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The development of the specialty of Oral and Maxillofacial Surgery in the European Union
Journal of Cranio-MaxillofaeialSurgery (1996) 24, 193 194 © 1996 European Association for Cranio-Maxillofacial Surgery
Editorial The development of the specialty of Oral and Maxillofacial Surgery in the European Union The event, characterising the Jubilee Congress of EACMFS commemorating its foundation in 1970, provides the opportunity to recall the development of the specialty from the professional point of view. Legal recognition in Europe occurred in 1989. At that particular time, oral and maxillofacial surgery was not recognized as an independent specialty in any of the European Union Member States. It was practised in the majority of countries but did not have legal status. Oro-maxillary surgery existed in Germany but surgeons, despite undertaking extensive surgery, had not obtained the right to bear the maxillofacial title. Therefore, it was not surprising that the Council Directive of 16 June 1975 (75/362/EEC) concerning the medical recognition of diplomas, certificates and other evidence of formal qualifications in medicine, does not mention the specialty of maxillofacial surgery. The movement towards recognition of maxillofacial surgery in the Doctors' Directive has been very slow, and if finally it has managed to assert itself in Europe as a medical specialty, the credit is due to the Stomatology and Maxillofacial Surgery Monospecialist Section of the European Union of Medical Specialists (UEMS), which for 17 years concentrated all its intense activity on attaining this objective. In 1972 at the first EAMFS Congress, organized in Ljubljana by Professor Celesnic, the managers of the Society and the main leaders of European maxillofacial surgery gave a free hand to the UEMS Section of Stomatology and its new General Secretary, R. Peiffer. The UEMS Section, thereby, in the same year obtained the change of its title to Stomatology and Maxillofacial Surgery Monospecialist Section from the Management Council (Florence, 1972). The decision had encountered fierce opposition, particularly from surgeons and plastic surgeons, with the consequence that discussions on the problem lasted 12 years. Two very important meetings organized by UEMS in Monaco in 1974 must be mentioned. The first brought together representatives of the sections of surgery, orthopaedics, ORL, plastic surgery, ophthalmology, neurosurgery and stomatology and maxillofacial surgery. It resulted in the publication of a document stipulating that to practise maxillofacial surgery it was necessary to be a medical doctor.
In October of the same year, a second meeting in Monaco was attended by the same representatives, who unanimously decided that, to practise maxillofacial surgery, it was necessary to have a sufficient and pertinent training in odonto-stomatology. In 1976, in the then Federal Republic of Germany, the specialty took the name of Mund-KieferGesichtschirurgie, a title which Dr. Dr. Kurt Hemmerich, at the time President of the German Professional Union of Oral and Maxillofacial Surgeons and Vice President of the UEMS Section, commendably obtained from the Bundesfirztekammer. In 1978, an independent specialty, 'cirurgia oral y maxilofacial', was formed in Spain. In Italy the University of Naples obtained legal status for maxillofacial surgery, thereby including it in that countries' list of recognized specialties. During a consultation of experts organized in 1982 by the Advisory Committee for Medical Training ACMT, the Secretary of the Section had the opportunity of officially proposing the inscription of the oral and maxillofacial surgery specialty in the Doctors' Directives. In 1983 the ACMT proceedings resulted in the publication of the Second Report and Recommendations on the conditions for specialist training, which contained the description of a maxillofacial specialty with 5 years' training. It was classified, among the specialties requiring 'a sound knowledge of the connected specialties'. It was, however, only a recommendation. In the Stomatology and Oro-Maxillofacial Section in 1985, the representatives of EU Member States signed an agreement stating that to practise oral and maxillofacial surgery in Europe, it was necessary to be both a doctor and a dentist. In countries where the second requirement could not be met, a 2,000 hours' stomatology training was prescribed. The profession thereby found a basis for mutual recognition. Subsequently, and from the legal point of view, the development of the specialty in Belgium led to mutual recognition between the former and Germany. Conditions for mutual recognition between France, Italy and Spain were also met, with the consequence that the Council Directive of 30 October 1989 amending Directive 75/362/EEC contained two new specialties; maxillofacial surgery for Spain, France and Italy, specialty based on the doctor's diploma, and dentooro-maxillofacial surgery for Germany and Belgium, 193
194
Journal of Cranio-Maxillofaeial Surgery
which were joined by Great Britain and Ireland, based on the legally required doctor's and dentist's diploma. The requirement for this double basic training was inscribed in Article 24, la and 2, where it is explicitly stated that alongside the accomplishment and validation of 6 years' study in the doctor's training cycle for the specialist in dental, oral and maxillofacial surgery (basic doctor's and dental practitioner's training), the accomplishment and validation of the cycle of training as a dental practitioner was in addition prescribed by virtue of Article 1 of the Council Directive 78/687/EEC of 25 July 1978. In 1993, three new countries joined the European Union, Austria, Finland and Sweden. The Council Directive 93/16/EEC of 5 April 1993 described the situation in these countries, dento-oro-maxillofacial surgery, based on the double medical and dental qualification was inscribed for Finland. The act relating to the accession conditions for Norway, Austria, Finland and Sweden (94/C/241/08), published before the withdrawal of Norway's candidature for entry into the EU, also quoted the latter country in the specialty's category. Liechtenstein and Switzerland were other EFTA countries included in the document. It is to be hoped that in the near future, the Grand Duchy of Luxembourg, Greece and the Netherlands
will also join the list. In these countries, the principle of the double dental and medical qualification as the basic training has in the meantime been accepted by national authorities. Conducted in close agreement with EACMFS and based on cooperation between UEMS delegates from all European countries interested in the development, professional policy has resulted in t h e specialty's recognition in the EU. It has thereby formed the legal basis for an opening towards central Europe and the world, started by EACMFS from the end of the 1980s. In the meantime, the Section has founded its European Board of Oral and Maxillofacial Surgery as proposed by the UEMS Management Council, with the aim of guaranteeing a very high level of quality in the care provided for patients. As part of EACMFS Jubilee Congress in Ztirich, the Board is organizing its first assessment. After passing the Recognition of Qualification Assessment (RQ), colleagues are eligible to hold the title 'Fellow of the European Board of Oral and Maxillofacial Surgery'.
Dr. Robert Peiffer Secretary-General UEMS, (Former President EACMFS)
Editorial The development of the specialty of Oral and Maxillofacial Surgery in the European Union The event, characterising the Jubilee Congress of EACMFS commemorating its foundation in 1970, provides the opportunity to recall the development of the specialty from the professional point of view. Legal recognition in Europe occurred in 1989. At that particular time, oral and maxillofacial surgery was not recognized as an independent specialty in any of the European Union Member States. It was practised in the majority of countries but did not have legal status. Oro-maxillary surgery existed in Germany but surgeons, despite undertaking extensive surgery, had not obtained the right to bear the maxillofacial title. Therefore, it was not surprising that the Council Directive of 16 June 1975 (75/362/EEC) concerning the medical recognition of diplomas, certificates and other evidence of formal qualifications in medicine, does not mention the specialty of maxillofacial surgery. The movement towards recognition of maxillofacial surgery in the Doctors' Directive has been very slow, and if finally it has managed to assert itself in Europe as a medical specialty, the credit is due to the Stomatology and Maxillofacial Surgery Monospecialist Section of the European Union of Medical Specialists (UEMS), which for 17 years concentrated all its intense activity on attaining this objective. In 1972 at the first EAMFS Congress, organized in Ljubljana by Professor Celesnic, the managers of the Society and the main leaders of European maxillofacial surgery gave a free hand to the UEMS Section of Stomatology and its new General Secretary, R. Peiffer. The UEMS Section, thereby, in the same year obtained the change of its title to Stomatology and Maxillofacial Surgery Monospecialist Section from the Management Council (Florence, 1972). The decision had encountered fierce opposition, particularly from surgeons and plastic surgeons, with the consequence that discussions on the problem lasted 12 years. Two very important meetings organized by UEMS in Monaco in 1974 must be mentioned. The first brought together representatives of the sections of surgery, orthopaedics, ORL, plastic surgery, ophthalmology, neurosurgery and stomatology and maxillofacial surgery. It resulted in the publication of a document stipulating that to practise maxillofacial surgery it was necessary to be a medical doctor.
In October of the same year, a second meeting in Monaco was attended by the same representatives, who unanimously decided that, to practise maxillofacial surgery, it was necessary to have a sufficient and pertinent training in odonto-stomatology. In 1976, in the then Federal Republic of Germany, the specialty took the name of Mund-KieferGesichtschirurgie, a title which Dr. Dr. Kurt Hemmerich, at the time President of the German Professional Union of Oral and Maxillofacial Surgeons and Vice President of the UEMS Section, commendably obtained from the Bundesfirztekammer. In 1978, an independent specialty, 'cirurgia oral y maxilofacial', was formed in Spain. In Italy the University of Naples obtained legal status for maxillofacial surgery, thereby including it in that countries' list of recognized specialties. During a consultation of experts organized in 1982 by the Advisory Committee for Medical Training ACMT, the Secretary of the Section had the opportunity of officially proposing the inscription of the oral and maxillofacial surgery specialty in the Doctors' Directives. In 1983 the ACMT proceedings resulted in the publication of the Second Report and Recommendations on the conditions for specialist training, which contained the description of a maxillofacial specialty with 5 years' training. It was classified, among the specialties requiring 'a sound knowledge of the connected specialties'. It was, however, only a recommendation. In the Stomatology and Oro-Maxillofacial Section in 1985, the representatives of EU Member States signed an agreement stating that to practise oral and maxillofacial surgery in Europe, it was necessary to be both a doctor and a dentist. In countries where the second requirement could not be met, a 2,000 hours' stomatology training was prescribed. The profession thereby found a basis for mutual recognition. Subsequently, and from the legal point of view, the development of the specialty in Belgium led to mutual recognition between the former and Germany. Conditions for mutual recognition between France, Italy and Spain were also met, with the consequence that the Council Directive of 30 October 1989 amending Directive 75/362/EEC contained two new specialties; maxillofacial surgery for Spain, France and Italy, specialty based on the doctor's diploma, and dentooro-maxillofacial surgery for Germany and Belgium, 193
194
Journal of Cranio-Maxillofaeial Surgery
which were joined by Great Britain and Ireland, based on the legally required doctor's and dentist's diploma. The requirement for this double basic training was inscribed in Article 24, la and 2, where it is explicitly stated that alongside the accomplishment and validation of 6 years' study in the doctor's training cycle for the specialist in dental, oral and maxillofacial surgery (basic doctor's and dental practitioner's training), the accomplishment and validation of the cycle of training as a dental practitioner was in addition prescribed by virtue of Article 1 of the Council Directive 78/687/EEC of 25 July 1978. In 1993, three new countries joined the European Union, Austria, Finland and Sweden. The Council Directive 93/16/EEC of 5 April 1993 described the situation in these countries, dento-oro-maxillofacial surgery, based on the double medical and dental qualification was inscribed for Finland. The act relating to the accession conditions for Norway, Austria, Finland and Sweden (94/C/241/08), published before the withdrawal of Norway's candidature for entry into the EU, also quoted the latter country in the specialty's category. Liechtenstein and Switzerland were other EFTA countries included in the document. It is to be hoped that in the near future, the Grand Duchy of Luxembourg, Greece and the Netherlands
will also join the list. In these countries, the principle of the double dental and medical qualification as the basic training has in the meantime been accepted by national authorities. Conducted in close agreement with EACMFS and based on cooperation between UEMS delegates from all European countries interested in the development, professional policy has resulted in t h e specialty's recognition in the EU. It has thereby formed the legal basis for an opening towards central Europe and the world, started by EACMFS from the end of the 1980s. In the meantime, the Section has founded its European Board of Oral and Maxillofacial Surgery as proposed by the UEMS Management Council, with the aim of guaranteeing a very high level of quality in the care provided for patients. As part of EACMFS Jubilee Congress in Ztirich, the Board is organizing its first assessment. After passing the Recognition of Qualification Assessment (RQ), colleagues are eligible to hold the title 'Fellow of the European Board of Oral and Maxillofacial Surgery'.
Dr. Robert Peiffer Secretary-General UEMS, (Former President EACMFS)