In “Training the Future,”1JOMS examined the challenges facing the future of our specialty and the need to recruit, invest, ally, and plan for the future success of oral and maxillofacial surgery (OMS). Investment is the one tool that provides the resources for strategic change. This month we examine how the specialty must invest in our future to create the specialty we desire.
No practice, professional organization, or public entity can survive long without systematically reserving, and wisely expending, capital to support a healthy infrastructure. Our infrastructure for the future is not equipment and buildings. It is our people, our influence, and our science.
Invest in People
The failure of our profession and society to adequately invest in people has resulted in many disparate problems linked by the common problem of a lack of capital investment. These include a declining quality of applicants seeking graduate training due to student debt that hinders altruistic career goals, loss of their faculty, loss of training and experience as patients are denied necessary surgical care, and scarcity in the auxiliary workforce. Elaboration on these problems and some capital strategies to address them follow:
•The cost of graduate OMS education has diminished the desire to seek residencies, especially our 6-year programs. One program director of a prestigious 6-year program (along with 7 other directors of 6-year programs and but 2 directors of 4-year programs) was faced with unmatched positions for 2007. He recently wrote, “I believe that the…6-year training concept has finally reached the point of obsolescence.” Many of today’s applicants are daunted by the length of training and mounting tuition cost of 6-year programs. Overall, there are now just 1.4 qualified applicants per OMS residency position. Once residents have completed training with high educational debts, they may be financially unable to spend the time to volunteer; to care for those patients requiring low pay or no pay procedures.
Capital Strategies: invest in the future members of our specialty while ensuring that they will invest as well. With industry, government, foundation and individual support a comprehensive scholarship program for OMS education needs to be in place to obviate the financial stress of residency education. As with the Faculty Education Development Award, a plan for ensuring the recipients investment in the future of the specialty can be developed. Many 6-year programs now offer exceptional financial aid and scholarships to their residents. Other programs are able to pay their residents as faculty in the dental school while they are enrolled in medical school.
•It was once typical for academic health centers to care for patients solely on the basis of need rather than ability to pay. While this is still granted time-honored position in mission statements, the golden rule now prevails. That is, “the clinical services with the gold rule.” Attention to financial success has driven many important clinical tasks from the academic health center and from our training programs. Lack of insurance for orthognathic and temporomandibular joint procedures have reduced the impact of this training in our educational programs.
•The lack of support for graduate medical education has also affected the ability to adequately support faculty positions. There is essentially no capital reserve to support graduate medical education. Capital reserved for that purpose, available through Medicare reimbursement for graduate medical education, has gone in large part toward general expenditures and support of indigent care.
Capital Strategies: invest in our academic programs: The financial success of education depends upon improving the payer mix of patients, efficiencies in clinical care delivery, sound business practices and the dollar support of alumni, grateful patients, and friends. Educating program directors and academic surgeons in practice management and development skills (fundraising) will support the success of their departments and the ability to build a future for the specialty. The Oral and Maxillofacial Surgery Foundation (OMSF) and AAOMS remain essential vehicles to this success with the Faculty Education Development Award. Funded professorships, named clinics and laboratories and other development opportunities at our academic health centers need to match those of other surgical specialties.
•Development of our allied workforce is hindered by insufficient training and career opportunities for our staff. Training retention and development of our future staff is a task for every oral and maxillofacial surgeon. Our specialty does not have a specialty path for nurses or physician assistants. Dental hygienists are not given experiences in oral and maxillofacial surgery and remain unaware of career opportunities in surgery.
Capital Strategies: invest in our clinical staff: Development of career paths for dental hygienists and nurses in OMS has begun with the OMAAP anesthesia assistants program and other developments. So much more remains to be done. Continuing education for RNs and hygienists in OMS must be developed. Development of a physician’s assistant and nurse practitioner program specific to the needs of oral and maxillofacial surgeons is needed. Development of an OMS track for dental hygienists would allow advanced education for hygienists permitting surgical duties for appropriately trained individuals in the OMS workforce. In developing this model we must adhere to the well-considered policies of the American Dental Association; ie, that the dentist is the head of a health care team and that the dentist must carry out all irreversible clinical procedures.
Invest in Influence
Our specialty needs the positive influence of public opinion, political and business community support to gain future excellence. Wishing to be seen in a certain light does not make it so. Constant effort is required to inform the public on the importance of OMS to their health. Politicians and business leaders must know the value of oral and maxillofacial health to the effectiveness of the workforce and the common good.
Capital Strategies: invest in information: Sources of information in no way resemble those of the past. While newspaper inserts and network advertising remain useful modalities, people are now gaining their information, and forming their opinions in new ways. Our next public information campaign needs to utilize the full contemporary means of marketing and education including electronic (eg, Ipod), Internet, blog-based, “stealth” marketing, and “Daily Show” approach meant to appeal to the next generation of health care consumers.
Capital Strategies: invest in public policy: While OMSPAC and our lobbying efforts get our opinions heard by political leaders, oral and maxillofacial surgery can gain an even greater role in health care by participating in the policy debates by opinion leaders that surround the various plans for utilization of health care resources in the future. Public health physicians and dentists, medical directors of insurance companies, dental insurance leaders, the leaders of the Centers for Disease Control, the National Institutes of Health, and the Centers for Medicare and Medicaid Services are but a few constituencies who need to be able to utter the words “oral and maxillofacial surgery” with understanding and support of our role in health care. The excellent track record of AAOMS in this regard will surely require ever-greater emphasis in the future.
Invest in Science and Technology
Those who find knowledge will usually own it. OMSF and AAOMS-sponsored research have been the best means of addressing essential scientific issues of importance to the practicing surgeon such as the health consequences associated with third molars and their clinical management. Federal funding agencies such as the NIDCR do not consistently have goals for funding projects of particular interest in surgical practice.
Capital Strategies: invest in new knowledge: Write that check to the OMSF. Support federally funded clinically relevant biomedical research. Support those oral and maxillofacial surgeons who devote themselves to research and of course enjoy, regale, and utilize their findings as they appear in this month’s JOMS.1
Reference
1. 1Assael LA. Training the future: Protecting the scope and diversity of oral and maxillofacial surgery. J Oral Maxillofac Surg. 2007;65:161. Full Text |
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