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 office 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 identification of individual specialties and the demographic variables.

Results: Subjects in both settings correctly matched an average of 72% of the specialists. The most commonly identified 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 identification 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 difficult 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 specific 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 office setting. The dental group consisted of 101

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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

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 office.

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 identification of individual specialties and the demographic variables, and to assess for differences

in the likelihood of correctly identifying the specialties. Differences between the practice settings were assessed by Fisher's exact test.

Results

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 identification rates, ranging from 0% to 100% correct. In addition, there appeared to be differences between the identification rates depending on the specialty. Table 2 shows that the most commonly identified 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 identification 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

Specialist

Percent Correct

Dental Practice Setting

Differences* According to

Gender

Age

Education

Different Than OMFS

Percent Correct

Medical Practice Setting

Differences* According to

Gender

Age

Education

Different Than OMFS

Gastroenterologist 89.1

Urologist

84.2

Hematologist

80.2

Opthalmologist

78.2

Orthopedist

76.2

OMFS

77.2

Neurologist

77.2

Physiatrist

70.3

Oncologist

63.4

Otolaryngologist

65.3

Hepatologist

54.5

Nephrologist

43.6

.0030 .0138 .0020 .0002

.0063

.0208 .0152

.0074 .0014 .0378 .0230

.0001 .0001 .0001 .0001 .0020 .0008 .0005 .0005 .0001 .0002 .0001 .0005

91.1

82.8

83.4

79.6

78.3

77.1

69.4

66.2

62.4

53.5

56.1

64.3

.0001 .0001

.0121 .0135

.0007 .0009

.0001 .0001

.0250

.0001

.0003 .0001

.0001

.0148 .0001

.0004

.0046 .0007

.0225 .0001

Abbreviation: OMFS, oral and maxillofacial surgeon.

*P values from separate analyses for each specialty. Nephrologist is the only specialist with significantly 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).

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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 identification rate according to the subject's gender, age, and education level and the specialty being identified (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 identification 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 identification 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) identified 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 significantly 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 identification 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 significantly

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 significantly 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.

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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 findings 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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