Knowing Your Limits

What is the scope of practice of a general practitioner? This question elicits a broad range of responses, and those responses reveal an underlying issue about which many dentists have strong feelings and opinions. Just as the tools, materials, and protocols of dentistry are evolving, so too are its general practitioners, and they are offering more and more specialized treatments to their patients. Our September cover story explores the industry and patient factors that are driving this phenomenon and discusses some of the procedures that are being offered by general practitioners in the areas of orthodontics, implant therapy, endodontics, periodontics, and prosthodontics.

There are specialists who are greatly opposed to this trend, but if a general practitioner possesses the skills to perform a procedure to the standards of a specialist, then doing so is only increasing treatment options for patients, particularly in underserved areas with limited numbers of specialists. The only danger lies in general practitioners performing treatments that don't meet the standard of care. Technology, such as cone-beam computed tomography and guided surgery, has greatly improved predictability; however, it isn't a substitute for education and training. When things don't go as digitally planned, you need to have the analog knowledge to back it up. Furthermore, clinicians' decisions to perform procedures instead of referring them out must be driven by their skills, not by other reasons, such as financial pressures, or they're going to get into trouble. If they invest in quality education and don't go beyond their skill level, the money will come. Success requires protecting your patients and your reputation.

General practitioners who are interested in expanding into more specialized treatment should pursue continuing education with a comprehensive course curriculum, such as what is offered at the Kois Center. Acquiring a mentor can also help to expedite the process, but it's essential not to rush and to know your limits. If offering these types of procedures was easy, everyone would already be doing it. Although the line between generalist and specialist may have become blurred, the line between meeting the standard of care and failing to do so is as clear as ever!

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com