EDITORIAL J Oral Maxillofac Surg 72:1229-1230, 2014
The Importance of Being Walter The truth is rarely pure, and never simple. —Oscar Wilde All of us in our specialty owe some degree of debt to those who have come before us. Oral and maxillofacial surgery (OMS) remains a craft learned at the elbows of those from preceding generations. There is always something about the manner in which we weigh a decision, scribe a note, or tie a suture that betrays our intellectual and surgical bloodlines. There is no hiding from our OMS DNA. In September, the 2014 AAOMS Annual Scientific Meeting will be dedicated to Dr Walter C. Guralnick. This honor recognizes a man who has devoted nearly three quarters of a century to dentistry and OMS, continuing, even today, to exude an unquenchable optimism for the specialty’s future. To say that Walter helped put the ‘‘M’’ in OMS is not an overstatement. The privilege of our operating at the intersection of dentistry and medicine is very much a consequence of his life’s work. Our recognition as professional peers among surgical specialists in our hospitals is due, in large part, to his calculated efforts, personal style, and unique vision for the future of our specialty. I am proud to say that I have known Dr. Guralnick for over 30 years, yet this total span of my career fails to cover even half of his own. He was department chairman when I completed a dental school rotation in what was then called ‘‘oral surgery.’’ Committed since high school to a career in orthodontics, I had been home fewer than 24 hours from my honeymoon when I entered Dr Guralnick’s service. The experience was transformative. To hear my wife describe it, I walked 3 feet off the ground for 30 days and nights. When I looked in the mirror one morning after a long night in the hospital, I could not envision any career path other than becoming an oral and maxillofacial surgeon. There are many of us who think of Dr. Guralnick as a giant—proof that one’s legacy need not be defined by one’s physical stature. He is a soft-spoken man of slight build, always dapper in his crisply laundered shirts and hand-knotted silk bowties. At the age of 97 he still has a full head of his trademark white hair. He commands as much attention for his words and thoughts today as he did in his prime, when I first witnessed the influence he wielded over his faculty, residents, and patients. Our specialty is peppered with oral and maxillofacial surgeons trained by Dr Guralnick. The stories of
his work ethic and that which he demanded of his staff are the stuff of legends. In the tradition of great surgeons, he knows what he knows and argues his positions passionately. I love ‘‘discussing’’ with him whether we charge too much for procedures, use antibiotics appropriately, or remove too many wisdom teeth. He is a worthy opponent on any subject, because he remains as informed and opinionated as any among us. When I think of Dr Guralnick’s legacy, there are 3 areas where his leadership made an indelible stamp not only on our specialty, but on a broader sphere of medical/dental education and practice. First, is as an educational innovator. In an era when most faculty and even chairs were part-time, he recognized the importance of having full-time faculty based at the institution. In this way, he heightened the importance of the teaching mission of OMS programs to bring greater intensity to the training and mentoring of residents and fellows within the context of the clinical service. In addition, he architected and implemented one of the first double-degree programs for OMS training in the United States. The rationale was not a matter of adding an MD for the sake of the degree. Rather, he recognized the value of the general surgery resident experience to those becoming surgical specialists. The MD degree is not the end, but a means to an end: it is the golden ticket that grants OMS residents the privilege of training as fully integrated members of the general surgical team with clinical responsibility on par with their surgery peers. Second, is for his public policy vision. In the mid1960s dental insurance was a fledgling industry. Indeed, the idea of negotiated payment rates for dental procedures was anathema, believed by many to be detrimental to the dental enterprise. Dr Guralnick’s efforts to introduce dental insurance to the state of Massachusetts came at great cost to his personal and professional reputation. He realized, however, that applying an insurance model to dental care would promote greater access to dental services. As cofounder of Delta Dental of Massachusetts, where he served as president for 10 years, Dr Guralnick helped generations of Massachusetts residents seek affordable dental care. And, I believe it is no coincidence that operative treatment for impacted wisdom teeth is covered under medical, not dental, insurance. Third, is his insight into the financial plight of dental students and residents. It is a frequent theme in my
1229
1230 editorials that our specialty is facing a serious challenge in recruiting and retaining career academics in OMS, largely because of the shadow of debt that follows residents into practice. ‘‘The enormous increase in the cost of dental education is a matter of grave concern for everyone in dentistry . The first year oral surgical resident frequently begins his . training burdened with an indebtedness . often borrowed at extremely high rates of interest. Career choices can understandably be influenced by this responsibility.’’1 Dr Guralnick published this observation nearly 40 years ago. He proposed an ‘‘educational opportunity bank’’ where students would pledge a fixed percentage of future annual income over a number of years in lieu of student loans. Radical in its day, models such as that proposed by Dr Guralnick are now gaining traction. Financially strapped and Internet-savvy students are crowd-sourcing private ‘‘human capital contracts’’ that attract investors to fund advanced education in return for a percentage of promising salaries.2,3 Last summer, the state of Oregon approved a plan that could lead its public institutions to trade up front tuition payments for an at-risk share of a student’s future earnings.4 Those of us who have been fortunate enough to know Dr Guralnick and to work side-by-side with him appreciate the colleague as well as the visionary. He still attends the departmental service meeting each week, just as he has done for the past 64 years. When I marvel at what we can do for patients, I frequently check my impressions with his—coming as they do from one who grappled with the same challenges since the pre-antibiotic era. No longer performing surgery, he nonetheless keeps pace with the latest surgical innovations, adding substantively to conversations about personalizing medicine based on individual genetic codes or applying minimally invasive operative techniques. During the debates that inevitably ensue, those in the room always manage to
EDITORIAL
turn toward Dr Guralnick, seeking from him the wisdom of the ages. Commonly he offers a thoughtful or insightful response. At other times he simply shrugs and quips, ‘‘that approach didn’t work in 1950 either.’’ I am privileged to have spearheaded the effort leading to this recognition of Dr Guralnick’s lifetime of service to our specialty. I felt it was important that this man, who is so beloved at his own institution, be recognized nationally for the contributions that touch us all. In addition, so many among us wished for an opportunity to make public our affection and respect for one who has factored so prominently in our collective journey as oral and maxillofacial surgeons. Finally, for the younger generation of oral and maxillofacial surgeons, they should know how much of their good fortune they owe to a man named Walter. THOMAS B. DODSON, DMD, MPH Associate Editor
References 1. Guralnick WC: The educational opportunity bank. J Oral Surg 34: 1067, 1976 2. Roose K: The IPO of you and me: How normal people are becoming corporations. New York Magazine, November 19, 2013. Available at: http://nymag.com/daily/intelligencer/2013/11/ipo-of-you-andme.html. Accessed April 21, 2014 3. Bernard TS: Your money: Program links loans to future earnings. The New York Times, July 19, 2013. Available at: http://www. nytimes.com/2013/07/20/your-money/unusual-student-loanprograms-link-to-future-earnings.html?_r=0. Accessed April 21, 2014 4. Perez-Pe~ na R: Oregon looks at way to attend college now and repay state later. The New York Times, July 3, 2013. Available at: http://www.nytimes.com/2013/07/04/education/in-oregona-plan-to-eliminate-tuition-and-loans-at-state-colleges.html?ref= richardperezpena. Accessed April 21, 2014
Ó 2014 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2014.04.020
The Importance of Being Walter The truth is rarely pure, and never simple. —Oscar Wilde All of us in our specialty owe some degree of debt to those who have come before us. Oral and maxillofacial surgery (OMS) remains a craft learned at the elbows of those from preceding generations. There is always something about the manner in which we weigh a decision, scribe a note, or tie a suture that betrays our intellectual and surgical bloodlines. There is no hiding from our OMS DNA. In September, the 2014 AAOMS Annual Scientific Meeting will be dedicated to Dr Walter C. Guralnick. This honor recognizes a man who has devoted nearly three quarters of a century to dentistry and OMS, continuing, even today, to exude an unquenchable optimism for the specialty’s future. To say that Walter helped put the ‘‘M’’ in OMS is not an overstatement. The privilege of our operating at the intersection of dentistry and medicine is very much a consequence of his life’s work. Our recognition as professional peers among surgical specialists in our hospitals is due, in large part, to his calculated efforts, personal style, and unique vision for the future of our specialty. I am proud to say that I have known Dr. Guralnick for over 30 years, yet this total span of my career fails to cover even half of his own. He was department chairman when I completed a dental school rotation in what was then called ‘‘oral surgery.’’ Committed since high school to a career in orthodontics, I had been home fewer than 24 hours from my honeymoon when I entered Dr Guralnick’s service. The experience was transformative. To hear my wife describe it, I walked 3 feet off the ground for 30 days and nights. When I looked in the mirror one morning after a long night in the hospital, I could not envision any career path other than becoming an oral and maxillofacial surgeon. There are many of us who think of Dr. Guralnick as a giant—proof that one’s legacy need not be defined by one’s physical stature. He is a soft-spoken man of slight build, always dapper in his crisply laundered shirts and hand-knotted silk bowties. At the age of 97 he still has a full head of his trademark white hair. He commands as much attention for his words and thoughts today as he did in his prime, when I first witnessed the influence he wielded over his faculty, residents, and patients. Our specialty is peppered with oral and maxillofacial surgeons trained by Dr Guralnick. The stories of
his work ethic and that which he demanded of his staff are the stuff of legends. In the tradition of great surgeons, he knows what he knows and argues his positions passionately. I love ‘‘discussing’’ with him whether we charge too much for procedures, use antibiotics appropriately, or remove too many wisdom teeth. He is a worthy opponent on any subject, because he remains as informed and opinionated as any among us. When I think of Dr Guralnick’s legacy, there are 3 areas where his leadership made an indelible stamp not only on our specialty, but on a broader sphere of medical/dental education and practice. First, is as an educational innovator. In an era when most faculty and even chairs were part-time, he recognized the importance of having full-time faculty based at the institution. In this way, he heightened the importance of the teaching mission of OMS programs to bring greater intensity to the training and mentoring of residents and fellows within the context of the clinical service. In addition, he architected and implemented one of the first double-degree programs for OMS training in the United States. The rationale was not a matter of adding an MD for the sake of the degree. Rather, he recognized the value of the general surgery resident experience to those becoming surgical specialists. The MD degree is not the end, but a means to an end: it is the golden ticket that grants OMS residents the privilege of training as fully integrated members of the general surgical team with clinical responsibility on par with their surgery peers. Second, is for his public policy vision. In the mid1960s dental insurance was a fledgling industry. Indeed, the idea of negotiated payment rates for dental procedures was anathema, believed by many to be detrimental to the dental enterprise. Dr Guralnick’s efforts to introduce dental insurance to the state of Massachusetts came at great cost to his personal and professional reputation. He realized, however, that applying an insurance model to dental care would promote greater access to dental services. As cofounder of Delta Dental of Massachusetts, where he served as president for 10 years, Dr Guralnick helped generations of Massachusetts residents seek affordable dental care. And, I believe it is no coincidence that operative treatment for impacted wisdom teeth is covered under medical, not dental, insurance. Third, is his insight into the financial plight of dental students and residents. It is a frequent theme in my
1229
1230 editorials that our specialty is facing a serious challenge in recruiting and retaining career academics in OMS, largely because of the shadow of debt that follows residents into practice. ‘‘The enormous increase in the cost of dental education is a matter of grave concern for everyone in dentistry . The first year oral surgical resident frequently begins his . training burdened with an indebtedness . often borrowed at extremely high rates of interest. Career choices can understandably be influenced by this responsibility.’’1 Dr Guralnick published this observation nearly 40 years ago. He proposed an ‘‘educational opportunity bank’’ where students would pledge a fixed percentage of future annual income over a number of years in lieu of student loans. Radical in its day, models such as that proposed by Dr Guralnick are now gaining traction. Financially strapped and Internet-savvy students are crowd-sourcing private ‘‘human capital contracts’’ that attract investors to fund advanced education in return for a percentage of promising salaries.2,3 Last summer, the state of Oregon approved a plan that could lead its public institutions to trade up front tuition payments for an at-risk share of a student’s future earnings.4 Those of us who have been fortunate enough to know Dr Guralnick and to work side-by-side with him appreciate the colleague as well as the visionary. He still attends the departmental service meeting each week, just as he has done for the past 64 years. When I marvel at what we can do for patients, I frequently check my impressions with his—coming as they do from one who grappled with the same challenges since the pre-antibiotic era. No longer performing surgery, he nonetheless keeps pace with the latest surgical innovations, adding substantively to conversations about personalizing medicine based on individual genetic codes or applying minimally invasive operative techniques. During the debates that inevitably ensue, those in the room always manage to
EDITORIAL
turn toward Dr Guralnick, seeking from him the wisdom of the ages. Commonly he offers a thoughtful or insightful response. At other times he simply shrugs and quips, ‘‘that approach didn’t work in 1950 either.’’ I am privileged to have spearheaded the effort leading to this recognition of Dr Guralnick’s lifetime of service to our specialty. I felt it was important that this man, who is so beloved at his own institution, be recognized nationally for the contributions that touch us all. In addition, so many among us wished for an opportunity to make public our affection and respect for one who has factored so prominently in our collective journey as oral and maxillofacial surgeons. Finally, for the younger generation of oral and maxillofacial surgeons, they should know how much of their good fortune they owe to a man named Walter. THOMAS B. DODSON, DMD, MPH Associate Editor
References 1. Guralnick WC: The educational opportunity bank. J Oral Surg 34: 1067, 1976 2. Roose K: The IPO of you and me: How normal people are becoming corporations. New York Magazine, November 19, 2013. Available at: http://nymag.com/daily/intelligencer/2013/11/ipo-of-you-andme.html. Accessed April 21, 2014 3. Bernard TS: Your money: Program links loans to future earnings. The New York Times, July 19, 2013. Available at: http://www. nytimes.com/2013/07/20/your-money/unusual-student-loanprograms-link-to-future-earnings.html?_r=0. Accessed April 21, 2014 4. Perez-Pe~ na R: Oregon looks at way to attend college now and repay state later. The New York Times, July 3, 2013. Available at: http://www.nytimes.com/2013/07/04/education/in-oregona-plan-to-eliminate-tuition-and-loans-at-state-colleges.html?ref= richardperezpena. Accessed April 21, 2014
Ó 2014 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2014.04.020
