mouth or belittle us. He just stated the fact that our CODA numbers required are way less than the medical specialties, which is true. Realistically, if we did up our numbers to 1000 cases needed to graduate, over 50% of OMFS programs would have to shut down since there are quite a handful of country club programs who don’t do much in the OR and do almost everything in their clinics.

 

[craniomxface]

They are leaving out that not all of our cases count towards the requirement. Laceration repairs, teeth, etc do not count. I doubt many count most biopsies, etc, etc. I bet all of their cases count. And let's be honest, removing small lesions from the face or an ENT doing their 200th tonsillectomy is no different than us on our 200th set of thirds.

 

[dentmass]

Laceration repairs count towards trauma. That is how some programs get away with minimal trauma numbers.

 

[LegendaryPanda]

Laceration repairs count towards trauma. That is how some programs get away with minimal trauma numbers.

I’m at a level 1 trauma center, repaired a ton of lacs and none of them counted towards anything.

They are leaving out that not all of our cases count towards the requirement. Laceration repairs, teeth, etc do not count. I doubt many count most biopsies, etc, etc. I bet all of their cases count. And let's be honest, removing small lesions from the face or an ENT doing their 200th tonsillectomy is no different than us on our 200th set of thirds.

Exactly my point. This comparison is asinine. It’s as if a general dentist said “GPs do like combined 2500 cases of class II restorations and orthognathic surgeries, while OMS only needs a total 220. Guess GPs are way better trained.” It’s misleading, and disingenuous, and only fits their narrative. Take aesthetics out of both those numbers he listed and add in our actual trauma numbers then compare.

 

[craniomxface]

Laceration repairs count towards trauma. That is how some programs get away with minimal trauma numbers.

If you look at your programs actual CODA report you will see that whatever is logged as lacerations gets categorized as "other" and not counted towards trauma numbers.

 

[AlbinoPolarBear]

We don't want this. The more medicine tries to control our specialty, it will be for the worst, not the better.

For example, we provide the cheapest deep sedation/general anesthesia, at levels of safety comparable to anesthesiologists. Some of my colleagues accept insurance plans that would only pay them $200 for sedations, and most insurance plans pay around $400-500. Granted, we do not do in office anesthesia to ASA 4 and above patients like the anesthesiologists do. Our most vocal critics for providing anesthesia is actually MD anesthesiologists, and when a general dentist or pediatric dentist who took a weekend moderate sedations course kills someone, they want to ban providing moderate sedation to general anesthesia for all dentists, including OMFS.

When the anesthesiologists were pushing hard for the American Medical Association to stop us from providing in office anesthesia, like 10 years ago, there were numerious dual degreed oral surgeon, who had membership with the AMA, had random AMA representatives show up to their office unannounced, and monitored their technique. The single degree OMFS? Well, they left them alone.

Let us be our own thing. Kings of the dental speciality.

 

[D1Bound]

We don't want this. The more medicine tries to control our specialty, it will be for the worst, not the better.

For example, we provide the cheapest deep sedation/general anesthesia, at levels of safety comparable to anesthesiologists. Some of my colleagues accept insurance plans that would only pay them $200 for sedations, and most insurance plans pay around $400-500. Granted, we do not do in office anesthesia to ASA 4 and above patients like the anesthesiologists do. Our most vocal critics for providing anesthesia is actually MD anesthesiologists, and when a general dentist or pediatric dentist who took a weekend moderate sedations course kills someone, they want to ban providing moderate sedation to general anesthesia for all dentists, including OMFS.

When the anesthesiologists were pushing hard for the American Medical Association to stop us from providing in office anesthesia, like 10 years ago, there were numerious dual degreed oral surgeon, who had membership with the AMA, had random AMA representatives show up to their office unannounced, and monitored their technique. The single degree OMFS? Well, they left them alone.

Let us be our own thing. Kings of the dental speciality.

Wow $200!

 

[TheBigLebowski]

He didn’t even really bad mouth or belittle us. He just stated the fact that our CODA numbers required are way less than the medical specialties, which is true. Realistically, if we did up our numbers to 1000 cases needed to graduate, over 50% of OMFS programs would have to shut down since there are quite a handful of country club programs who don’t do much in the OR and do almost everything in their clinics.

What programs would you define as a "Country Club Program"? Are they mostly 4yr?

 

[Big Time Hoosier]

What programs would you define as a "Country Club Program"?

Here’s a list someone compiled…

Periodontal Programs - American Academy of Periodontology

www.perio.org

Big Hoss

 

[D1Bound]

Here’s a list someone compiled…

Periodontal Programs - American Academy of Periodontology

www.perio.org

View attachment 396188

Big Hoss

Dude just BEGGING to start a flame war 🤣

 

[HockeyDocOMFS]

What programs would you define as a "Country Club Program"? Are they mostly 4yr?

Unsure. I mainly mean the ones that have little OR time, and I know of both 4 and 6 years that have that issue.

 

[nade0016]

OK, I think it is time for me to chime in. I have horses in this race and I have some insight on the CODA standards and some recent changes to the standards.

First, the most recent CODA standard changes were designed to align the CODA OMS standards more with GME standards. The intent was to help promote a 2 for 1 equivalency of OMS years for GME years. This would allow MD/OMS to practice under the medical license in every state. I was not a big fan of the changes but they are geared toward resident well-being and safety.

I don't really care about the ABMS and if there is that much push back then ABOMS should back off. Not sure what it would get our specialty outside more recognition.

Second, ACGME specialty would invite all kinds of reorganization of our training programs. While ACGME has great resources, faculty development and support of residents. I am not sure we should go there yet.

I do believe that we should increase our "number" requirements and be more specific about what counts and what does not toward accreditation. As a site visitor for CODA, I can tell you that there is a lot of ambiguity and double dipping in programs. We need to be more specific about procedure numbers but also be ready for a couple, 5-10 programs to have to close. I am not sure this would be a bad idea. Focus the training where it needs to be, the OR.

I could be way off base as well. I am only one small voice in the din.

Additionally, as a mostly clinical based, DA/Implant/Sedation profession, how many cases are actually necessary? For general surgery I understand the need for more procedure numbers of general surgery procedures. Let's not forget that OMS does not count Dentoalveolar procedures outside of implants and even then we don't have requirements for those. If we wanted to count apples to apples, lets compare our # of thirds extractions with the number of appendectomies. Of number of teeth removed with the number of scopes needed for a GI doc. I think our numbers would crush the others.

Lastly, we get paid really well for what we all mostly do. Let's just keep that up and enjoy the financial windfall while it lasts..........