What is the future of OMFS?

[GTFOOMICT]

I might not get any play out of this, but I am bored out of my mind studying med school stuff so here goes.

Where do you see the future of OMFS going? Historically there was a time when orthognathics was the next expansion of scope as an example. Some tentative examples I could see for present day examples are craniofacial, aesthetic/cosmetic, malignant pathology, face transplants, etc. But since I am new to my training I don't have much perspective, haven't rotated with other services, etc. I realize this is all currently 'within the scope' but it's not a part of most training programs and the average graduate can't do it. So I don't really count it yet.

1) Do you think OMFS will lose their roots in dentistry? We have general dentists and periodontists doing more of traditional bread and butter oral surgery. AND alot of old school oral surgery procedures aren't done anymore. Do you think we will no longer be the 'surgical branch of dentistry'?

2) Will we finally change our name to OMS like AAOMS and the official specialty name?

3) Surgically, where do you see the next major expansion? By major, I mean a sizable core of the residents will be trained in it and not at the fellowship level.

4) On a totally different topic, as medicine begins to be less physician centered (nurse practitioners, physician assistant/assistants/associates whatever their latest name is, etc) do you think we will drop our push for Medical Degrees? After all...the scope is getting wider and can we realistically get it all in in less than 4 years (assuming 2+ are lost to med school and general surgery)

5) Does anyone believe the argument that OMFS should not be in private practice is absolutely ridiculous? We hear this in academic settings all the time. If all OMFS one day decided private practice was dumb and joined their local hospital, what would they do? Do we truly have a need
for surgeons trained at the level they are trained at? Just a thought, not that I agree.

I would be interested in hearing opinions from those who have been able to have discussions with their faculty and leaders at national meetings and such.

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[servitup]

1) Do you think OMFS will lose their roots in dentistry? We have general dentists and periodontists doing more of traditional bread and butter oral surgery. AND alot of old school oral surgery procedures aren't done anymore. Do you think we will no longer be the 'surgical branch of dentistry'?

No. We will remain the go to guys for wisdom teeth and sedation. Neither of those are profitable unless you do them in volume. Implants will continue to be gobbled up by everybody and we will pretty much do complex bone grafting cases only.

2) Will we finally change our name to OMS like AAOMS and the official specialty name?

Not sure what this even means, but if you are referring to us being called "oral surgeons" I don't see that changing anytime soon, although I think people would better understand our scope if we made it a point to include maxillofacial when referring to ourselves. The bottom line is, that's a mouthful so it probably won't change.

3) Surgically, where do you see the next major expansion? By major, I mean a sizable core of the residents will be trained in it and not at the fellowship level.

Cancer IMO b/c we can be extremely busy with it without ANY MD referrals. Dentists and oral surgeons find lots of cancer and would happily refer it to an OMS who tx's cancer if one is available locally.

Cosmetics and craniofacial will remain niche areas within OMS IMO.

4) On a totally different topic, as medicine begins to be less physician centered (nurse practitioners, physician assistant/assistants/associates whatever their latest name is, etc) do you think we will drop our push for Medical Degrees? After all...the scope is getting wider and can we realistically get it all in in less than 4 years (assuming 2+ are lost to med school and general surgery)

No. On the contrary, how many full-time academics under age 40 don't have MD's. Before long, all programs will be MD-integrated IMO b/c all of the professors will have them and will place value on having them. Further, the broader scope we become, the more politically beneficial the MD becomes. The use of nurse practitioners, PA's, etc. will not change that fact.

5) Does anyone believe the argument that OMFS should not be in private practice is absolutely ridiculous? We hear this in academic settings all the time. If all OMFS one day decided private practice was dumb and joined their local hospital, what would they do? Do we truly have a need
for surgeons trained at the level they are trained at? Just a thought, not that I agree.

I have never heard this argument to be honest. I think we should all do whatever we want to do, whether it be private practice, hospital employee, or academic.

 

[GTFOOMICT]

Cancer IMO b/c we can be extremely busy with it without ANY MD referrals. Dentists and oral surgeons find lots of cancer and would happily refer it to an OMS who tx's cancer if one is available locally.

Thanks for those thoughts.

If I interpreted him correctly, one of our faculty members suggested that the profession missed the boat by not becoming bigger players in this. It is something that OMS can provide the medical community, as opposed to many of the things we do the results are only seen in the dental community (except for trauma). I also believe he said that cosmetics won't garner any respect because of the very nature of it being non-disease treating and craniofacial will always be so small due to low incidence in our population.


And in regards to my initial question 5.
Did you ever make it to Houston for an interview? I almost got thrown out when I suggested that a graduate should do what they want and if private practice is what they want, then that is not a waste!

 

[armorshell]

And in regards to my initial question 5.
Did you ever make it to Houston for an interview? I almost got thrown out when I suggested that a graduate should do what they want and if private practice is what they want, then that is not a waste!

I said something along the same lines and was looked at with utter revulsion and one of the faculty actually said something like "I hope don't don't really think that."

servitup, GTFO was referring how we constantly refer to oral and maxillofacial surgery as OMFS when in reality the proper acronym is OMS, since maxillofacial is one word.

Personally, OMFS rolls off the tongue better than OMS so that's what I'll say. Also, speaking of rolling off the tongue, your mom.

 

[CanuckDDS]

I might not get any play out of this, but I am bored out of my mind studying med school stuff so here goes.

Where do you see the future of OMFS going? Historically there was a time when orthognathics was the next expansion of scope as an example. Some tentative examples I could see for present day examples are craniofacial, aesthetic/cosmetic, malignant pathology, face transplants, etc. But since I am new to my training I don't have much perspective, haven't rotated with other services, etc. I realize this is all currently 'within the scope' but it's not a part of most training programs and the average graduate can't do it. So I don't really count it yet.

1) Do you think OMFS will lose their roots in dentistry? We have general dentists and periodontists doing more of traditional bread and butter oral surgery. AND alot of old school oral surgery procedures aren't done anymore. Do you think we will no longer be the 'surgical branch of dentistry'?

2) Will we finally change our name to OMS like AAOMS and the official specialty name?

3) Surgically, where do you see the next major expansion? By major, I mean a sizable core of the residents will be trained in it and not at the fellowship level.

4) On a totally different topic, as medicine begins to be less physician centered (nurse practitioners, physician assistant/assistants/associates whatever their latest name is, etc) do you think we will drop our push for Medical Degrees? After all...the scope is getting wider and can we realistically get it all in in less than 4 years (assuming 2+ are lost to med school and general surgery)

5) Does anyone believe the argument that OMFS should not be in private practice is absolutely ridiculous? We hear this in academic settings all the time. If all OMFS one day decided private practice was dumb and joined their local hospital, what would they do? Do we truly have a need
for surgeons trained at the level they are trained at? Just a thought, not that I agree.

I would be interested in hearing opinions from those who have been able to have discussions with their faculty and leaders at national meetings and such.

GR where you at?

 

[gary_ruska]

Gary "crystal ball was in the repair shop until today" Ruska here, with some answers. Truth be told, who knows what the future will bring. However - one should be reassured about the future of the specialty because a) smart people are going into OMFS, b) new applications of technology are making treatment less invasive, but still under the control of OMFS and c) the specialty, cantankerous as it may be at times, is generally united with regard to goals.

Question: Do you think OMFS will lose their roots in dentistry? We have general dentists and periodontists doing more of traditional bread and butter oral surgery. AND alot of old school oral surgery procedures aren't done anymore. Do you think we will no longer be the 'surgical branch of dentistry'?

Answer: A tough call to be sure. A lot of this will depend on whether the US specialty splits like the overseas counterparts have. In the event that this does occur, one could imagine a scenario in which there are oral surgeons and maxillofacial surgeons with two different paths of training and divergent scopes of practice. However, since $$$ drives everything and the $$$ is in dentoalveolar and implant surgery, don't expect this to happen anytime soon.

2) Will we finally change our name to OMS like AAOMS and the official specialty name?

Answer: Probably not. Though "oral surgeon" is a somewhat nebulous term (i.e. some in the medical community labor under the misapprehension that "oral surgeon" is a fancy term for general dentist), it's hard to get the masses to embrace change. Just ask the ORL-HNS folks whether they are referred to as such versus the traditional "ENT". One may suggest that a more important question is "Would it help the specialty if the name were changed to Maxillofacial Surgery or OMS, etc?" The answer to this is also likely no. What OMFS/OMS, etc. do is not in any way related to what people call the surgeons. GR has never been told not to book an ORIF orbital floor or frontal sinus because the operating service was "Oral Surgery". So what if, from time to time, patients who need cleanings get sent to the "Oral Surgery" Clinic? It makes no huge difference in the end.

3) Surgically, where do you see the next major expansion? By major, I mean a sizable core of the residents will be trained in it and not at the fellowship level.

Answer: Head and neck oncology seems the most likely. There are an increasing number of graduating fellows who are practicing the full scope of extirpative and microvascular surgery and these fellows are starting their own fellowships - it's a self-propagating expansion. In addition, a good number of the younger FACS who are OMFS are H+N guys, which suggests that the surgical community at large is becoming increasingly aware of this aspect of OMFS practice. This, coupled with the relative decline in ENT and PRS folks pursuing H+N training in favor of "greener" pastures, makes for a favorable situation. Incidentally, GR has heard that, in the next 1-2 years, the OMFS H+N fellowship appointments will be made through a match system, such is the volume of applicants.

4) On a totally different topic, as medicine begins to be less physician centered (nurse practitioners, physician assistant/assistants/associates whatever their latest name is, etc) do you think we will drop our push for Medical Degrees? After all...the scope is getting wider and can we realistically get it all in in less than 4 years (assuming 2+ are lost to med school and general surgery)

Answer: The medical degree debate will likely not end anytime soon. It has been around for 30+ years and the specialty is, essentially, at the same point as in the 1970s. As long as OMFS roots are in dentistry and as long as everyone's take home pay is determined by implants and wizzies, the single-degree practitioner will be a viable entity. The reason for this is that they are competing only with other dentists (i.e. GPs and periodontists). The MD confers no relative advantage in this arena. If a situation arises in which competition for $$$ comes down to hospital-based or privileged procedures, the MD degree will likely become more important, as it levels the playing field, to some extent, with ENTs/PRS/etc. To be sure, the medical degree debate will unlikely be influenced by mid-level providers, as they have little to no role in dentistry (at the present time) and will likely not be trained to the extent that they could usurp OMFS procedures. However, if an NP/PA model emerges in dentistry, one COULD make the argument that this would force OMFS to compete with periodontists/GP/NP/PA for dentoalveolar/implant/office based stuff and perhaps turn to larger procedures, in which an MD could potentially be a valuable asset.

5) Does anyone believe the argument that OMFS should not be in private practice is absolutely ridiculous? We hear this in academic settings all the time. If all OMFS one day decided private practice was dumb and joined their local hospital, what would they do? Do we truly have a need
for surgeons trained at the level they are trained at? Just a thought, not that I agree.

Answer: The beauty of OMFS training is the flexibility. One should enter training with an open mind, work hard to learn everything about the specialty and all of the procedures one can potentially do, become technically adept at all aspects of the specialty and then decide what to do with those skills. An OMFS who goes into private practice after 4-6 years of surgical training should not be admonished for doing so. There are many factors which influence such a decision, finances being primary. Academic surgeons may look down upon their private-practice counterparts. However, if private-practice guys took trauma call, did oncologic surgery, had large volume orthognathic practices or managed craniofacial patients, academic centers and their practitioners would suffer. Another advantage of broad training is that one can choose to narrow their practice, as opposed to having a limited practice by virtue of limited training. This is especially important in the possible setting of other providers encroaching on what have traditionally been specialty-specific procedures. If one well dries up, the well-trained OMS has a few others to dip into. Granted, it may take some AO courses and refreshers, but the knowledge and skills will be there, they just may need to be updated and fine tuned.

The future is bright and one should have no hesitation about becoming an OMFS. It is a great specialty and you will constantly be surrounded by intelligent, creative minds who work hard and ultimately strive to improve patient care at all levels of disease, from impacted teeth to raging H+N cancer.