USYD DClinDent (Oral Surgery)

[Smith88]

Thank you Wilson91 for your information. We all know what it takes to become an OMS in Australia. And good on you and others for doing it!

Oral Surgery Training in Australia

It is however fair to say that the new DClinDent programs are controversial (https://onlinelibrary.wiley.com/doi/full/10.1111/adj.12585).

However,
That article is nothing more than 1: a regurgitation copy/paste of a book published by the RACDS in 2015. (See link: Extractions to reconstruction : the development of oral & maxillofacial surgery in Australia and New... | National Library of Australia) The only thing new about that article is a single paragraph that was added denigrating The University of Sydney! ....and 2: it is nothing but a biased self glorification of the RACDS dual degree program, and in fact ... with the sly addition of that single new paragraph and getting it re-published in a different format makes it nothing but an underhanded attempt to discredit the single degree OS pathway in Australia and New Zealand by someone with a political axe to grind!

Oral Surgery training is only controversial in that those who have completed the RACDS program don't want these alternative options to exist!

No one else considers the DClinDent programs in Oral Surgery to be controversial (other than local OMS who feel threatened by them).

Maybe the local OMS crew should spend more time building supportive collegiate relationships instead of attacking colleagues.

 

[Wilson91]

Thank you Smith88 I am glad to have contributed to this important topic.

You are right of course to point out that there is likely to be bias in the article references. We should also accept that there are biases on both sides of this contentious issue.

I think it is important not to dismiss out of hand the fact that the new DClincDent programs are controversial. You have said that this is view is only held by OMS however this does not mean that it should be ignored. OMS continue to provide much of the complex dentoalveolar service and their views are important to take into account.

Collegiate relationships are critical and the best units I have seen maintain good working relationships with other specialities with only a healthy dose of competition.

 

[SquirtleSquad]

Hi Wilson 91,

Great summary and appreciate your input. I'm amazed at the people that come onto this forum.

I just want to add a few things that others may find useful.

When it comes to OMFS, it is true that the UK is the closest comparison to the Australian system of training and scope of practice. You mention that it is important to consider the infrastructure one is training in before making comparisons and this is especially important to consider when saying OS is controversial and unproven. Again, if we take a look under the surface of the UK system-

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.

This is correct. However you have left out that in the UK OMFS is a medical specialty and that registration is with the General Medical council not Dental council. All OMFS get to automatically register as an Oral Surgeon with the General Dental council as well though.
Since the 1980's UK OMFS have continually expanded their scope of practice and today is most similar to facial plastics and ENT than it is to the traditional OMS of the past (focus is largely maxillofacial now). Hence, not all OMFS in the UK take out wisdom teeth and place implants despite being able to - which is the bread and butter of OMS globally.

This is different to Australia where by far the most common part of OMFS is the dentoalveolar surgery and is still what they spend most of the time doing (as it is everywhere else in the world).
It is only in the last decade that Australian OMFS trainees have aggressively been expanding into the realm of facial plastics and ENT via head and neck fellowships.
It is clear that the goal of the Australian OMFS community is to one day emulate the UK model of OMFS and become "medical" surgeons (ie. maxillofacial/head/neck rather than oral surgery). This is why the training has changed to reflect the UK model requiring both medicine and dental degrees and hospital based training. The Australian OMFS community have actually made submissions to the RACS (college of medical surgeons) to be accepted as a primary surgical specialty of medicine several times in past however has been declined despite the reformations made to the training.
In addition It is clear that in Australia if you ask around the medical community there are still some that view OMFS as not being "real surgery" because their bread and butter is dentoalveolar but that's another debate in itself.

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).

Correct. It is not well known internationally. However, if we're making comparisons to the UK again to imply the UK model is the future, then this is just a stronger argument for the Oral surgery profession. What some may not know, is that ever since OMFS became a medical specialty in the UK, Oral surgery (and previously a specialty called Surgical Dentistry) emerged as a dental specialty to help address the need for dentoalveolar surgeons now that the OMFS were moving away from the oral cavity.
As such, the Oral surgery specialty has actually been around since 1999 and there are many universities providing 3 year Oral surgery training courses in the UK. Similarly, New Zealand has actually had the Dclindentdent (oral surgery) course since the early 2000's and so has Ireland.

So while it may be controversial in Australia the Oral surgery specialty is actually a proven specialty in other commonwealth countries where OMFS is no longer just wisdom teeth and implants.
If this is the way OMFS in Australia is heading and clearly it is the way that they want to be heading, then I think all the animosity against Oral Surgery should stop.

There is a lot of literature around this, and it's been a while since I last read into it all but if anyone wants the various articles I will try find them again when I have time.

Would be interest to hear other peoples thoughts on this

 

[forevafrensbear]

The medical degree allows you to claim Medicare Benefit schedule benefit numbers and an appreciation of medicine, Perioperative care, pharmacology etc... that a dental degree alone does not.

OMFS is recognised as both a medical and a dental speciality by AHPRA. Whilst oral surgery alone may equip a dental specialist the qualifications to practice in oral surgery e.g. dental alveolar work. I don't know - the Australian qualification is too new for the dental specialist community to pass judgement. i.e. The scope of practice and how well the graduates of the DClinDent practice it and their outcomes. The qualification itself isn't as important as how qualified the graduates are.

Dentistry as a whole is a very unregulated speciality regarding scope of practice i.e. a general dentist first year out of dental school can attempt to extract an impacted wisdom tooth without supervision if they choose to do so. Many dentists now offer oral surgery ; implants ; orthodontic solutions without formal postgraduate speciality qualifications.

Just as there is Invisalign and online orthodontic solutions competing with traditional orthodontics.

OMFS also do more complex surgeries e.g. orthognathic ; fractures/trauma, complex abscess in addition to oral surgery alone. It has never been 'just wisdom teeth and implants'. They often work in tertiary hospital settings in addition to private practice. There is also competition with the plastic surgery craniofacialmaxillary pathway which is (allegedly) similar to OMFS without the dental degree. For better or worse. The dental degree does provide a more nuanced understanding of dental bite ; working with orthodontists/other dental specialists that a single qualified surgeon may not have. However, oral surgery and dental-alveleolar work is something OMFS have always done ; is their bread and butter ; they have been very good at and do so at a sub-speciality level. They can often extract a tooth in minutes that a general dentist has struggled with for hours and called for help on. Some OMFS especially in the US are skilled at complex reconstructive, oncological surgery and neck dissections that here are the realm of ENT or plastics. It comes down to training and scope of credentialed practice which differs between countries.

The Oral Surgery DClinDent process is rather controversial amongst the OMFS speciality. There is of course an overlay in the type of work. The history behind the people who set up these programs are also a discussion not for a public forum.

That the OMFS speciality is a RACDS fellowship and not a FRACS has complex, historical and other political reasons that are beyond the scope of this thread. OMFS are not interested in being 'medical surgeons'. They are OMFS surgeons. Technically they already are a medical surgical speciality. And already recognised by AHPRA with a specialist medical registration.

OMFS is a very niche speciality.

It is not possible in Australia to become a new, Australian trained OMFS surgeon without the requisite medicine, dental degrees and OMFS training program.

The excess of dual trained graduates not on an OMFS program is to do with the fact that medical/dental schools select and offer spots independently of the OMFS training program. Just as medical schools train interns independently of intern positions numbers or job selection.

I'll respectfully disagree with a few semantic points. To allege that OMFS isn't real surgery because it is not part of the FRACS is akin to saying obstetrics and gynaecology is not real surgery either (they are also their own college). And these assertions have been made in the past also. I can say on record that myself and other colleagues consider OMFS surgeons are an essential specialist surgical service. It is not recent that they have branched out into facial or other areas ; they have done so for some time and often work collaboratively with ENT, ophthalmology including regular multidisciplinary meetings.

Perhaps have a look at the US model(s) also. The UK model is not always one to look up to ; nor is it always relevant to the Australian system.

 

[forevafrensbear]

I can’t attest to any of the information in that post but thanks a lot for the write up. It’s clear you’ve given it a lot of thought and it’s a super thorough resource

I can. Wilson's posts are reasonably accurate.

 

[SquirtleSquad]

Thanks Forevafrensbear

I agree with what you’ve said and stand corrected. My wording was ill chosen comes across ill informed in hindsight. I am well aware of the nuances and will try to reword what I’ve said.

When saying "wisdom teeth and implants" I was trying to imply the traditional scope of OMFS which I know does encompass “orthognathic ; fractures/trauma, complex abscess in addition to oral surgery alone” - and has been part of the scope ever since the beginning of the profession. However these things historically did not require a secondary medical degree. In addition "wisdom teeth and implants" are the main overlap with Oral Surgery which is what I was trying to imply as a reason for why Oral Surgery came to be in the UK since OMFS started to focus more on the complex tertiary hospital and extra-oral areas of their scope.

I know OMFS is viewed as a proper specialty and is well respected. What I was trying to say is that those who only did traditional stuff haven’t always been viewed as “real surgeons” due to the lack of a secondary medical degree and RACS training. I know this isn’t the majority view but was just trying to say that the view is out there

“medical surgeons” was in hinsight poor wording but I was referring to the emergence of contemporary trained OMFS’s going beyond the traditional scope - who go on to do head and neck fellowships involving microvascular free flaps, neck dissections, oncology reconstructions etc. Which historically has NOT been the focus of OMFS and in recent years (ie. The last decade) has become a much bigger and important part of the OMFS skillset, but has been in the UK OMFS skillset for a lot longer. A skillset which absolutely requires proper medical and hospital based training. However of all the OMFS out there, there is still only a minority who do this stuff.

My point was that in the UK, there is a greater distinction between "oral surgery" and "maxillofacial surgery" and OMFS's who focus their time on doing head and neck surgery mostly don't dabble in "wisdom teeth and implants" anymore. In contrast to OMFS in Australia. And that is one of the primary reasons why Oral Surgery as a specialty came to be and has been around a lot longer than people may think. That was the focus of my argument.
Whether this Sydney course is equivalent to what they have in the UK (which it seems to be based off) remains to be seen as you've said. The course/specialty certainly wasn't some random idea conjured out of thin air to spite the OMFS community.

However if we assume equivalence to the UK system, then I believe Oral Surgery should be viewed as a colleagial specialty to OMFS not a competing/inferior/controversial one.
If it really was bad and the oral surgeons in the UK were a danger to patients then I'm sure the specialty would've been removed a long time ago

Appreciate your contribution

 

[forevafrensbear]

And also.

The head and neck fellowships are perhaps also controversial and not part of core OMFS training nor scope of practice. Whilst the complex procedures are well described by OMFS in the US for instance, It is indeed new in Australia and best viewed as a subspecialty developing within a speciality.

I suspect the addition of a medical degree was to better understand working within the hospital system, an understanding of basic medicine and also to legally access prescribing/billing rights exclusive to medical practitioners. And to set the speciality apart. There is a lot of respect for a practitioner who has invested 15 years of life in training and fellowship.

However do not quote me as this is mere personal speculation.

I might add that even general dentists (including family) sometimes do not understand the difference between an oral surgeon and OMFS nor the scope of practice.

I will comment that there are still singular qualified OMFS in the system and who vocationally are excellent.

 

[Smith88]

You are right of course to point out that there is likely to be bias in the article references.

Likely?.. You mean Definitely.

Collegiate relationships are critical and the best units I have seen maintain good working relationships with other specialities with only a healthy dose of competition.

Nothing healthy about the view of OS from Australian OMS. Slandering OS colleagues, attempting to block them from appointments in hospitals. This is not "healthy competition". Its just bad (unprofessional) behaviour, and its rife among Australian OMSs unfortunately.

I have yet to hear of an OS who has spoken similarly or done anything similar in reference to an OMS. Its pretty much one sided bias.

and ... I get it. You "paid your dues" and you want to protect your turf and market. But lets be honest. That is what it really comes down to for most OMSs who act unprofessionally in Australia.

 

[Smith88]

The history behind the people who set up these programs are also a discussion not for a public forum.

Funny you say that. It was an OMS who published (I should say re-published) the history of the people involved in a public forum (ADJ) and also at the same time slandered the University of Sydney. Once you do that I feel its only fair to expect some further public discussion.

Perhaps have a look at the US model(s) also. The UK model is not always one to look up to ; nor is it always relevant to the Australian system.

I actually agree with you here.

Ok. Guess what, you better be ready to fully accept the single degree path to becoming an OMS (as dual degree programs only make up roughly 40% of the training programs in North America). The single degree programs make up 60% of training spots and these are also actually more competitive as they have a higher applicant to spot ratio). Both dual and single degree OMS in the US and Canada are equivalent in terms of their specialty training in OMS.

You can't have it both ways. Both requiring a medical degree to becoming an OMS and then also not allowing a single degree path of any description.

Facts:

• The Australian education system is (historically) British. However, Australia has slowly converted to a more North American education system over the past 10-20 years. Now most dental and medical schools are graduate MD/DDS programs in their structure (and almost all international students are Canadian or American). Australian and New Zealand dental schools have not had UK accreditation since the year 2000! All dental schools in Australia and New Zealand since 2010 are now full accredited in Canada (and visa versa). (I agree that a North American training comparison may be more accurate than the UK especially moving forward)
• Those in charge of the Australian OMS program have "tried" to emulate the UK OMFS (maxfax medical specialty) in the past. However, the average OMFS in the UK has a much broader scope of practice than the average Australian OMS. Australia just doesn't have the same population and case volumes that the UK does. Nor do we have the same H/N and craniofacial training centres for OMFS. The Australian OMS is more akin to North American counterparts (in fact with less trauma experience than the US!). The large majority of Australian OMS work is dentoalveolar surgery with some practicing wider scope.
• In Countries where OMFS/Maxfax is a medical specialty (UK, Germany, Switzerland, etc). There also exists a dental specialty of OS as in these places the medical specialists of OMFS do not routinely perform third molar surgery or implant work. This is not controversial in those locations either.

The future of OMS/OS in Australia will involve one of two paths:
1. The two specialties fusing into one and there being both a 4-year (residency) training path to OMS for both Single and Dual qualified applicants (exactly equivalent to Canada and the United States). As we already have a reciprocal accreditation agreement between Canadian and Australian dental programs this might extend to specialty training programs soon as well, as the ADC and Canadian Dental Council mirror accreditation requirements for all postgraduate dental programs.
or
2. The OMS training program will maintain their current structure and program and equally the OS programs will also continue to exist as a technically seperate specialty (with their own set of requirements and regulation). The two specialties in Australia (when comparing their relationship in the UK) will have MUCH more overlap in scope in Aus than the UK.

Either way all Australian OMSs need to just accept that the single degree path is not going away, and get over yourselves (ego check) and start behaving like the professionals you claim to be.

 

[forevafrensbear]

Conflict of interest check:
1. I am not an OMFS surgeon. I do know OMFS surgeons (as well as other medical and dental specialities) professionally and personally.
2. Smith88 is making a number of assertions which I assume are based upon his/her own personal opinion. I assume you have a vested interest in the oral surgeon DClinDent program and/or had conflict with the OMFS speciality.
3. Your implied post that OMFS surgeons are not behaving like professionals is on a public forum. I'm not a moderator. But making such public assertions can be considered borderline unprofessional.
4. I have known OMFS specialist colleagues to be professional and mindful to their referrers and patients.

An oral surgeon is not an oral maxillofacial surgeon. They are in fact two different specialities as recognised by AHPRA. That oral surgery was not removed a speciality from AHPRA also has some historical background. Combining the two specialities into one training program is not likely to happen due to the broader scope of practice and training inherent for OMFS ; and their established foundational practice in Australia.

Credentialing in hospitals at specialist level is made by a committee process and the final decision made by the Director of Medical/Surgical Services or CEO. I sit on the credentialing committee. Scope of practice for OMFS depends upon individual practice, public v private etc... some states have much more trauma exposure than others. Whilst other institutions will have head and neck OMFS fellowship trained specialists.

Dental-alveolar surgery is an integral part of OMFS training and scope. So there will be overlap. Many general dentists are now increasingly comfortable with doing themselves rather than referring on. It is not a protected area of practice.

Of your two pathways cited, I suspect that 'option 2' will continue to be the way moving forward.

The dual pathway medicine and dental degree is not going to go away in the near future. AHPRA require it for new OMFS specialist registration.

https://www.dentalboard.gov.au/Registration/Specialist-Registration.aspx

I am rarely on the MSO forums and do not have much more to add to this discussion - so will politely take my leave here.

 

[dotwingz]

3. Your implied post that OMFS surgeons are not behaving like professionals is on a public forum. I'm not a moderator. But making such public assertions can be considered borderline unprofessional.

Just want to comment here that it's not our role to moderate the professionalism of our users. That being said, the discussion focusing around the bias of the author in reference to the ADJ article must remain strictly non-personal in accordance with MSO rules. Any comments on the author outside of what would be considered critical discussion of their work will not be tolerated.

 

[Smith88]

Just want to comment here that it's not our role to moderate the professionalism of our users. That being said, the discussion focusing around the bias of the author in reference to the ADJ article must remain strictly non-personal in accordance with MSO rules. Any comments on the author outside of what would be considered critical discussion of their work will not be tolerated.

Noted. I agree.

I have not made this a personal attack on anyone. I'm simply pointing out that a re-published opinion piece in the ADJ by someone who has a political agenda is not "evidence" of anything (other than that some OMSs feel threatened by the training and registration of single qualified surgeons).

 

[Smith88]

Conflict of interest check:
1. I am not an OMFS surgeon. I do know OMFS surgeons (as well as other medical and dental specialities) professionally and personally.

I am an Australian born and bred. An Australian dental graduate who then completed a single degree OMS training program in the US. I am a registered Oral and Maxillofacial surgeon in the states. If I were to return to Australia (possibly in the future) I will be registered as an Oral Surgeon. If I move back I will most likely relocate to a rural area and practice largely routine oral surgery, but I also plan on offering an on call facial trauma management service to my local public hospital in my region (and yes that is within my scope as an Oral Surgeon in Australia).

2. Smith88 is making a number of assertions which I assume are based upon his/her own personal opinion.

No personal opinion here. I have a colleague (another Australian registered Oral Surgeon who is an overseas trained OMS) who has direct evidence and proof of such bad behaviour. No names shall be mentioned.

4. I have known OMFS specialist colleagues to be professional and mindful to their referrers and patients.

As do I. Many are professional and lovely people. ... some aren't.

3. Your implied post that OMFS surgeons are not behaving like professionals is on a public forum. I'm not a moderator. But making such public assertions can be considered borderline unprofessional.

If I have proof and evidence of such behaviour. Its not implied. Its a fact. I am not going to out anyone in a public forum. But its a fact (and not an isolated incident).

An oral surgeon is not an oral maxillofacial surgeon. They are in fact two different specialities as recognised by AHPRA.

In Australia at the present time. Yes, this is true. Two different specialties who have much overlap in Australia.

Credentialing in hospitals at specialist level is made by a committee process and the final decision made by the Director of Medical/Surgical Services or CEO. I sit on the credentialing committee. Scope of practice for OMFS depends upon individual practice, public v private etc... some states have much more trauma exposure than others. Whilst other institutions will have head and neck OMFS fellowship trained specialists.

I agree with you. Oral Surgeons and Oral and Maxillofacial Surgeons both come from a variety of different training backgrounds; and credentialing and scope depend on clinical training and experience.

(it should be noted there are some Oral Surgeons registered in Australia who have a wider scope of practice and more clinical experience than some Oral and Maxillofacial surgeons).

Dental-alveolar surgery is an integral part of OMFS training and scope.

In Australia it is. Yes.

So there will be overlap. Many general dentists are now increasingly comfortable with doing themselves rather than referring on. It is not a protected area of practice.

I agree with you here.

Of your two pathways cited, I suspect that 'option 2' will continue to be the way moving forward.
The dual pathway medicine and dental degree is not going to go away in the near future. AHPRA require it for new OMFS specialist registration.

I also agree that this is the most likely outcome. It is very unlikely that the RACDS-OMS Board of studies will be open to change of any sort. So yes, it is much more likely that the two OS/OMS will continue into the future as two seperate but very much similar specialties with much overlap in scope in this country.

 

[toothdoc]

I am an Australian born and bred. An Australian dental graduate who then completed a single degree OMS training program in the US. I am a registered Oral and Maxillofacial surgeon in the states. If I were to return to Australia (possibly in the future) I will be registered as an Oral Surgeon. If I move back I will most likely relocate to a rural area and practice largely routine oral surgery, but I also plan on offering an on call facial trauma management service to my local public hospital in my region (and yes that is within my scope as an Oral Surgeon in Australia).



No personal opinion here. I have a colleague (another Australian registered Oral Surgeon who is an overseas trained OMS) who has direct evidence and proof of such bad behaviour. No names shall be mentioned.



As do I. Many are professional and lovely people. ... some aren't.

If I have proof and evidence of such behaviour. Its not implied. Its a fact. I am not going to out anyone in a public forum. But its a fact (and not an isolated incident).


In Australia at the present time. Yes, this is true. Two different specialties who have much overlap in Australia.



I agree with you. Oral Surgeons and Oral and Maxillofacial Surgeons both come from a variety of different training backgrounds; and credentialing and scope depend on clinical training and experience.

(it should be noted there are some Oral Surgeons registered in Australia who have a wider scope of practice and more clinical experience than some Oral and Maxillofacial surgeons).


In Australia it is. Yes.


I agree with you here.

I also agree that this is the most likely outcome. It is very unlikely that the RACDS-OMS Board of studies will be open to change of any sort. So yes, it is much more likely that the two OS/OMS will continue into the future as two seperate but very much similar specialties with much overlap in scope in this country.

Big ask, but is there any way I can pick your brains about your journey through private message

 

[Smith88]

Post Graduate eOpen House 2021

uvents.nus.edu.sg

Anyone applying to Singapore for OMS? They are accepting applications again it seems.

 

[Smith88]

View attachment 4757

Post Graduate eOpen House 2021

uvents.nus.edu.sg

Anyone applying to Singapore for OMS? They are accepting applications again it seems.

Just a reminder that NUS Online open day is this friday/sat if anyone wants info about their OMS program.

 

[Marcel H]

Hello Dr Smith. Thank you for sharing much generous insight about your OMFS journey. This is Marcel. I hold a postgraduate qualification in OMFS from the UK and has successfully passed the iNBDE. Strongly aspire to become OMFS in North America. Is there any way I could contact you? Apologies, I am new to medstudentonline forum, still figuring out how to send a private message, but was not successful yet. Thank you Smith.