Specialists who perform general dentist duties....

[MsPurtell]

I love general dentistry, but lately I've been thinking of pursuing a specialty. I remember always being told that once you specialize and bill yourself as, let's say, a prosthodontist, you are only allowed to do prosth under the law.

However, I know of two practitioners who are specialists (one is a periodontist, one is a pediatric dentist) and both also do plenty of general dentistry. I would like to pursue a specialty, but may not always want to feel so limited. So, how does this work. Would I bill myself basically as a general dentist, but also practice at the specialty level in the area I'm trained in.

In school, they made this sound like such a huge issue. I think it really should be straightforward....but I don't want to take the plunge into a specialty until I know for sure.

Thanks for responses in advance.

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[FireDancer]

My "orthodontist" practiced as a GP - he has a certificate from SUNY Buffalo in orthodontics - he liked the tx planing in orthodontics but found the actual execution boring so he also did general dentistry. Basically, I think he was able to work as a general dentist because he did not advertise as an orthodontist but as a general dentist who does orthodontics.

 

[MsPurtell]

Ah, ok, thx firedancer. That makes sense to me.

My "orthodontist" practiced as a GP - he has a certificate from SUNY Buffalo in orthodontics - he liked the tx planing in orthodontics but found the actual execution boring so he also did general dentistry. Basically, I think he was able to work as a general dentist because he did not advertise as an orthodontist but as a general dentist who does orthodontics.

 

[capisce?]

You can legally do any treatment as long as you do it to the standard of care that the specialist is held to.

Ie...in pedo if a kid avulses a tooth then it needs endo. Many pedos will do endo on anterior teeth, which is fine...as long as it's done up to the standard of care for that procedure.

 

[backaction]

I think if you advertise as a specialist that limits ones speciality to say endodontics, that you must only do endodontics, but you can advertise as an endodontist and do general dentistry as long as you do not say "practice limited to endodontics." I've also heard that once you become boarded in a specialty that you can only practice as a specialist or a GP at that point, but not both, but not sure whether this is true or not. I asked one of the deans at my school and was told that you can do general as well as be a specialist. Probably have to call the board for a definitive answer to this very popular question.

This is off topic, but wanted to know what opinions others have about what general dentist perceptions are about specialists also performing general dentistry (ex. a periodontist who does all forms of perio, places implants and restores them, as well as doing restorative, pros and endo). The other side of the coin is GP's placing and restoring implants and doing perio surgery etc. My opinion:
There are many individuals that beleive that specialists should be bound to there speciality and not be able to perform general dentistry. I am not in that group, however. I think that a specialist has the same education as a general dentist in the area of general dentistry, and therefore should be able to practice general dentistry. Dental programs basically train you to be able to be a starting general dentist by graduation and both the specialist and the GP have this qualification. The only opposing argument is that specialists don't spend enough time doing general dentistry and therefore don't have the skill, but I think this is a very weak point. I think it basically boils down to whether the specialist can perform general dentisty to the same standard of care as a GP. I think that the majority of individuals who think that specialists should be bound are general dentists, probably out of the fear of the publics perception that a specialist who performs general dentisty is a more qualified practitioner and makes them more competetive. Obviously this is false, but the public may think this way, who knows. The other side of the coin is specialists probably not liking it when GPs do sinus lifts and orthodontics. Again, it boils down to whether or not a GP can perform at the same standard as the specialist including complications etc., which is why I have been against anyone but OMFS and anesthesiologists doing IV sed. and OMFS doing 3rds. I know that you can get certain licenses by doing 20 IV seds (perio for example gets a class 3), and this is the standard according to the law, but I don't think that standard is high enough. I've always had the opionion that being a good general dentist is much harder than being any specialist, except maybe a good oral surgeon. I'm a perio resident, but I would never let a loved one get IV sed by one.

 

[Tbone10452]

You can legally do any treatment as long as you do it to the standard of care that the specialist is held to.

Ie...in pedo if a kid avulses a tooth then it needs endo. Many pedos will do endo on anterior teeth, which is fine...as long as it's done up to the standard of care for that procedure.

You're allowed to do whatever you want as long as its the standard of care, yes. But specialists work on refferals. What do you think the GP would say if he refers a patient for a root canal and he comes back with the root canal, the crown, plus all his operative dentsitry work done. Plus, once you're equiped to practice your specialty its not worthwhile anymore to do general dentistry. Not only are you more efficient at what you do best, it takes more time to do general dentistry then a GP, and your staff and your clinic arent set up to do general dentistry. It just dosent make sense. It would be a waste of resources. You can do it if you want, but you'd probably be losing money if you consider all this, and the fact that the time you put in your extra education's gotta pay off.

 

[capisce?]

You're allowed to do whatever you want as long as its the standard of care, yes. But specialists work on refferals. What do you think the GP would say if he refers a patient for a root canal and he comes back with the root canal, the crown, plus all his operative dentsitry work done. Plus, once you're equiped to practice your specialty its not worthwhile anymore to do general dentistry. Not only are you more efficient at what you do best, it takes more time to do general dentistry then a GP, and your staff and your clinic arent set up to do general dentistry. It just dosent make sense. It would be a waste of resources. You can do it if you want, but you'd probably be losing money if you consider all this, and the fact that the time you put in your extra education's gotta pay off.

I'm not sure what you are so upset about, but by and large all pedodontists do is general dentistry. We are just trained to manage children's behavior while performing the dentistry. A majority of a pedo practice is bread and butter dentistry...meaning restorations, exams etc. Pedo practices are equipped to perform those things.

As far as a pedo doing anterior endo on one of their patients in a case of trauma....all that is doing is providing a service to your patient family. Let's face it, anterior endo isn't rocket science. As long as I do my RCTs correctly I'm doing a lot of patients a favor, since I will probably charge 1/3 of what an endodontist will to do the same work. Sure, maybe an endo can do it 3 times as fast but as long as they are clinically and fundamentally sound it's a great service to be able to offer patients. I'm not going to put endos out of business, lmao. Most of our referrals are via word of mouth, not from GPs fyi.

 

[Jediwendell]

Pedo is a little different because it is basically GP for little kids. They can have a hygienist and are trained differently than most specialists. I can tell you from experience that pediatric dentists don't rely on GP referrals as much as you might think. If you are a pediatric dentist you would be better off setting up next to a pediatrician's office. Orthodontists shouldn't be doing anything other than ortho (particularly me, since I haven't done a class II in seven years) . The point about being cognizant of your referrals is very astute. I know a lot of people that want to do it all when they get out. It just doesn't work that way unless you are in the right area, ie rural.

 

[MsPurtell]

You make some great points. I would never take someone's gp work if they sent a pt to me for specialist work. That would be unethical. I was thinking more in terms of having my own patient pool and doing specialist work on my patients (and any referred patients) as needed.

You're allowed to do whatever you want as long as its the standard of care, yes. But specialists work on refferals. What do you think the GP would say if he refers a patient for a root canal and he comes back with the root canal, the crown, plus all his operative dentsitry work done. Plus, once you're equiped to practice your specialty its not worthwhile anymore to do general dentistry. Not only are you more efficient at what you do best, it takes more time to do general dentistry then a GP, and your staff and your clinic arent set up to do general dentistry. It just dosent make sense. It would be a waste of resources. You can do it if you want, but you'd probably be losing money if you consider all this, and the fact that the time you put in your extra education's gotta pay off.

 

[Tbone10452]

I'm not sure what you are so upset about, but by and large all pedodontists do is general dentistry. We are just trained to manage children's behavior while performing the dentistry. A majority of a pedo practice is bread and butter dentistry...meaning restorations, exams etc. Pedo practices are equipped to perform those things.

I'm not going to put endos out of business, lmao. Most of our referrals are via word of mouth, not from GPs fyi.

I'm not upset. By and large most specialists, except pedodontists, dont do general dentistry.

FYI, most referrals for specialists are from GPs. I dont see a patient go straight to an Oral Surgeon for wisdom teeth removal, or straight to a perio for a palatal graft. Maybe orthos and especially pedos can publicise more, but still...