Biting the Hand That Feeds You!
We’ve been through all of this and the decisions have been made - or
forced. The specialty of prosthodontics has its third year of training
in place. We have decided that to encompass all of the training needed
in order to become competent in “implant dentistry”, a year added to
the old two years of training is necessary. The American College of
Prosthodontists has even added the words “Implant, Esthetic and
Reconstructive Dentistry” to its journal title, a broadening that just
about covers everything that we are supposed to be doing. We took
ourselves there (“there” including training in the surgical placement
of implants) and the graduates of the new training are coming out.
A major speed bump in the road will occur should grants connected with
the government’s Medical Education program cease. With these grants,
three years in training is tolerable. Without them, two years in
training is a burden few can carry. But that aside, we are where we are
now, and we must now live with the outcomes, at least for now.
Considering the third year of training, a recent conversation in the
Washington D. C. office of a trained prosthodontist went something like
this:
“I have spent over ten years building this practice in
prosthodontics. The practice is now one of the premier specialty
practices in the city. I am not bragging, but I am doing well,
achieving beyond my dreams. I am well known; my reputation for
excellence is well accepted; and most important, my referral base for
implant dentistry has become extensive, coming from oral surgeons,
periodontists and a few well trained general dentists all over the
Washington D. C., Maryland and Virginia areas. I have now reached the
place where I should, no must, consider bringing in a trained
prosthodontist as an associate. I started that way and the need for
associates to find a place to start is always there.
“Here’s the problem: a newly trained prosthodontist wanting to
begin practice will want to make use of the extensive training received
in the surgical placement of implants and subsequently restoring them.
That’s what the ACP’s journal says we do isn’t it? And this associate
I’m after wasn’t born yesterday; the income gained from doing “all”
will be substantial. Wait a minute! When that happens my referral bases
will dry up. The oral surgeons, periodontists and general dentists I
have courted so well and who now have great confidence in me will
immediately shut me off. There are other fine restoring dentists they
can refer to, and by using them, the surgical practitioners won’t be
losing the income they receive from placing implants.”
What a dilemma! This prosthodontist’s problem wasn’t caused by some
misstep of his own. It was caused by some hierarchy in our own
specialty circles; a hierarchy who thought that the inclusion of
surgical training in prosthodontic specialty training would best
prepare us to function in the world of implant dentistry. With their
surgical leanings, the surgeons, periodontists, general dentists and
yes, even the endodontists took advantage of and grabbed the surgical
segments early in the game. Seeing their profits, what other reason was
there for us to include ourselves in the pot of gold at the end of the
implant surgery rainbow? Or was it that we thought we could become more
expert, more proficient and greatly more successful in the surgical
techniques necessary to place implants? It certainly couldn’t have been
that adding a third year of training was to increase our restorative
skills; and certainly it wasn’t to relieve our trainees of thousands
and thousands of their dollars in order to complete a third year.
Well, it becomes clear what will happen to practices built on
referrals. Prosthodontists with surgical training will be seen by the
other specialties of dentistry as something to stay away from. The
surgical specialties will wonder if there any limit on our capabilities
or our desires to do “all”. Added to that is their knowledge that for
years we have been doing general dentistry, on the sly so to speak,
only calling ourselves specialists. Such a coverup already had laid the
ground work for referring with caution. They know it and we know it;
and these perceptions of us have always caused many specialists and
general dentists to be hesitant in their referrals to prosthodontists.
Can we live with this problem now? Perhaps.These suggestions might work:
• If a practice is ongoing and older and referral based, it should
be careful to exclude surgical procedures. The practice must continue
to rely on those specialists and general dentists who are successful in
implant placement and who cooperatively plan, refer to and are
satisfied with the restorative outcomes provided by the trained
prosthodontist.
• If a three year trained prosthodontist is beginning practice
anew, the skills as learned can be put into place; understanding that
referrals may come, but probably coming only from those dentists and
specialists not performing implant surgery.
• Prosthodontics should quickly revisit the third year of training
concept. It will be a win/win deal should decisions be made to revert
back to the two year program. Hopefully the Medical Education stipend
program will continue, but should it not, some few will still be able
to afford our specialty training. With luck, our specialty will live.
Are we second guessing? Yes, but let’s undo the three year training
programs before all specialties turn on us. Three years of training -
NO. Surgical training - NO. Restoring referred patients as we best know
how - YES! NDW
