J Oral Maxillofac
Surg
50:102,1992
PROBLEMS FACING OUR SPECIALTY To the Editor-The Special Committee on Strategic Planning and the AAOMS Board of Trustees are to be commended on the plan that they have developed. We must, however, avoid finding ourselves in the position of not seeing the forest for the trees. Simply put, the major problems that face oral and maxillofacial surgery are as follows: 1) Oral and maxillofacial surgery manpower exceeds the number of patients that require our services. As a result, the battle for turf, with the accompanying loss of camaraderie, is taking a great deal of satisfaction out of practice. 2) While we compete for patients, our colleagues in periodontics are mounting an all-out effort to take dentoalveolar surgery, the very lifeblood of our practices, away from us. 3) As the AAOMS supports and encourages involvement in cosmetic surgery, our plastic surgery and ENT colleagues with whom we have worked long and hard to develop harmonious relationships are doubting our intentions and preparing for battle. At present, we are able to perform all procedures associated with the management of maxillofacial trauma and orthognathic reconstruction to include cosmetic softtissue procedures and nasal reconstruction. It only makes sense, that if one wishes to do more, he or she should obtain residency training in the appropriate specialty. To do battle with the specialties of plastic surgery and ENT is not in our best interest. 4) Patients belonging to HMOs and PPOs are receiving services at ridiculously low fees, while conventionally insured and noninsured individuals are charged usual and customary fees. Our specialty provides the service, takes all the risk, and the insurance company receives equal or better profits. Such programs exist because, as a group, we are disorganized and uninformed. These are the major problems that I believe face our specialty and require priority attention before we bury ourselves in busywork. ROY D.KINDRICK, DDS,MSD
Denton, Texas
INFORMED CONSENT FOR THE DUAL DEGREE To the Editor-Ever since the Scope Conference, sponsored by the American Association of Oral and Maxillofacial Surgeons, and later the Teneriffe and Bermuda Conferences, sponsored by the European Oral and Maxillofacial Surgeons (to which some of the American Oral and Maxillofacial Surgeons were invited as observers), there appears to be an
understanding and an agreement by most members of the Board of Directors of the American Association of Oral and Maxillofacial Surgeons that dual-degree programs in oral and maxillofacial surgery will be the new educational standard. Dr McCallam’s published prescription for the future training of oral and maxillofacial surgeons, which will integrate our specialty into the current field of medicine, seemed to be far reaching and attainable. Later, the Council on Residency Education and Training of the American Association of Oral and Maxillofacial Surgeons filled in the details, which provide for an integrated program in both medicine and Oral and Maxillofacial surgery that will lead to a dual degree in a 4 to &year period. Now, with over 33% of the programs offering dualdegree options, it appears to me that we will become a medical specialty when the number of dual-degree members and the time period are appropriate. The idea of a dual track in our specialty is just a temporary expediency. Anecdotally, about 40 years ago, Reed Dingman, MD, DDS, and James Cameron, DDS, had a vigorous discussion at one of our National meetings regarding the necessity for medical training in our specialty. I was told that in this discussion, Dr Dingman stated that single-degree oral and maxillofacial surgeons should confine their surgery to the dentoalveolus and that they were not trained for surgery beyond that. Dr Cameron countered by calhng Dr Dingman a 90-day wonder since he had received his medical degree after only 18 months of training while in the service. Since that debate, I thought we had won the dual-degree battle with the advance of our specialty from 1960 through 1989. Now it seems that single-degree oral and maxillofacial surgeons may have lost the war. Dual-degree issues and the impact on our specialty of oral and maxillofacial surgery have never been fully discussed with all of our membership, nor has the decision to integrate dual degrees into our training programs been accepted by a vote in the House of Delegates. True, there have been two or three open forums on dual-degree issues at our National meeting, and Dr McCallum’s call for debate and discussion has elicited some letters to the editor in our Journal. Nowhere have I seen a call for a consensus conference, nor has there been a referendum by and for our membership. The House of Delegates, as far as I know, has not had the opportunity to ratify such a decision. It seems to me that a decision that would change our specialty from one that is now primarily based on dentistry to one that will be primarily based in medicine should be fully discussed and ratified by our House of Delegates at a future national meeting. I think it is appropriate to discuss this issue at the state and local level, and then if it is appropriate, our House of Delegates should ratify the pursuit of dual-degree educational programs in our specialty as the preferred standard of the AAOMS, if we all agree. To do otherwise will lead to an early splitting of our specialty into oral surgeons, oral and maxillofacial surgeons, and maxillofacialcraniofacial surgeons. If that split is not apparent in the next few years, then the marketplace will create the split for us. IRWINA.SMALL, DDS
Birmingham,
102
Michigan
Surg
50:102,1992
PROBLEMS FACING OUR SPECIALTY To the Editor-The Special Committee on Strategic Planning and the AAOMS Board of Trustees are to be commended on the plan that they have developed. We must, however, avoid finding ourselves in the position of not seeing the forest for the trees. Simply put, the major problems that face oral and maxillofacial surgery are as follows: 1) Oral and maxillofacial surgery manpower exceeds the number of patients that require our services. As a result, the battle for turf, with the accompanying loss of camaraderie, is taking a great deal of satisfaction out of practice. 2) While we compete for patients, our colleagues in periodontics are mounting an all-out effort to take dentoalveolar surgery, the very lifeblood of our practices, away from us. 3) As the AAOMS supports and encourages involvement in cosmetic surgery, our plastic surgery and ENT colleagues with whom we have worked long and hard to develop harmonious relationships are doubting our intentions and preparing for battle. At present, we are able to perform all procedures associated with the management of maxillofacial trauma and orthognathic reconstruction to include cosmetic softtissue procedures and nasal reconstruction. It only makes sense, that if one wishes to do more, he or she should obtain residency training in the appropriate specialty. To do battle with the specialties of plastic surgery and ENT is not in our best interest. 4) Patients belonging to HMOs and PPOs are receiving services at ridiculously low fees, while conventionally insured and noninsured individuals are charged usual and customary fees. Our specialty provides the service, takes all the risk, and the insurance company receives equal or better profits. Such programs exist because, as a group, we are disorganized and uninformed. These are the major problems that I believe face our specialty and require priority attention before we bury ourselves in busywork. ROY D.KINDRICK, DDS,MSD
Denton, Texas
INFORMED CONSENT FOR THE DUAL DEGREE To the Editor-Ever since the Scope Conference, sponsored by the American Association of Oral and Maxillofacial Surgeons, and later the Teneriffe and Bermuda Conferences, sponsored by the European Oral and Maxillofacial Surgeons (to which some of the American Oral and Maxillofacial Surgeons were invited as observers), there appears to be an
understanding and an agreement by most members of the Board of Directors of the American Association of Oral and Maxillofacial Surgeons that dual-degree programs in oral and maxillofacial surgery will be the new educational standard. Dr McCallam’s published prescription for the future training of oral and maxillofacial surgeons, which will integrate our specialty into the current field of medicine, seemed to be far reaching and attainable. Later, the Council on Residency Education and Training of the American Association of Oral and Maxillofacial Surgeons filled in the details, which provide for an integrated program in both medicine and Oral and Maxillofacial surgery that will lead to a dual degree in a 4 to &year period. Now, with over 33% of the programs offering dualdegree options, it appears to me that we will become a medical specialty when the number of dual-degree members and the time period are appropriate. The idea of a dual track in our specialty is just a temporary expediency. Anecdotally, about 40 years ago, Reed Dingman, MD, DDS, and James Cameron, DDS, had a vigorous discussion at one of our National meetings regarding the necessity for medical training in our specialty. I was told that in this discussion, Dr Dingman stated that single-degree oral and maxillofacial surgeons should confine their surgery to the dentoalveolus and that they were not trained for surgery beyond that. Dr Cameron countered by calhng Dr Dingman a 90-day wonder since he had received his medical degree after only 18 months of training while in the service. Since that debate, I thought we had won the dual-degree battle with the advance of our specialty from 1960 through 1989. Now it seems that single-degree oral and maxillofacial surgeons may have lost the war. Dual-degree issues and the impact on our specialty of oral and maxillofacial surgery have never been fully discussed with all of our membership, nor has the decision to integrate dual degrees into our training programs been accepted by a vote in the House of Delegates. True, there have been two or three open forums on dual-degree issues at our National meeting, and Dr McCallum’s call for debate and discussion has elicited some letters to the editor in our Journal. Nowhere have I seen a call for a consensus conference, nor has there been a referendum by and for our membership. The House of Delegates, as far as I know, has not had the opportunity to ratify such a decision. It seems to me that a decision that would change our specialty from one that is now primarily based on dentistry to one that will be primarily based in medicine should be fully discussed and ratified by our House of Delegates at a future national meeting. I think it is appropriate to discuss this issue at the state and local level, and then if it is appropriate, our House of Delegates should ratify the pursuit of dual-degree educational programs in our specialty as the preferred standard of the AAOMS, if we all agree. To do otherwise will lead to an early splitting of our specialty into oral surgeons, oral and maxillofacial surgeons, and maxillofacialcraniofacial surgeons. If that split is not apparent in the next few years, then the marketplace will create the split for us. IRWINA.SMALL, DDS
Birmingham,
102
Michigan
