Hi everyone,
This is a brilliant forum and there have been some interesting discussions. I am a bit concerned however that the landscape of Oral & Maxillofacial Surgery in Australia could be being misconstrued.
I have organised my thoughts into different sections below.
Oral Surgery Training in Australia
The USyd and and UOtago DClinDent in Oral Surgery are relatively new qualifications. It cannot be said that they are highly regarded as they are not well known in Australia let alone Internationally. This is not to say they are not good training programs – just that they are as yet unproven. It is however fair to say that the new DClinDent programs are controversial (
https://onlinelibrary.wiley.com/doi/full/10.1111/adj.12585).
The DClinDent programs are university based and they are not the same as the historical training program in OMS that was available to dental graduates in the 1990s. The name of the program is slightly confusing as some of the historical OMS training programs had similar names however the two – old and new - should not be conflated.
Oral & Maxillofacial Training in Australia
OMS is a rapidly evolving speciality especially in Australia where dual qualification was made mandatory in the 1990s / 2000s. The introduction of dual qualification in Medicine and Dentistry has been identified as key to the expansion of scope of OMS in Australia and New Zealand. The same story is true in the UK and a return to single qualification in OMS is unlikely.
OMS of course operates in the Head & Neck as do a number of other specialities and there is often some overlap with ENT and Plastics. OMS is unique in requiring dual qualification. All surgical specialists have undergone the same undergraduate training in medicine, this is critical in facilitating a smooth working relationship especially in the acute setting where communication is key.
The modern undergraduate dental curricula does not cover medicine in enough detail or breadth to be able to safely interact with other specialties in an acute or inpatient setting. In the past undergraduate dental degrees included more general medicine however this has been reduced over time as the practice of dentistry itself has become more complex and required a greater proportion of the curricula.
The argument for training in OMS for singly qualified dentists can equally be made for singly qualified medics. OMS is a speciality of both Medicine and Dentistry and is regulated by both in Australia and New Zealand.
Understandably the idea that OMS is only a dental speciality comes from two places. Firstly OMS training is administered by the Royal Australian College of Dental Surgeons and secondly that historically OMS specialists were singly qualified as dentists.
It is worth noting that overseas it is possible to train in OMS without a dental degree at all, for example in Spain. That is not to say that a singly medically qualified OMS specialist from Spain could register as such in Australia or New Zealand.
Scope of Practice
This is another area that has been misrepresented on this forum. OMS and Oral Surgeons do not have the same scope of practice in Australia and New Zealand. It is not just about what you feel confident to be able to operate on. The whole premise of regulation is that it is not always safe to be able to judge for yourself what is appropriate. External verification is necessary to temper the hubris. AHPRA, MCNZ and DCNZ are the regulatory boards in Australia and New Zealand. You need to be registered in the appropriate category to practice your speciality (
https://www.dentalboard.gov.au/docu...23744&dbid=AP&chksum=ZNdmNqeUIgEZjPqBogy66w==).
Oral Surgery is a great speciality and in Australia and New Zealand they are able to operate on the “oral and dento-alveolar tissues”. This is in contrast to Oral and Maxillofacial Surery who have a broader range of practice “…adjunctive treatment….of the human jaws and associated structures”
Oral & Maxillofacial Training Abroad
It is not always useful to make comparisons to training programs abroad as, especially with postgraduate training, you are trained to work within your local infrastructure. In a speciality where teamwork is so critical it is not necessarily as simple as being able to transfer your skills to another country where there is a different infrastructure.
Currently the most common place for Australian OMS specialists to undertake fellowships is the UK and visa versa. In the UK, dual qualification has been a prerequisite for OMFS training since the 1980s and they have never looked back.
In the USA medical and dental graduates can begin speciality training as soon as they qualify and therefore rarely have significant experience outside their base speciality. In the UK and Australia trainees are expected to work for a number of years on a rotational basis prior to entering speciality training.
Oral & Maxillofacial Consultants in the UK for example will have typically spent 16-18 years in training prior to registering as specialists. It is a very similar situation in Australia with the RACDS OMS training program leading to well trained specialists with a broad experience.
The final 4 years of OMS training is not the only part of training that makes an OMS specialist. The entire process from qualifying in the first degree, either medicine or dentistry, to the end of training and beyond is what makes a safe and effective surgeon. Trying to skip straight to end, although understandable, is unadvisable.
Myth Busting
You cannot become an Oral & Maxillofacial Surgeon in Australia or New Zealand without a medical degree, it is an integral part of training.
If you have trained abroad as an Oral & Maxillofacial Surgeon you can apply to have your training recognised in Australia or New Zealand. If you do not have a medical degree you may be able to register an Oral Surgeon and your practice will be limited to that defined by the Dental Board of Australia or equivalent in New Zealand.
I appreciate that trainees who have moved abroad to train and have not acquired a medical degree may consider this to be unfair. A medical degree however should not be considered as a nice addition or an optional add on to training.
A medical degree, as with a dental degree, is an integral part of OMS training.