Overlap of the scope of practice
Daril Atkins
colleagues from aroud the world. Everyone in the developed world is
obviously aware of the 'scope of practice' yet there seems to be a
status quo on the overlapping of this scope where Anaplastology and
Maxillofacial Prosthetics is concerned.
Institutions in the developing world look to the JCIA for
accreditation. The JCIA being an American organization concerned with
the standards of quality in the healthcare services has also
emphasized the importance of clearcut 'scope of practice' for various
healthcare professionals.
Recently I browsed the the ‘American Academy of Maxillofacial
Prosthetists’ website and was surprised to see that ocular, orbital,
ear, and somato prostheses included in their scope of services. Is the
JCIA turning a blind eye, or are we just content to accept the status
quo in the USA and in the UK.
I would be most obliged if anyone can educate me on this subject.
Daril Atkins
Daril Atkins
scope of practice and are routinely designing and fabricating somato
prostheses. It is surely an issue of revenue and here it becomes an
ethical issue. I really wonder why there is no response to this topic
from them. I guess that if they venture into providing artificial eyes
then its probably restricted to the standard reform cut and fit. After
all even in the USA one will spend five years with a cerified
Ocularist to gain experience and exposure. So the subject is a
dedicated one. In other words the fitting of artificial eyes is a
dedicated profession just like somato prostheses. But when you inform
us that an American Academy of Maxillofacial Prosthetics condones this
scope pf services, then perhaps this issue should be on their table.
What do you think?
Tandigon
michael williams
| Hello Daril, This question has resulted in quite a long answer below (sorry for that) but it does raise some interesting points. With regard to the services provided by members of the AAMP that you say may be "outside their scope of practice and the JCIA turning a blind eye" It is often the fact that services come about by certain groups or individuals as a case of historical necessity, i.e., that there isn't or wasn't anyone else locally available that provided/s those services at a particular time. Revenue, certainly in the UK, NZ and Australia doesn't usually come into it due to the fact its free healthcare. Patient need is the driver. I would argue that primarily, dentistry was historically the specialty/profession that responded to the need and established the provision of services we know today as modern Maxillofacial prosthetic appliances and surgical support (mainly thanks to WW1 &WW2). As I went through UK training, I can only comment about that and know that the general training and qualifications of maxillofacial prosthetists/technologists (MPT's) does cover the provision of many of those prostheses you may deem outside the scope as defined by JCIA. With regard to the AAMP, you will have noted the AAMP membership is aimed at Maxillofacial Prosthodontists, a specialty of dentistry, and who are dentists with postgrad qualification (or training for) in providing maxillofacial prosthetic services. Unfortunately Anaplastologists are not even invited as a member category but dental technicians and MPT's are, but they are ineligible to vote or hold office. I do not know how extensive the scope of training for our American colleagues in terms of extraoral Maxfac training programme is (content and time spent clinically/technically) so cannot comment about that, except that I would assume it is fairly similar. Dentists do have a wider base of knowledge in health sciences (similar to a medical doctor) but the practical application of our work is the same as we all know. In terms of how that plays out in a clinical setting, the only major difference being that the Prosthodontist is the team leader and may do only clinical work with minimal lab work ( Dental or M/F tech will do this under prescription) though this is not always the case. I have met some very talented M/F Prosthodontists who can produce both excellent technical and clinical work. Whereas in the UK MPT's are usually Dental Techs who have undergone specialised postgrad training to ensure they are qualified and experienced enough to provide those services safely to a high standard, eliminating the need for a prosthodontist. But still working in close collaboration with M/F surgeons and dentists in training to become M/F surgeons. MPT's provide prosthetics, appliances and surgical support to prescription from referral from any medical, specialist or dental practitioner, not solely from prescribing dentists, but practice within a maxillofacial/prosthetics dept but with senior medical and/or dental help on hand should the need arise for intervention of any sort. Their scope also includes also the provision of obturator prostheses which may also be implant retained, (Implants placed by M/F surgeon). But when a dentist or prosthodontist is required then the patient will be referred appropriately. (In fact in terms of facial and somato prosthetic provision it could be argued employing MPT's/Anaplastologists actually keeps costs down as dentists/ dental specialist are nearly always higher paid than techs!) It is also that registration authorities in each jurisdiction may recognise a practitioners training and experience and allow practioners to practise in that defined scope providing they can prove that they do have sufficient experience and/or qualifications (e.g, new entrants from overseas with differing qualifications). But the overriding requirement for any registering authority in determining scope of practice and registering practitioners is that practitioners must have a current knowledge base, can provide those services in a safe manner to a minimum required standard and most importantly, that the patient is protected from harm. The professions themselves will often define what their scope of practice(s) should be in their jurisdiction (and that may differ from what JCIA define). And that has to stand up to Governmental scrutiny and the obligation to protect patients. So wether we like it or not, differing specialties will have overlap in their scope of practice but as long as treatment is safe, effective and the patient has satisfactory outcomes, there wont be much anyone can do about that. Maybe it's more about being proactive, building relationships with and informing patients and referring specialists that certain practitioner groups may have arguably better, more extensive training and can provide superior services compared to other groups due to their more specific, specialised nature? regards, Mike Williams, RCDT,MIMPT(UK), Maxillofacial Prosthetist & Technologist Maxillofacial,Oral Surgery and Dental Department, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton, New Zealand. Tel ++64 7 839 8805 Fax ++64 7 839 8996 --- On Fri, 13/8/10, Daril Atkins <darila...@gmail.com> wrote: |
|
Paul Tanner
I know regulating entities like to define the scope of practice. I do not see a problem with the AAMP including ocular and craniofacial in their scope of services. Truth be told, by means of peer publishing, prosthodontists have done our field large favors over the decades. They continue to do so today. We have some excellent artists in our group that have learned to make the highest quality prostheses. That I am proud of. Our shortcoming is that anaplastologists and technicians do not do much good for the field because unfortunately very few use science to improve patient care. If you want to be respected by the doctors you work with, you must use science and show them that you know how. Obviously the AAMP declaring their scope of service is necessary because they are dentists and everybody thinks their work is in the mouth. We always need to remember that advertising the services of a profession is not bad and is different than declaring a turf war. I personally think that people that declare turf wars perceive their services to be inferior to that of another competitor and thus they feel it is necessary to declare what is "rightfully" theirs. There are turf wars in all services of medicine. In the end, what is most important is that the patient is being provided the best services available regardless of credentials. In my opinion, our profession is self-regulating. If you provide poor service and the quality of prosthesis is bad, patients will not be happy and will not want to wear the prosthesis. You know you have failed as a service provider when that happens. Doctors will not want to send their patients to people that provide poor service (unless there is not competition). Our profession is unique in healthcare, in that we are able to provide a satisfaction guarantee. My suggestion to all is that we take advantage of this. We can do relatively little harm to patients and have great potential to do good.
Best wishes to all, prosthodontists, anaplastologists, MPT's alike,
Paul
Daril Atkins
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Daril Atkins
would request Paul to offer his view on the level you have.
Saying " I personally think that people that declare turf wars
and thus they feel it is necessary to declare what is "rightfully"
people you barely know? Perhaps Paul has done an intensive survey
internationally to state so authoratatively that few Anaplastologists
NOT hit below the belt!
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Paul Tanner
I am not hitting below the belt. That is not my intention. Everybody should know that prosthodontists publish more than anaplastologists do. If not everybody knows that, then everybody needs to read the literature. That should be evidence enough. No survey was conducted. I bet you could conduct a survey with google groups though if you wanted.
On the other subject - if I personally feel like I provide a better service that my competitors, I do not feel much of a threat - thus there is no need to declare what "is rightfully mine". There is nothing wrong with me sharing my opinion. Please take it for what it is worth. Again, I have no ill intentions. In my opinion, patients can choose who they want to treat them. There are several factors for them to consider. In the USA, patients usually follow the recommendation of their surgeon. I know it is different in other countries. I just think that we practitioners get caught up thinking about our own best interest.
Paul
________________________________________
From: anapla...@googlegroups.com [anapla...@googlegroups.com] On Behalf Of Daril Atkins [darila...@gmail.com]
Sent: Tuesday, August 17, 2010 10:32 AM
To: Anaplastology
Subject: [Anaplastology] Re: Overlap of the scope of practice
Daril Atkins
services to be inferior to that of another competitor and thus they
feel it is necessary to declare what is "rightfully" theirs"
question as a turf war?
If yes, then do you consider that I perceive my services as inferior?
Do you perceive this issue as a competition?
There is no question of what is rightfully ours or theirs. The
question pertains to the scope of service, which as your own JCIA
insists is a parameter of the quality of the healthcare services.
It is your perception that this is a turf war, which it is not. If you
have perused the AAMP it clearly mentions the devices they consider
within their scope, which includes ocular prostheses, digit
prostheses, etc. All I am asking if indeed this is proper. In terms of
turf, can you inform me which is my turf? If every pointed question is
seen as war, then in scientific terms, where is the clarity in various
disciplines.
You are well aware that the Anaplastology Journal can publish only a
limited selection of scientific articles. Perhaps you mean that
Anaplastologists should publish in other journals if permitted by
those bodies.In the meanwhile could you post a bibliography of such
scientific articles by Prosthodontists in journals other than their
own. On the other hand I welcome you to use this forum to conduct the
survey yourself.
What threat are you talking about? In my forty plus years in this
field, I have never felt threatened by either any other
Anaplastologist or by any Maxillofacial Prosthodontist for that
matter.
Daril Atkins
Certified Clinical Anaplastologist (BCCA)
On Aug 17, 9:24 pm, Paul Tanner <Paul.Tan...@hci.utah.edu> wrote:
> Daril,
>
> I am not hitting below the belt. That is not my intention. Everybody should know that prosthodontists publish more than anaplastologists do. If not everybody knows that, then everybody needs to read the literature. That should be evidence enough. No survey was conducted. I bet you could conduct a survey with google groups though if you wanted.
>
> On the other subject - if I personally feel like I provide a better service that my competitors, I do not feel much of a threat - thus there is no need to declare what "is rightfully mine". There is nothing wrong with me sharing my opinion. Please take it for what it is worth. Again, I have no ill intentions. In my opinion, patients can choose who they want to treat them. There are several factors for them to consider. In the USA, patients usually follow the recommendation of their surgeon. I know it is different in other countries. I just think that we practitioners get caught up thinking about our own best interest.
>
> Paul
>
> ________________________________________
Paul Tanner
I want you to know that I was not saying anything about your work either. If you remember, I sent a patient with microtia to you and you made a prosthetic ear for him. He wrote to me and was extremely happy with the work you did. I have no reason to think otherwise. I was addressing the google group. Since the questions are now directed more towards me, please email me separately.
The International Journal of Anaplastology accepts all sorts of articles. The biggest problem is that very few publish. When I write an article, I want to put it in the best journal for the subject content. Prosthodontists publish in other places when appropriate. They also will accept articles from anaplastologists if they feel it will benefit their readers. I have published in a prosthodontics journal, a plastic surgery journal, and the IJA. I was never excluded from publishing just because I was an anaplastologist.
ocul...@gmail.com
I feel that every anaplastologist and maxillofacial prosthetist have their duty to do the best, in practical scenrio, when there is no one else available, he should tried their best to help
Warm regards
Kuldeep Raizada, Ph D
Sent from BlackBerry® on Airtel
Daril Atkins
It is true that historically, the dearth of specialized personnel
skilled in ocular, facial and somato prostheses may have required
improvisation by those involved in maxillofacial restoration. However
over the years, such skilled specialized personnel have grown in
numbers and is most western countries they have organized themselves
in Associations that meet regularly to exchange notes. They also have
their own journals and certification exams. In the light of this new
scenario, they ought to be an integral part of the team in specialized
healthcare services. Naturally revenue will be the driver in private
practices.
In the UK and in Paris during the WW One, it was Sculptors who
improvised the famous copper masks to cover facial disfigurements. In
the USA after the wars, Glass eye makers were scarce and were
replaced by the acrylic eyes developed by the likes of Dr Walter Spohn
among others. Eventually the Ocularists developed their own system of
certification. Also in the USA after the first war, it was Carl Dame
Clarke from Maryland who developed fabrication systems for many such
restorative devices. Like him there was Milton Tenenbaum in New York
who developed hand gloves, fingers, toes and dress hands made from
polyvinyls.
The distinction between the MFP and the MPT is known to those in the
field. Where in the UK the MPT seems to be the equivalent of the
Anaplastologist, however the MPT would have additional skills in
fabrication intraoral prostheses. Currently there are perhaps one or
two Anaplastologist who are members in the AAMP in the technician
category, but there are also other Anaplastologists who have been
refused membership.
Thank you for your focused response to my pointers. By now it will be
obvious to you that this can become a debate which cannot reach a
conclusion in this forum. I am enlightened by the FACT that we have a
long road ahead where each cog in the mechanism knows its exact role.
Most developing nations look to the West for standards, so the
responsibility of the West cannot be understated.
Regards,
Daril Atkins
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