Already approved in California's Senate, S.B. 438, jointly sponsored by the California Dental Association (CDA) and the California Association of Oral and Maxillofacial Surgeons (CALAOMS), proposes that oral and maxillofacial surgeons be allowed to apply to the CDA for credentials to perform elective cosmetic procedures of the head and neck.
The credentialing process would require applicants to submit at least 10 operative reports from cosmetic-oriented residency training or proctored procedures to a five-person committee appointed by the CDA with input from organizations including the Medical Board of California and the California Society of Plastic Surgeons (CSPS).Facing opposition At press time, the measure was expected to reach a vote in the California Assembly's Business and Professions Committeein June, despite continued opposition from groups including the CSPS and the California Society of Dermatology and Dermatologic Surgery. Should it pass thecommittee's muster, the bill likely would reach a full Assembly vote late this summer.
"It's not clear why there's any reason to support the bill," says Michael G. Cedars, M.D., CSPS president and a plastic surgeon based in Oakland. "There's no pressing need for it. In addition to plastic surgeons, there are already other medical specialties that provide cosmetic surgery to the public.
"The public expects that facial surgery, soft tissue surgery and cosmetic surgery will be done by a physician, while teeth will be treated by a dentist," he adds.
"This bill blurs the distinction by giving (dentists) a legislative route to becoming equivalent in legal scope to an EN surgeon, whereas really, they're not even physicians. It's worrisome that if this is approved by the state, the public, in theory, would have the state endorsing the safety of having these operations performed by a dentist."
Protecting turf "That's probably an argument made by those who are simply trying to protect their turf," counters Doug Elmets, a spokesman for the CDA and the CALAOMS.
"Many plastic surgeons in California know all too well that oral and maxillofacial surgeons are capable, qualified and available in trauma centers many times when plastic surgeons are not available."
According to Dr. Cedars,"They're doing operations in the same region of the body, but they are in no way the same operation."
"The devil is in the details," adds Jack G. Bruner, M.D., CSPS Political Action Committee chairman and past president, and a Sacramento-based private practitioner. "Three of the committee's members will be board-certified oral surgeons. Another member will be a specialist in plastic surgery; the other, a specialist in otolaryngology. As it stands, those two specialists can be anyone (the CDA) deems as a specialist in plastic surgery. The language does not say these two will be board-certified in their specialties."
However, Mr. Elmets says, "It is my understanding at the time of this printing that the positions on the five-member board will include those who are board-certified."
Hospital privileges Dr. Bruner also expresses concern over how the bill would award hospital privileges.
"Instead of allowing oral surgeons to take their training and cases to a surgery committee," he says, "this bill would create a five-person committee on the dental board that's supposed to take the place of all the hospital surgical committees in the state."
Additionally, Dr. Bruner says the requirement that applicants submit at least 10 operative reports fails to specify that they be the primary surgeon in these cases.
"According to the text," he says, "they can be an assistant surgeon or second assistant and qualify. That's a big loophole."