What's a kidney?

[ip]

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http://www.ama-assn.org/amednews/2006/11/06/prse1106.htm

California expands oral surgeons' scope of practice
More than two dozen medical groups raised patient safety concerns before lawmakers acted.

By Myrle Croasdale, AMNews staff. Nov. 6, 2006.

California's oral and maxillofacial surgeons without medical degrees may now do elective facelifts, rhinoplasties and eyelifts. A new law California Gov. Arnold Schwarzenegger signed Sept. 30 expanded the scope of practice for the doctors, leaving many physicians concerned about patient safety.

The measure allows oral and maxillofacial surgeons to perform elective facial surgery, including the head and neck area. More than a dozen other states have similar laws.

Before California lawmakers passed the bill, the American Medical Association-backed Scope of Practice Partnership e-mailed its member organizations asking them to consider signing a letter in opposition to the bill and to encourage their members to contact their legislators and the governor's office to voice concern. As a result, 18 national specialty organizations, including the AMA, and 12 state medical societies signed a letter to the California governor explaining their opposition to the bill.

"They've replaced education with legislation," said John Osborn, MD, president of the California Society of Plastic Surgeons, which opposed the legislation and signed the letter.

Dr. Osborn said the legislation allows oral surgeons to perform procedures beyond what they were trained to do. For example, he said, the doctors don't have the same depth of knowledge as those with medical degrees. "They don't learn how to take care of such things as kidney problems, which can be important at times."
[...]

 

[Jediwendell]

http://www.ama-assn.org/amednews/2006/11/06/prse1106.htm

California expands oral surgeons' scope of practice
More than two dozen medical groups raised patient safety concerns before lawmakers acted.

By Myrle Croasdale, AMNews staff. Nov. 6, 2006.

California's oral and maxillofacial surgeons without medical degrees may now do elective facelifts, rhinoplasties and eyelifts. A new law California Gov. Arnold Schwarzenegger signed Sept. 30 expanded the scope of practice for the doctors, leaving many physicians concerned about patient safety.

The measure allows oral and maxillofacial surgeons to perform elective facial surgery, including the head and neck area. More than a dozen other states have similar laws.

Before California lawmakers passed the bill, the American Medical Association-backed Scope of Practice Partnership e-mailed its member organizations asking them to consider signing a letter in opposition to the bill and to encourage their members to contact their legislators and the governor's office to voice concern. As a result, 18 national specialty organizations, including the AMA, and 12 state medical societies signed a letter to the California governor explaining their opposition to the bill.

"They've replaced education with legislation," said John Osborn, MD, president of the California Society of Plastic Surgeons, which opposed the legislation and signed the letter.

Dr. Osborn said the legislation allows oral surgeons to perform procedures beyond what they were trained to do. For example, he said, the doctors don't have the same depth of knowledge as those with medical degrees. "They don't learn how to take care of such things as kidney problems, which can be important at times."
[...]

I know quite a few plastic surgeons that don't know what teeth are, yet they attempt orthognathic surgery. Jerks.

 

[aphistis]

I know quite a few plastic surgeons that don't know what teeth are, yet they attempt orthognathic surgery. Jerks.

Silly orthodontist, we've been through this before. Training, intelligence, & ability don't make you a good doctor. Having "MD" after your name makes you a good doctor.

 

[Bifid Uvula]

http://www.ama-assn.org/amednews/2006/11/06/prse1106.htm

"They've replaced education with legislation," said John Osborn, MD, president of the California Society of Plastic Surgeons, which opposed the legislation and signed the letter.

Dr. Osborn said the legislation allows oral surgeons to perform procedures beyond what they were trained to do. For example, he said, the doctors don't have the same depth of knowledge as those with medical degrees. "They don't learn how to take care of such things as kidney problems, which can be important at times."
[...]

By that stance, NOBODY but Kidney Transplant Surgeons and Nephrologists should ever treat a patient with kidney problems (regardless of their medical condition... Patients shouldn't get ophthalmologic treatment, pulmonary care, OB/GYN care or see a family medicine doc because none of those doctors are qualified to care for the kidney either! The M.D. doesn't mean anything when it comes down to your specialty's scope of training.

You mean to tell me that the plastic surgeon PERSONALLY manages all renal problems when he/she does ELECTIVE "BOOBY-Augmentation?" What a load of crap!

Dr. Osborn doesn't seem to have any opposition to OMFS guys/gals doing Head/Neck/Facial trauma reconstruction (because these often involve late-night and NON-PAYING patients without any insurance).

The bottom line is that the reputation of the AAOMS and Maxillofacial Surgeons is growing, the public is becoming better educated regarding the services and benefits that can be offered by an OMFS, and there will be a continued trend in EXPANDED SCOPE of PRACTICE FOR OMFS. Doctors like Osborn and his PRS cronies are just gonna have to go home to cry to momma.

 

[LSU-Cowboy]

By that stance, NOBODY but Kidney Transplant Surgeons and Nephrologists should ever treat a patient with kidney problems (regardless of their medical condition... Patients shouldn't get ophthalmologic treatment, pulmonary care, OB/GYN care or see a family medicine doc because none of those doctors are qualified to care for the kidney either! The M.D. doesn't mean anything when it comes down to your specialty's scope of training.

You mean to tell me that the plastic surgeon PERSONALLY manages all renal problems when he/she does ELECTIVE "BOOBY-Augmentation?" What a load of crap!

Dr. Osborn doesn't seem to have any opposition to OMFS guys/gals doing Head/Neck/Facial trauma reconstruction (because these often involve late-night and NON-PAYING patients without any insurance).

The bottom line is that the reputation of the AAOMS and Maxillofacial Surgeons is growing, the public is becoming better educated regarding the services and benefits that can be offered by an OMFS, and there will be a continued trend in EXPANDED SCOPE of PRACTICE FOR OMFS. Doctors like Osborn and his PRS cronies are just gonna have to go home to cry to momma.

Yes, I agree. The bill that Arnie passed is a great thing for OMFS. Hopefully this will increase the public's awareness of the scope of our specialty.

 

[scedd]

Its funny to see surgeons (MD) treating OMFS like the way OMFS treats the Periodontist.Well being said that OMFS are definitly way higher than any dentist.Only thing i cannot accept is , when GP or a dental student talks about the quality of work a periodontist does.

NOTE😀int intend to start a OMFS Vs perio disscusion.It is obvious that OMFS are trained to do things beyond a periodontist do (at least most of the OMFS)

 

[flat4]

It's about time Arnie got his head out of his ass. Here's another article:
http://www.medicalnewstoday.com/medicalnews.php?newsid=53335

 

[WestCoast]

here is the full article

California expands oral surgeons' scope of practice
More than two dozen medical groups raised patient safety concerns before lawmakers acted.

By Myrle Croasdale, AMNews staff. Nov. 6, 2006.

California's oral and maxillofacial surgeons without medical degrees may now do elective facelifts, rhinoplasties and eyelifts. A new law California Gov. Arnold Schwarzenegger signed Sept. 30 expanded the scope of practice for the doctors, leaving many physicians concerned about patient safety.

The measure allows oral and maxillofacial surgeons to perform elective facial surgery, including the head and neck area. More than a dozen other states have similar laws.
With this article
* Links
* See related content
* Regional news: West

Before California lawmakers passed the bill, the American Medical Association-backed Scope of Practice Partnership e-mailed its member organizations asking them to consider signing a letter in opposition to the bill and to encourage their members to contact their legislators and the governor's office to voice concern. As a result, 18 national specialty organizations, including the AMA, and 12 state medical societies signed a letter to the California governor explaining their opposition to the bill.

"They've replaced education with legislation," said John Osborn, MD, president of the California Society of Plastic Surgeons, which opposed the legislation and signed the letter.

Dr. Osborn said the legislation allows oral surgeons to perform procedures beyond what they were trained to do. For example, he said, the doctors don't have the same depth of knowledge as those with medical degrees. "They don't learn how to take care of such things as kidney problems, which can be important at times."

Gerald Gelfand, DMD, California Assn. of Oral and Maxillofacial Surgeons president, disagreed with that assessment and said members of his profession do get proper training.
More than a dozen states allow oral surgeons to perform elective facial surgery.

"We do the same type of procedures in the emergency department during the night, but are not allowed to do them during the day [outside of emergency call]," Dr. Gelfand said.

He said the law eliminates the inequity. "Safety is our primary concern," Dr. Gelfand said. "We're not some fringe group. We are a sophisticated group of surgeons, and we want to make sure our members are doing this safely. Only a small group of well-trained oral and maxillofacial surgeons will be doing this."

He estimated there were 30 to 40 oral surgeons among his group's 600 members who would qualify for the elective cosmetic surgery license. These oral surgeons have had four years of dental school for a DDS or DMD, followed by four years of surgical training.

There are also oral surgeons who have an MD degree and a DDS or DMD degree. These physicians are fully licensed to practice medicine and would not need a cosmetic surgery license. Their background includes four years of dental school, the last two years of medical school and four years of surgical training.

Dr. Osborn said he and his colleagues are concerned about oral surgeons without a medical degree.

"Now they have another pathway where they don't have to get an MD," he said. "It almost makes a mockery of our training. ... Our main hope is that the [oversight] committee is truly a gatekeeper committee and does its job -- that these people will get the training they need to do good work. I don't care what they call themselves if they do good work, are properly trained and don't hurt anybody. But we have real concerns that won't happen."

 

[tx oms]

Silly orthodontist, we've been through this before. Training, intelligence, & ability don't make you a good doctor. Having "MD" after your name makes you a good doctor.

Training isn't everything. If you want to do something in life there are usually hoops to jump through. Everyone would love something for nothing, but it's not going to happen.

Mediocre candidates are always posting on here, wanting to become an oral surgeon, nurses want to be anesthesiologists, hygienists want to fill teeth, lab techs want to open offices and make dentures, and about 500 Indian nationals on this board want to be dentists in American. Everyone wants to find a loophole. Sometimes they do find the loophole, but the reality is if you want certain privelages you usually have to complete the prerequisites.

Sure, plastic surgeons don't manage renal complications. But, how can we balk at periodontists taking out wisdom teeth and then complain when medical docs don't like dentists doing face lifts? Wisdom teeth aren't that hard. Periodontists can take them out; hell, they're trained to take out teeth in dental school. What dental school teaches face lifts? Medical school teaches surgery, including surgical subspecialties like plastics. How would we feel if ENT's started taking out wisdom teeth?

Six year OMFS programs were developed to get around the issue in California. You want to do face lifts as an oral surgeon? Spend the two extra years in training. Sorry, but it's reality. Put the law aside, what's the difference in a four year OMFS doing face lifts and a lab tech making dentures?

The MD conveys something to the public and opens doors. Look at JediWendell. He went into OMFS, got the MD, and moved to ortho. Why? Read his previous posts--he wanted an MD. Without the MD, you are a dentist. Period. Maybe a dental specialist, but still a dentist.

Even with an MD, there is an interesting flaw with oral surgeons doing face lifts: we are dental specialists. A medical license clearly gives you the legal authority to do anything you want, but in a court case how would that stand up? What would you say to the attorney who asks you, "You are a dental specialists governed by the ADA. What MEDICAL training do you have in cosmetic surgery? Sure, you have a medical degree and can legally do cosmetic surgery, but who taught you how to do the surgery--a dentist?"
Obviously there are answers, but it's an interesting point.

The ultimate answer is this: if you want medical privelages, follow the traditional route to get there. You want to be an anesthesiologist? Go to medical school instead of or after nursing school. You want to be a cosmetic surgeon? Go to med school and a PRS residency instead of or after dental school. There are OMFS guys who have gone on to complete other residencies. I'm sure those guys think they, more than plain six year oral surgeons, have the right to do expanded scope. Without the training you are relying on local attitudes, customs, and laws to do expanded scope oral surgery. If you're the type to be concerned about what the general surgeon in the next office over thinks you need to follow the traditional route. If you're confident, likeable, and capable do what you want.

Finally, these things are usually only issues in institutional settings. In the private world things are based more on free market economics than rules and policies. If your colleagues, medical and dental, and patients like you, you'll be able to do what you like. Of course, people jealous of your success may not like you too much.

In school and early in your residency it's easy to focus only on your training and your job, to think the whole world revolves around oral surgery. As you get further along, you begin to see the light at the end of the tunnel and start thinking about the rest of your life. Everyone at the hospital talks about what they're doing professionally. Who cares? That's only a small part of your life.

 

[EuroOMFS]

Just a few thought from overseas.

Training isn't everything. If you want to do something in life there are usually hoops to jump through. Everyone would love something for nothing, but it's not going to happen.

Agreed.

What dental school teaches face lifts? Medical school teaches surgery, including surgical subspecialties like plastics. How would we feel if ENT's started taking out wisdom teeth?

No dental school teaches face lifts, but then again no medical school does either, not in the pre-doctoral phase anyway. Isn't that our argument, as OMSs, for doing a lot of the things we do? A pre-grad degree, be it in medicine or dentistry, doesn't teach any of the things dental OR medical specialists do during and after their post-grad training. It teaches you the BASICS, that's it.

If ENTs started taking out wisdom teeth, we would probably feel a lot like, I don't know....ENTs that compete with thorasic surgeons doing thyroid surgery. But what if they actually did a good job, and could document similar or better complications rates than OMSs? It's a competitive world.

Put the law aside, what's the difference in a four year OMFS doing face lifts and a lab tech making dentures?

No difference as long as they both have the proper training.

Even with an MD, there is an interesting flaw with oral surgeons doing face lifts: we are dental specialists. A medical license clearly gives you the legal authority to do anything you want, but in a court case how would that stand up? What would you say to the attorney who asks you, "You are a dental specialists governed by the ADA. What MEDICAL training do you have in cosmetic surgery? Sure, you have a medical degree and can legally do cosmetic surgery, but who taught you how to do the surgery--a dentist?"
Obviously there are answers, but it's an interesting point.

What medical training do OMSs have for treating orbital fractures and frontal sinus fractures or doing tracheostomies, deep sedations etc? These are all procedures not at all related to teeth or jaws.

In northern Europe there a lot of OMS depts. where single qualified OMSs will only be allowed to treat mandible fractures and dentoalveolar trauma. The rest belongs to plastics or ENT. Yet these same depts. do bimaxillary orthognathic surgery and nobody complains. Why not? They're in the maxillary sinus for crying out loud!! That's ENT territory. Or the patient could bleed to death if these dentists can't ligate that artery! They don't teach that in dental school do they?!

We're single qualified in my dept. and we are one of a handful of places here where OMSs treat all facial trauma. I think (of course) that we do a great job. When I started my residency I wondered if not being medically qualified would really mean anything, and I have found that it doesn't mean anything when diagnosing and treating patients. It's was a drawback in the beginning, when I had to consult other specialities, order blood tests etc. After having rotated through medicine, ENT, anaesthesia and gen.surg. that wasn't a problem any more. I'm not saying these rotations can replace med school, but they go a long way.

The ultimate answer is this: if you want medical privelages, follow the traditional route to get there. You want to be an anesthesiologist? Go to medical school instead of or after nursing school. You want to be a cosmetic surgeon? Go to med school and a PRS residency instead of or after dental school.

Again I agree to certain extent. I would argue that a lot procedures single qualified OMSs do are medical procedures. However, I do not agree that they are any less competent to perform those procedures or care for their patients before and after, just because they are single qualified. I don't agree either, that they should have to go to med school to be able to perform cosmetic surgery on the face. If you can do a bimaxillary procedure or a NOE fracture with a dental degree, why should you need a medical degree to do a rhinoplasty or a brow lift?

 

[tx oms]

If ENTs started taking out wisdom teeth, we would probably feel a lot like, I don't know....ENTs that compete with thorasic surgeons doing thyroid surgery. But what if they actually did a good job, and could document similar or better complications rates than OMSs? It's a competitive world.

I plan on practicing in an area where I can do whatever I want. In private practice you are credentialed and judged on experience and results. Plastic surgeons or whoever would be hard pressed to stop a double degree guy from doing whatever they want. It may be easier to block a single degree guy from doing facelifts at the hospital, but not in his office or an outpatient surgery center, assuming it's legal in that state. You're right, it's a competitive world. Like I said:

"...these things are usually only issues in institutional settings. In the private world things are based more on free market economics than rules and policies. If your colleagues, medical and dental, and patients like you, you'll be able to do what you like."

Again I agree to certain extent. I would argue that a lot procedures single qualified OMSs do are medical procedures. However, I do not agree that they are any less competent to perform those procedures or care for their patients before and after, just because they are single qualified. I don't agree either, that they should have to go to med school to be able to perform cosmetic surgery on the face. If you can do a bimaxillary procedure or a NOE fracture with a dental degree, why should you need a medical degree to do a rhinoplasty or a brow lift?

More than anything, an MD opens some doors and gives a certain measure of street cred.

 

[Bitters]

must not be busy tonight nightfloatboy

 

[tx oms]

must not be busy tonight nightfloatboy

The nurses are scared of me. BTW, general surgery has got to be one of the most miserable residencies in the hospital. At least when they graduate they can look forward to...more misery.

 

[scalpel2008]

Even if we were to rename OMS to Oral and orbitozygomaticomaxillomandibulonasoethmoidosphenolacrimotemporofacial surgeons, we will still be dentists in the eyes of plastic surgeons. Do you really give a $hit? I know I don't. I will still get my 18 holes in every week with my general dentist friends and live comfortably. Isn't that what it's about?

 

[toofache32]

BTW, general surgery has got to be one of the most miserable residencies in the hospital. At least when they graduate they can look forward to...more misery.

Amen to that.

 

[IcedOMFS]

Even if we were to rename OMS to Oral and orbitozygomaticomaxillomandibulonasoethmoidosphenolacrimotemporofacial surgeons, we will still be dentists in the eyes of plastic surgeons. Do you really give a $hit? I know I don't. I will still get my 18 holes in every week with my general dentist friends and live comfortably. Isn't that what it's about?

I was hoping for a Hugh Hefner-style life... 4-5 bunny girlfriends... A mansion... Millions of dollars... My own personal 'grotto'... Wear a robe around all day...

 

[ItsGavinC]

Well being said that OMFS are definitly way higher than any dentist.

Yes, that's the goal. To be higher.