Medicine's Turf Wars
Specialists without M.D.'s are pushing for more medical power. Are they ready--and are you?
Knife fights
Even mightier than the prescription pen, when it comes to medical practice, is the sword--actually, the scalpel. And fights are breaking out around the nation over whether non-physicians can wield one. Such fights, often fought in the absence of quality data, are among the feistiest around--and some of the most difficult for patients who need to choose which hand will do their surgery.
One such hand could belong to Richard Joseph. He finished his residency in 1977. He started out in trauma surgery, rebuilding faces mangled by car accidents and violence in Jacksonville, Fla. Eventually, he got permission from Jacksonville's Baptist Medical Center to perform face-lifts as well. Now, his private practice includes face-lifts, eyelid surgery, Botox injections, and the occasional impacted wisdom tooth. Joseph is an oral surgeon, or, more properly, an oral and maxillofacial surgeon, a dental school graduate, and he's never been to medical school.
Oral surgeons are increasingly getting involved in doing cosmetic surgery. In a world of unhappy doctors and insurance hassles, cosmetic surgery looks like a good place to be. Oral surgeons are, technically, dentists. But they do at least four more years of training after dental school, when they learn to cut open, sew up, and improve the appearance of faces and necks, and they say they are just as qualified as plastic surgeons to do cosmetic surgery. Much of the facial trauma in the nation is handled by oral and maxillofacial surgeons; hospitals designated as Level I and Level II trauma centers are required to have one around to deal with facial injuries. And oral surgeons don't do the things you usually associate with dentists. Oral and maxillofacial surgeon Mark Steinberg, who teaches at Loyola University Medical Center in Chicago, says he hasn't filled a cavity in 25 years.
Plastic surgeons, for their part, go through medical school and several years of training in general surgery and plastic surgery. Oral surgeon training just doesn't match up, says Scott Spear, a plastic surgeon at Georgetown University Hospital and the president of the American Society of Plastic Surgeons. He and his colleagues insist that their concern is only for patient safety and good surgical results; predictably, oral surgeons shoot back that plastic surgeons just want to keep others off their lucrative turf.
State regulations that define dentistry have been the arena for the plastic surgeons' and oral surgeons' dust-ups. At issue is the American Dental Association's 1997 definition, which states that dentistry includes work on "the oral cavity, maxillofacial area and/or the adjacent and associated structures."
That is so ambiguous as to be useless, scoffs Bill Seward of the American Society of Plastic Surgeons. "The jaw is connected to the neck, which is connected to the torso. You can drive a Mack truck through that hole." He claims the "adjacent and associated structure" language gives oral surgeons the right to do breast augmentations, abdominal liposuction, or anything else they want, but oral surgeons point out that the definition also says they're only supposed to do work within the scope of their training.
advertisement
