oral maxillofacial surgery VS Otolaryngology

[DREDAY]

"OMFS get just enough to warrant an MD." What are you basing it on? You are surely not basing it on the 230-260 STEP 1 scores that OMFS residents routinely get.

Clemenza, 1st 2 years of medical or dental school are not that hard, anyone can memorize disease names, drug names, bacteria names, and biochemistry which we learned 5 times in undergrad. Its not hard to score 1 standard deviation above mean in medical school. Real medicine is learned 3rd and 4th year.

Clemenza you are wrong. All MD integrated programs require you to to take all of 3rd and most of 4th year. All MD integrated programs, with the exception of 2 or 3 require you to take at least 2nd year of medical school.

Clemenza you are wrong. Where did you attend dental school? The amount of time you spend in biomedical sciences in dental school is different for each school. Where did you attend? Surely not UCSF, Harvard, UCLA or any of the top programs. In any case, during first 2 years of dental school, I went to school 8-5 5 days a week. In medical school, I went to school 8-12 everyday with afternoon labs once or twice a week.

And as for the medical schools granting MD degrees to OMFS residents, there are likely many more factors at play. Who knows? Maybe these medical schools feel that the OMFS residents get 'just enough' to warrant an MD degree, whereas the actual medical students who make it through the full curriculum get 'more than enough' to earn an MD.

And again, Armorshell, the numbers just don't add up. The first two years of dental school are not equivalent to the first two years of medical school. Approximately half of those two years, if not more, are devoted to dental-specific sciences. This is a fact. So where do the OMFS residents make up the difference? (And don't say "as part of their residency training", because we both know they are awarded the MD degree as soon as they complete the two years of medical school, which is usually by the third year of the 6 year program).

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[DREDAY]

No. We're talking about people sticking to their professions, and not cherry-picking work from other professions.

Think about it, Armorshell: How would oral surgeons feel about ENTs making wisdom teeth extractions a part of their practice? Do you think oral surgeons would accept this? ENTs are every bit as intimately familiar with the anatomy of the hard and soft tissues in the area. And the task of troughing, sectioning, and elevating the teeth are well within the surgical abilities of an ENT. But would oral surgeons tolerate this? Absolutely not! They'd go ballistic! They'd scream that exodontia is not a part of otolaryngology, and that extracting third molars requires a great deal of knowledge about dentition that ENTs don't possess (which is utter nonsense).


.

The reason ENT cannot do Exodontia is because most dental insurances will not reimburse them for it. And sure if ENT are adequately trained to perform exodontia to the standard of care I have no problem with ENT doing exodontia. One of the ENTs at my hospital peforms exodontia.... so what. Like a previous poster said, what dictates what you do is your referral base.

 

[Clemenza]

The USMLE board exams are in place to address exactly what you have just stated "standardization of education". Infact, with those USMLE scores an OMFS can apply to any other medical residency.

I didn't say they don't have an "MD" degree. What I'm saying is that they have not endured the same medical education that I am enduring right now.

To correct you, you are wrong. Programs require 2-3 years of medical school. Most programs require years 2, 3, and half of year 4. A couple of programs require years 3 and 4. NO PROGRAMS REQUIRE YEARS 1 AND 2 ONLY. All MD integrated programs require 1-2 years of General Surgery.

From the UNC School of Dentistry website:

Residents are eligible to receive a MD degree from UNC School of Medicine after 18 months of medical school study. The six year curriculum is integrated and residents enter medical school only after completing the internship year. They are required to pass USMLE 1 and USMLE 2. They are required to complete a post-graduate General Surgery Internship year at the completion of medical school.

Eighteen months is not even two full years of medical school, my friend!

From the UCLA School of Dentistry website:

The Section of Oral and Maxillofacial Surgery, in conjunction with the UCLA School of Medicine and the UCLA Medical Center, offers a six-year training program leading to the M.D. degree and the Oral and Maxillofacial Surgery residency certificate. The program includes three years as a resident on the Oral and Maxillofacial Surgery Service, two years as a full-time student at the UCLA School of Medicine, and one year as an intern/resident on the General Surgery Service of the UCLA Medical Center. For more information about the residency program, please refer to the admissions pages of the website.

Again, two years.

I picked these two programs at random. My own dental school requires residents to complete the 2nd and 3rd year of medical school, along with the 4th year of medical school, 7 months of which is spent in OMFS and anesthesia. So much for the fourth year, eh?

Once again, hospitals use evidence of competence to grant privileges to perform procedures.

And let me make it clear to you. There is nothing that I learned I learned in medical school, which I didn't learn in dental school which would help me perform a facelift or rhinoplasty. In fact, the head and neck anatomy that I received in dental school was more complete than in medical school.

Isn't that exactly what CRNAs say about CRNA programs vs. medical school and providing anesthesia?

Where did you go to dental school? Unlike you, I found a lot of redundancy in my medical education.

Where did you do your internship?

There's definitely redundancy. In fact, I'd say that the general breadth of topics covered in dental school is similar to medical school. Where they differ, though, is in the depth. Medical sciences like cardiology, nephrology, pathology, neurology, endocrinology etc. etc. are delivered to dental students as little more than a survey of the medical sciences for the sake of exposure -- i.e. so that dentists can have an idea of what goes on outside the mouth and make clinical decisions accordingly. In medical school, they are covered in vastly more detail. Moreover, they are taught to you in a manner where they clearly want you to potentially be able to manage conditions relating to these disciplines. That's a big, big difference in objective, and the discrepancy in actual material covered reflects this.

Now, don't get me wrong. I'm not saying that the medical science covered in dental school is a joke. It's certainly more than what a nurse-practitioner or a PA would get....albeit less clinically-oriented than a mid-level's training. But they are far, far less than what a medical student studies.

 

[Clemenza]

The minimum requirement to be accredited is 30 months of OMFS. The amount of time on service will vary by program ranging between 30 months to 42 months. I believe the average is 34 months in OMFS service.

DREDAY, I'll say two things in response:

First a four-year OMFS residency requires anything from 4 to 6 months on anesthesia, 1 to 2 months of internal medicine, a month of cardiology, 1-2 months of general surgery, 1 month of ICU, 1 month of emergency medicine, and so on and so forth. So the total time on OMFS might actually approach 30 months.

More importantly, you have to remember that OMFS programs must take care of the patients that are referred to them! That means they will spend a great deal of time extracting teeth, performing dentoalveolar surgery, treating mandible fractures, treating odontogenic infections, orthognathic cases, and managing pathology cases (e.g. cysts and tumors of the jaws, osteonecrosis, etc. etc.). That stuff takes up a lot of time. In fact, it takes up MOST of their time. So when you cut out the off-service rotations -- especially the ones that are not surgeries -- and you eliminate the time that they spend handling bread-and-butter oral surgery cases, it's easy to see that they simply don't have much time to do cosmetic cases. And again, who in the hell is going to refer cosmetic cases to them anyway??

 

[Clemenza]

The reason ENT cannot do Exodontia is because most dental insurances will not reimburse them for it. And sure if ENT are adequately trained to perform exodontia to the standard of care I have no problem with ENT doing exodontia. One of the ENTs at my hospital peforms exodontia.... so what. Like a previous poster said, what dictates what you do is your referral base.

Hold on there cowboy! OMFS's would be fuming mad if ENTs were taking out wisdom teeth the way oral surgeons were, and they'd fight it tooth and nail.

 

[Clemenza]

"OMFS get just enough to warrant an MD." What are you basing it on? You are surely not basing it on the 230-260 STEP 1 scores that OMFS residents routinely get.

First off, I'd like you to provide a reference for those stats.

But even if they're true, I am neither disputing the fact that OMFS residents are very capable of excelling in medical school nor the fact that they can study effectively for the USMLE. They have enough of a medical background by the end of their first year of residency to study for and succeed on the exam....especially if they're in a program where they enter medical school right off the bat.

Clemenza, 1st 2 years of medical or dental school are not that hard, anyone can memorize disease names, drug names, bacteria names, and biochemistry which we learned 5 times in undergrad. Its not hard to score 1 standard deviation above mean in medical school. Real medicine is learned 3rd and 4th year.

Maybe you're some sort of super-genius, DREDAY. But you have not completed a full-fledged medical education.

Clemenza you are wrong. All MD integrated programs require you to to take all of 3rd and most of 4th year. All MD integrated programs, with the exception of 2 or 3 require you to take at least 2nd year of medical school.

Oh, so I just happened to pick the "2 or 3 exceptions", eh?

Clemenza you are wrong. Where did you attend dental school? The amount of time you spend in biomedical sciences in dental school is different for each school. Where did you attend? Surely not UCSF, Harvard, UCLA or any of the top programs.

They don't rank dental schools, DREDAY. To my knowledge, the "top programs" to which you refer are simply "top programs" by word or mouth...or worse, only in your mind.

As for the school I attended, that's information I'd rather not divulge here for privacy reasons. Suffice it to say that it's a dental school here in the continental U.S., (and not Howard or Meharry.)

In any case, during first 2 years of dental school, I went to school 8-5 5 days a week. In medical school, I went to school 8-12 everyday with afternoon labs once or twice a week.

DREDAY, do we really need to get into the nitty-gritty of the curriculum? As a dental student I went to school 8AM to 5PM, 4 to 5 days a week, with the occasional "short" day where we left at 12. That doesn't mean squat.

Why don't you tell the physicians viewing this thread how your dental school spent your time from 8-5? In dental school, we didn't spend the entire day in lectures. We spent about half the day in lectures, and the other half in labs.

Let's talk about the lectures first. Three days a week for the entire duration of the second year, we had TWO HOURS of lecture on dentures. We also had one hour of lecture on crown & bridge, three days a week, for the entire second year. We had a year of endodontics lecture - also one hour, twice a week. A year of periodontics, three times a week, also for an hour. We had an oral pathology course that lasted a semester, occupying an hour of lecture time. There were other dental-specific courses that took up lecture time too. All in all, less than half of our time spent in lecture was devoted to biomedical sciences. And of those lectures, the material covered was narrower in scope and much shallower in depth.

Now for the afternoon. Are you going to have everyone here believe that you spent each afternoon from 1PM to 5PM sitting in lectures on renal physiology and congenital heart defects? Or are you going to be honest and tell everyone here that you spent those 4 hours drilling holes into plastic teeth and placing amalgam fillings, or grinding down the same plastic teeth in preparations for crown and bridge work? Will you be honest and tell everyone here that you spent some of those afternoons learning how to access the pulp chambers of teeth, and spent other afternoons learning how to insert files and instrument the root canals of those teeth? I also hope that you'll come clean and tell everyone here how you spent many afternoons, from 1-5, sitting in front of a bunsen burner, melting wax so that you could place plastic denture teeth onto the pink denture base. If you admit to that, then perhaps you'll also admit to spending a few afternoons -- also from 1-5 -- dripping wax onto tooth so that you could cast a gold crown. Hell, I even remember spending several afternoons, from 1-5, carving teeth out of wax blocks. None of that had anything to do with medicine, my friend. Not even remotely.

In medical school, we had anywhere from 3-5 lectures each morning, ALL OF THEM on biomedical sciences, all of them one-hour in duration, and all of them blasting through huge amounts of material. In addition to those, we had anatomy labs, pathology labs, and so on. And in addition to that, we had the occasional humanities or clinical competency lectures.

 

[DREDAY]

I didn't say they don't have an "MD" degree. What I'm saying is that they have not endured the same medical education that I am enduring right now.

A foreign medical grad has not endured the same medical education you have endured.... USMLE boards standardizes everyone's education so they are comparable.

From the UNC School of Dentistry website:

Residents are eligible to receive a MD degree from UNC School of Medicine after 18 months of medical school study. The six year curriculum is integrated and residents enter medical school only after completing the internship year. They are required to pass USMLE 1 and USMLE 2. They are required to complete a post-graduate General Surgery Internship year at the completion of medical school.

Eighteen months is not even two full years of medical school, my friend!

From the UCLA School of Dentistry website:

The Section of Oral and Maxillofacial Surgery, in conjunction with the UCLA School of Medicine and the UCLA Medical Center, offers a six-year training program leading to the M.D. degree and the Oral and Maxillofacial Surgery residency certificate. The program includes three years as a resident on the Oral and Maxillofacial Surgery Service, two years as a full-time student at the UCLA School of Medicine, and one year as an intern/resident on the General Surgery Service of the UCLA Medical Center. For more information about the residency program, please refer to the admissions pages of the website.

Again, two years.

I picked these two programs at random. My own dental school requires residents to complete the 2nd and 3rd year of medical school, along with the 4th year of medical school, 7 months of which is spent in OMFS and anesthesia. So much for the fourth year, eh?

The standardization of education is in the step 1. So what if they did 2 years of medical school, those students are still getting 230-240 on step 1.... That means that one way or another they learned the material they needed to learn to become a competent MD. Not only that.... if they decided to jump ship from OMFS and do a medical specialty, they could... why?? THEY ARE MDs.

The highest score for step 1 in the history of University of Michigan School of Medicine was a 280.... by an OMFS who did 2.5 years of medical school.

Don't be bitter you made the wrong career choice and are doing everything all over again.

Isn't that exactly what CRNAs say about CRNA programs vs. medical school and providing anesthesia?

OK.... so tell me something I could have learned during 1st year of medical school that I did not learn in dental school that would have helped me perform a rhinoplasty or facelift...... thank you

BTW at my program OMFS residents do 1st and 2nd year Med at the same time, followed by all of 3rd and half of 4th.

 

[DREDAY]

First off, I'd like you to provide a reference for those stats.

But even if they're true, I am neither disputing the fact that OMFS residents are very capable of excelling in medical school nor the fact that they can study effectively for the USMLE. They have enough of a medical background by the end of their first year of residency to study for and succeed on the exam....especially if they're in a program where they enter medical school right off the bat.



Maybe you're some sort of super-genius, DREDAY. But you have not completed a full-fledged medical education.



Oh, so I just happened to pick the "2 or 3 exceptions", eh?



They don't rank dental schools, DREDAY. To my knowledge, the "top programs" to which you refer are simply "top programs" by word or mouth...or worse, only in your mind.

As for the school I attended, that's information I'd rather not divulge here for privacy reasons. Suffice it to say that it's a dental school here in the continental U.S., (and not Howard or Meharry.)




DREDAY, do we really need to get into the nitty-gritty of the curriculum? As a dental student I went to school 8AM to 5PM, 4 to 5 days a week, with the occasional "short" day where we left at 12. That doesn't mean squat.

Why don't you tell the physicians viewing this thread how your dental school spent your time from 8-5? In dental school, we didn't spend the entire day in lectures. We spent about half the day in lectures, and the other half in labs.

Let's talk about the lectures first. Three days a week for the entire duration of the second year, we had TWO HOURS of lecture on dentures. We also had one hour of lecture on crown & bridge, three days a week, for the entire second year. We had a year of endodontics lecture - also one hour, twice a week. A year of periodontics, three times a week, also for an hour. We had an oral pathology course that lasted a semester, occupying an hour of lecture time. There were other dental-specific courses that took up lecture time too. All in all, less than half of our time spent in lecture was devoted to biomedical sciences. And of those lectures, the material covered was narrower in scope and much shallower in depth.

Now for the afternoon. Are you going to have everyone here believe that you spent each afternoon from 1PM to 5PM sitting in lectures on renal physiology and congenital heart defects? Or are you going to be honest and tell everyone here that you spent those 4 hours drilling holes into plastic teeth and placing amalgam fillings, or grinding down the same plastic teeth in preparations for crown and bridge work? Will you be honest and tell everyone here that you spent some of those afternoons learning how to access the pulp chambers of teeth, and spent other afternoons learning how to insert files and instrument the root canals of those teeth? I also hope that you'll come clean and tell everyone here how you spent many afternoons, from 1-5, sitting in front of a bunsen burner, melting wax so that you could place plastic denture teeth onto the pink denture base. If you admit to that, then perhaps you'll also admit to spending a few afternoons -- also from 1-5 -- dripping wax onto tooth so that you could cast a gold crown. Hell, I even remember spending several afternoons, from 1-5, carving teeth out of wax blocks. None of that had anything to do with medicine, my friend. Not even remotely.

In medical school, we had anywhere from 3-5 lectures each morning, ALL OF THEM on biomedical sciences, all of them one-hour in duration, and all of them blasting through huge amounts of material. In addition to those, we had anatomy labs, pathology labs, and so on. And in addition to that, we had the occasional humanities or clinical competency lectures.

Again... what dental school did you attend?
My morning lectures 8-12 were biomedical sciences.
My afternoon classes 1-5 were dental lab.

Medical school lectures 8-12 biomedical sciences.

Like I said before Pathophysiology and Physical diagnosis are subjects that were not covered in depth in dental school. Everything else was equivalent.

 

[DREDAY]

Oh, so I just happened to pick the "2 or 3 exceptions", eh?

Where does it say they dont do 2nd year of medical school?

 

[DREDAY]

So you are telling me what an OMFS resident does? hahaha

DREDAY, I'll say two things in response:

First a four-year OMFS residency requires anything from 4 to 6 months on anesthesia, 1 to 2 months of internal medicine, a month of cardiology, 1-2 months of general surgery, 1 month of ICU, 1 month of emergency medicine, and so on and so forth. So the total time on OMFS might actually approach 30 months.

More importantly, you have to remember that OMFS programs must take care of the patients that are referred to them! That means they will spend a great deal of time extracting teeth, performing dentoalveolar surgery, treating mandible fractures, treating odontogenic infections, orthognathic cases, and managing pathology cases (e.g. cysts and tumors of the jaws, osteonecrosis, etc. etc.). That stuff takes up a lot of time. In fact, it takes up MOST of their time. So when you cut out the off-service rotations -- especially the ones that are not surgeries -- and you eliminate the time that they spend handling bread-and-butter oral surgery cases, it's easy to see that they simply don't have much time to do cosmetic cases. And again, who in the hell is going to refer cosmetic cases to them anyway??

 

[bobby6]

I've personally have done dental extractions and third molars as an otolaryngology resident as we worked with an oral surgeon employed by our department during residency. There's nothing magic about it and its not all that hard. I'll pull teeth if during a cancer case the tumor is abutting the tooth.

I know of an ENT and a Plastic surgeon who are doing dental implants since its so lucrative for their patients who have had mandibular reconstruction with a osteocutaneous free flap. We do get training in osseointegrated implants for bone anchored hearing aids and auricular prosthesis.

Since I'm not a dentist, I would rather stay far away from doing those things. If medical reimbursement plummets with the healthcare reform, I wouldn't be suprised that other professionals may do more lucrative procedures such as dental implants. I think OMFS is already fumming with periodontists doing more and more dental implants.

 

[Leforte]

It seems that there is a lot of finger pointing and accusations that certain programs are or are not as qualified as others. The fact is that if a OMFS programs offers an MD as part of their training, that MD is considered equal to any other MD offered by any accredited US medical school. It does not matter how many hours one spends in lecture, or lab, or clinics or wherever. Some schools now do only PBL, some still have hours of lectures per day. Some have significantly lower clinical requirements (as a matter of fact, my medical school had 5 weeks of internal medicine in year 3. You read that correctly).

It does not bother me that an OMFS program is producing oral surgeons who possess both the MD and DDS degree. In fact, I find it reassuring that they have received additional clinical training in medicine aside from their dental training.

As anyone who has completed a residency will tell you, your knowledge of what you will practice daily once out on your own is learned in residency, not medical school. If OMFS surgeons are learning appropriate operative technique, preoperative patient selection and postoperative management, that is all that should really matter. Just as there can be wide variation in what surgical cases/volumes that allopathic surgical residents are exposed to in their training, I am sure that such variation also exists in the OMFS world. I do believe that the majority of graduating residents in any surgical specialty (including OMFS) will recognize their limitations when they go into practice and will either practice within their abilities or seek additional training for areas which they wish to focus, but feel unprepared. Yes, there are exceptions to this.

Personally, I feel that as surgeons, instead of going after one another, we should be more united. I am not a "the sky is falling" type of person, but if we fight among each other in turf wars, it is easier for mid-levels to make ingrowths into all of our fields. I think we would all agree that it is better that a trained OMFS with an MD degree and facial plastics experience be doing Botox injections than some Doctor of Nurse Practitioner who attended a weekend course. They are out there.

In the end, the medical and dental state boards, which serve to protect the public, have determined that OMFS surgeons who have completed an MD and passed the USMLE are qualified for a medical license. It really doesn't matter what prejudices you or I may or may not have against this.

 

[Gingiva]

So you are telling me what an OMFS resident does? hahaha

I'm a dental student and reading this thread with great interest. I seem to remember as a predental student seeing posts for DREDAY who had just gotten into dental school in 2005 or 2006. How far along are you in your OMFS residency to speak with such authority on the subject matter?

 

[280040]

wowowowowow. Slingin some mud!!

I must congratulate clemenza on bringing back my painful memories of dental labs, perio lectures, plastic teeth, dentures: those will drive almost anyone away from dentistry into medicine!

So much anger from the DDSs here, come on, we're not like this. You're preaching to people who don't want to listen. You're like the mormon missionary showing up at the door of a devout muslim. Both sides are passionate, and invested, but neither is superior or 100% correct or non biased.

I was wondering why the OS sdn boards are so slow, bring back the excitement there!

Great points brought up by both sides though. If you ignore the finger pointing and name calling, great ideas.

I am curious how those who feel DDS/MD OMFS can not/should not do cosmetics will plan on controlling them? If you're licensed physician in your state, you are able to practice medicine, is this correct? Does the sticking point come with malpractice since OMFS is covered under dental malpractice and thus you are giving care as a dentist and not a physician? Just wondering. And hospital credentialing may not be an issue either with community based surgical centers. Again, am I wrong or misguided?

With the info that DreDay has posted over the past few months I think I know what residency they are at. This is a VERY unique program in OMFS and his/her training is extraordinary and not the norm for the rest of the country. This may explain their perspective on this and why they are so passionate about it. Majority of other residents in the country don't have that kind of training access. This is not my perspective but comes from program directors, faculty, and chiefs.

 

[bobby6]

Again, I have no issues with anyone or any specialty doing any procedure as long as they have adequate training, consistently achieve results that are considered within the standard of care, and can manage postoperative complications. Its about patient safety.

If you are going to be doing facelifts, blepharoplasties, etc you better have admitting privileges at a hospital and have those privileges to perform them there also even if you are going to be doing those procedures at an outpatient surgicenter

I've seen and managed some horrible complications from those procedures in residency.

How about the facelift patient that developed a postoperative expanding hematoma 2 hours out from surgery that caused stridor and airway obstruction who almost needed to be trach'd emergently as multiple attempts at intubation failed and finally was intubated using a glidescope. Incidence of postoperative hematoma from a facelift has been reported in the literature as high as 8%!

How about the blepharoplasty that woke up from anesthesia bucking and coughing on the endotracheal tube and developed massive orbital hematoma requiring emergent lateral canthotomy and cantholysis?

What are you going to do with those patients if you don't have admitting privileges?

You better make sure that your malpractice covers you to do those procedures as one lawsuit without malpractice coverage can put an end to your career.

wowowowowow. Slingin some mud!!

I am curious how those who feel DDS/MD OMFS can not/should not do cosmetics will plan on controlling them? If you're licensed physician in your state, you are able to practice medicine, is this correct? Does the sticking point come with malpractice since OMFS is covered under dental malpractice and thus you are giving care as a dentist and not a physician? Just wondering. And hospital credentialing may not be an issue either with community based surgical centers. Again, am I wrong or misguided?

.[/I]

 

[Doc Smile]

I've personally have done dental extractions and third molars as an otolaryngology resident as we worked with an oral surgeon employed by our department during residency. There's nothing magic about it and its not all that hard. I'll pull teeth if during a cancer case the tumor is abutting the tooth.

Do you think this is the same mentality that the OMFS residents have for the procedures regarded as ENT specialties that they have been trained in during residency? I would think that most OMFSs will deal with a area outside the "immediate" oral cavity and surrounding structures if the need arises just as otolaryngologists deal with teeth abutting a tumor. $.02

 

[neutropeniaboy]

Nice post, LeFort.

We worked very closely with our OMFS colleagues in residency. We did cases together occasionally. They did trauma; we did trauma -- all trauma. They did cancer, neck dissections and free flaps; we did cancer, neck dissections and free flaps. We did sinus surgery; they did dental work/dental cosmetics. They did cleft lip; we did ear surgery. We did rhinoplasties and facelifts; they did orthognathic surgery.

Some of it is the same; some of it is different.

Frankly, now that I am out, I'm glad I have OMFS colleagues to call on for help and to receive my referrals. They do the same for me.

We coexist. We cross-over. That's medicine.

I've taken care of some of their messes, and they've taken care of some of mine. That's for sure...

 

[280040]

Again, I have no issues with anyone or any specialty doing any procedure as long as they have adequate training, consistently achieve results that are considered within the standard of care, and can manage postoperative complications. Its about patient safety.

If you are going to be doing facelifts, blepharoplasties, etc you better have admitting privileges at a hospital and have those privileges to perform them there also even if you are going to be doing those procedures at an outpatient surgicenter

I've seen and managed some horrible complications from those procedures in residency.

How about the facelift patient that developed a postoperative expanding hematoma 2 hours out from surgery that caused stridor and airway obstruction who almost needed to be trach'd emergently as multiple attempts at intubation failed and finally was intubated using a glidescope. Incidence of postoperative hematoma from a facelift has been reported in the literature as high as 8%!

How about the blepharoplasty that woke up from anesthesia bucking and coughing on the endotracheal tube and developed massive orbital hematoma requiring emergent lateral canthotomy and cantholysis?

What are you going to do with those patients if you don't have admitting privileges?

You better make sure that your malpractice covers you to do those procedures as one lawsuit without malpractice coverage can put an end to your career.

You're so right. BUT, I bet that doesn't stop people from doing it in the community. You ENTs provide good conversation. thx

 

[Clemenza]

Again... what dental school did you attend?
My morning lectures 8-12 were biomedical sciences.
My afternoon classes 1-5 were dental lab.

Medical school lectures 8-12 biomedical sciences.

Like I said before Pathophysiology and Physical diagnosis are subjects that were not covered in depth in dental school. Everything else was equivalent.

DREDAY, I suppose you consider your endodontics (root canal) course to be a "biomedical science"?

Or your periodontics course?

Or your orthodontics course?

Or your complete dentures course?

Or your removable partial dentures course?

Or your fixed prosthodontontics (crown & bridge) course?

Or your operative dentistry (fillings) course?

Or your dental materials course?

Or your dental / tooth anatomy course?

Or your dental treatment planning course?

....You consider these to be "biomedical sciences", do you?

I had lab from 1-5 too, DREDAY. Lab is where I, you, and every other dental student spends his time drilling on fake teeth, melting wax onto denture "plates" to set denture teeth, and practicing root canals on extracted teeth, etc.

Biomedical sciences, my ass!

The amount of biomedical sciences covered in medical school blows dental school out of the water. How do I know? Because I've been through both. I've been through a complete dental education, and am in the process of going through an unabridged medical education.

 

[Clemenza]

wowowowowow. Slingin some mud!!

I must congratulate clemenza on bringing back my painful memories of dental labs, perio lectures, plastic teeth, dentures: those will drive almost anyone away from dentistry into medicine!

So much anger from the DDSs here, come on, we're not like this. You're preaching to people who don't want to listen. You're like the mormon missionary showing up at the door of a devout muslim. Both sides are passionate, and invested, but neither is superior or 100% correct or non biased.

I was wondering why the OS sdn boards are so slow, bring back the excitement there!

Great points brought up by both sides though. If you ignore the finger pointing and name calling, great ideas.

I am curious how those who feel DDS/MD OMFS can not/should not do cosmetics will plan on controlling them? If you're licensed physician in your state, you are able to practice medicine, is this correct? Does the sticking point come with malpractice since OMFS is covered under dental malpractice and thus you are giving care as a dentist and not a physician? Just wondering. And hospital credentialing may not be an issue either with community based surgical centers. Again, am I wrong or misguided?

With the info that DreDay has posted over the past few months I think I know what residency they are at. This is a VERY unique program in OMFS and his/her training is extraordinary and not the norm for the rest of the country. This may explain their perspective on this and why they are so passionate about it. Majority of other residents in the country don't have that kind of training access. This is not my perspective but comes from program directors, faculty, and chiefs.

DrDM, I believe you are correct. A licensed physician can do anything within the scope of medicine. A pulmonologist can legally perform a hip-replacement, and a pediatrician can legally perform a craniotomy. Hence, there are no legal barriers that distinguish one specialty from the next. It is up to physicians to stick to the scope of their specialties.

Oral surgeons, however, are a bit different. Even the ones with medical degrees are still dentists. Even an oral surgeon with an active medical license who practices "oral surgery" is still practicing dentistry. Oral surgery is a specialty of dentistry, period. And as I've said before, facelifts and nosejobs are not a part of dentistry.

 

[gary_ruska]

I'm sorry, Armorshell, but the difference between medicine and dentistry is hardly a "superficial" matter. And the difference between an MD and a DDS is much more than a minor technicality, despite your wishes.

Gary "Leave the gun. Take the cannoli" Ruska here,

Why are you so bent out of shape about this? People who have completed ENT training have commented, very eloquently, about how practice is a collaborative effort and that these issues really aren't a huge deal for the vast majority of practitioners.

It seems that the only people who make a stink about this are either dental students or med students, neither of whom have actually completed surgical training or been in surgical practice. Conversely, people who have actually completed OMFS/ENT/PRS training have stated that, in general, these specialties get along and they respect each other's training and experience.

Also, it is somewhat arrogant of a medical student (or resident), to suggest that their opinions on what constitutes adequate medical education for an MD degree and approrpriate surgical training trumps the collective opinions of the medical schools, LCME, state medical and dental boards, ACGME and CODA.

If you have such a problem with this, write to your medical school dean, state medical board, state dental board and anyone else in a position of power to effect the current state of affairs.

You don't seem to have a problem with ENTs (or PRS) doing orthognathic surgery or repairing fractures that involve malocclusions. GR doesn't either, because GR assumes that a responsible practitioner would only do those cases if they felt comfortable with their knowledge of occlusion. They certainly did not learn any occlusion in medical school and must have picked up those skills in residency/fellowship. Because they are, technically, correcting malocclusions, are they practicing dentistry without proper training? Absolutely not - they are doing what they are trained to do, just like the OMFS who decides to do some facial esthetic surgery.

Finally, cosmetic surgery is elective and the patients are healthy (ASA 1 or 2). In real life, anyone who has more comorbidities will have a medical and anesthesia clearance before surgery. The surgeon's job becomes to recognize the need for clearance and to perform the surgery. A little common sense and some education will help you get to the clearance part. You sure as heck don't learn how to do the surgery in medical school - surgical training does that.

GR works with ENT/PRS attendings on a daily basis and care is always collaborative. GR has cleaned up some ENT/PRS messes and vice versa. The real enemies are malpractice attorneys and insurance companies - don't let these cosmetic battles (pun intended) blindside you.

BTW - facelifts and nosejobs fall under the dental practice act for oral and maxillofacial surgery. If you read the actual laws for the dental practice acts in most states, you will see that esthetic modification of the maxillofacial complex is included in the definition of dentistry and/or oral and maxillofacial surgery. If you think it is not appropriate for an oral surgeon to do esthetic surgery, then maybe you should suggest that they stop doing esthetic orthognathic surgery. You should also stop maxillofacial prosthodontists from creating prosthetic eyes, ears and noses.

 

[Clemenza]

Gary "Leave the gun. Take the cannoli" Ruska here,

Why are you so bent out of shape about this? People who have completed ENT training have commented, very eloquently, about how practice is a collaborative effort and that these issues really aren't a huge deal for the vast majority of practitioners.

I'm not "bent out of shape" about this. I've been around oral surgeons enough to know that the overwhelming majority of them will spend their days pulling teeth. What I'm debating (heatedly) is purely a technical matter--i.e. that of scope.

Conversely, people who have actually completed OMFS/ENT/PRS training have stated that, in general, these specialties get along and they respect each other's training and experience.

I've never said otherwise. In fact, if you read my earlier posts, you'll see that I said that oral surgeons may very well be qualified to perform procedures that are more appropriately considered to be within the scope of ENT or plastics.

Also, it is somewhat arrogant of a medical student (or resident), to suggest that their opinions on what constitutes adequate medical education for an MD degree and approrpriate surgical training trumps the collective opinions of the medical schools, LCME, state medical and dental boards, ACGME and CODA.

You're putting words in my mouth, Gary. I'm not saying that the medical education received by oral surgery residents in 6-year (i.e. "dual degree") oral surgery residencies is inadequate for a medical degree. Obviously it's adequate for a medical degree because they're being given medical degrees!! What I am saying is that by the time they are awarded the MD degree, they have not covered the same volume of material that standard medical students have covered. This is not my opinion. It is a fact that can be readily deduced when you look carefully at the actual education of a dual degree oral surgeon. When you add up the medically-oriented content of their dental education with the content of their two years in medical school, the aggregate simply doesn't add up to that of 4 years in medical school.

Does this make a difference materially, i.e. in practice? Probably not. Every dual degree oral surgeon I've met was a medical whiz. But as far as I'm concerned, they haven't paid the same dues to earn their MDs as ENTs, plastic surgeons, neurosurgeons, pediatricians, or other physicians have. And the lack of standardization between the different 6-year oral surgery residency programs with regard to which years of medical school are to be completed strongly suggests that little effort has been made by the residency programs and medical schools to ensure that these oral surgeons have actually covered, topic-for-topic, the same exact couses as standard medical students have.

In reality, what medical schools are probably doing is saying, "Well.....it's close enough, so let's go ahead and award them the MD."

If you have such a problem with this, write to your medical school dean, state medical board, state dental board and anyone else in a position of power to effect the current state of affairs.

You don't seem to have a problem with ENTs (or PRS) doing orthognathic surgery or repairing fractures that involve malocclusions.

Two points in response to this:

Dentistry falls within the scope of medicine, and not vice-versa. A physician can legally perform a root canal. But under no circumstance can a dentist (such as an oral surgeon with a medical degree) perform heart transplants as part of his clinical practice. That's looking at the matter from a technical standpoint.

Realistically, I do tend to look at medicine and dentistry as two separate (but related) professions and as a result I would certainly have a problem with ENTs performing orthognathic surgeries and other such dental procedures.

BTW - facelifts and nosejobs fall under the dental practice act for oral and maxillofacial surgery. If you read the actual laws for the dental practice acts in most states, you will see that esthetic modification of the maxillofacial complex is included in the definition of dentistry and/or oral and maxillofacial surgery.

That is a relatively new thing. The ADA modified its definition of dentistry in the 90's to accommodate oral surgeons who were doing facelifts, and basically make it so that they were doing them more "legally".

If you think it is not appropriate for an oral surgeon to do esthetic surgery, then maybe you should suggest that they stop doing esthetic orthognathic surgery.

Orthognathic procedures are bread-and-butter oral surgery. That's a ridiculous analogy you just made.

You should also stop maxillofacial prosthodontists from creating prosthetic eyes, ears and noses.

Making prosthodontic eyes, ears, and noses is not surgery, pal. It is a non-surgical field. Maxillofacial prosthodontists don't even place the magnetic implants that would hold the prostheses in place!! In fact, it really doesn't even require a doctoral degree. There are plenty of people who make prosthetic eyeballs who don't have dental degrees.

 

[Doc Smile]

I'm not "bent out of shape" about this. I've been around oral surgeons enough to know that the overwhelming majority of them will spend their days pulling teeth. What I'm debating (heatedly) is purely a technical matter--i.e. that of scope.



I've never said otherwise. In fact, if you read my earlier posts, you'll see that I said that oral surgeons may very well be qualified to perform procedures that are more appropriately considered to be within the scope of ENT or plastics.



You're putting words in my mouth, Gary. I'm not saying that the medical education received by oral surgery residents in 6-year (i.e. "dual degree") oral surgery residencies is inadequate for a medical degree. Obviously it's adequate for a medical degree because they're being given medical degrees!! What I am saying is that by the time they are awarded the MD degree, they have not covered the same volume of material that standard medical students have covered. This is not my opinion. It is a fact that can be readily deduced when you look carefully at the actual education of a dual degree oral surgeon. When you add up the medically-oriented content of their dental education with the content of their two years in medical school, the aggregate simply doesn't add up to that of 4 years in medical school.

Does this make a difference materially, i.e. in practice? Probably not. Every dual degree oral surgeon I've met was a medical whiz. But as far as I'm concerned, they haven't paid the same dues to earn their MDs as ENTs, plastic surgeons, neurosurgeons, pediatricians, or other physicians have. And the lack of standardization between the different 6-year oral surgery residency programs with regard to which years of medical school are to be completed strongly suggests that little effort has been made by the residency programs and medical schools to ensure that these oral surgeons have actually covered, topic-for-topic, the same exact couses as standard medical students have.

In reality, what medical schools are probably doing is saying, "Well.....it's close enough, so let's go ahead and award them the MD."



Two points in response to this:

Dentistry falls within the scope of medicine, and not vice-versa. A physician can legally perform a root canal. But under no circumstance can a dentist (such as an oral surgeon with a medical degree) perform heart transplants as part of his clinical practice. That's looking at the matter from a technical standpoint.

Realistically, I do tend to look at medicine and dentistry as two separate (but related) professions and as a result I would certainly have a problem with ENTs performing orthognathic surgeries and other such dental procedures.



That is a relatively new thing. The ADA modified its definition of dentistry in the 90's to accommodate oral surgeons who were doing facelifts, and basically make it so that they were doing them more "legally".




Orthognathic procedures are bread-and-butter oral surgery. That's a ridiculous analogy you just made.



Making prosthodontic eyes, ears, and noses is not surgery, pal. It is a non-surgical field. Maxillofacial prosthodontists don't even place the magnetic implants that would hold the prostheses in place!! In fact, it really doesn't even require a doctoral degree. There are plenty of people who make prosthetic eyeballs who don't have dental degrees.

It seems, regardless of anyone else's views or opinions, that you will continue to argue your point stubbornly and somewhat ridiculously. I am confused at what your goal is in this conversation. Is it to attempt and degrade other professionals in another field, establish your dominance, or reassure yourself of your ever-changing career choice? All I have witnessed is other professionals, ENTs, MDs, OMFS, DDSs, etc, adding positive and noteworthy pieces to the conversation as you pick apart their statements and attempt to provide counterarguments to every line without adding anything valuable. If you wish to coexist with other professionals on a friendly basis, I suggest you stop taking each post as a personal attack on your character/profession and learn from what others are saying.

DS

 

[K Niner]

Lol actually the vast majority of physicians can perform neither a root canal nor heart transplant. Ask a malpractice lawyer. And I don't think any physician can perform a root canal legally (as many have stated you can do what you have been trained to do, and no physician is trained to perform a root canal at all).

Quit being so bitter you didn't go to med school, or just actually go...

 

[Clemenza]

It seems, regardless of anyone else's views or opinions, that you will continue to argue your point stubbornly and somewhat ridiculously. I am confused at what your goal is in this conversation. Is it to attempt and degrade other professionals in another field, establish your dominance, or reassure yourself of your ever-changing career choice? All I have witnessed is other professionals, ENTs, MDs, OMFS, DDSs, etc, adding positive and noteworthy pieces to the conversation as you pick apart their statements and attempt to provide counterarguments to every line without adding anything valuable. If you wish to coexist with other professionals on a friendly basis, I suggest you stop taking each post as a personal attack on your character/profession and learn from what others are saying.

DS

Doc Smile, you're still a dental student, so I think you need to get a bit further into your career and accrue some more experience before you comment on this topic.

Nobody is belittling anyone's profession here. And to be sure, I have a lot of respect for the knowledge and skill of an oral surgeon -- if I ever needed orthognathic surgery, I sure as hell wouldn't go to an ENT or plastic surgeon for it. And God forbid, should the bones in my face ever get broken from a car-accident, I'd be happy to have an oral surgeon fix 'em. But that's not the point. This whole discussion here is about people sticking to their professions. Read some posts further back, and you'll see that there are physicians here who agree that oral surgeons should not be dipping into the work of ENTs and plastic surgeons.

 

[Doc Smile]

Doc Smile, you're still a dental student, so I think you need to get a bit further into your career and accrue some more experience before you comment on this topic.

Nobody is belittling anyone's profession here. And to be sure, I have a lot of respect for the knowledge and skill of an oral surgeon -- if I ever needed orthognathic surgery, I sure as hell wouldn't go to an ENT or plastic surgeon for it. And God forbid, should the bones in my face ever get broken from a car-accident, I'd be happy to have an oral surgeon fix 'em. But that's not the point. This whole discussion here is about people sticking to their professions. Read some posts further back, and you'll see that there are physicians here who agree that oral surgeons should not be dipping into the work of ENTs and plastic surgeons.

Thank you for pointing out that I am a dental student! I, however, did not know that a DDS or other professional degree was required to read all the posts and comment on your tone and patterns! How foolish of me! You are right, experience in my field will help me make educated responses to posts on an internet forum.

You know what, I DID read a few posts back! (I think I learned that in high school but I will check my diploma) You know what I found! -That many ENTs agreed that if OMFS are trained in the 'work' of ENTs and PRSs, from residency, fellowship, etc, then they agreed that they have perfect reason to expand their scope of practice! GASP!

Do I need a degree to point out this makes no sense:
"Dentistry falls within the scope of medicine, and not vice-versa. A physician can legally perform a root canal."

Because if Medicine does not fall within the scope of dentistry, then, according to your logic, physicians cannot perform a root canal.

Oh and:
"I do tend to look at medicine and dentistry as two separate (but related) professions"

But you just said dentistry falls within the scope of medicine? Hmmmm

What about this:
"I'm not saying that the medical education received by oral surgery residents in 6-year (i.e. "dual degree") oral surgery residencies is inadequate for a medical degree. Obviously it's adequate for a medical degree because they're being given medical degrees!!"

But then you continue to say:
"as far as I'm concerned, they haven't paid the same dues to earn their MDs as ENTs, plastic surgeons, neurosurgeons, pediatricians, or other physicians have"

Wait! You just that 6yr oral surgery residences are adequate for a medical degree. . .. but then again they haven't paid the same dues? Hmm 4 years DS, 2 years medicine, 4 years Residency (relatively). 4+4+2 = 10 years post secondary school. Isnt the path to ENT 4 years Med school, 4 years residency? 4+4 still equal 8 right and 8 is less than 10. Now, don't misquote me as you have so famously done, I am not trying to say that OMFS are better trained, more trained, or better than ENTs, I am just using this as a point to counter argue your 'dues' statement.

This statement of yours shows your true reasoning behind your fiery temper:
"I didn't say they don't have an "MD" degree. What I'm saying is that they have not endured the same medical education that I am enduring right now."

You want us to congratulate you on your hard work. Well congratulations! you are going to be more trained than most people in your field! I am sorry you made poor choices in your past and are now trying to rationalize them with everyone else's supposed inadequacies.

See, I can do what you do! Damn, I may ask my dean if I can go up a year!

Regardless, my point still stands. You quoted me and attacked me, as a dental student, in an attempt to subordinate me without adding any knowledge or useful information.

Thank you for your input!
DS

PS: since you think that OMFS are doing something unethical (I mean it has to be unethical from what you said because they dont have the proper training to broaden their scope), have you done anything about this topic besides argue you it behind a avatar on internet forums? Have you written to anyone - AAOMS, ABOMS, AMA, FACS, ABS, ABOTO? I am guessing no. But, if you have, then I am guessing they have thought about this topic much more than you. I am still uneducated in many areas. The only action I currently am aware of to limit the scope of OMFS is the recent AMA publication.

PPS: Regardless of my current degree, I am educated and educate myself in many areas that I am interested in. While I do not have my OMFS certificate or DDS, I am aware of what is going on in the field and that alone should qualify me as being knowledgeable - more proof that the letters behind one's name does not limit their knowledge!

 

[Leforte]

Isnt the path to ENT 4 years Med school, 4 years residency? 4+4 still equal 8 right and 8 is less than 10.

ENT residency is 5-7 years. So 9-11 in total. Fellowships are 1-2 years on top of that.

Regardless, this thread is getting irritating. If the surgeons who are performing the operations, have no problem with surgeons in other fields who are adequately trained and have outcomes within the standard of care in their community performing the same operations (nor do hospital credentialing committees, malpractice insurance, state licensing boards, etc), I really do not see why we are debating the issue with people who are in no position to 1) comment on another surgeons capabilities or training or 2) affect state licensing/hospital credentialing/malpractice rates.

This issue comes up in many combined programs. Whether it is a OMFS/MD program, MD/PhD program, BA/MD program. The PhD only crowd will insist that their PhD is "better" than an MD/PhD because it takes longer. It really doesn't matter. The Deans/Administrators who are in leadership positions have decided that all these combined pathways develop people who are trained equally to those who complete them separately. These same deans/administrators would have thoroughly investigated the curriculum/syllabus of the individual programs as well as the combined programs and have determined that the core material to be delivered is compatible across each. Are there additional subjects covered if you pursues each independently? I am sure that there is. The question is, however, does this make someone a better physician, scientist, surgeon, etc? I would argue that it is the training that one receives post MD, DDS, PhD, etc, that separates those with potential from mediocrity.

 

[Doc Smile]

ENT residency is 5-7 years. So 9-11 in total. Fellowships are 1-2 years on top of that.

Thanks for the correction!

DS

 

[Fah-Q]

OK. Stupid question time:

Do OMF surgeons obtain a medical license or dental license or both when they start practice? Does it depend on the state?

 

[Gingiva]

Great question. Perhaps DREDAY can comment on this.

OK. Stupid question time:

Do OMF surgeons obtain a medical license or dental license or both when they start practice? Does it depend on the state?

 

[armorshell]

OK. Stupid question time:

Do OMF surgeons obtain a medical license or dental license or both when they start practice? Does it depend on the state?

This sort of depends. I have heard tales of dual-degree OMFS practicing under a medical license only. Suffice to say that since all OMFS must have a dental degree, all may also obtain a dental license, and those that obtain an MD may obtain a medical license. All dual degree surgeons I've met activated and maintain both licenses, but there are almost certainly exceptions.

 

[servitup]

As my chairman says, the MD is really just a membership card. The fact is, 10 years from now Clemenza, you will remember as much from your 1st two years of med school as I do and I didn't have to do them.

Remember, the difference between an ENT and a pyschiatrist is residency training, not the first two years of medical school.

Further, it seems to me that OMFS med students tend to be upper echelon medical students once they integrate into the class. Afterall, these are by default the most driven and some of the most intelligent people in the dental community. Otherwise, they wouldn't sign up for such a long and grueling residency in a profession that doesn't even require a residency.

 

[Clemenza]

You know what, I DID read a few posts back! (I think I learned that in high school but I will check my diploma) You know what I found! -That many ENTs agreed that if OMFS are trained in the 'work' of ENTs and PRSs, from residency, fellowship, etc, then they agreed that they have perfect reason to expand their scope of practice! GASP!

Change the word "many" to "some", and your statement would be believable.

Do I need a degree to point out this makes no sense:
"Dentistry falls within the scope of medicine, and not vice-versa. A physician can legally perform a root canal."

Because if Medicine does not fall within the scope of dentistry, then, according to your logic, physicians cannot perform a root canal.

Well Doc Smile, I'm kind of duped here. I really don't know how to put it in more simple terms that the ones you quoted above. I'll give it a shot, though.

Dentistry is a subset of medicine. That means that everything that a dentist does falls within the scope of medicine, but not vice-versa.

Oh and:
"I do tend to look at medicine and dentistry as two separate (but related) professions"

But you just said dentistry falls within the scope of medicine? Hmmmm

Hmmm what? I said that I, Clemenza, tend to look at medicine and dentistry as two separate professions. Legally, dentistry is a subset of medicine. A physician has a legal right to perform a root canal. Under no circumstance does a dentist have any legal authority to perform hip replacements or manage high-risk pregnancies the way a licensed physician of any specialty does.

What about this:
"I'm not saying that the medical education received by oral surgery residents in 6-year (i.e. "dual degree") oral surgery residencies is inadequate for a medical degree. Obviously it's adequate for a medical degree because they're being given medical degrees!!"

But then you continue to say:
"as far as I'm concerned, they haven't paid the same dues to earn their MDs as ENTs, plastic surgeons, neurosurgeons, pediatricians, or other physicians have"

You missed my point, Smile Doc. My point is that U.S. medical students receive far more extensive didactic and clinical training than that which is required to earn an M.D. I've taken the USMLE, and the amount of material covered on it doesn't amount to a third of what I studied during my first two years of medical school. So, like I said: dual-degree oral surgeons are getting enough to be awarded an MD, but have not covered as much ground as a regular 4-year medical student has. Hence, they haven't paid the same dues to earn their MDs as physicians have.

Seriously, Smile Doc. Do you even understand why dual-degree oral surgery programs came into existence here in the U.S.? Are you aware that very few of them give a damn about having a medical education per se, and only want the "MD" by their name so that they can avoid the resistance that single-degree oral surgeons often deal with? About half the oral surgery residencies in this country are single-degree, so that should make it clear to you that the profession itself is sharply divided over the value of the MD degree as it relates to oral surgery. In light of this, it should come as no surprise that there is no standardization as to what part of a medical school the dual-degree OMFS residents will receive, nor when during their 6 year residencies these years will be completed. At VCU, for example, it's tacked onto the very end of the residency--presumably because they consider it to be an utter waste of time that is of no value to the resident.

Wait! You just that 6yr oral surgery residences are adequate for a medical degree. . .. but then again they haven't paid the same dues? Hmm 4 years DS, 2 years medicine, 4 years Residency (relatively). 4+4+2 = 10 years post secondary school. Isnt the path to ENT 4 years Med school, 4 years residency? 4+4 still equal 8 right and 8 is less than 10. Now, don't misquote me as you have so famously done, I am not trying to say that OMFS are better trained, more trained, or better than ENTs, I am just using this as a point to counter argue your 'dues' statement.

Don't fool yourself into thinking that your first two years of dental school are anything like the first two years of medical school. While much of the dental school curriculum during the 1st and 2nd years are purely dentistry-related (e.g. crown/bridge, dentures, dental anatomy, dental materials, operative/fillings, etc. etc.), nearly 100% of the M1 and M2 years are biomedical science courses...with a few humanities lectures thrown in here and there.

And then there are the D3 and D4 years of dental school. When I was in dental school, I spent most of my time during those years placing fillings, doing crown-preps, and making dentures. And, of course, I extracted many teeth. That's not exactly very medically-oriented clinical training, now is it!?

In medical school, students rotate through surgery (CT, ENT, general, orthopaedic), ophthalmology, family medicine, internal medicine, pediatrics, OBGYN, and...and...and. That's training you won't even taste in dental school.

Your comparison between OMFS and ENT by simply tallying up the number of years spent in school or residency is completely misguided. The bottom line is that a dental education is not even remotely a medical education. And by the way, Smile Doc, you should also know that oral surgery residents spend a lot of their time......can you guess what?.......pulling teeth in their oral surgery clinic!! In fact, most OMFS residencies have their residents spend an entire year in their oral surgery clinic, shucking teeth. That's not exactly very medically-oriented work either.

This statement of yours shows your true reasoning behind your fiery temper:
"I didn't say they don't have an "MD" degree. What I'm saying is that they have not endured the same medical education that I am enduring right now."

Your psychoanalysis aside, my statement is factually correct.

You want us to congratulate you on your hard work. Well congratulations! you are going to be more trained than most people in your field! I am sorry you made poor choices in your past and are now trying to rationalize them with everyone else's supposed inadequacies.

Actually, Smile Doc, you are absolutely wrong about me. For the most part, I've always enjoyed dentistry and, more importantly, I've always recognized the importance of my work as a dentist. It's a fantastic profession, and attending medical school has only made me appreciate its value more. While I think medicine is more interesting and perhaps more intellectually challenging than dentistry, I have never thought of myself as moving from a lesser profession to a greater one.

That being said, as a dentist, I think that dentists should stick to practicing dentistry and not try to delve into areas that are traditionally medicine. I don't think that oral surgeons should ever refer to themselves as "cosmetic surgeons" or "maxillofacial surgeons", nor should they ever name their practices as "John Doe, MD, DMD. Maxillofacial and Cosmetic Surgery".

Oral surgeons are super-important specialists within the field of dentistry, and should act like it.

See, I can do what you do! Damn, I may ask my dean if I can go up a year!

Regardless, my point still stands. You quoted me and attacked me, as a dental student, in an attempt to subordinate me without adding any knowledge or useful information.

Well, I was a naive, clueless dental student once too. But unlike you, I kept my mouth shut and watched and learned how things work, and never pretended to possess wisdom.

Thank you for your input!
DS

PS: since you think that OMFS are doing something unethical (I mean it has to be unethical from what you said because they dont have the proper training to broaden their scope),

I never said that they don't have the proper training. I said that they are dentists, not physicians, and thus should be practicing dentistry rather than medicine. Doing facelifts is practicing medicine.

have you done anything about this topic besides argue you it behind a avatar on internet forums? Have you written to anyone - AAOMS, ABOMS, AMA, FACS, ABS, ABOTO? I am guessing no. But, if you have, then I am guessing they have thought about this topic much more than you. I am still uneducated in many areas. The only action I currently am aware of to limit the scope of OMFS is the recent AMA publication.

Like I said earlier in this thread, there are some oral surgeons who recognize what profession in which they're practicing, and others who want to be physicians and basically practice medicine. Nothing--certainly not a general dentist like me--is going to redirect their intentions.

PPS: Regardless of my current degree, I am educated and educate myself in many areas that I am interested in. While I do not have my OMFS certificate or DDS, I am aware of what is going on in the field and that alone should qualify me as being knowledgeable - more proof that the letters behind one's name does not limit their knowledge!

No, you are not aware. How do I know this? Because in dental school, they keep your nose busy doing operative, prosthodontics, and periodontics. Your exposure to oral surgery is pretty-much limited to your dental school's oral surgery clinic where you'll spend your time there pulling teeth and perhaps performing a little alveoloplasty or tori reductions if you're lucky. You'll also spend no more than a week or two shadowing the residents performing their hospital-based duties. Trust me, you don't know much about oral surgery. Neither did I when I graduated from dental school.

 

[Clemenza]

As my chairman says, the MD is really just a membership card. The fact is, 10 years from now Clemenza, you will remember as much from your 1st two years of med school as I do and I didn't have to do them.

Remember, the difference between an ENT and a pyschiatrist is residency training, not the first two years of medical school.

Further, it seems to me that OMFS med students tend to be upper echelon medical students once they integrate into the class. Afterall, these are by default the most driven and some of the most intelligent people in the dental community. Otherwise, they wouldn't sign up for such a long and grueling residency in a profession that doesn't even require a residency.

Servitup, I agree with your statement to an extent. Yes, after 10 years, a dual-degree oral surgeon is probably going to remember as much general medicine as an ENT or a plastic surgeon will....assuming he/she deals with medical issues with the same regularity that ENTs and plastic surgeons do. And that's a big "if". Most dual-degree OMFSs do the same kind of office-based work that single-degree guys do. Pull teeth, place implants, and sedate ASA I's and II's.

On another note, I'd surmise that not in 20 or 30 years of clinical practice would a mid-level provider know the same amount of medicine that an MD does. A medical education does have some long-term value!

 

[servitup]

And that's a big "if". Most dual-degree OMFSs do the same kind of office-based work that single-degree guys do. Pull teeth, place implants, and sedate ASA I's and II's.

Interestingly, I have rotated with a private ENT group and the bulk of their time is spent doing tubes and tonsils, allergy, sinus surgery, and picking old men's earwax. These activities require no more medical expertise than the OMFS office-based work you speak of. In the absence of providing general anesthesia in-office, they probably require less.

I'm sure private plastic surgeons sit around reading up on hypertension, diabetes, and the like rather than thinking about boob jobs and face lifts too (<-- sarcasm).

 

[gary_ruska]

Gary "lines are blurred usually because someone is blurring them" Ruska here,

GR thinks that an important point that is being glossed over here is the suggestion that dentistry is a subset of medicine. While this may be the philosophy of certain dental schools and a theoretical construct for academic faculties of medicine, it bears little relevance in the practing world.

There are dental boards and there are medical boards and they license these two professions independently. While a medical license is per se unrestricted, it is not carte blanche to do anything. An important corollary to practice is malpractice coverage, which most states require in order to issue a medical license.

Here's where the "MD endodontist" you keep mentioning gets into trouble. No medical malpractice carrier that GR knows of would cover a non-DDS doing a primary dental procedure (even for MD OMFS who don't have dental licenses, but have medical licenses, there are significant hurdles toward getting malpractice coverage for routine oral surgery procedure). The converse of this is not necessarily true, as many oral surgeons (DDS and DDS, MD) have facial esthetic surgery covered by their malpractice insurance.

A lot of the arguments posted here are typical medical student arguments about theoretical constructs that have little to no actual relevance in the practicing world.

Sure, dentistry may be considered a subspecialty of medicine, but one that is so unimportant to medicine that:

1) it is not included in a standard medical education.
2) licensure of practitioners is generally not associated with medical boards
3) malpractice insurers for medical insurance are hesitant to cover primary dental service by non-DDS as well as those with DDS but without dental licenses.

GR would be curious about what MD Clemenza thinks about OMFS who harvest their own rib, calvarial, iliac crest, tibial bone grafts? Are they practicing medicine as well? One could make the argument that a pneumothorax following rib harvest is a medical problem and that only someone trained to manage said complication should do the procedure. If Clemenza thinks that most OMFS programs do not teach their residents these things, then perhaps Clemenza went to a dental school without an oral surgery program or one that had an unacceptably limited scope.

Below is an abbreviated list of the core credentialing procedures for OMFS at GR's institution (obvious "dental procedures" like teeth, intraoral procedures, orthognathic, TMJ and implants removed). GR would be VERY interested in hearing Clemenza's take on which of these procedures are not appropriate because OMFS is a dental specialty. Keep in mind that these procedures are in the "Core" for OMFS and no additional evidence needs to be furnished by the practitioner, other than being BC/BE and licensed with malpractice coverage, to do the following:

Arthroscopic & Endoscopic procedures involving facial skeleton or salivary glands
Blepharoplasty
Bone harvest, iliac crest (anterior and posterior)
Bone harvest, tibia
Bone harvest, calvarium
Bone harvest, costochondral
Decompression of nerves
Fracture treatment (open and closed), mandible, maxilla, zygoma, orbital bones, frontal bone
Grafting procedures including bone, skin, gingival,inlay, and pedicle
Implant procedures, facial, orbital and nasal
Lip, palatal cleft, & tongue surgery (including shave and wedge resection)
Mandibulectomy
Maxillectomy including radical w/ orbital exenteration
Mentoplasty
Nasal Septoplasty (w or w/o maxillary osteotomy)
Nerve graft harvest
Otoplasty
Palatoplasty
Partial glossectomy
Placement of nasal balloon to control hemorrhage
Reanastomosis of nerves
Repair of traumatic oroantral, oronasal communication
Repositioning of muscles, nerves, and ducts
Rhinoplasty (w or w/o maxillary osteotomy)
Sequestration & saucerization
Surgical procedures of salivary gland/duct
Tracheostomy and/or Tracheotomy

 

[DREDAY]

I still don't understand how Clemenza argues that maxillofacial trauma including NOE's and frontal table fractures are within the scope of OMFS but facial cosmetics is not.....

 

[Fah-Q]

Interestingly, I have rotated with a private ENT group and the bulk of their time is spent doing tubes and tonsils, allergy, sinus surgery, and picking old men's earwax. These activities require no more medical expertise than the OMFS office-based work you speak of. In the absence of providing general anesthesia in-office, they probably require less.

This might be the most uninformed statement I've read on this board in years.

 

[Doc Smile]

I still don't understand how Clemenza argues that maxillofacial trauma including NOE's and frontal table fractures are within the scope of OMFS but facial cosmetics is not.....

:troll:

His argument is based purely on others comments. He has no facts. Just the ability to pick apart what people say.

 

[servitup]

Don't misunderstand me. I think ENT is a great specialty with a fantastic broad scope requiring very detailed and in depth medical knowledge. I feel the same way about OMFS.

My only point was that office-based OMFS and office-based ENT both require medical knowledge. Most OMFS spend the majority of their time in their offices. Same can be said for most ENT. That doesn't mean medical knowledge become useless to either group.

 

[wolfman26]

I think your BS about OMFS who are dual degreed not goin through all the "years of medical training" an ENT goes through is purely technical. If they can take step 1 and make the score then WHO ARE YOU to disqualiy them from pursuing the rest of their medical education and getting an MD? You can't and shouldn't remark as though you have the authority to do so. It makes no difference if years 1 and 2 are completed if one can learn the material and not just pass step 1 but get a decent score. Some dental schools integrate both med and dent schools years 1 and 2 so to say arbitrarily that the dual degreed omfs are not qualified for the MD has no basis. Reading your arguments has done Nothing but shown your ignorance of the actuality of most dual degreed surgeons and their scope and the level of excellence with how they do surgery within that scope, no matter whether it be dentalveolar or cosmetic in nature. As mentioned, what is more cosmetic than surgically repositioning one's jaws ad putting them in a more natural and ESTHETIC appearance for not only function but form as well.

A surgeon in any field within his/her right mind will not perform nor have the desire to perform a procedure he/she is unsure of how to manage COMPLETELY including complications not just from a privilege standpoint but from malpractice as well. So why not just give up an argument that you will not win but will only prolong. I would argue with great confidence that some omfs are more qualified at some surgeries outside the oral cavity than some ENT's are. So does that mean because they didn't go to year 1 and 2 of medical school as you the"almighty expert on the issue" did, that they shouldn't proceed with the surgery? Absolutely not. That is completely unfounded and proposterous to think such a thing. Have fun picking this apart as I have seen you can, but know that I would guess most omfs in this forum would clearly hear my arguments and agree on most levels.

It's all really about prestige and money collected to you. Isn't that the big issue at heart? Just don't want your pocketbook encroached upon by those who might be just as qualified even though it may not be their bread and butter they do every day. Or to say some " dentist" can do a surgery better than you, you just can't stand it. Your way outta left field. Just let go of something so elementary in nature. Why can't you just work with them in peace as happens every day in private practice. Have a good one!

 

[dilated]

It's all really about prestige and money collected to you. Isn't that the big issue at heart? Just don't want your pocketbook encroached upon by those who might be just as qualified even though it may not be their bread and butter they do every day. Or to say some " dentist" can do a surgery better than you, you just can't stand it. Your way outta left field. Just let go of something so elementary in nature. Why can't you just work with them in peace as happens every day in private practice. Have a good one!

Did you just argue that HE'S the one who's all about prestige and money because he thinks OMFS shouldn't do cosmetic blepharoplasties?

Money makes the world go round. Strange how you don't hear ENTs saying that OMFS shouldn't do orbital fractures while OMFS argues that they're awesome at them. It's like every turf war in medicine: people fight over $$$$ procedures. I don't think anybody who's not making money off the debated procedures (one way or the other) really cares.

 

[5150]

This might be the most uninformed statement I've read on this board in years.

The theme of this thread seems to be people making generalizations based on limited knowledge/exposure, as evidenced by servitup among others.

Any way we can move this thread to the OMFS board? Seems to be mostly them aruging amongst themselves at this point.

 

[servitup]

The theme of this thread seems to be people making generalizations based on limited knowledge/exposure

Says the guy finishing his prelim year.........

 

[MRSA]

A lot of the arguments posted here are typical medical student arguments about theoretical constructs that have little to no actual relevance in the practicing world.

GR for the win.

 

[5150]

Says the guy finishing his prelim year.........

Yes, as your research into my background confirms, I am a PGY-2. Hence, you don't see me making uninformed statements about other people's professions, as you have done in this thread.

These subtleties appear to be lost on you...

 

[servitup]

Hence, you don't see me making uninformed statements about other people's professions, as you have done in this thread.

I apologize if the original intent of that post was unclear and I want to be clear that I have the utmost respect for the specialty of otolaryngology/H&N surgery.

The point I tried to make (but failed miserably at) was that to the uninformed whose only exposure to a specialty is superficial, it is easy to portray a specialty as boring or unimpressive. For example, one may say "OMFS shouldn't be doing cosmetic surgery. I spent some time shadowing my local OMFS and all he does is put people to sleep and pull teeth." Or one may say, "I rotated with a private ENT group and all they did was tubes, tonsils, and pick old men's earwax." Or "I shadowed a general surgeon and all he did was repair hernias and do colonoscopies."

I was intentionally being over the top with my original statement because it was akin to many of the posts which were directed at OMFS. My sarcasm was well intentioned but poorly carried off. This will be my last post on this thread but the bottom line is that both ENT and OMFS are fantastic specialties with great broad scopes which serve important roles in the community. Despite some overlap in scope, the skills and knowledge of the individuals in each community will determine who is or is not "the best" at whatever procedure is in question.

Sorry again for the confusion and condescending tone of my earlier posts.

 

[Clemenza]

I still don't understand how Clemenza argues that maxillofacial trauma including NOE's and frontal table fractures are within the scope of OMFS but facial cosmetics is not.....

DREDAY, that is an incredibly lousy comparison.

First off, I don't think that fixing NOEs and frontal sinus fractures should be within the scope of oral surgery. But I recognize the fact that it is, and I can see how it became so.

Fixing NOEs and frontal sinus fractures, which could occur in conjunction with LeFort 1 and LeFort 2 fractures (injuries which are well-within the scope of oral surgery) isn't much of a stretch. So it's easy to see how injuries a tad further up became part of oral surgery.

Bringing a healthy patient in for an elective procedure on the soft tissues of their face for the purpose of making cosmetic improvements is an entirely different process.

If you can't recognize the difference between the two, then I don't know what to tell you.

 

[Clemenza]

:troll:

His argument is based purely on others comments. He has no facts. Just the ability to pick apart what people say.

And you, as a measely dental student who spends the vast majority of his time melting wax onto acrylic trays, are in a position to claim that I "have no facts".

Like I said, Doc Smile, get a little further into your career. Then talk.

 

[Clemenza]

I think your BS about OMFS who are dual degreed not goin through all the "years of medical training" an ENT goes through is purely technical. If they can take step 1 and make the score then WHO ARE YOU to disqualiy them from pursuing the rest of their medical education and getting an MD?

I've taken the USMLE and I can tell you that it covers less than half of the material we learn in medical school.

And since dual-degree oral surgeons haven't attended 4 years-worth of medical school, I can say comfortably that they have not been through all of the years of a medical education.

You can't and shouldn't remark as though you have the authority to do so.

Since I've been through dental school and am now in medical school, I think I'm well-equipped to make the remarks I do.

It makes no difference if years 1 and 2 are completed if one can learn the material and not just pass step 1 but get a decent score.

See my answer above regarding the USMLE.

Some dental schools integrate both med and dent schools years 1 and 2 so to say arbitrarily that the dual degreed omfs are not qualified for the MD has no basis.

First off, most dental schools do not have the medical and dental students take classes together. Second, even the schools that do this do not have the dental students take all of the courses the medical students take. And third, there is no standardization in terms of which two years of medical school that dual-degree residents complete. The chances are exceedingly small that a dual-degree OMFS resident has completed, year-for-year, the same medical education that a traditional medical student has.

Reading your arguments has done Nothing but shown your ignorance of the actuality of most dual degreed surgeons and their scope and the level of excellence with how they do surgery within that scope, no matter whether it be dentalveolar or cosmetic in nature.

Oral surgeons are very well-trained and very capable surgeons. I've never said anything otherwise. I am simply arguing that they should be practicing dentistry, and not medicine.

As mentioned, what is more cosmetic than surgically repositioning one's jaws ad putting them in a more natural and ESTHETIC appearance for not only function but form as well.

Surgery on hard-tissues and surgery on soft-tissues are quite different. They're different in terms of the problems they address. They're different in terms of patient evaluation. They're different in terms of surgical skill. They're different in terms of post-operative management. They're quite different, period.

A surgeon in any field within his/her right mind will not perform nor have the desire to perform a procedure he/she is unsure of how to manage COMPLETELY including complications not just from a privilege standpoint but from malpractice as well. So why not just give up an argument that you will not win but will only prolong. I would argue with great confidence that some omfs are more qualified at some surgeries outside the oral cavity than some ENT's are. So does that mean because they didn't go to year 1 and 2 of medical school as you the"almighty expert on the issue" did, that they shouldn't proceed with the surgery? Absolutely not. That is completely unfounded and proposterous to think such a thing. Have fun picking this apart as I have seen you can, but know that I would guess most omfs in this forum would clearly hear my arguments and agree on most levels.

I don't know, Wolfman. Maybe I'm just one of those crazy people who think that people who wish to practice medicine should become physicians, and people who wish to practice dentistry should become dentists, and that dentists who decide they want to practice medicine should bite the bullet and go through channels that physicians have (and vice-versa...although you really don't see many plastic surgeons or ENTs trying to perform orthognathic surgery, now do you).