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The MD degree: A panacea or a problem?
J Oral Maxillofac 55209, 1997
Surg
The MD Degree:
A Panacea
or a Problem?
One of the basic questions that has never been fully addressed, however, is whether one really needs a medical degree to practice the full scope of our specialty. If one accepts the idea that the medical management of a severely traumatized patient is just as complex as the medical management of a cancer patient or one with a craniofacial anomaly, then we must agree that the ability to provide proper medical care is really not the issue. If this is true, then the argument is really territorial, because mastering the technical aspects of any operation is not degree based. One need only look to Japan to see the full scope of oral and maxillofacial surgery being practiced by those with only a dental degree. Another important question to be considered is whether the current two-track system of educating oral and maxillofacial surgeons is having a divisive effect on our specialty. With managed health care programs looking to save dollars, we are beginning to see instances where the practitioner who is able to provide lhe broadest scope of service is in lhe best position lo compete for such contracts, and in the opinion of the insurance carrier this is often the double degree person. Another issue that needs to be looked at is the limited case load in certain areas of expanded scope and what will happen as competition for these patients increases between practitioners with one and two degrees. These are factors thal need lo be considered as we make judgements about future patient service needs. Finally, there is the question of what effect our uncertainty about degrees and scope is having on competition from outside the specialty. While we attempt to define our future role in the health care scheme, we find others within dentistry already beginning to erode our existing bvundaries and waiting anxiously to become the new oral surgeon. Obviously, this discussion raises more questions than it provides answers, but that is what editorials are designed to do. There are clearly both advantages and disadvantages to the dual degree concept. Many factors will determine which direction to take and then only time will tell whether the decision was correct. However, in the meantime we need to continue to look carefully at this issue and to make every effort to assure that whatever we do is in the best long-term interest of our entire specialty as well as the public we serve. DANIEL M. LASKE-J
More than 25 years have passed since the idea that the oral and maxillofacial surgeon should obtain both a dental and a medical degree was reintroduced in the United States, and therefore it is a good time to take a look at the impact this has had on our specialty. However, to place things in proper perspective, it is important to first look back at the history of when this practice started and how we have reached this point. The concept of oral and maxillofacial surgeons obtaining both a dental and medical degree is certainly not new. In fact, most of the early practitioners of the specialty had both degrees. However, with time the emphasis shifted and by the early 1900s most oral surgeons possessed only a denlal degree. Throughout the subsequent years there were always a few practitioners who obtained a medical degree, but their numbers were small because of the cost involved, the length of the curriculum, and the prevailing attitude of the medical schools that it better serves the public to have two people with a single degree than a single person with two degrees. The concept of the dual degree oral and maxillofacial surgeon was resurrected in the early 1970s when the ability of dental graduates to take Part I of the National Medical Board enabled them to be admitted to medical school with 2 years of advanced standing, and this led some oral and maxillofacial surgery training programs to develop a 6-year integrated curriculum. The motivation behind this new curriculum was not to change the scope of practice, but rather to expand the medical knowledge of the practitioner. However, around the same time that this was occurring hospitals began to require that oral and maxillofacial surgeons admitting a patient have the history and physical examination done by a physician, and possessing the MD degree appeared to be a way to resolve this issue. Shortly thereafter, the problem of decreased busyness arose and the idea of expanded scope then entered th,e picture. Finally, IAOMS’s development of international guidelines for the education and training of the oral and maxillofacial surgeon, which favored the dual degree, became a contributing factor. As a result of these influences, about 38% of our training programs now offer an integrated MD degree and 43% of the trainees are in such programs.
209
Surg
The MD Degree:
A Panacea
or a Problem?
One of the basic questions that has never been fully addressed, however, is whether one really needs a medical degree to practice the full scope of our specialty. If one accepts the idea that the medical management of a severely traumatized patient is just as complex as the medical management of a cancer patient or one with a craniofacial anomaly, then we must agree that the ability to provide proper medical care is really not the issue. If this is true, then the argument is really territorial, because mastering the technical aspects of any operation is not degree based. One need only look to Japan to see the full scope of oral and maxillofacial surgery being practiced by those with only a dental degree. Another important question to be considered is whether the current two-track system of educating oral and maxillofacial surgeons is having a divisive effect on our specialty. With managed health care programs looking to save dollars, we are beginning to see instances where the practitioner who is able to provide lhe broadest scope of service is in lhe best position lo compete for such contracts, and in the opinion of the insurance carrier this is often the double degree person. Another issue that needs to be looked at is the limited case load in certain areas of expanded scope and what will happen as competition for these patients increases between practitioners with one and two degrees. These are factors thal need lo be considered as we make judgements about future patient service needs. Finally, there is the question of what effect our uncertainty about degrees and scope is having on competition from outside the specialty. While we attempt to define our future role in the health care scheme, we find others within dentistry already beginning to erode our existing bvundaries and waiting anxiously to become the new oral surgeon. Obviously, this discussion raises more questions than it provides answers, but that is what editorials are designed to do. There are clearly both advantages and disadvantages to the dual degree concept. Many factors will determine which direction to take and then only time will tell whether the decision was correct. However, in the meantime we need to continue to look carefully at this issue and to make every effort to assure that whatever we do is in the best long-term interest of our entire specialty as well as the public we serve. DANIEL M. LASKE-J
More than 25 years have passed since the idea that the oral and maxillofacial surgeon should obtain both a dental and a medical degree was reintroduced in the United States, and therefore it is a good time to take a look at the impact this has had on our specialty. However, to place things in proper perspective, it is important to first look back at the history of when this practice started and how we have reached this point. The concept of oral and maxillofacial surgeons obtaining both a dental and medical degree is certainly not new. In fact, most of the early practitioners of the specialty had both degrees. However, with time the emphasis shifted and by the early 1900s most oral surgeons possessed only a denlal degree. Throughout the subsequent years there were always a few practitioners who obtained a medical degree, but their numbers were small because of the cost involved, the length of the curriculum, and the prevailing attitude of the medical schools that it better serves the public to have two people with a single degree than a single person with two degrees. The concept of the dual degree oral and maxillofacial surgeon was resurrected in the early 1970s when the ability of dental graduates to take Part I of the National Medical Board enabled them to be admitted to medical school with 2 years of advanced standing, and this led some oral and maxillofacial surgery training programs to develop a 6-year integrated curriculum. The motivation behind this new curriculum was not to change the scope of practice, but rather to expand the medical knowledge of the practitioner. However, around the same time that this was occurring hospitals began to require that oral and maxillofacial surgeons admitting a patient have the history and physical examination done by a physician, and possessing the MD degree appeared to be a way to resolve this issue. Shortly thereafter, the problem of decreased busyness arose and the idea of expanded scope then entered th,e picture. Finally, IAOMS’s development of international guidelines for the education and training of the oral and maxillofacial surgeon, which favored the dual degree, became a contributing factor. As a result of these influences, about 38% of our training programs now offer an integrated MD degree and 43% of the trainees are in such programs.
209