60:1182-1185,2002 Public Recognition of Specialty Designations

J Oral Maxillofac Surg

60:1182-1185, 2002

Public Recognition of Specialty Designations

Daniel M. Laskin, DDS, MS,* John A. Ellis, Jr, DDS, MD,? and

Al M. Best, PhD?

Purpose:

Although there is no supporting evidence, there is a perception that the public is unfamiliar

with what an oral and maxillofacial surgeon does. The purpose of this study was to evaluate the

knowledge of persons about the type of treatment rendered by 12 different specialties and to determine

if such unfamiliarity is true only for oral and maxillofacial surgery or whether it occurs with other

specialties.

Patients and Methods: Two groups of patients, one in a dental setting (n ? 101) and one in a general

medical of?ce setting (n ? 157), were asked to match a list of 12 different specialists with list of 15 brief

treatment options. Data related to level of education, gender, and age were also collected. Logistic

regression was used to assess the relationship between correct identi?cation of individual specialties and

the demographic variables.

Results:

Subjects in both settings correctly matched an average of 72% of the specialists. The most

commonly identi?ed specialist in both groups was the gastroenterologist (90%), and the least recognized

was the nephrologist in the dental setting (44%), and the otolaryngologist in the medical setting (53%).

The oral and maxillofacial surgeon had an identi?cation rate of 77%. Older and better-educated respondents correctly recognized the greatest number of specialists.

Conclusions: The results of this study show that name recognition is not a problem faced only by oral

and maxillofacial surgeons. It also shows that efforts directed at improving this situation should be aimed

at the younger and less-educated population.

? 2002 American Association of Oral and Maxillofacial Surgeons

J Oral Maxillofac Surg 60:1182-1185, 2002

Ever since the change in the name of the specialty

from ¡°oral surgery¡± to ¡°oral and maxillofacial surgery¡±

(OMFS) in 1977, there has been concern about

whether the public understands the meaning of the

name. Although it accurately describes the anatomic

region and scope of treatment provided by its practitioners, the term ¡°maxillofacial¡± not only is dif?cult

for some persons to pronounce but also may not be

one with which they are familiar. A survey published

in the Journal of Oral and Maxillofacial Surgery in

*Professor and Chairman Emeritus, Department of Oral and

Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth

University, Richmond, VA.

?Formerly, Chief Resident in Oral and Maxillofacial Surgery,

Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA; Currently, Private Practice, Augusta, ME.

?Associate Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA.

Address correspondence and reprint requests to Dr Laskin: Department of Oral and Maxillofacial Surgery, PO Box 980566, School

of Dentistry, Virginia Commonwealth University, Richmond, VA

23298-0566; e-mail: DMLaskin@vcu.edu

? 2002 American Association of Oral and Maxillofacial Surgeons

0278-2391/02/6010-0014$35.00/0

doi:10.1053/joms.2002.35000

1996 showed only 72% of the public had heard of the

specialty.1 In a prior study conducted in England in

1994,2 79% of the general public had not heard of

OMFS and 74% did not understand the role of the oral

and maxillofacial surgeon. Although it would obviously be preferable to have greater name recognition,

the question arises as to whether the failure of the

public to comprehend what the oral and maxillofacial

surgeon does is speci?c to this specialty or whether it

occurs in other specialties as well, even those whose

names have been in use for a longer period. This

study was designed to provide an answer to this

question.

Patients and Methods

A questionnaire was designed that listed 12 different specialists and 15 different brief treatment options. Respondents in 2 practice settings were asked

to ¡°Please match the following specialists with the

correct treatment¡° (Table 1). Demographic data relating to the highest level of education (high school,

college, graduate school), gender, and age were also

collected.

Two groups of patients were surveyed: those in a

dental school setting and those in a general medical

of?ce setting. The dental group consisted of 101

1182

1183

LASKIN, ELLIS, JR, AND BEST

Table 1. QUESTIONNAIRE THAT ASKED ¡°PLEASE

MATCH THE FOLLOWING SPECIALISTS WITH THE

CORRECT TREATMENT¡±

Specialist

Treats . . .*

Orthopedist

Gastroenterologist

Physiatrist

Oral and maxillofacial

surgeon

Hepatologist

Opthalmologist

Urologist

Hematologist

Otolaryngologist

Nephrologist

Neurologist

Oncologist

in the likelihood of correctly identifying the specialties. Differences between the practice settings were

assessed by Fisher¡¯s exact test.

Results

Bone disorders

Stomach problems

Physical rehabilitation

Face and jaw problems

Liver disease

Eye problems

Urinary problems

Blood diseases

Ear, nose, and throat problems

Kidney disorders

Nerve conditions

Cancer

Items listed with no matching

specialist

Skin diseases

Cosmetic problems

Root canals

*In the actual questionnaire these treatments were randomly

arranged and numbered 1 through 15.

newly registered patients presenting to the Virginia

Commonwealth University School of Dentistry for

general care. Patients presenting for OMFS services

were excluded from the study. The second group

consisted of 157 patients presenting to a private general medical of?ce.

The number of the 12 specialties matched correctly

by each group was calculated. Logistic regression was

then used to assess the relationship between the correct identi?cation of individual specialties and the

demographic variables, and to assess for differences

The demographic characteristics of the patients in

the 2 survey settings were comparable. There were

65% women in the dental practice setting and 64% in

the medical practice setting. Their age distribution

was 13% in the age range of 18 to 25 years, 18%

between 26 and 35 years, 29% between 36 and 45

years, 15% between 46 and 55 years, 16% between 56

and 65 years, and 9% older than age 65. The highest

level of education was high school for 45%, college

for 43%, and graduate school for 12%.

Overall, subjects in both practice settings correctly

matched an average of 72% of the specialties. This

corresponds to approximately 3.4 of the 12 specialties being incorrectly matched. However, there was a

large variation in individual identi?cation rates, ranging from 0% to 100% correct. In addition, there appeared to be differences between the identi?cation

rates depending on the specialty. Table 2 shows that

the most commonly identi?ed specialist was the gastroenterologist (approximately 90% correct in both

practice settings), and the least recognizable was the

nephrologist in the dental practice setting (44%) and

the otolaryngologist in the medical practice setting

(53%). In both settings, the oral and maxillofacial

surgeon had a middle identi?cation rate of 77%.

Because the correct matching of specialists was

suspected to be a function of both the demographic

characteristics of the subject and the recognizability

of the specialist designation, a logistic regression anal-

Table 2. DIFFERENCES IN IDENTIFICATION RATES BASED ON GENDER, AGE, AND LEVEL OF EDUCATION

Dental Practice Setting

Specialist

Percent

Correct

Gastroenterologist

Urologist

Hematologist

Opthalmologist

Orthopedist

OMFS

Neurologist

Physiatrist

Oncologist

Otolaryngologist

Hepatologist

Nephrologist?

89.1

84.2

80.2

78.2

76.2

77.2

77.2

70.3

63.4

65.3

54.5

43.6

Differences* According to

Gender

Age

Education

.0030

.0138

.0020

.0002

.0001

.0001

.0001

.0001

.0020

.0008

.0005

.0005

.0001

.0002

.0001

.0005

.0063

.0208

.0152

.0074

.0014

.0378

.0230

Medical Practice Setting

Different

Than OMFS

Percent

Correct

?

?

91.1

82.8

83.4

79.6

78.3

77.1

69.4

66.2

62.4

53.5

56.1

64.3

?

?

?

?

Differences* According to

Gender

Age

Education

.0001

.0121

.0007

.0001

.0001

.0135

.0009

.0001

.0250

.0001

.0001

.0001

.0001

.0004

.0007

.0001

.0003

.0148

.0046

.0225

Different

Than OMFS

?

?

?

?

?

Abbreviation: OMFS, oral and maxillofacial surgeon.

*P values from separate analyses for each specialty.

?Nephrologist is the only specialist with signi?cantly different recognition in the 2 practice settings (Fisher¡¯s exact P value ? .0013).

?Post hoc contrast with OMFS after demographic differences are taken into account (P ? .05).

1184

PUBLIC RECOGNITION OF SPECIALTY DESIGNATIONS

FIGURE 1. The probability of

patients in 2 practice settings correctly identifying each specialty

designation. The asterisks indicate the specialty designations

that have higher or lower recognition than OMFS (see Table 1

for a list of the specialists).

ysis was performed to assess the differences in identi?cation rate according to the subject¡¯s gender, age,

and education level and the specialty being identi?ed

(Table 2). The results showed that there was a genderassociated difference (P ? .0091) in the dental practice setting but not in the medical practice setting

(P ? .6451). In the dental practice setting, males had

a higher identi?cation rate for otolaryngologists (80%

for males vs 58% for females) and nephrologists (60%

for males vs 35% for females).

The age and education differences in identi?cation

rate were as expected (P ? .0001); older and more

educated subjects correctly recognized more specialties. For example, in the medical practice setting

males with a high school education matched 44% of

the specialists correctly, those with a college education matched 82% correctly, and those with a graduate education matched 90% correctly. Females with

similar educational levels matched 66%, 82%, and

94%, respectively. Overall, young adults (age 18 to 25

years) identi?ed approximately half as many specialties as did any of the older age groups (39% correct vs

at least 74% for all ages above 25 years). The nephrologist was the only specialist with signi?cantly different recognition in the 2 practice settings (Fisher¡¯s

exact P value ? .0013).

These demographic differences were taken into

account when assessing the primary question of this

study: Does the OMFS specialty have a different identi?cation rate than other specialties? The answer in

both practice settings was yes (P ? .0001). The between-specialty differences are shown in Figure 1 and

in the right columns in Table 2. In the dental setting,

gastroenterology and urology had a signi?cantly

higher recognition rate than OMFS, whereas the oncologist, otolaryngologist, hepatologist, and nephrologist had lower recognition rates than the oral and

maxillofacial surgeon. Similarly, in the medical practice setting, the gastroenterologist and hematologist

had signi?cantly higher recognition rates, whereas

the otolaryngologist, hepatologist, and oncologist enjoyed less recognition than did the oral and maxillofacial surgeon. Overall, the OMFS specialty attained a

77% recognition rate, which is in the range of a wide

variety of other specialties, and similar to that reported in other studies.1,2

Discussion

When the name of the specialty of ¡°oral surgery¡±

was changed to ¡°oral and maxillofacial surgery¡± in

1977, the intent was to more clearly delineate the

scope of practice of the specialty to the public. Since

that time there has been considerable debate over

whether this goal has been accomplished. In attempting to answer this question, it is important to know

whether other specialties may have similar problems.

The results of this study clearly indicate that this is not

a problem faced by OMFS alone. Not only do many

other specialties have similar problems with recognition of their scope, but perhaps it is not possible for

a brief name to describe exactly all of what any

specialist does. Therefore, although this does not

mean that there should not be efforts to inform the

public about what oral and maxillofacial surgeons do,

it does indicate that no name alone can ever be

completely descriptive.

1185

LASKIN, ELLIS, JR, AND BEST

Considering that OMFS is a dentally based specialty,

this study shows that there is relatively good recognition of what it includes among both dental and medical patients, even when compared solely with medical specialties. In fact, in both groups, it outranked

the one specialty listed, otolaryngology, with which

there is an overlapping scope. The difference between these data and those data presented by Ameerally et al2 and by Hunter et al,1 who showed better

recognition of the scope of otolaryngology (ear, nose,

and throat), is probably due to the manner in which

the questions were posed. In the former study, subjects were asked, ¡°What do you think an oral and

maxillofacial surgeon does?¡± and ¡±What do you think

an ear, nose, and throat surgeon does?¡± Obviously, the

latter questions used anatomic descriptions that are

more familiar than ¡°maxillofacial.¡± The same is true in

the Hunter et al study,1 in which the lay subjects were

asked if they had ever heard of ear, nose, and throat

specialists and specialists in OMFS.

Age, gender, and level of education have an effect

on the recognition of specialty scope. The older and

more educated respondents in this study were better

able to recognize what the various specialties did than

were the younger, less-educated respondents. Also,

males were more knowledgeable than females about

some specialties. These ?ndings indicate the best potential target populations for future educational efforts.

Although this study did not involve an analysis of

knowledge about the scope of OMFS by healthcare

professionals, the study by Hunter et al1 included

both dental and medical practitioners. Although most

professionals in both groups had heard of OMFS

(94%), their referral patterns for the treatment of

conditions that overlapped different specialties did

not always favor the oral and maxillofacial surgeon.

Thus, it is clear that any future educational efforts

need to include the healthcare community as well as

the general public.

References

1. Hunter JH, Rubeiz T, Rose L: Recognition of the scope of oral

and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 54:1227, 1996

2. Ameerally P, Fordyce AM, Martin IC: So you think they know

what we do? The public and professional perception of oral and

maxillofacial surgery. Br J Oral Maxillofac Surg 32:142, 1994

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