The death of the specialist dentist
I think I became a specialist in 1999.
But became a ‘specialist’, it’s laughable really that the specialist status was conferred upon me when I was just 5 years qualified.
I was 27 years old.
It was by pure chance that I happened to be working in a role which confirmed me as a Defacto specialist and because of my experience, my logbook of my FDS RCS I was ‘grandfathered’ onto the new specialist in surgical dentistry list that was created at that time.
I can’t remember exactly where it was because what happened was, I got a letter through the post that told me and then I went to work to do the same job I’d already been doing.
No fanfair, no holiday, no change of job, no change of uniform or badge or anything like that.
It means though that I’m 22 years into being a specialist and later the list was changed and the specialists in surgical dentistry were moved up to specialists in oral surgery and the surgical dentistry list was shut because it was too confusing.
Funny that though because it’s more confusing now.
With the scramble for qualifications and titles that allow us to differentiate ourselves in a marketing capacity from the person down the road, everyone want an MSc or a specialist ticket to show that they’re good.
This was designed to help the public choose who their providers are based on experience and quality but if anything it’s made it worse.
If you were to take the chance to look at the profiles of dentists who provide the type of work that I do, you would be mistaken for thinking that everybody is a specialist.
Of course there is no specialist in dental implants, they have decided (rightly I think) to hold off on providing a specialist list for such a subject but more and more I wonder if the title of specialist doesn’t make you less qualified to provide the treatment not more.
There is much discussion going on about the role of the specialist against the role of someone with a more general and broad background of experience and how the latter maybe better suited to more complex problems than the former.
In many circles it’s described as the difference between an I and a T with the ‘I’ being someone that’s able to go very deep down into a subject and the ‘T’ being a broad ‘I and T’, the ‘T’ being a short ‘I’ with a long and broad experience over other subjects.
When you watch lectures (almost certainly including mine) by people whose field is narrow, the answer always seems to lie within the narrow field.
If you watch a periodontist speak; who doesn’t do implants, they’ll talk about the disgrace of extracting teeth too early. If you change to the endodontist, they’ll tell you they can keep teeth for the longest possible time and if you come to the person who provides implant dentistry (perhaps a specialist in perio or a specialist in oral surgery or a restorative specialist) they’ll tell you to take the teeth out earlier to get a better chance to put the implant in the right place.
All of these things are obviously true and at the same time in the same person.
My life over the past 5-10 years has moved more and more to the assessment and early stage diagnosis of complicated cases.
Every second Wednesday now I will regularly see up to 10 new patients (it’s completely exhausting) most of whom have a complicated starting points.
I find that I need to know the likely successes of potential endodontic treatment, restorative treatment, periodontal treatment and orthodontic treatment on patients who might want multi-disciplinary care.
My role then becomes collecting the information across a broad range of dental problems using a broad range of technologies which allows me to then present them to the other specialists and experts who I work with to get their view and to mix it together in a big old baking recipe of a complex treatment plan.
I then have the requirement to present that back to the patient and try to help them to navigate it as a patient advocate in an ethical and honest way.
Difficult when I don’t even understand my own unconscious biases.
It leads me to the title of the blog, if you’re chasing a registrable Masters qualification in a specific area of dentistry then please continue to do so, understanding that it’s because you enjoy the subject and wish to understand it more thoroughly. It will not make you a specialist.
Similarly, if you’re running down a specialist pathway don’t give up the fact that you’re a dentist because in the years to come from here, the most valuable job of all will the specialist generalist.
Blog Post Number - 2638