OMS training and infrequent events

994 know the writers and feel some issues must have come forth for this letter to be written. I also respect our organization and want to believe that the American Association of Oral and Maxillofacial Surgeons (AAOMS) has a broader understanding of the issues we are discussing. Yet, the “need to do trauma surgery” and the “need to take emergency call” has become a divisive battle cry amongst many members in our specialty and a “future of our specialty” concern at AAOMS (just look at the number of trauma-related articles just in the January 2006 Journal of Oral and Maxillofacial Surgery). I would like to suggest that in a perfect world we all would take emergency calls. In a perfect world, oral surgeons, plastic surgeons and ear, nose, and throat (ENT) surgeons would equally take trauma— what ever comes in, one by one, divided out among the staff in some fashionable order. In some places perhaps that scenario exists. But we are not in a perfect world. Geographic and hospital politics (even in educational or federal services settings) dictate an adjustment of this blanket call to “save our specialty.” In some areas the undue burden of trauma care falls to the oral surgeon because plastics or ENT “don’t do” trauma or the distribution of the trauma is by the famously quiet “wallet biopsy.” Is it fair to ask oral surgeons in those areas to take the brunt of this care that often carries with it significant personal and professional liability? Additionally, in some areas oral surgeons are at odds with each other. Those OMS whose practices need the hospital (orthognathic, TMJ, reconstructive, etc) must take call. In some areas these very OMS go out of their way to protect their referrals for hospital as well as office surgeries. Yet these very same OMS want the help of managing the surgical burden of trauma? Let’s not forget, there are many among us who take call because they like it or it’s their “duty” or it is one way in which to give back to the community, no strings attached, regardless of the politics or financial remuneration. For us to insure the future of oral and maxillofacial surgery we must not forget where the history of oral and maxillofacial surgery lies. Many have. Oral and maxillofacial surgery is not where it is solely because of trauma. Oral and maxillofacial surgery is where it is because of dentistry and great doctors (dentists, physicians, and researchers) who expanded and continue to expand our specialty with the development of better ways to take out teeth, and treat infection, tumors, and reconstruction. Trauma happens to be on that list. Yet, many seem to have forgotten about dentistry. Perhaps there are oral and maxillofacial surgeons who don’t want to be identified as dentists. Without our roots in dentistry, the rest wouldn’t be here for us as oral and maxillofacial surgeons. Perhaps it is time for our members and association to stop the outcry about the emergency department and trauma and to worry more about our specialty’s relationship with our dental colleagues. Don’t get me wrong. I am proud of what our specialty has accomplished by way of the hospital operating and emergency rooms. It is exciting to think about what we accomplish individually and as a collective each and every day— with all the surgeries we carry out. It is a truly wonderful specialty, as varied in its membership as it is in the way it is practiced and delivered. So don’t hang the future of our specialty on trauma, and don’t disgrace the doctor who no longer feels trauma is to be a part of his or her practice. Look at trauma as one item on our agenda that must have attention similar to the attention we pay to the integration of a surgeon with a dual degree or the surgeon who wishes to practice esthetic procedures.

LETTERS TO THE EDITOR Although I am on a hospital staff and take calls through the emergency department, I’d much rather know the phone is ringing because a dentist needs my help than to worry the emergency department is calling about the next fractured mandible. More importantly, I’d like to be comfortable knowing our specialty organization and my colleagues accept the diversity of how we individually choose to practice without segregating members due to decisions related to the surgeries that may or may not be performed. MICHAEL L. O’NEIL, DMD Birmingham, AL

doi:10.1016/j.joms.2006.02.018

OMS TRAINING AND INFREQUENT EVENTS To the Editor:—It was with great pleasure that I recently read your editorial “The High Cost of Infrequent Events” in the February 2006 Journal.1 As someone who has recently joined the ranks of academia, I too have found myself asking similar questions. In fact, I suspect many surgeons involved with training programs ponder if what we teach our residents in the operating room will be of benefit when they graduate. To complicate matters, I’ve heard many residents express the desire to limit their practice to dentoalveolar surgery, implants, and sedation upon graduation. However, as you stated in your editorial, rare events do seek us out whether we like it or not. The purpose of residency training is not to churn out well-trained technicians, but well-trained surgeons, who are able to handle even the most unusual cases. Whether that surgeon chooses to manage the case or not is a personal decision, taking the patient’s best interests into consideration. If that surgeon has the desire to manage an unusual case or even practice the full scope of our specialty, at least he or she is equipped with the knowledge and skill to do so. HARRY PAPADOPOULOS, DDS, MD Memphis, TN

Reference 1. Assael LA: The high cost of infrequent events. J Oral Maxillofac Surg 64:157, 2006

doi:10.1016/j.joms.2006.03.004

CONTRACTING RESIDENT OPPORTUNITIES To the Editor:—Most of the membership of the American Association of Oral and Maxillofacial Surgeons (AAOMS) is probably unaware of a major deletion in our residency program accreditation standards that the Commission on Dental Accreditation approved in January. This was the removal of the standard requiring residency programs to provide residents several months of “expanded opportunities.” I believe that our membership should be concerned about this significant change in our accreditation standards. I believe most surgeons in practice today who trained during and before my era remember the assignments to hospital and/or dental school “toothache extraction clinics.” Although these clinics were and still are fertile grounds for initial training in outpatient surgery and helped residents detect pathology requiring operating room care, after many months on the