772
LETTERS TO THE EDITOR
las which took place in 1972. Dr Tessier’s movie was very clear and explicit, and I am sure Dr Kaban, particularly because of his association with Dr Tessier in Boston, would agree about adding this citation to his bibliography. S. ANTHONYWOLFE, MD, FACS Miami, Florida DIVISION OF THE SPECIALTY To rhe E&or:-It is with interestthat I note the recent advertisementfor the American Board of Cosmetic Surgery in the January 1990 issue of Journal of Oral and
Maxiiiofacial Surgery: Although many of us are performing procedures that would qualify us for admittance into any subspecialty that can be deemed “cosmetic surgery,” The American Board of Cosmetic Surgery has taken upon itself to segmentalize our specialty into those who have obtained a dual MD-DDS degree and those who have not. I have read the protests of many oral and maxillofacial surgeons over the past few months in regard to the double degree situation and their expressed interest in maintaining a lack of duality within our specialty. It is obvious that this segmentalization has already occurred as recognized by the American Board of Cosmetic Surgery. I am afraid that what we are seeing is just the beginning of the further disjointing of our specialty; it is becoming a two-tiered specialty as has been feared by numerous members of our association. I would, therefore, hope that the powers that be within our organization (the members themselves) reconsider the proposed changes, for they have created a “can of worms” that has just been opened.
JOELS. TEE, DMD Brentwood, New York LOSING DENTOALVEOLAR SURGERY TO THE GENERAL DENTIST To rhe Editor:-The article on specialist-generalist relations in the last issue of the AAOMS Digest is overdue by about 20 years. I had personally approached the AAOMS people about this very thing at least 20 years ago and I was shrugged off. I also confronted AAOMS at that time about the concept of offering “how to” programs to the generalist, and the reaction was arrogant and smug. In this part of the world in today’s marketplace, prying patients away from the generalist is like pulling teeth. With the advocacy of the double-degree oral and maxillofacial surgeon, advanced training of the generalist in general practice residencies, and the continuation of “how to” programs offered to dentists by oral and maxillofacial surgeons, I see the demise of the dentoalveolar oral and maxillofacial surgeon in a very few years. ROBERTJ. BLUM, DMD Wayne, New Jersey THE PROPERWAY TO OBTAIN MEDICAL AND SURGICAL TRAINING
To the Editor:-Your editorial “A Second Look at the Double Degree” in the June 1989 issue was timely but, regrettably, stresses some of the lesser reasons for the program rather than the more substantial ones. The essential reason for advocacy of becoming medically qual-
ified was to remedy the medical education deficit of dental graduates. This is particularly important for oral and maxillofacial surgeons who cannot provide optimal patient care without sound basic medical knowledge and surgical skills. Our specialty has, indeed, broadened even without the four areas of future expansion you mentioned, although some of our colleagues do operate in those specific areas even now. McCallum’s article,’ in the same issue of the Journal as your editorial, lends support to this. He wrote, “My first question is whether our scope has changed? To this I would give a resounding yes.” In fact, if one overlooks the present burgeoning interest in cosmetic surgery, trauma, orthognathic, temporomandibular joint, and jaw reconstructive surgery, which constitute a significant portion of the present oral and maxillofacial surgeon’s work, are all complex procedures that demand knowledgeable pre- and postoperative care, as well as sophisticated surgical expertise. You posed the question of whether the present expanded training curriculum can provide the medical knowledge and core surgical training that oral and maxillofacial surgeons need. I would suggest that formal education, in the medical school context, is a more certain way of learning what we all declare to be necessary than an “apprentice” system integrated within a training program. Furthermore, all other surgical core specialties have recognized (and require) at least a year of basic surgical training. Despite that, our specialty assumes that if a resident spends 1 of 4 years rotating through various surgical departments, an equivalent surgical core will be acquired. In this litigious era, that seems particularly questionable. Being the responsible surgeon of record, for general surgery, requires medical licensure, and assuming responsibility is essential to the maturation of a surgeon in training. I agree with your last sentence, “The question of whether it is necessary for everyone in our specialty to have such training, however, still remains to be answered.” There are, however, a few suggestions I would make. One is that those who disagree with the double-degree concept be as tolerant of its advocates as they are of its adversaries. Time will, in fact, settle the issue and there is no need of confrontation. Secondly, the fear that our specialty will lose its identity as medically qualified members defect to “medicine” is not borne out by the record to date. A review of the San Francisco annual meeting program, with its numbers of presentations by double-degree colleagues, should hearten those who doubt their allegiance. WALTERGURALNICK,DMD Boston, Massachusetts
Reference 1. McCallum CA: The future of oral and maxillofacial surgery. J Oral Maxillofac Surg 1989 PROPERTRAINING FOR ORAL AND MAXILLOFACIAL SURGERY
To the E&or:-1 read with dismay the December editorial entitled “Maintaining the Unity of Oral and Maxillofacial Surgery” (48:1247, 1990). It implied that those residents finishing oral and maxillofacial surgery programs with a medical degree have somehow mysteriously expanded the scope of their training, and therefore the scope of their expected hospital credentials. As
LETTERS TO THE EDITOR
las which took place in 1972. Dr Tessier’s movie was very clear and explicit, and I am sure Dr Kaban, particularly because of his association with Dr Tessier in Boston, would agree about adding this citation to his bibliography. S. ANTHONYWOLFE, MD, FACS Miami, Florida DIVISION OF THE SPECIALTY To rhe E&or:-It is with interestthat I note the recent advertisementfor the American Board of Cosmetic Surgery in the January 1990 issue of Journal of Oral and
Maxiiiofacial Surgery: Although many of us are performing procedures that would qualify us for admittance into any subspecialty that can be deemed “cosmetic surgery,” The American Board of Cosmetic Surgery has taken upon itself to segmentalize our specialty into those who have obtained a dual MD-DDS degree and those who have not. I have read the protests of many oral and maxillofacial surgeons over the past few months in regard to the double degree situation and their expressed interest in maintaining a lack of duality within our specialty. It is obvious that this segmentalization has already occurred as recognized by the American Board of Cosmetic Surgery. I am afraid that what we are seeing is just the beginning of the further disjointing of our specialty; it is becoming a two-tiered specialty as has been feared by numerous members of our association. I would, therefore, hope that the powers that be within our organization (the members themselves) reconsider the proposed changes, for they have created a “can of worms” that has just been opened.
JOELS. TEE, DMD Brentwood, New York LOSING DENTOALVEOLAR SURGERY TO THE GENERAL DENTIST To rhe Editor:-The article on specialist-generalist relations in the last issue of the AAOMS Digest is overdue by about 20 years. I had personally approached the AAOMS people about this very thing at least 20 years ago and I was shrugged off. I also confronted AAOMS at that time about the concept of offering “how to” programs to the generalist, and the reaction was arrogant and smug. In this part of the world in today’s marketplace, prying patients away from the generalist is like pulling teeth. With the advocacy of the double-degree oral and maxillofacial surgeon, advanced training of the generalist in general practice residencies, and the continuation of “how to” programs offered to dentists by oral and maxillofacial surgeons, I see the demise of the dentoalveolar oral and maxillofacial surgeon in a very few years. ROBERTJ. BLUM, DMD Wayne, New Jersey THE PROPERWAY TO OBTAIN MEDICAL AND SURGICAL TRAINING
To the Editor:-Your editorial “A Second Look at the Double Degree” in the June 1989 issue was timely but, regrettably, stresses some of the lesser reasons for the program rather than the more substantial ones. The essential reason for advocacy of becoming medically qual-
ified was to remedy the medical education deficit of dental graduates. This is particularly important for oral and maxillofacial surgeons who cannot provide optimal patient care without sound basic medical knowledge and surgical skills. Our specialty has, indeed, broadened even without the four areas of future expansion you mentioned, although some of our colleagues do operate in those specific areas even now. McCallum’s article,’ in the same issue of the Journal as your editorial, lends support to this. He wrote, “My first question is whether our scope has changed? To this I would give a resounding yes.” In fact, if one overlooks the present burgeoning interest in cosmetic surgery, trauma, orthognathic, temporomandibular joint, and jaw reconstructive surgery, which constitute a significant portion of the present oral and maxillofacial surgeon’s work, are all complex procedures that demand knowledgeable pre- and postoperative care, as well as sophisticated surgical expertise. You posed the question of whether the present expanded training curriculum can provide the medical knowledge and core surgical training that oral and maxillofacial surgeons need. I would suggest that formal education, in the medical school context, is a more certain way of learning what we all declare to be necessary than an “apprentice” system integrated within a training program. Furthermore, all other surgical core specialties have recognized (and require) at least a year of basic surgical training. Despite that, our specialty assumes that if a resident spends 1 of 4 years rotating through various surgical departments, an equivalent surgical core will be acquired. In this litigious era, that seems particularly questionable. Being the responsible surgeon of record, for general surgery, requires medical licensure, and assuming responsibility is essential to the maturation of a surgeon in training. I agree with your last sentence, “The question of whether it is necessary for everyone in our specialty to have such training, however, still remains to be answered.” There are, however, a few suggestions I would make. One is that those who disagree with the double-degree concept be as tolerant of its advocates as they are of its adversaries. Time will, in fact, settle the issue and there is no need of confrontation. Secondly, the fear that our specialty will lose its identity as medically qualified members defect to “medicine” is not borne out by the record to date. A review of the San Francisco annual meeting program, with its numbers of presentations by double-degree colleagues, should hearten those who doubt their allegiance. WALTERGURALNICK,DMD Boston, Massachusetts
Reference 1. McCallum CA: The future of oral and maxillofacial surgery. J Oral Maxillofac Surg 1989 PROPERTRAINING FOR ORAL AND MAXILLOFACIAL SURGERY
To the E&or:-1 read with dismay the December editorial entitled “Maintaining the Unity of Oral and Maxillofacial Surgery” (48:1247, 1990). It implied that those residents finishing oral and maxillofacial surgery programs with a medical degree have somehow mysteriously expanded the scope of their training, and therefore the scope of their expected hospital credentials. As
