- Email: [email protected]
Halting the trend toward a double degree
548
LETTERS
and deliberate attempts to develop the surgical science of oral and maxillofacial surgery. These advances, which led the way to the expansion in scope that we currently enjoy, have been nurtured by many individuals-the vision of Robert Walker, the research of Bell, the academic scrutiny of Epker and Laskin, and the innovative and clinically critical work of Wolford and West. In reality, it has been the surgeons who have been privileged to practice oral and maxillofacial surgery over the last 15 years who, by listening and reading, by writing and sharing, have given birth to the surgical renaissance of our specialty. Oral and maxillofacial surgeons, regardless of the number of degrees, have achieved recognition in the hospital, academic, and private sectors. We enjoy a scope and diversity of clinical practice that ranges from anesthesia to xeroradiography, based on our self-fueled energy and creativity and the proven track record of our membership. Having an MD degree has had nothing to do with our development to this date. So what has happened? I believe a consortium of leaders in political and academic circles have caused this stampede. There is no doubt that the discussions at Tenerife and Bermuda have created this manifest destiny for oral and maxillofacial surgery. By converting the training programs to mandatory double-degree status in a short generation, the specialty will change without even providing the mainstream of its membership the opportunity to confirm this direction. Hardly democratic. There is no question that this evolution is highly complex, and, while well-meaning educators and politicians alike move the specialty forward in this area, many questions remain unresolved. I just cannot help asking, “Why the rush, and why is the operative word mandatory rather than optional?” Indeed, the implications on scope, professional liability, credentials, insurance reimbursement, and academic advancement are far-reaching and meaningful. Will the single-degree oral and maxillofacial surgeon have his scope limited, will his credential list be cut back? What will the country do with 200 high-powered double-degree maxillofacial surgeons being produced each year? Who will take out the teeth, and on, and on? Perhaps most poignant for me is the comment made by an individual whom I respect as a surgeon and as an educator, when, in a moment of truth, stated, “well, now at last people I meet at cocktail parties will understand what I tNly do.” It is both frustrating and sad for me to see that after we have won the great battles in the operating room, in the laboratory, and in the classroom, we are rolling over and becoming a specialty that, I believe, will be incorporated into the mainstream of American medicine and lose its uniqueness and true strength as time passes. STEPHEN A. SACHS,DDS Lake Success, New York MAKING Two EQUAL ONE
To the Editor:-1 am writing in regard to the editorial in the November 1988 Journal of Oral and Maxillofacial Surgery and the current trend of our specialty. There are many reasons for and against oral and maxillofacial surgeons seeking both DDS and MD degrees. On the one hand, we now have extensive training programs, 4 years in length, which include rotations in medicine, surgery, anesthesia, and pathology. We have a tre-
TO THE EDITOR
mendous increase in research in our specialty, some of which has led the world in the use of alloplastic implant materials. We have a Board Certification program in our specialty that is supposed to provide an essence of quality peer review. On the other hand, we have a movement afoot that will disenfranchise single-degree oral and maxillofacial surgeons from dual-degree oral and maxillofacial surgeons in the eyes of the public and on some hospital staffs. The reasons seem vague and unclear to me as to the need for an MD degree. However, if it is important to have an MD degree, then all programs should make it available to their residency candidates, and those already in practice should be able to attend part-time programs to fulfill this requirement. Such a plan of action would produce unity rather than disharmony in our specialty. If this solution does not evolve, then we are doomed to follow a two-tier system with some being less equal than others. K.G. MILLER,DDS Scranton, Pennsylvania HALTING THE TREND TOWARD A DOUBLE DEGREE
To the Editor:-When I entered the practice of our specialty almost 28 years ago there were few hospitals that permitted extraoral surgical procedures to be performed by oral surgeons. Today oral surgeons perform complex maxillofacial surgical procedures and are even encouraged to take their own hip and skin grafts. This entire level of competence was achieved within the dental specialty of oral surgery. Why, then, has the issue of the MD degree, perhaps once necessary, again raised its head? Do we need those two letters to do competently what we are doing every day? Would we be permitted to do what we are doing if we were not doing it competently? This issue has again arisen because of intramural competition. Will an MD degree better attract patients? Will the appointment or promotion at the university proceed more quickly? Will the poor training program attract better candidates if it is a double-degree program? These are poor reasons, indeed, to destroy the viability of our specialty. May I be given the privilege of predicting why this will destroy our specialty? If good programs capitulate to the critical mass theory and go double degree we will soon abolish the advantages of an MD degree and we will be back where we started, except we will now have a 6- to 7-year training program. Cost factors to society will inevitably raise their heads in the future. Because we will now be closely tied to medicine, the next logical question will soon be presented-Do we need 4 years of dental school to do oral and maxillofacial surgery? I’m afraid the answer will be “No.” One year of dental training will be adequate; there will be no need to spend 3 years in restorative and prosthetic techniques. Oral and maxillofacial surgery will then be a full-fledged medical specialty with perhaps a year of postgraduate education in dentistry. Who will now serve the needs of the patient for dentoalveolar surgery? Once again, the exodontist will be born. We will have completed the circle of our own demise. Enter the 1930s again. The saddest thought of all is that medicine for many years tried to restrict our privileges but never succeeded. Now, “We have met the enemy and they are us.” What is the solution? AAOMS is composed of a vast
549
LETTERS TO THE EDITOR
majority of single-degree oral surgeons. It is time that muscle is exerted by the membership to curb this devastating threat to our existence. The time is late. A formal statement of position is necessary. Through appropriate lobbying at the ADA, programs that are double-degree must lose their dental approval. Let them seek approval from the Medical Society. This will quickly return them to their rightful place. Oral and maxiliofacial surgery is a specialty of dentistry. Those who wish to achieve second degrees are free to pursue them, but the pursuit should not be fostered by our own specialty. ROBERTHIMMELFARB,DDS, FACD Hempstead, New York
THE EFFECTS OF CHANGES IN THE EDUCATION OF ORAL AND MAXILLOFACIAL
SURGEONS
To the Editor:-1 am writing this letter to express my concern about the changes that are developing in the training of oral and maxillofacial surgeons. Initially, a small number of our training programs offered a combined medical and dental degree program. That was a viable alternative for those who desired that type of training. Suddenly, a significant number of programs are converting to the double degree. This will no longer be an
BERTRAM BLIJM, DDS
Jamaica, New York
D
CHILDREN 1835 K Street, N.W. . Suite 700 202/634-9939 TDD: 1-800-929-7653
alternative but a standard training for oral and maxillofacial surgeons. During the transitional period we will create severe identity problems for the single-degree surgeon when compared with those individuals who hold both degrees. Furthermore, as the number of trained double-degree oral and maxillofacial surgeons increases significantly, their aRiliation and identification with dentistry will disappear. They will become a medical specialty separate and distinct from dentistry. The double-degree trained oral and maxillofacial surgeon will also attempt to compete in areas that are now well managed by the plastic, the ear, nose and throat, and the head and neck surgeons. He will have difficulties in competing with those individuals and at the same time will lose his identification with the referral base from dentistry. May I urge that whatever actions are possible be made to discourage this rapid change in training that has been in existence for so many years. If a critical number of programs become double degree then all programs will be double degree, and this will mean an ultimate change in oral and maxillofacial surgery as we have known it for many years.
l
Washington, D.C. 20K16
DEBRA JEAN COLE Abducted by an unknown individual Date Missing: OI3/29/81 Missing From: Lebanon, Indiana Date of Birth: 03/29/69 Age at Disappearance: 12 years old Sex: Female Race: White Height: 5 ft, 3 in Weight: 115 lb Hair: Blonde Eyes: Hazel Identifying Information: Birthmark the size of a half-dollar on one ankle. Circ~tances: Child was originally thought to be a runaway. Foul play suspected. ANYONE HAVING INFORMATION SHOULD CONTACT The National Center for Missing and Exploited Children 1400-843-5678 OR Lebanon Police Department (Indiana) Missing Persons unit l-317-482-2280
LETTERS
and deliberate attempts to develop the surgical science of oral and maxillofacial surgery. These advances, which led the way to the expansion in scope that we currently enjoy, have been nurtured by many individuals-the vision of Robert Walker, the research of Bell, the academic scrutiny of Epker and Laskin, and the innovative and clinically critical work of Wolford and West. In reality, it has been the surgeons who have been privileged to practice oral and maxillofacial surgery over the last 15 years who, by listening and reading, by writing and sharing, have given birth to the surgical renaissance of our specialty. Oral and maxillofacial surgeons, regardless of the number of degrees, have achieved recognition in the hospital, academic, and private sectors. We enjoy a scope and diversity of clinical practice that ranges from anesthesia to xeroradiography, based on our self-fueled energy and creativity and the proven track record of our membership. Having an MD degree has had nothing to do with our development to this date. So what has happened? I believe a consortium of leaders in political and academic circles have caused this stampede. There is no doubt that the discussions at Tenerife and Bermuda have created this manifest destiny for oral and maxillofacial surgery. By converting the training programs to mandatory double-degree status in a short generation, the specialty will change without even providing the mainstream of its membership the opportunity to confirm this direction. Hardly democratic. There is no question that this evolution is highly complex, and, while well-meaning educators and politicians alike move the specialty forward in this area, many questions remain unresolved. I just cannot help asking, “Why the rush, and why is the operative word mandatory rather than optional?” Indeed, the implications on scope, professional liability, credentials, insurance reimbursement, and academic advancement are far-reaching and meaningful. Will the single-degree oral and maxillofacial surgeon have his scope limited, will his credential list be cut back? What will the country do with 200 high-powered double-degree maxillofacial surgeons being produced each year? Who will take out the teeth, and on, and on? Perhaps most poignant for me is the comment made by an individual whom I respect as a surgeon and as an educator, when, in a moment of truth, stated, “well, now at last people I meet at cocktail parties will understand what I tNly do.” It is both frustrating and sad for me to see that after we have won the great battles in the operating room, in the laboratory, and in the classroom, we are rolling over and becoming a specialty that, I believe, will be incorporated into the mainstream of American medicine and lose its uniqueness and true strength as time passes. STEPHEN A. SACHS,DDS Lake Success, New York MAKING Two EQUAL ONE
To the Editor:-1 am writing in regard to the editorial in the November 1988 Journal of Oral and Maxillofacial Surgery and the current trend of our specialty. There are many reasons for and against oral and maxillofacial surgeons seeking both DDS and MD degrees. On the one hand, we now have extensive training programs, 4 years in length, which include rotations in medicine, surgery, anesthesia, and pathology. We have a tre-
TO THE EDITOR
mendous increase in research in our specialty, some of which has led the world in the use of alloplastic implant materials. We have a Board Certification program in our specialty that is supposed to provide an essence of quality peer review. On the other hand, we have a movement afoot that will disenfranchise single-degree oral and maxillofacial surgeons from dual-degree oral and maxillofacial surgeons in the eyes of the public and on some hospital staffs. The reasons seem vague and unclear to me as to the need for an MD degree. However, if it is important to have an MD degree, then all programs should make it available to their residency candidates, and those already in practice should be able to attend part-time programs to fulfill this requirement. Such a plan of action would produce unity rather than disharmony in our specialty. If this solution does not evolve, then we are doomed to follow a two-tier system with some being less equal than others. K.G. MILLER,DDS Scranton, Pennsylvania HALTING THE TREND TOWARD A DOUBLE DEGREE
To the Editor:-When I entered the practice of our specialty almost 28 years ago there were few hospitals that permitted extraoral surgical procedures to be performed by oral surgeons. Today oral surgeons perform complex maxillofacial surgical procedures and are even encouraged to take their own hip and skin grafts. This entire level of competence was achieved within the dental specialty of oral surgery. Why, then, has the issue of the MD degree, perhaps once necessary, again raised its head? Do we need those two letters to do competently what we are doing every day? Would we be permitted to do what we are doing if we were not doing it competently? This issue has again arisen because of intramural competition. Will an MD degree better attract patients? Will the appointment or promotion at the university proceed more quickly? Will the poor training program attract better candidates if it is a double-degree program? These are poor reasons, indeed, to destroy the viability of our specialty. May I be given the privilege of predicting why this will destroy our specialty? If good programs capitulate to the critical mass theory and go double degree we will soon abolish the advantages of an MD degree and we will be back where we started, except we will now have a 6- to 7-year training program. Cost factors to society will inevitably raise their heads in the future. Because we will now be closely tied to medicine, the next logical question will soon be presented-Do we need 4 years of dental school to do oral and maxillofacial surgery? I’m afraid the answer will be “No.” One year of dental training will be adequate; there will be no need to spend 3 years in restorative and prosthetic techniques. Oral and maxillofacial surgery will then be a full-fledged medical specialty with perhaps a year of postgraduate education in dentistry. Who will now serve the needs of the patient for dentoalveolar surgery? Once again, the exodontist will be born. We will have completed the circle of our own demise. Enter the 1930s again. The saddest thought of all is that medicine for many years tried to restrict our privileges but never succeeded. Now, “We have met the enemy and they are us.” What is the solution? AAOMS is composed of a vast
549
LETTERS TO THE EDITOR
majority of single-degree oral surgeons. It is time that muscle is exerted by the membership to curb this devastating threat to our existence. The time is late. A formal statement of position is necessary. Through appropriate lobbying at the ADA, programs that are double-degree must lose their dental approval. Let them seek approval from the Medical Society. This will quickly return them to their rightful place. Oral and maxiliofacial surgery is a specialty of dentistry. Those who wish to achieve second degrees are free to pursue them, but the pursuit should not be fostered by our own specialty. ROBERTHIMMELFARB,DDS, FACD Hempstead, New York
THE EFFECTS OF CHANGES IN THE EDUCATION OF ORAL AND MAXILLOFACIAL
SURGEONS
To the Editor:-1 am writing this letter to express my concern about the changes that are developing in the training of oral and maxillofacial surgeons. Initially, a small number of our training programs offered a combined medical and dental degree program. That was a viable alternative for those who desired that type of training. Suddenly, a significant number of programs are converting to the double degree. This will no longer be an
BERTRAM BLIJM, DDS
Jamaica, New York
D
CHILDREN 1835 K Street, N.W. . Suite 700 202/634-9939 TDD: 1-800-929-7653
alternative but a standard training for oral and maxillofacial surgeons. During the transitional period we will create severe identity problems for the single-degree surgeon when compared with those individuals who hold both degrees. Furthermore, as the number of trained double-degree oral and maxillofacial surgeons increases significantly, their aRiliation and identification with dentistry will disappear. They will become a medical specialty separate and distinct from dentistry. The double-degree trained oral and maxillofacial surgeon will also attempt to compete in areas that are now well managed by the plastic, the ear, nose and throat, and the head and neck surgeons. He will have difficulties in competing with those individuals and at the same time will lose his identification with the referral base from dentistry. May I urge that whatever actions are possible be made to discourage this rapid change in training that has been in existence for so many years. If a critical number of programs become double degree then all programs will be double degree, and this will mean an ultimate change in oral and maxillofacial surgery as we have known it for many years.
l
Washington, D.C. 20K16
DEBRA JEAN COLE Abducted by an unknown individual Date Missing: OI3/29/81 Missing From: Lebanon, Indiana Date of Birth: 03/29/69 Age at Disappearance: 12 years old Sex: Female Race: White Height: 5 ft, 3 in Weight: 115 lb Hair: Blonde Eyes: Hazel Identifying Information: Birthmark the size of a half-dollar on one ankle. Circ~tances: Child was originally thought to be a runaway. Foul play suspected. ANYONE HAVING INFORMATION SHOULD CONTACT The National Center for Missing and Exploited Children 1400-843-5678 OR Lebanon Police Department (Indiana) Missing Persons unit l-317-482-2280