SPECIAL EDITORIAL
The Future of Facial Trauma Care Larry Hollier, MD, FACS
T
he advancements in the care of patient with severe facial trauma have been nothing short of phenomenal over the last 30 years. These have been on every level, from the diagnosis to the treatment of these conditions. Imaging has progressed from plain radiographs to intraoperative systems that allow imaging and bone movement to preassigned positions. Fixation has evolved from wires to sophisticated titanium systems capable of rigid fixation of even the smallest bone segments. Most recently, remarkable advancements in soft tissue reconstruction have come to the forefront. We have moved from tubed pedicle flap reconstruction through microvascular surgery to the current work using transplantation of cadaveric tissue. What does the future hold for facial trauma care in the next generation? The uncertainty regarding the changes in our health care system makes this very difficult to predict. There is no getting around the fact that innovation costs money, regardless of whether this is occurring at the level of industry or the individual. There can be no question that these resources will be in increasingly short supply as we move forward. Whatever comes of health care reform, it is clear that more persons are being covered financially without a proportionate increase in the overall funding to the system. Although this is controversial, many would argue that much of the money for the increased coverage is being moved out of the Medicare system into the Medicaid system. Translated, more people are being covered with the same amount of money. As the financial margin generated per patient decreases for the system, compromises will have to be made. As we have seen so often in the pharmaceutical industry, one
of the first sacrifices made is research and development. It is entirely likely that our industrial partners who have been so important in technologic advancements in our field will have to focus more and more on their bottom line and less upon investing in new ideas. Contracts for supplies of plating instrumentation and equipment increasingly are going to those companies that can bundle this material with a broad array of other hospital products, generating deep discounts for the purchasing institution. That is not to say that quality and technological innovation are no longer being considered in purchases, but they are being considered increasingly on an equal par with cost savings. When one considers that many facial trauma patients are treated at financially strapped institutions funded by county and state governments, the importance of cost cutting to this discussion becomes even more profound. This is not to say that the future is all doom and gloom. There are remarkable opportunities for surgeons interested in facial reconstruction, particularly because of what would appear to be a looming shortage in surgeons. Although we are graduating more medical students today than we did 10 years ago, the number of residency and fellowship training spots is static. When this is combined with the fact that our newest generations of surgeons do not work the hours or career span that previous generations did, there can be no other conclusion. For old and young surgeons alike, those committed to the field of craniofacial reconstruction should continue to have a very bright and rewarding career. To paraphrase Charles Darwin, it is not the strongest that survive, but the most adaptable. Every generation has its challenges, and ours is becoming increasingly apparent.
What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
From the Baylor College of Medicine, Houston, TX. Received August 9, 2013. Accepted for publication September 30, 2013. Address correspondence and reprint requests to Larry Hollier, MD, FACS, Baylor College of Medicine, Houston, TX. E-mail: [email protected] The author reports no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000356
20
The Journal of Craniofacial Surgery
& Volume 25, Number 1, January 2014
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Future of Facial Trauma Care Larry Hollier, MD, FACS
T
he advancements in the care of patient with severe facial trauma have been nothing short of phenomenal over the last 30 years. These have been on every level, from the diagnosis to the treatment of these conditions. Imaging has progressed from plain radiographs to intraoperative systems that allow imaging and bone movement to preassigned positions. Fixation has evolved from wires to sophisticated titanium systems capable of rigid fixation of even the smallest bone segments. Most recently, remarkable advancements in soft tissue reconstruction have come to the forefront. We have moved from tubed pedicle flap reconstruction through microvascular surgery to the current work using transplantation of cadaveric tissue. What does the future hold for facial trauma care in the next generation? The uncertainty regarding the changes in our health care system makes this very difficult to predict. There is no getting around the fact that innovation costs money, regardless of whether this is occurring at the level of industry or the individual. There can be no question that these resources will be in increasingly short supply as we move forward. Whatever comes of health care reform, it is clear that more persons are being covered financially without a proportionate increase in the overall funding to the system. Although this is controversial, many would argue that much of the money for the increased coverage is being moved out of the Medicare system into the Medicaid system. Translated, more people are being covered with the same amount of money. As the financial margin generated per patient decreases for the system, compromises will have to be made. As we have seen so often in the pharmaceutical industry, one
of the first sacrifices made is research and development. It is entirely likely that our industrial partners who have been so important in technologic advancements in our field will have to focus more and more on their bottom line and less upon investing in new ideas. Contracts for supplies of plating instrumentation and equipment increasingly are going to those companies that can bundle this material with a broad array of other hospital products, generating deep discounts for the purchasing institution. That is not to say that quality and technological innovation are no longer being considered in purchases, but they are being considered increasingly on an equal par with cost savings. When one considers that many facial trauma patients are treated at financially strapped institutions funded by county and state governments, the importance of cost cutting to this discussion becomes even more profound. This is not to say that the future is all doom and gloom. There are remarkable opportunities for surgeons interested in facial reconstruction, particularly because of what would appear to be a looming shortage in surgeons. Although we are graduating more medical students today than we did 10 years ago, the number of residency and fellowship training spots is static. When this is combined with the fact that our newest generations of surgeons do not work the hours or career span that previous generations did, there can be no other conclusion. For old and young surgeons alike, those committed to the field of craniofacial reconstruction should continue to have a very bright and rewarding career. To paraphrase Charles Darwin, it is not the strongest that survive, but the most adaptable. Every generation has its challenges, and ours is becoming increasingly apparent.
What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
From the Baylor College of Medicine, Houston, TX. Received August 9, 2013. Accepted for publication September 30, 2013. Address correspondence and reprint requests to Larry Hollier, MD, FACS, Baylor College of Medicine, Houston, TX. E-mail: [email protected] The author reports no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000356
20
The Journal of Craniofacial Surgery
& Volume 25, Number 1, January 2014
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
