When the other team closed their eyes and counted to 10, you would run like heck. Nightly games of Ringolevio tore multiple paths through the woods. The shouts of the players would tell whether their path was clear or blocked by fallen brush.
Many paths have been taken in the practice of oral and maxillofacial surgery in this decade, most of them clear of significant obstacles. It is certain that we are in the midst of a highly successful and lucrative period; albeit for most surgeons committing their efforts to office-based surgery, perhaps with a loss of the diversity and excitement of the hospital-based advances of the previous decades. It is said that oral and maxillofacial surgeons are returning to their “cottages,” thus abandoning the path of the major surgical procedures that have become identified with our specialty. This has been recounted in conventional wisdom that says that we are in danger of losing our specialty's preeminence because of this trend. According to OMS on a major surgical path, those surgeons who do not regularly perform major hospital-based procedures are not practicing “the specialty.”
Conversely, community-based surgeons may voice the concern that surgeons who are working in hospitals and residency programs are not supporting the OMS workforce needs of the community, in that OMS graduates are not as adept at office-based procedures as they should be. Hospital-based surgeons are in the midst of a resurgence of need for services especially for the complex trauma, tumor, infectious disease, and reconstruction patients. In that environment and with the poor payer mix associated with most residency programs, the resident experience is necessarily skewed toward hospital-based, medically necessary procedures. Areas of clinical care that are often self-pay such as implant dentistry, cosmetic surgery, and in some environments, ambulatory intravenous anesthesia or orthognathic surgery, are not paths easily taken by surgeons in most academic health centers.
These diverging paths have given voice to concerns regarding our professional identity that seem to question the future success of the specialty. Some of these complaints are based upon patient care concerns, some on misperception, and some on the individual needs of surgeons to find a sense of camaraderie on the path they have chosen. This seems to be dividing the specialty between the hospital-based surgeons and the community-based surgeons and further subdividing the specialty among areas of clinical interest.
Such comments include:
OMS does not have the same commitment to (fill in the blanks depending on your point of view) trauma, anesthesia, dentoalveolar surgery, implant dentistry, pathology, cleft/craniofacial, cosmetic surgery, etc, as it had in the past.
Competition from (fill in the blanks with the surgical or dental specialty) must be addressed with renewed commitment and improved skills in (fill in the blanks with the clinical endeavor) if we are going to ensure the future success of the specialty.
Joining Paths in JOMS
While all of these concerns serve to energize our efforts and improve patient care in oral and maxillofacial surgery, they should not serve to ignite any self-doubt about our current or future success. Our specialty is making great progress on every path it has taken.
The pages of this and every issue of JOMS demonstrate the diversity, vibrancy, and cutting edge leadership of oral and maxillofacial surgeons. This month's articles are as eclectic as always and are page-turners for a varied specialty with interests that span every functional, esthetic, and pathologic aspect from “dura to pleura” with firm roots in dental as well as surgical training. The JOMS Editor's Report to the Editorial Board informed our readers that of the 433 articles citable in JOMS in 2008, the following topics were presented (organized by frequency):
 | Trauma Surgery | 49 articles | |
| Orthognathic Surgery | 48 | |
| Pathology | 43 | |
| Reconstruction Surgery | 42 | |
| Tumor Surgery | 41 | |
| Dentoalveolar Surgery | 37 | |
| Dental Implants | 28 | |
| Medicine | 27 | |
| Anesthesia | 21 | |
| Temporomandibular Disorders | 18 | |
| Cleft/Craniofacial | 16 | |
| Cosmetic Surgery | 14 | |
| Education | 14 | |
| Politics | 14 | |
| Infectious Disease | 13 | |
| Neuroscience | 8 | |
| | |
If the 2 major paths of practice are compared, in 2008, 100 articles relate to more office-based procedures while 214 address hospital-based topics. The remaining 119 articles are pertinent to both. Each of these areas and their subsets represents a path that is joined in JOMS every month. Indeed, nearly all paths of the specialty are mixed in the pages of the Journal each month so that, as in this month's issue, an article discussing esophagogastroduodenoscopy in oral cancer patients is followed by one on symphyseal mandible fractures, and yet another on the distribution of OMS in practice.
Perhaps seeing the rich and varied nature of JOMS every month will stimulate you to choose your path or to change it. Good advice is to pick a path that you will succeed on and that will do some good. Patients benefit from devoted, expert care. If yours is a well-defined and committed path you will become a recognized expert in that endeavor. Group practices offer the opportunity to develop your expertise and interests. Only unwavering commitment to a chosen path creates experts.
A specialty's diversity in clinical care is its strength. By that measure, we are a very strong specialty. Our many paths foster yet greater knowledge and expertise. Decades ago, one surgeon could grasp all aspects of oral and maxillofacial surgery. Today no one surgeon can claim to be expert in all areas that our readers see presented in just a single issue of JOMS.
Yes we are one specialty, but with many paths. Whatever your interests, there is room in the game for you in the pages of JOMS.
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