California expands oral surgeons' scope of practice

California's oral and maxillofacial surgeons without medical degrees may now do elective facelifts, rhinoplasties and eyelifts. A new law California Gov. Arnold Schwarzenegger signed Sept. 30 expanded the scope of practice for the doctors, leaving many physicians concerned about patient safety.

The measure allows oral and maxillofacial surgeons to perform elective facial surgery, including the head and neck area. More than a dozen other states have similar laws.

Before California lawmakers passed the bill, the American Medical Association-backed Scope of Practice Partnership e-mailed its member organizations asking them to consider signing a letter in opposition to the bill and to encourage their members to contact their legislators and the governor's office to voice concern. As a result, 18 national specialty organizations, including the AMA, and 12 state medical societies signed a letter to the California governor explaining their opposition to the bill.

"They've replaced education with legislation," said John Osborn, MD, president of the California Society of Plastic Surgeons, which opposed the legislation and signed the letter.

Dr. Osborn said the legislation allows oral surgeons to perform procedures beyond what they were trained to do. For example, he said, the doctors don't have the same depth of knowledge as those with medical degrees. "They don't learn how to take care of such things as kidney problems, which can be important at times."

Gerald Gelfand, DMD, California Assn. of Oral and Maxillofacial Surgeons president, disagreed with that assessment and said members of his profession do get proper training.

"We do the same type of procedures in the emergency department during the night, but are not allowed to do them during the day [outside of emergency call]," Dr. Gelfand said.

He said the law eliminates the inequity. "Safety is our primary concern," Dr. Gelfand said. "We're not some fringe group. We are a sophisticated group of surgeons, and we want to make sure our members are doing this safely. Only a small group of well-trained oral and maxillofacial surgeons will be doing this."

He estimated there were 30 to 40 oral surgeons among his group's 600 members who would qualify for the elective cosmetic surgery license. These oral surgeons have had four years of dental school for a DDS or DMD, followed by four years of surgical training.

There are also oral surgeons who have an MD degree and a DDS or DMD degree. These physicians are fully licensed to practice medicine and would not need a cosmetic surgery license. Their background includes four years of dental school, the last two years of medical school and four years of surgical training.

Dr. Osborn said he and his colleagues are concerned about oral surgeons without a medical degree.

"Now they have another pathway where they don't have to get an MD," he said. "It almost makes a mockery of our training. ... Our main hope is that the [oversight] committee is truly a gatekeeper committee and does its job -- that these people will get the training they need to do good work. I don't care what they call themselves if they do good work, are properly trained and don't hurt anybody. But we have real concerns that won't happen."