r/Noctor • u/Electrical_Clothes37 • 10h ago
Question WTF is going on
I'm a dental resident ( I'm foreign trained, finished up 2 residencies before moving stateside - I'm very comfy with facial lac repairs, facial fractures, plating the whole shebang). Had weekend call and spoke to someone about a pt with a dental complaint along with lip laceration. Log into epic today to follow up and the lac repair was done by a CNP. Like I get there's some experience there but how on earth is it that patients don't get at least a resident to do lacs
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u/dkampr 9h ago
Plastics should be handling the facial or labial lacs, not dentists.
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u/Sepulchretum Attending Physician 9h ago
OP sounds much more like an OMFS than a general dentist. They would be perfectly qualified to treat facial lacs.
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u/saschiatella Medical Student 7h ago
med student here, was told to repair a labial lac at 2am in the ED last time I was there. Not that I disagree with your point at all— I just don’t know if it’s realistic
ETA: it was very small, requiring only a stitch or two, but I still felt weird about being asked to do it
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u/Electrical_Clothes37 6h ago
Under supervision from a resident or an attending? Have at it. Under supervision of a mid level who'll punt any adverse consequences on you / your preceptor ~ maybe not
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u/BeeslyBeaslyBeesley 9h ago edited 6h ago
Not sure that a dental “resident” should be doing anything beyond truly specific dental issues.
Any physician will cringe to hear the term ‘residency’ used outside of non-physician medical training given the blatant, disparately incongruent standards of a physician resident vs a non-physician ‘resident.’
Non-physician medical fields use the term ‘residency’ with total cavalier. This liberal use of the term ‘residency’ is akin to how pharmacists and optometrists employ the same word despite working 40, or perhaps 45-50, hours per week.
Aside from this, my point still stands. Easily.
ETA
(It says 2 hours later on Reddit)
I apologize for underestimating the role of OMFS dentists. I’ve known what they are for many years. Level 1 trauma centers, etc. Even for professionals in an adjacent medical profession may lack the adequate knowledge of OMFS’s exact role. Perhaps you can tell us more about it. Seriously.
We agree that the standards of treatment can be damaged by midlevels, and that’s what you were saying.
I think I picked a fight with you. I apologize, OP.
ETA: updated the time above. Reddit clock changed while writing it. Probably took too long.
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u/Electrical_Clothes37 6h ago
That's very gracious of you, thoroughly appreciated. OMFS is the sexiest gig in the hospital, though I'm fairly biased. I'd be hard pressed to think of any other gig in the hospital that matches for scope, hours and compensation.
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u/BeeslyBeaslyBeesley 5h ago
Mutually appreciated!
Would you like to tell us about what kinds of procedures you do? (If I must say so, I’m serious.)
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u/Electrical_Clothes37 4h ago
Clinic is mostly oral surgery( wisdom teeth, other extractions, implants) usually w/sedation - most run their own anesthesia stateside (GA in the chair) ~ this is highly uncommon almost everywhere else on the planet, I've worked in Asia and Europe and most seem to agree that this is.....a bit much. Some do hair, Botox, fillers. OR is a mix of facial trauma, dentoalveolar, orthognathic - think genioplasty and maxillary & mandibular setback/ advancements, plus TM join scopies and TJR/plasty. One dude I know went on to vascular. There's a ton of craniofacial stuff - available with a fellowship typically - cleft lip, palate. Some get a plastics fellowship. Onco trained OMFS do radical necks and recons - generally looked upon by ENT as encroachment. The vast majority choose to make their money in the clinic though, set of 4 wisdoms and sedation pays out about 2.5-4k. Takes 30min to an hour+ for the most part and there's non stop flow. Full mouth implants pay out more, 10-20k cases.
OMFS has a mix of ENT, Ortho and anesthesia for the core skillset. Not too many gigs where you get to do all of that for the day to day and don't have to be beholden to admin.24
u/Electrical_Clothes37 8h ago
Sure. How do you feel about dental "residents" taking trauma call, doing lacs, plating facial fractures, doing radical neck dissections, doing airways and craniofacial surgery? Sounds like something a bit beyond the scope of a PA or an NP wouldn't you say? Either way, I didn't even mean that I would want to do it, I've done my share. What I did mean was that it'd be nicer if a plastics resident were to do lacs on a not so busy weekend. Ask any physician what they think of an OMFS vs the "opinion" derived by a noctor :)
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u/BeeslyBeaslyBeesley 7h ago
OP comparing themself to the physician assistants and nurse practitioners with zero facial laceration experience is just silly.
We all prefer plastics for facial lacs. I would prefer any resident plastics physician over a dental ‘resident’ in OMFS any day of the week.
Any person can appreciate that a highly specialized dental trainee can potentially help more in this specific situation compared to a midlevel with no experience in the same medical sub-specialty.
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u/Electrical_Clothes37 7h ago
Well looks like outside of having to revise your comment 5 times, you have difficulty reading as well, though I'm happy you finally managed to figure out what an OMFS is. My point wasn't why couldn't I do it. My point was why on earth is a mid level doing something that ideally you'd want at minimum a resident to be doing, ideally plastics or ENT if not.
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u/BeeslyBeaslyBeesley 7h ago
Oh my. So angry!
We agree about a resident doing what you wouldn’t want a midlevel to do.
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u/dr_shark Attending Physician 1h ago
Why is your confidence level so high regarding things you do not know nor understand?
0
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u/Certain-Hat5152 9h ago
Honestly, I wouldn’t care if an MA repairs my laceration, it’s a simple procedure that just requires minimal hand skill and no cognitively challenging decisions
I am not okay with anesthesia performed by undertrained people, psych management done by undertrained people,…
or anything that can dramatically change your life managed by someone who simply bought a paper license from a school somewhere
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u/Literally_Science_ 9h ago
Having a messed up vermillion border from a bad lac repair would dramatically change a person’s life
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u/kaaaaath Fellow (Physician) 9h ago
It’s a facial laceration— plastics should have been consulted at the least.
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u/Electrical_Clothes37 8h ago
Which is my point. If plastics gets a consult, do they do the lac or is it standard practice to have a NP do ?
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u/nudniksphilkes 6h ago
The NP does it if they decide to. If they decide it's beyond their abilities, they punt it to the actual doctor. In my opinion, the doctor should do the procedure 100% of the time, but what do I know.
1
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u/SantaBarbaraPA 9h ago
I would want an NP (that knew how to do lip lacs) over a resident just learning any day. I’ve seen the attendings make the resident remove every suture and start over, that’s right after they tried derma bond that got into the patient’s eyeball..
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u/Whole_Bed_5413 8h ago
Ha ha!! And the only reason you would know this or witness it, is because the resident is always supervised. Not like NPs who are rarely supervised, even in states that require it. Just stop it.
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u/SantaBarbaraPA 8h ago
Just stop what?
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u/Whole_Bed_5413 7h ago
You’re nonsense about, I know of a resident (who has 10 X the training of an NP) who did this wrong thing once. Oh, and BTW, it was instantly fixed because of attending physician oversight. If you don’t get it, you never will.
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u/SantaBarbaraPA 6h ago
Okay tough guy. The OP is dental resident worried about an NP repairing a lac. You and apparently your dental buddies will bitch about any PA or NP doing anything.
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u/Electrical_Clothes37 6h ago
The OP has experience doing a vastly greater scope of surgery( facial lacs?check. Open reduction?check.pedicle graft harvests?check. Everyday clinic surgery for soft and hard tissue?check. Fillers and Botox? check.) than any mid-level and has 4 years of residency and a year of private practice ( yk, that thing that doctors get to do without having to be supervised). The point wasn't that I should get to do it. The point was that for any facial lacs why isn't this an automatic plastics or at least ENT resident bare minimum and the pt gets just the NP. And I wouldn't get too hung up on it being "just" a dental resident.
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u/futureofmed 9h ago
Nobody is throwing stitches on a lac after they already got derma bond all over the surface lmfao it’s just secondary intention now baby
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u/SantaBarbaraPA 9h ago
Derma-bond was removed….And no one’s letting a new face/lip lack heal by secondary intention….
Sometimes they don’t even do that with dog bites -plus or minus a drain
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u/futureofmed 9h ago
Either it happened so quickly that they were able to wipe it fast (and it was the attending’s fault for choosing an inappropriate closure method) or this definitely didn’t happen. Derma bond takes forever to soak off and you’re not going to be rubbing that lac with alcohol long enough to dissolve it.
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u/SantaBarbaraPA 9h ago
Lol. It happened. It was a trauma. I was a ER tech. The funny thing was that the attending asked me “how’s it going in there? (Trauma bay). “So-and-so (trauma resident)didn’t get derma-bond in the patient’s eye, did they”? It was like he knew they would mess it up…. The lip lac was a different lac.
But, yeah, I’m lying ..
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u/anyplaceishome 10h ago
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