Face to Face Issue 43

www.icoms2015.com

REGISTRATION NOW OPEN We are pleased to announce that registration is now open for ICOMS 2015.

The Conference will be held from 27 – 30 October 2015 at the Melbourne Convention and Exhibition Centre, located in the heart of the world’s most liveable city, Melbourne.

Visit the website (www.icoms2015.com) now for all the information you will need to assist in your plans – registration, social events, optional tours and accommodation. You don’t want to miss this experience.

Please find below an invitation message from the IAOMS President Piet Haers and the ICOMS 2015 Conference Chair David Wiesenfeld.

We look forward to welcoming you to Melbourne in October.

CLICK HERE TO REGISTER

PROGRAM A preliminary program for ICOMS 2015 is now available. The program is designed to assist with your travel plans and provide an overall view of the program which will showcase a variety of themes complemented by our invited speakers and free papers sessions. Please visit the website (www.icoms2015.com/program/) to view the preliminary program.

We are pleased to announce an outstanding faculty of national and international speakers for the Conference. Visit the website (www.icoms2015.com/invited-speakers/) for further information.

Pre-Conference Workshops supported by our Industry Partners will be held in the days immediately preceding the Conference. Further information will be available on the website (www.icoms2015.com/program/) shortly.

View the video below for an overview of the program highlights.

22ND I N T ERN AT IONAL C ONFE R ENCE ON ORAL & M A X IL LO FACIAL SURGE R Y

SOCIAL EVENTS To complement the outstanding scientific program, an equally outstanding social program has been developed to allow you the chance to relax, enjoy and experience genuine hospitality whilst you are in Melbourne. Please visit the website for more information (www.icoms2015.com/social-page/)

IAOMS FOUNDATION EVENTS The IAOMS Foundation events held during ICOMS 2015 offer you an outstanding experience while making a valued contribution to the Foundation and its programs. Find out more about these events and book via the online registration form to secure your place (www.icoms2015.com/iaoms-foundation-page/)

ACCOMPANYING PERSONS

We are delighted to invite accompanying persons to the Conference. For more information on the activities on offer please visit the website (www.icoms2015.com/registration/accompanyingpersons/)

SPONSORSHIP & EXHIBITION ICOMS 2015 offers a prime opportunity for providers of services and equipment within this specialised field to establish new and consolidate and grow existing networks and relationships.To find out more please visit the website (www.icoms2015.com/sponsorship-exhibition/)

WE ACKNOWLEDGE THE SUPPORT OF OUR VALUED PARTNERS: ®

PLATINUM PARTNERS M a k e

i t

S i m p l e

GOLD PARTNERS

SILVER PARTNERS

PROUDLY SUPPORTED BY

Please visit the Conference website for further information www.icoms2015.com, or contact WALDRONSMITH Management: 119 Buckhurst Street ❙ South Melbourne VIC 3205 Australia T +61 3 9645 6311 ❙ F +61 3 9645 6322 E ICOMS2015@wsm.com.au ❙ www.icoms2015.com

Issue 43 / October 2015

Editor-in-Chief Javier González Lagunas

Managing Editor Lisa Markovic

Graphic Designer María Montesinos

Executive Committee 2014 – 2016 Board of Directors Piet Haers, President Kishore Nayak, Past President Julio Acero, Vice President Alexis Olsson, Vice President Elect Robert T.M. Woodwards, Treasurer Larry W. Nissen, Foundation Chairman Pierre Désy, Executive Director

Members-at-Large Gabriele A. Millesi Sanjiv Nair Javier González Lagunas

Regional Representatives John Fisher, Africa Kenichi Kurita, Asia Henri Thuau, Europe Alejandro Martinez, Latin American Arthur Jee, North American David Wiesenfeld, Oceania

Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMST Committee Steve Roser, HADR Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Committee Juan Antonio Hueto Madrid, eLearning Sub-Committee

CONTACT US IAOMS

5550 Meadowbrook Industrial Court, Suite 210, Rolling Meadows, IL 60008 U.S.A. 1.224.232.8737 / communications@iaoms.org

Letter from the Editor How I see it

I

f you think we have a focus on postgraduate training, you are right. The combination of scientific associations and postgraduate medical education is a winning ticket. Most professionals consider medical associations the best source for education, being the most secure, serious, updated and unbiased path to quality training.

But I think there must be something else. To date scientific associations have exercised the very important role of technically supporting their specialties. Globalization gives us the opportunity to advance and give one further step beyond the purely clinical function, and thus to participate actively in the standardization, organization and management of the sector. In other words, to be politically involved as a key stakeholder in front of national or regional health institutions whose knowledge of our specialty might be limited (and unfortunately sometimes, non-existent).

It is in the DNA of IAOMS and its foundation...”our mission of advancing the standards of care through improved education and training.

We directly support surgeon-to-surgeon educational efforts led by experienced clinicians who travel from around the globe to developing countries to teach young surgeons and trainees state-of-the art skills and procedures.”

Improving the standards of care require not only better trained surgeons, but also educated health authorities. We are very good in the first part of the equation, but we still have to advance in the second.

Javier González Lagunas Editor in Chief

“The combination of scientific associations and postgraduate medical education is a winning ticket”.

contents October 2015 special report

Education for growth

NEXT GEN

Building a melting pot of ideas...

OMS on a mission

kraine.

U n i n e r for child s e v i l w Ne

IDEAS

IAOMS: Ideas worth spreading

Fellowship

Cleft Lip and Palate and Craniofacial Surgery.

From Proust to Pivot Henning Schliephake. copy me

Endoscopically assisted intraoral

24 hours

A day in the life of a resident of bucomaxillofacial surgery in Cape Town, South Africa.

beyond the or

: surgeons rs te s a is d g n ti n Preve and finances.

Working Together for Education Pierre Désy IAOMS Executive Director

“Education is the most powerful weapon which you can use to change the world” Nelson Mandela (1923-2013)

I

think there is no better sight than an experienced person passionately engaged in educating others. The exchange of knowledge and experiences between people is not only important for development processes but also for preserving traditional knowledge resulting from lives and activities of different generations.

Whether you call it coaching, training or mentoring or describe it as recording your knowledge, I think that every leader should devote time to this task.

in developing countries to teach young surgeons and trainees state-of-the art skills and procedures. Finally, each year, three junior oral and maxillofacial surgeons receive funding through the IAOMS Foundation Fellowship program to spend a full year with leaders in the field of cleft lip and palate surgery and oncology and reconstructive surgery to advance their surgical knowledge, experience and skills to bring back their new knowledge to their country to share with other surgeons.

That is why IAOMS as a leader has diligently worked at building a way to share knowledge between generations as well as bringing you progress in technology and science, in turn providing “valuable learning experiences.” By the end of this year, IAOMS will unveil a continually growing repository of eLearning webinars, videos, and lectures recorded by world-renowned oral and maxillofacial surgeons. In addition, through the IAOMS Website, you will have access to multiple community exchanges on key specialty areas (e.g., Cleft lip and palate, orthognatic, TMJ, oncology, etc.) to network with and learn from your peers from around the world keeping you in the forefront of the healing profession.

Let’s not forget in just a few short weeks, IAOMS will hold its biennial conference, ICOMS, in Melbourne, Australia. ICOMS 2015 brings the world experts in oral and maxillofacial surgery together and we look forward to presenting you with the latest advancements in the oms field. Several of the scheduled talks promise to be fascinating including the ‘Trans-oral Robotic Surgery – An Overview of Current Practice’ presented by Eric Dierks.

See the complete program here – http://www.icoms2015. com/program/ What is the result of all this sharing of knowledge? We hope that it will arm you to change the world, enhance your future, and provide the best care for your patients.

The IAOMS Foundation is helping to share knowledge through surgeon-to-surgeon educational programs

So what are you going to do to pass on knowledge? Email me and let me know your plan – pdesy@iaoms.org. ■

www.iaoms.org/membership/renew

Charting IAOMS’ Educational Course Piet Haers IAOMS President

T

he editorials and contributions in this issue of Face to Face demonstrate the passion of IAOMS to provide educational opportunities.

When I first became President, IAOMS was just entering a new domain in regards to digital education and exploring the different avenues we could make available to our members. Two years later, we have a well charted course for providing educational opportunities to OMFS worldwide whilst considering legal and ethical issues such as copyright and consent, but also appropriate formats for several educational programs.

You have heard me say many times, that to be truly relevant today and in the future, we have to increasingly invest in developing a strong digital presence. IAOMS has assertively initiated this over the past two years, putting in place a wide range of educational platforms to assure our place in the technical future with far-reaching and comprehensive educational resources. Embracing technological change is no longer optional, it is essential for our specialty in order to be relevant in the future.

in specialty interests, as well as relevant information for surgeons in training. We currently have 12 online courses available to you, but by the end of this year our eLearning library will house over fifty-five (55) on-demand Webinars available 24/7, and it will only grow from there.

If the use of technology is to have differential impact, then assuring a relevant digital presence also means to provide platforms for discussions on new ideas about the changing reality of the profession in terms of new technology but also the workforce, working environment, relationships with staff, nurses, patients and the community as a whole. Facilitating communication on these aspects of our changing profession is important for IAOMS if it wishes to represent pioneering ideas on how innovators in our profession prepare the future of our profession.

So, whilst continuing with traditional educational efforts around the world, we are integrating new technologies to assist you in this whole new wave of knowledge, which will surely multiply the educational impact of our mission and make considerable strides in the advancement of OMFS.

So how are we making ourselves relevant?

One of these platforms is the IAOMS Oral and Maxillofacial Surgery Review Course for Fellows who wish to prepare for the International Board for the Certification of Specialists in Oral and Maxillofacial Surgery (IBCSOMS) examination and/or their national fellowship examination.

This comprehensive review course is already available online and will provide you with the tools you need to succeed in these examinations.

Another platform is IAOMS eLearning. Our eLearning is delivering general information for continued medical education, advanced knowledge for those interested

One of our traditional resources for updates on the state of our profession has been ICOMS, IAOMS’ biennial conference. In a few days, over 1,500 delegates will gather to participate in a program of utmost quality covering the entire scope of our specialty. ICOMS brings together all of us who wish to share communications on new developments, insights and evidence, making it a success now and certainly for those ICOMS yet to come.

So join me on this expedition and pledge an investment in your future.

See you in Melbourne. ■

Inspiration by Ravi Hebballi, Bangalore, India Acrylic on Canvas ❙ 48” x 48” (thickness 1.25”) ❙ July 2015

Stop by the IAOMS Foundation booth during ICOMS to bid on this one-of-a-kind acrylic painting by renowned artist Dr. Ravi Hebballi. All proceeds benefit the IAOMS Foundation. Bidding starts at $750 USD.

About the Painting...

This painting has been inspired by the Strength, Love and Beauty of a woman. She herself is a beautiful creation and is gifted with abilities to create, foster, inspire and spread happiness. The bright colors in this painting not only glorify the qualities of the woman but also highlight the passion to be as powerful and fierce as the fire itself.

About the Artist...

Ravi Hebballi is a Maxillofacial Surgeon from Bangalore, India and is currently the Councilor to the IAOMS from the Indian Association of Oral and Maxillofacial Surgeons (AOMSI). In spite of his busy practice, he is a prolific artist. His paintings are mostly thought-provoking abstracts. He has been invited to showcase his talent in various places in India and abroad, including the Indian Embassy in London.

Auction winner is responsible for shipping arrangements from India.

special report

Education

growth

for

01

“Oh the places you will go…”

By Rui Fernandes, MD, DMD, FACS Educational Chairman 2011-Present

I

t was over four years ago when I became the new chairman for the education committee. It was a daunting task as I was replacing Julio Acero. Julio had done a tremendous job during his tenure and had overseen a number of successful projects.

➺ Nigeria – My Beginning

At the outset, I was in charge of the Nigerian microvascular teaching program. It was the first of its kind for both our association and the host country. I was asked by Julio to develop the training program several months before our first trip to Nigeria, and I was really looking forward to the opportunity. When Julio, Nabil, and I traveled to Lagos to assess the capabilities of the host program, our colleagues received us with warmth and excitement. There was a determination felt by all to make the program a success, which was great because our goal was a lofty one. Julio and I had to train 10 Nigerian colleagues to perform microvascular surgery in 3 years time.

Over the three-year period, Julio and I would make at least two trips annually to Lagos to train our colleagues.

During our time together, we progressed from demonstrating the techniques to performing several successful cases with our colleagues. By the end of the three years, we had the privilege of observing the Nigerian surgeons perform their own microvascular cases without our help.

The work was hard and at times the dissection lab was hot, but we persevered, inspired by the infectious energy and enthusiasm of our hosts. We both taught and learned from our Nigerian colleagues, and developed deep friendships based on mutual respect. It was truly a rewarding experience.

➺ El Salvador

It was apparent that a training program was needed in Central America. After several discussions with colleagues from various countries, it was decided that El Salvador would be a fantastic host program. The country’s selection was in large part due to the incredible support and enthusiasm of our colleagues in the El Salvadorian

Initial meeting in 2011 to plan the project, Julio and I in dissection lab.

Association of Oral and Maxillofacial Surgery (in particular Gerardo Cuenca, the association’s President at the time).

In February 2012, the first of four modules was presented to colleagues representing all of the Central American countries, as well as others from South America. The course was received with extreme enthusiasm and exceeded participant expectations based on the feedback we received. It was a true team effort as we had faculty visiting from Latin America, North America and Europe, who were all eager to participate in the program and share their knowledge with our colleagues. Not only did we learn from one another, some of the faculty even learned some basic cooking skills. (Photo of Alejandro Martinez cooking, another of the attendees at one of the programs).

➺ Tunisia

It has long been a goal of our current president, Piet Haers, to establish an IAOMS program in French-speaking Africa. At the European Congress in Prague last year, I had the opportunity to meet the current president of the Tunisian Society of Oral and Maxillofacial Surgeons, Professor Montacer Bouzaiene. He graciously agreed to take the lead in planning a collaborative program between the Tunisian Society and IAOMS and decided to have the initial program during the society’s national meeting in June of this year.

I have attended many meetings during my tenure as education chair, but I must say that I was truly impressed with the level of presentations and scope of practice of our Tunisian colleagues. The presentations ranged from microvascular surgery to breast reconstruction to trauma

special report to craniofacial surgery. I had the opportunity to not only engage our colleagues during training sessions but also to learn about the Roman influence in the region. Thanks to the kindness of Professor Bouzaiene I even had the chance to take a camel ride. It was a great experience and I look forward to our continued engagement with our colleagues in the region.

Photo of Dr. Parmar at dinner, photo of Esquillo, Parmar, Fernandes, with traditional Philippino dress shirt, induction of Ida Balanag as President.

➺ Philippines

The presence of IAOMS in Asia transitioned from the programs established by Dr. Acero in Malaysia to the implementation of a new program in Manila Philippines.

I had the privilege to collaborate with colleagues from this country the likes of Mario Esquillo, Ida Balanag, Joy Bautista, and many others. During a two year period we had several programs and provided a comprehensive presentation of our specialty by leading experts from the region as well as colleagues from afar.

It was what during one of these programs the professor Sat Parmar participated as a faculty, lending his considerable expertise in cranial maxillofacial trauma.

During one of our dinner receptions, I felt very sorry for him as he watched the entire delegation enjoy a very hearty meal while he ate a cup of pea soup. It appeared that I had neglected to inform our hosts that Mr. Parmar was a vegetarian. In true form he was a good spirit and remained the life of the party for the rest of the night. It was during one of these meetings that I had the privilege of participating in the invocation of new members into their national association, it was a fantastic experience to also see the induction of the first female President of the Philippine Society, Dr. Ida Balanag.

➺ Sri Lanka

This year we began a multiyear project in Colombo Sri Lanka. Leading experts in various subspecialty areas of maxillofacial surgery from the USA, United Kingdom, and China served as faculty during the Sri Lankan annual Congress. The faculty led a pre-Congress dissection course in microvascular surgery as well as local regional flaps commonly employed in reconstructing various head and neck defects. I was very fortunate this year to have the participation of our colleagues. We are looking forward to a continuous engagement of our colleagues not only in Sri Lanka but also in surrounding countries.

➺ Brazil

I just recently returned from Salvador, Bahia where the Congresso Brasileiro de Cirurgia e Traumatologia BucoMaxillofacial took place. As usual, our Brazilian colleagues put together a fantastic Congress and a superb social program.

I was very fortunate to have our current president, Piet Haers and our President-elect Alexis Olsson as faculty

in the inaugural IAOMS/COBRAC symposia. They both gave informative lectures on Orthognathic Surgery and both were very well received. The attendance during the symposia was exceptional and was only surpassed by the amount of positive feedback.

True to form, our colleagues from the COBRAC, Drs. Fernando Bastos and Jose Nazareno Gil, Luis Maurinho and many more rolled out the red carpet for the IAOMS and made everyone feel extremely well looked after.

➺ Panama

The next program to start during my tenure as education committee chairman will be in Panama. As I write this article, I am two days away from traveling to Panama City to serve as faculty on a course unlike any IAOMS has implemented before. This program will highlight surgical pearls in the form of short videos by collaborating faculty.

The intent will be to provide technical nuances of the procedures to a small group of about 30 to 40 surgeons from the region. It is my hope that this approach will foster a robust dialogue between the faculty and participants and that everyone will leave with new tricks in their toolbox. It has been a pleasure to collaborate with our colleagues from the Panamanian Association to organize the program and I would like to give special thanks to Dr. German Velasquez, Dr. Julio Gonzalez, and Dr. Manuel Ortiz.

The role of chairman of the education committee extends beyond the programs listed. It entails preparing and hosting the trainees’ symposium during the ICOMS (which will be fantastic this year in Melbourne), providing review course opportunities for trainees in their respective countries, reviewing educational documents for the association and journal and many other tasks. While there are many commitments and the responsibilities are great, it is truly a “once in a lifetime” opportunity to meet colleagues from around the world and share with them our awesome profession. It has been and continues to be my privilege to serve as chairman, to have a fantastic group of dedicated members of the committee. I hope that my service to date has reflected my sentiments towards our association. See you in Melbourne. ■

02

My adventures as Educational Chairman

By Julio Acero The invitation of Javier Gonzalez to write thisarticle But during the often difficult job of implementing brought to me incredible memories of those years educational programs in different areas of the world, in which I had the responsibility to and trying to collaborate with our local lead the Education Committees of partners in order to organize high quality “For more than 12 courses, we have also experienced many, both the IAOMS (after taking over years, I have had Nabil,s enormous work) and the and some times hilarious, anecdotes. The EACMFS. This particular task has the opportunity to progress of communication technologies been a privilege for me, allowing with the proliferation of webinars has work together with been critical to manage our Association, me to meet and exchange opinions many great speakers however contacting people face to face and knowledge with wonderful and highly motivated people. For is still highly appreciated in the field of and organizers of more than 12 years, I have had and this requires travelling, courses throughout education the opportunity to work together which in the field of action for the IAOMS the globe, all looking means to be a globetrotter. To reach the with many great speakers and organizers of courses throughout different locations we have traveled by forward to offer the globe, all looking forward the best in the field all means, by land, sea and air. Difficult to offer the best in the field of connections, long distances, sometimes for of education, one education, one of the keys in the short but critical visits in order to launch progress of the specialty. of the keys in the of major programs that have been historic.

progress of the specialty.�

special report

“All efforts were worth it, especially due to the impact on the wonderful residents and young specialists who have always shown their enthusiasm for the IAOMS programs”.

I remember a flight in winter in Eastern Europe, after the second connection, late night, immediately after takeoff, the pilot announced the deviation of the aircraft due to poor meteorological situation to a city completely unknown to me. This happened to be near the border of Ukraine. After landing there, several hours of travel by bus under an intense fog allowed us to arrive at our destination and to open the course only few hours later.

For the return, the air connection was also canceled and the only chance was a long journey by train.

But beside heavy educational tasks, sometimes there has been time to visit unforgettable places. Can you imagine a helicopter flight over the Iguazu Falls between Argentina and Brazil? Nothing comparable if the flight is co-piloted by Kishore Nayak. We live in a world plenty of problems but also of incredible wonders.

I have traveled more than 10 times to Africa where we have been developing programs for many years in East Africa and later in Nigeria. I have known in this region of the world incredible, lively, dynamic people, willing to progress under very difficult conditions.

Unfortunately and due to the intense dedication to our educational projects and the shortage of time

available, I was not able to enjoy the African natural wonders in-depth but did not miss some opportunities to visit interesting natural parks.

Trending topic for IAOMS was the attack by a rhino that I did suffer together with Paul Stoelinga and John Williams. After arriving in Nairobi and once we met with the local academic authorities, on Sunday before the first course opened in East Africa, we heard that there was a national park around the city and there we go, in my case for my first African experience. I’m still hearing the roars of the rhino on the attack against our van for being interposed between her and her baby .... Luckily our driver was faster and although we were hit inside the car, he avoided the impact.

Among other adventures, lost baggage, robbery attempts, extremely complex borders, police checks, missed connections, made sometimes working on the “battle field” of global education a ‘risky sport “. But all efforts were worth it, especially due to the impact on the wonderful residents and young specialists who have always shown their enthusiasm for the IAOMS programs. I would like to end these words expressing my deep gratitude to them and to all colleagues who have worked with us in developing the international educational programs. I tried to give as much as I could over the years, but I have received much more than I have given. My full support as the current IAOMS Vice-President and incoming President will remain to the future educational events under the leadership of the Education Committee, currently chaired by Rui Fernandes. ■

03

Course in the Philippines

By Mario Esquillo The IAOMS Educational Program is now on its 3rd year of existence in the Philippines with the Philippine College of Oral and Maxillofacial Surgeons taking the lead in organizing the different modules. With the strong support provided by the IAOMS, the program has provided vast training for all the participants.

The scientific session on Head and Neck Pathology and Reconstruction was well-attended not only by dentists but also by our friends from allied professions such as ENT specialists and general surgeons. The fruitful exchange of ideas whichtranspired during the session, resulted in developing a clear distinction on the role of each specialist in these procedures.

Dental Implant and TMJ Surgery symposium was indeed one of the most well attended sessions. Dental implant rehabilitation is now gaining popularity among the dentistal practitioners brought about by the high demand of patients. Strong emphasis was given on the importance of a multi-disciplinary approach by

the prosthodontist, surgeon and periodontist. The relationship of occlusion as well as the TMJ was alsoemphasized during the scientific symposium. Both general dentist and ----were enlightened that some TMD cases need to be managed surgically.

Cleft Lip and Palate, Cranio-maxillofacial Deformities and Orthognathic Surgery was also well-attended not only by dentists but also by Cosmetic Surgeons and orthodontists. A remarkable open forum with each specialty sharing their skill and expertise, paved the way for the enlightenment of every participant on the role each one should perform. The vital role of the oral and maxillofacial surgeon and the orthodontist was well-established during the healthy discussion.

Co-management was given emphasis as each specialty plays a significant role in coming up with a successful treatment.

The symposium on Management of Oral and Maxillofacial Trauma proved to be one of the much-

“A remarkable open forum with each specialty sharing their skill and expertise, paved the way for the enlightenment of every participant on the role each one should perform. “

awaited event, with every dentist – even general dentists,eagerly learned on how they can manage complications, the best way they can.

These learning modules experienced by the Filipino dentists not only satisfied their hunger and thirst for knowledge but also ignited their enthusiasm in practicing surgery to serve their countrymen.

With the four modules, the PCOMS fellows were able to establish good rapport with all the speakers and enjoyed not only the academic exchange of ideas but most importantly the camaraderie during the fellowship.

Our international faculties were accorded the traditional Filipino hospitality, treated to the famous San Miguel Beer and faced the ”extra” challenge of sampling some of our world-renowned delicacies such as the “Balut”,

“No words can suffice to best describe the gratitude the Philippine surgeons would like to extend to the IAOMS for all its contributions to the academic advancement of OMS in the country”. described by some as an aborted duck egg. Some may find it squeamish to eat the Balut but really, it is a good send off dish specially for those taking a long flight back home, it provides one with great stamina.

No words can suffice to best describe the gratitude the Philippine surgeons would like to extend to the IAOMS for all its contributions to the academic advancement of OMS in the country. Special thanks is extended to Dr Nabil Saman, Dr Julio Acero and Dr Rui Fernandez for the dedication and hard work to make the IAOMS Education activity a great success. The Philippines is very much fortunate to have received this assistance from its allied nations in promoting OMS as a field of specialization in the vast field of dentistry. The efforts of every member of the international organization to travel across the globe in pursuit of their advocacy to share their skills and expertise is truly commendable, undoubtedly, the financial support being extended to the local organization to sustain the needs of activity is very much appreciated. The intellectual exchange of ideas spiced up with a unique showcase of Philippine hospitality in promoting the rich Filipino culture makes us quip that indeed“Learning is more fun in the Philippines”.■

FOUNDATION CHAIRMAN’S MESSAGE

THE IAOMS FOUNDATION

LEGACY SOCIETY Planned-giving for the Future of the Specialty It is with great excitement that the Board of Directors of the IAOMS Foundation announces the establishment of the IAOMS Foundation Legacy Society. This plannedgiving organization is founded to allow Fellows and their families to make provisions in their estates for future gifts to the Foundation. The Board has established a minimum gift level of $5,000 US and this can be made in the form of a codicil in one’s will, a revocable living trust, or by making the Foundation the beneficiary of a life insurance policy, a retirement plan or a charitable trust. In making such a commitment, donors will have set aside a part of their estates to be placed in the IAOMS Foundation’s permanent endowment fund – a fund that will support the mission of the Foundation for generations to come. Charter or founding members, those whose letters of intent are received by June 30, 2016, will be recognized as such in perpetuity. The Board is planning on this to be a “named” Society and is working diligently to make this announcement at the ICOMS Opening Ceremony in Melbourne.

This Legacy Society is a continuation of expanding donor opportunities that the IAOMS Foundation is undertaking. It will give Fellows and their families’ potential taxadvantaged estate donations and an excellent opportunity to create long-term recognition for substantial donations to the Foundation.

Numerous vehicles are available for donations that will qualify under the Foundation’s Gift Acceptance Policy. You are encouraged

to consult your estate attorney or financial advisor, as well as Pierre Désy, the IAOMS Foundation Executive Director. A Donor Intent Letter is available in this issue and on the website at www.iaoms.org/foundation. I hope you will join me and my wife, Carol, in becoming a Charter Member of the IAOMS Legacy Society.

ICOMS 2015 in Melbourne, Australia, is rapidly approaching and the Foundation events are filling up. Numerous tours are available, the golfing event, which has a “hole-in-one” prize, looks to be exciting and the Tram Dinner Tour will be the crowning event to an exceptional ICOMS. Again, we all have Dr. John Curtin to thank for his dedication and diligence in planning these wonderful events. Thank you, John.

See you in Melbourne and I hope you will become Charter Members for the Legacy Society now, and help us reach our goal of 25 by the meeting. ■

Larry W. Nissen, IAOMS Foundation Chairman

OMS on a mission New lives for children in Ukraine

By Jeffrey J Moses, DDS FAACS

Diplomate, Amer. Board Oral/Maxillofacial Surgery. Rotarian Past President, Carlsbad Rotary Club. Founder, President Smiles International Foundation. www.SmilesInternationalFoundation.org

Y

ears ago, the withdrawal of the Soviet Union from distant areas in Ukraine, left medical centers without sufficient medical equipment and instruments to perform vital procedures for their patients.

One of the casualties of this situation included children born with craniofacial deformities such as cleft lip and palate. The governmental officials had no choice but to tell their delivery teams to inform the mother of these unfortunate babies that the child had little chance of survival due to the inability to provide closure of the lip and palate and that the baby would die of feeding difficulty. The mother was then told their baby would be taken and placed into one of the “State Baby

Certificate Honoring Project

Houses”. Those children lacked nurturing with human touch and many of them possessed so severe facial deformities that led to inhumane ridicule and ultimate prevention of adoption.

This is a story of how a solution was found to this tragedy after a meeting with Salah Hassanein, Founder of the Variety Children’s Lifeline Foundation.

From our foundation we proposed to prepare a full surgical team specialized in the cleft and craniofacial care carrying instrumentation that would demonstrate modern pediatric techniques and provide clinical education for the host doctors through the foundation’s credentials. The concept was to create a full team approach to care for the child since in average 3-5 surgeries are required during their growth. Various specialties such as Speech and Audiology clinicians, Orthodontia, E.N.T. Surgeons, Dentistry, and even Geneticists would be employed in this team process.

Also, full support of our local rotarians was received.

Then we should build the regional hospital and staff up with equipment and supplies along with providing world class surgeon experts to demonstrate and work side-by-side with their already proficient doctors to exchange techniques with the modern equipment.

Furthermore, after all this process became stable having the children receive proper care throughout the year, the team would then be transferred from Smiles International to a top level Academic University team for long term relationship maintenance whose members would be introduced to the Ukrainian doctors and

“Vision, hope and faith of a few individuals can make a difference if applied to the opportunity placed before them.”

mission clinic as the development progressed. This way, as specialized techniques advanced with time, the regional center’s surgeons would be kept up to date and the ambassadorial international relationships would be maintained.

With this agreed upon, the teams began their work.

Over the following three and a half years, approximately 9-10 mission clinics were accomplished with hundreds of children facial deformities operated and repaired.

Equipment and supplies as well as clinical services valued at many hundreds of thousands of dollars were donated and received with gratitude.

including names. An emotionally surprising outcome of this portion of the news conference came afterwards when a mother of one of the patients who had recognized the name of her daughter contacted the center and was able to reclaim her to join her siblings and reunite the family.

Unfortunately, our collaborative ambassadorial surgical mission was FUTURE CHILDREN recently interrupted, due to political and military actions taken by Russia in HAVE THE HOPES OF Ukraine.

ENTERING SOCIETY

WITH NORMALIZED FACIAL FEATURES, SPEECH AND EATING ABILITIES

Throughout the process of developing the Mechnikov Regional Hospital into a central provider point for Cleft and Craniofacial Surgery for the children born in the region of Dnepropetrovsk, Ukraine, support was garnered from many private and NGO sources.

The Dnepropetrovsk Regional Minister of Health presented us a Meritorious Award. In that particular conference, photographs were shown of some of the various children operated with before and after images

No longer will children born in the region of Dnepropetrovsk and Dneprodzerzhinsk, Ukraine be taken from their mothers and placed to face the “failure to survive” diagnosis. Future children have the hopes of entering society with normalized facial features, speech and eating abilities. Children in the orphanages will now have a better chance of adoption as well.

Many voices of appreciation are raised in praise of the work Children’s Variety Lifeline has given to the Ukraine Region of Dnepropetrovsk. These are not only from the Orphanages but from the general population and regional medical personnel free from the heartache associated with the newborns previously left without hope of a normal life. ■

IDEAS IAOMS: Ideas worth spreading

By Prof. Dr. S.J. Bergé, MD, DDS, PhD Head of the Department of Oral and Maxillofacial Surgery Head Cleft Palate Craniofacial Unit

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he IAOMS is planning to set up a SIGN-group called “OMFS, ideas worth spreading”. If you are interested in joining this SIGN group after reading this introduction, please contact lmarkovic@iaoms.org. Melbourne will be the place for our first meeting.

THERE IS A NEED FOR A DEEP CHANGE IN HEALTHCARE, ALSO IN OMFS Despite wondrous advances in medicine and technology, health care regularly fails at the fundamental job of any business: to reliably deliver what its customers need. In the face of ever-increasing complexity, the hard work and best intentions of individual physicians can no longer guarantee efficient, high-quality care. Fixing health care will require a radical transformation in the next decades, moving from a system organized around individual physicians to a team-based approach focused on patients1.

Unfortunately, most discussions about health care these days dwell only on its problems—spiraling costs, lack of access, uneven quality—and give short shrift to the possibility of a better future. To help physicians move beyond grief and anger about what they might be losing as the health care system remodels, responsible leaders, also in the IAOMS, must shift the conversation to something positive, noble, and important.

The IAOMS has not the ambition and will not solve the above-mentioned international problems of healthcare. Nevertheless, we better invest already now in being well prepared and therefore we should start acting proactively. We propose some ideas to overthink and start with.

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Overthink the OMF-team. Move from a system organized around individual physicians to a teambased approach focused on patients ✔ Patients included2: The paradigm shift, that patients gain more control of their own health process is an irreversible fact. Therefore, it is absolutely necessary that patients and caregivers don’t only look at each other, but really see each other, that they don’t only listen at each other, but really hear each other 3. Professionals have to stop talking about patients as if they were ” a third-person word” 4. IAOMS Conference organizers should use this logo to state that this is a Patient Included conference5. ✔ Nurses included6 Technology in healthcare does not only affect patients and the works of doctors, but certainly also the workflow of nurses. Their job is getting more technical by the day, and the speed of those changes is increasing as well. IAOMS Conference organizers should use this logo7 to state that this is a Nurse Included conference.

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Overthink OMF-communication. Change the way of sharing new developments in OMFS ✔ Newsletter: Lots of small textblocks with sparkling ideas about OMFS should be published in the newsletter. Literally everything that has to do with OMFS is allowed. Surgical tips and tricks as well as great educational ideas or organizational measures are welcome.

✔ IJOMS: The most important journal of our profession should be the platform par excellence for sharing all the brilliant ideas that exist in the clever minds of the members. We want to publish lots of ideas in a very low-profile way, even easier than the technical notes. A section called “OMF, ideas worth spreading” should be added to the IJOMS.

pure science-fiction. The advances made in medical technology are revolutionizing the diagnosis and treatment of diseases and benefiting both patients and caregivers and researchers. One of the crucial challenges of effective healthcare in the next decade will be to find a workable equilibrium between technology and humanity.

✔ TEDx Conferences: TED-Talks are truly wonderful and a great and democratic way of spreading knowledge and ideas8-9. We see great opportunities to realize an extraordinary atmosphere of sharing knowledge in a “different” way by implementing TEDtalk in IAOMS conferences.

For more information: read the e-book “The guide to the future of medicine: technology and the human touch”12.

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Overthinking OMF-ownership. Embrace the infinite creativity of patients and the disruptive power of technology ✔ Patient empowerment10: Patient empowerment is a philosophy that states that patients are active participants in, not passive recipients of the caring process, and thus should be well informed about all aspects of their health, ‘wellness status’ and disease state, to gain maximum health benefit within the context of their social demands. Patient empowerment puts the patient in the core of services.

For more information: watch the video “What is patient empowerment?”11 ✔ The future of medicine for the OMF-surgeon: Technology has transformed healthcare in ways that a mere decade ago would have sounded like

✔ Task shifting & new professions in OMFS: Dentist, physician assistants and nurses will take over significant parts of the working scope of OMF surgeons in several parts of the world. Although these issues may differ significantly in different parts of the world, it seems wise to look for adapting strategies (also internationally) already now. On the other hand, the evolution in to more personalized medicine and technology will create new jobs, such as OMF engineers, case managers or home care workers in oncology or congenital cases, etc.

CONCLUSION We are on the precipice of a new age in healthcare; like the industrial revolution that shaped big parts of the world in the 1800s, healthcare industry is now entering that same type of business revolution13. Awareness and anticipation are fundamental keystones to finally profit extensive of this promising medical future.

Please join the starting SIGN-group about “OMFIdeas worth spreading” if you would like to face this challenges with other friends of the IAOMS. Bibliography

Dr. Stefaan J. Bergé facetalk.

1. T homas H. LeeToby Cosgrove, Harvard Business Review, June 2014 2. h ttp://www.bmj.com/campaign/patient-partnership 3. “ Do not look at me, but see me. do not listen to me but hear me”.

René Tabak at the TEDx Maastricht conference 2012 4. h ttps://twitter.com/epatientdave 5. T his is a trademarked logo and can be used in the context as described above, for non-commercial purposes 6. h ttps://www.linkedin.com/pulse/20141113153613-19886490nurse-included 7. T his is a trademarked logo and can be used in the context as described above, for non-commercial purposes 8. https://www.ted.com/playlists/23/the_future_of_medicine 9. http://www.ted.com/playlists/171/the_most_popular_talks_of_all 10. http://www.eu-patient.eu 11. https://youtu.be/z91Ner8UJ60 12. http://www.amazon.com/The-Guide-Future-MedicineTechnology-ebook/dp/B00N3Z7NMC 13. http://craigrhinehart.com/2015/04/10/where-is-thedisruptive-innovation-in-healthcare-this-is-a-revolution-not-atransformation-five-key-areas/■

p i h s w o l l e F

The magic of maxillofacial surgery

Dra. Laura Gabriela Gonzalez Valdez / Mexico Fellowship in Cleft Lip and Palate and Craniofacial Surgery. IAOMS Fellow 2014-2015

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his story begins some years ago when i was doing my tranning in maxillofacial surgery at Hospiatl Central “Dr. Ignacio Morones Prieto” in San Luis Potosí, México; during this time i discovered the magic of this speciality and my passion for pediatric patients with congenital diseases and severe trauma whose tratment was always a challenge and i realized our importance like surgeons to restosre function, estehics and improve the quality of life of this patients.

Surgery day in Rumah Sakit Ibnu Sina with Dr. Abul Fauzi and Dr. Irfan Rasul in Makassar, Indonesia.

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Presurgical evaluations in charity mision in Makassar, Indonesia.

nce I finish my OMS training I realized I still had a lot of things to learn to improve my skills as surgeon and help this group of patients, so it was that I looked to study a fellowship in craniofacial surgery and that’s how I found this excellent program that IAOMS offers and IAOMS foundation support, whom I really thank for giving me this great opportunity. So i packed my dreams and part of my life and i started this adventure....

This one year program was divided into two parts, 6 months in USA in Arnold Palmer Hospital for Children in Orlando, FL and 6 months in Indonesia where i was three months in Rumah Sakit Hasan Sadikin in Bandung, Java and 3 months in Rumah Sakit Ibnu Sina in Makassar, Sulawesi.

Some reacreation after a long charity mission with Dr. Andi Tajrin and part of the team of Celebes Cleft Center, in Sulawesi, Indonesia

“

“This program teached me not just things related to surgical cases, also made me realize where im and what im doing in my life, looking outside i found a lot of things inside my self.”

T

his program allowed me to join different activities and to participate in the out patient clinics, multidisiplinary clinics for craniomaxillofacial disorders, surgical procedures in operating room and join trips for missions providing free surgeries. Also exposed me to different diagnostic criteria, protocols and surgical

Dr. Asri Arumsari and Dr. Melita Sylvyiana, in Rumah Sakit “Hasan Sadikin” Bandung, Indonesia

techniques. I had contact with different conditions especially cleft lip and palate, orthogantic surgery, skull deformities like craniosynostosis, syndromic cases, special medical conditions and severe maxillofacial pathology.

T

his program teached me not just things related to surgical cases, also made me realize where im and what im doing in my life, looking outside i found a lot of things inside my self. I had the oportunity to meet a lot of great people, meet new friends who, to live in different cultures and i discoverd different ways to see and enjoy life. Now im ready to return to Mexico and start a new stage... ■

www.iaoms.org/events/iaoms-invitational-conference/

From Proust to Pivot

An Apparently Innocent Questionnaire for Oral and Maxillofacial Surgeons You’ve heard of the Proust Questionnaire adapted and made famous in the back pages of Vanity Fair Magazine, it was named not for questions, but for the answers given by Marcel Proust to a set of questions asked by his friend Antoinette Faure.

Then, for many years Bernard Pivot conducted a cultural program in french TV called “Apostrophes.” All his guests received the same 10 questions at the end of the interview.

So, in Face to Face we thought that being oral and maxillofacial surgeons human beings as the rest, those questionnaires were a great method to let us know some personality traits of our interviewees. Enjoy, and compare their answers with those of celebrities!!!

Henning Schliephake What is your favorite word? Yes! What is your least favorite word?

Impossible.

What is your favorite drug? Good music.

What sound or noise do you love?

String quartet and morning birds.

What sound or noise do you hate? My alarm clock.

What is your favorite curse word? Oh, sh...

Who would you like to see on a new banknote? I don’t think banknotes are good for featuring people.

What profession other than your own would you not like to attempt? Tax advisor.

If you were reincarnated as some other plant or animal, what would it be? If I had to, I’ld come back as a human being.

What do you consider the most overrated virtue? Political correctness.

What is the trait you most deplore in others? Bigotry.

On what occasion do you lie? To save someone from harm.

Which living person do you most admire? Those who set out to help otheres no matter what.

What do you most dislike about your appearance? Don’t think about that so often.

What is your idea of perfect happiness? Holidays on a sunny island with family and friends.

What is your greatest extravagance? Good wine and great food.

What is your greatest fear? To loose someone beloved.

What is your current state of mind? Weekend feeling.

Which living person do you most despise? Narrow-minded people hiding behind harping on about principles.

If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates?

Welcome, we have been waiting for you all your life.

▼ ▼

What is the trait you most deplore in yourself?

Impatience.

What is your most treasured possession? Real treasures in life cannot be possessed.

What do you regard as the lowest depth of misery? Fatal disease of a family member.

What is your favorite occupation? Enjoy the good life (if I am not working on patients or papers).

What is your most marked characteristic? Curiosity.

What do you most value in your friends? That they still bear with me and make my life happier.

What is the quality you most like in a man? Honesty, wisdom determination.

What is the quality you most like in a woman? Honesty, wisdom determination.

Which words or phrases do you most overuse? I should do...

What or who is the greatest love of your life? My wife.

When and where were you happiest? When I am with family and friends.

Which talent would you most like to have? Patience.

If you could change one thing about yourself, what would it be?

Intolerance.

What do you consider your greatest achievement? Having raised kids.

If you were to die and come back as a person or a thing, what would it be? Maybe I don’t want to come back.

Where would you most like to live? By the sea.

Henning Schliephake is a full Professor in Oral and Maxillofacial Surgery at the GeorgAugust Universität in Göttingen, Germany.

He contributed too many publications in peer-reviewed journals and books.

Prof. Schliephake has received several recognitions during his career. He received a first award for the best doctoral thesis in medicine of the Medical University of Hannover in 1990. Then he obtained many awards for the best scientific paper at various events.

Who are your favorite writers?

No real preference, contemporary American and German novellists.

Who is your hero of fiction? All those invincible, invulnurable and incredibly strong guys.

Which historical figure do you most identify with? All the guys who set out to discover and explore e.g. Galileo Galilei, Isaac Newton, James Cook, Alexander v. Humboldt.

Who are your heroes in real life?

Those who devote their lives to the welfare of others.

What are your favorite names?

No preference as long as they match the person.

What is it that you most dislike?

Dishonesty.

What is your greatest regret?

Having spent too much time on useless things.

How would you like to die? In peace.

What is your motto: Make hay while the sun shines. ■

NextGen

Building a melting pot of ideas...

By Antonio F. Gagliardi Lugo

T

hrough history, human civilizations have always come up with ideas. It is pretty sure that our history arises from a pretty good idea, since the primitive man learned how to create and use tools. However, the transcendental of this idea wasn’t the creation of the tool, but the capacity of its creator to teach everyone else how to use this tool.

In the end, what’s the point of having a good idea if no one else can take advantage of it? Next comes the real challenge, eventually the life of this man would come to an end and his teaching work will come to an end. But this precursor of our civilization assures that his legacy will prevail in time despite his absence. The progress of tradition and the importance of study play a significant role in allowing the evolution of this idea and many more. It makes me wonder, the difficult part is not having the idea, the difficult part is make it last forever.

During the turn of the 1960’s, there was a man who worried about this issue, this man was Fred Henny. Dr. Henny was a visionary concerned about the future, as well as the state of the art of oral and maxillofacial surgery around the world. During this time the world was still recovering from the Second World War and news about the omfs specialty was minimal, it was very hard to know what the advances in Europe, Asia and America were. Every

“The difficult part is not having the idea, the difficult part is make it last forever”.

country had their journal, written in their own language and with their own knowledge, it was a shame that all this experience and knowledge wasn’t harnessed and used by the whole world. So Dr. Henny and Dr. Ward gave birth to the idea of having an International Oral Surgery Conference that eventually developed into the ICOMS, inspiring many doctors throughout the world. After gathering many fellows and members globally, by 1968 it was time for the International Association to fulfill a mission as an initiator of guidelines and promotion for education and training.

In Latin America there were women and men in our history, members of the IAOMS and ALACIBU, trained by the pioneers of the specialty in Europe and in the United States making sure that all this knowledge and experience in our countries was not forgotten. Training programs in oral and maxillofacial surgery were born by the initiative of illustrious visionaries like Basilio Arienza, Enrique Muller (Argentina), Waldemar Wilhelm (Colombia), Italo Alessandrini, Alberto Rahaussen (Chile), Luisa Romero de Johnston, Alberto Lander or Atilio Perdomo (Venezuela) to name a few. Today, there are other men and women trained by these visionaries that are still keeping their commitment to this good idea to prevail over time. It is a vital role of a scientific association, to open a window for social and scientific exchange nationally and internationally. They have to be the guardians of this knowledge and make sure the wisdom of our specialty will never again be forgotten or trapped by facilitating their promotion and diffusion among colleagues worldwide. ■

Copy Me ENDOSCOPICALLY ASSISTED INTRAORAL vertical ramus osteotomy approach to the mandibular condyle Traditionally a high condylectomy have been the procedure of choice for the surgical management of developmental and neoplastic conditions affecting the mandibular condyle such as condylar hyperplasia, osteochondroma and chondroblastoma. Herein an alternative technique is presented for the treatment of these growth disorders of the condyle.

2

1 Preoperative 3d reconstructions demonstrating a right condylar osteochondroma with the associated malocclusion. Note the lack of compensation of the maxilla.

3

Preoperative occlusion showing right posterior open bite.

Prof. Luis Vega Associate Professor and Program Director Department of Oral and Maxillofacial Surgery Vanderbilt University Medical Center.

4

Traditional ramus exposing incision.

5

Dissection of the entire mandibular ramus allowing identification of landmark structures. Note that a coronoidectomy was already done to improve the access to the condyle.

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6

Intraoral vertical ramus osteotomy already performed with an angled-oscillating saw.

The proximal segment is then completely skeletonized and removed.

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9

10

The residual condyle is then contoured and fixation is applied for re-implantation.

Proximal segment fixated of the mandible.

The affected region of the proximal segment is demarcated and removed ex-vivo.

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Endoscopic view of the inferior surface of the articular disk.

12 Immediate postoperative 3d reconstructions demonstrating resolution of the malocclusion.

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14 Postoperative occlusion.

Postoperative maximum interincisal opening.

Hours A day in the life of a maxillofacial resident in Cape Town, South Africa

By Allie Mohamed (Cape Town, South Africa)

I

am a recently qualified resident at the Department of Maxillo-Facial and Oral Surgery of the University of the Western Cape at Groote Schuur, Tygerberg and Red Cross children’s hospitals in Cape Town, South Africa. Our department has 7 residents that cover these three hospitals on a rotation basis.

5:45 a.m.

Time to wake up! A long day ahead. I have a shower, a quick breakfast and pack my lunchmost important!

6:30 a.m.

Leave for work. I stay approximately 10km from work. It’s a 30 minute drive in peak hour traffic.

7:00 a.m.

Morning Ward round. The residents follow up patients previously operated, review and preparation of patients planned for surgery for the day. Residents split up and each sees several patients so as to maximize efficiency and be ready for presentation when the Professor arrives.

7:30 a.m.

Dr. Allie Mohamed

Team Review of all patients with professor.

Cases discussed and day planned. Friday morning we have an academic ward round (90minutes) where cases are discussed in depth, and the consultant questions and tests the knowledge of the residents.

8:00 a.m.

Start of operating list and outpatient clinic. Each resident has a week in the main operating theatreteaming up with another resident and overseen by a consultant. Those residents who are not in surgery attend to the daily outpatient clinic.

During one’s theatre week, there are various cases including trauma, orthognathic surgery, TMJ surgery, Dentoalveolar surgery, maxillo-facial sepsis, tumour resections and reconstructions.

Friday morning after the academic ward round, there is a journal club discussion and critical review of an interesting case-these are presented by a resident. Every second Friday morning, there is a multidisciplinary orthognathic surgery outpatient clinic. All orthognathic cases are discussed and planned together with orthodontic residents and consultants.

14:00 p.m.

Outpatient clinic for Dentoalveolar procedures under local analgesia. Several cases are booked that cover the full range of Dentoalveolar procedures.

Thursday afternoon-departmental academic meetings 14h00-16h30 consisting of: Maxillo-facial radiology lecture by the head of radiologyOrthognathic surgery lecture 2 seminars by residents on various topics.

16:00 p.m.

Afternoon ward round- follow up ward patients from previous days and immediate postoperative cases. Preparation of patients planned for surgery for the following day.

16:30 p.m.

Office bound for academic work. Preparation of seminars, case planning,research, reading. 1resident is on call for any overnight emergency cases-some nights are quiet, others are very busy!

18:00 p.m.

Time to get home to the family. Spend quality time with wife and children-catchup on the day’s activities while having dinner.

. m . p 0 3 : 19

Off to gym/run to work off the stress from the day, and clear the mind.

21:00 p.m.

Settled in for the evening and do some academic work-journal articles, case planning, seminar preparations.

23:30 p.m.

Time for bed for much needed sleep. Let’s do this again tomorrow!

www.iaoms.org

Beyond OR

Preventing disasters:

surgeons and finances

By Javier GonzĂĄlez Lagunas

W

e have to admit it, no matter how much it hurts. Most doctors are really bad in running their economies, and some of their finacial decisions can be a burden to their professional career.

know which is the net profit margin of a particular procedure? Do you know if when performing a particular operation, you might well be losing money? Are your sure that the medical insurance companies are really paying what they owe you?

We are bad listening to the experts, and in many occasions being as we are university-trained and being succesful in the technical part of our profession, we believe that without any previous preparation we can take good (financial) decisions without listening to an expert. Because, how many of you have been taught in medical college what to do with money?

Investments in high.end technology or in a new practice. Have you taken the time to calculate the return of investment (ROI) of your last purchase?

How many procedures will you need to perform with that wonderful new gadget you bought for the operating room, to recover your investment and have a profit? That will tell you how efficient you are in your investments!

JUST A FEW OF OUR MISTAKES: Poor operation of the practice. Do you run a profit and loss account or do you know the balance sheet of your practice? Your accountant probably does, but are you able to understand its meaning? Do you

Saving for retirement. Despite high salaries in the summit of their careers, not much attention is paid to the sudden reduction of income that will happen after retirement. Are you sure that you will be able to maintain your standard of living when retiring?

Are you saving any money? Which percentage of your gross income? There is no universal rule: that depends on individuals and their specific goals for the future. But a good rule of the thumb is to start saving from the beginning of your career.

Remember that when starting a private practice, you stop being simply a technically gifted worker (a surgeon!). Now you run a small businees and you have transformed yourself in an entrepreneur. So behave as such! â–