2 shifts to monitor in oral surgery: Q&A with Dr. Jason Auerbach

Oral surgeons may see an increase in consolidation and a split between oral and maxillofacial surgery in the near future, according to one surgeon's predictions. 

Jason Auerbach, DDS, is the founder of Riverside Oral Surgery, a New Jersey practice with 10 locations in the state. He recently spoke with Becker's about the oral surgery field, why practitioners are wary of DSOs and what he expects for the future of oral surgery. 

Editor's note: Responses were lightly edited for clarity and length.

Question: What trends are you following in oral surgery?

Dr. Jason Auerbach: I don't think there are a whole lot of challenges facing the specialty, but there's a lot going on in the specialty that most surgeons, though they may be peripherally aware of, aren't really prepared to handle on a macro scale. In the last few years there's been significant interest by traditionally dental DSOs and multispecialty DSOs. A lot of people who have been doing what we've been doing for as long as we've been doing it are a little weary of it and I think rightfully so, given what people perceive corporate dentistry and DSOs to be about. That's a huge piece of what's going on right now in the space as a whole. I don't see it as a challenge. I just see it as something we have to handle.  

I think by and large medical professionals are a little bit weary of things that they don't understand. And I think there's just generally a negative reputation of DSOs without really even understanding what that means. People don't understand that a DSO is really nothing more than a management structure and a business and there are good players and there are bad players, and it's all about, like everything else, the people you decide that you want to do business with. I think people generally think DSOs and corporate dentistry is all about profits and nothing more. People are feeling like DSOs are going to be making the decisions in terms of clinical instrumentation or materials or whatever, which is overall not the case but that's a big concern for practitioners. They feel like they're going to lose their independence. They feel like they're going to lose their ability to make decisions for what's best for their patients. The fear is justified in many cases, but again, as long as you pick the right partner, that shouldn't be an issue. 

Q: What technology is improving patient care and efficiency?

JA: From the perspective of patient care, a lot of the digital technology is driving the progress in our specialty. A lot of surgery that was planned and done by hand is now digitally planned, including dental implants and orthognathic surgery, which specific to oral surgery, is kind of almost like a subspecialty. In terms of efficiency in the office, a lot of artificial intelligence is being laid over phone lines and websites and things like that to try to basically capture data that can help guide marketing dollars and things of that nature. 

One negative consequence is people becoming too dependent on technology. There's an art to what we do and there's of course the science behind it. If you take the art and the understanding of what goes into fundamentally making the decisions to, let's say for instance, place an implant where it needs to be placed, and you just kind of completely depend on surgical guides, if that surgical guide was to fail, which actually happens from time to time, now you're in a position without the baseline knowledge. So I think a lot of the younger surgeons, a lot of younger dentists in general, who become too dependent on the technology without fundamentally understanding how the technology improves the outcome, will be left at times holding the bag. 

As far as a positive goes, I think as technology becomes more available to the practitioner and the practitioner understands how to use the technology more, that enables the practitioner to provide services at a lower cost to a wider variety of patients who otherwise would not necessarily have access to that type of care. Technology opens things up to people who would otherwise not have access to care. But at the same time, you have to understand how you're using that technology in order to maximize the outcome. There needs to be an understanding of the importance of traditional training. It's really just a matter of proper training, really understanding what the fundamental principles of what you're trying to do are and doing it over and over again and understanding what the pitfalls are [and] how to handle complications that come your way. That's a big part of it. Proper training, pushing the limits, but not beyond understanding how to handle complications, which is a huge thing to keep people safe. Understanding the principles of the procedure will help us all deliver the best care for the patients. 

Q: How do you see the oral surgery industry evolving in the next three to five years?

JA: From a clinical perspective, oral surgery is becoming a little bit bifurcated. There are more and more oral maxillofacial surgeons who are fellowship trained. The vast majority of oral and maxillofacial surgeons today do provide what's considered dentoalveolar surgery. I do think you're going to see a bifurcation in the training and a bifurcation in the actual practice. There are going to be people who are practicing what is considered oral surgery and people who are practicing what's considered maxillofacial surgery. I do think we're going in that direction. That has been the way it is across the globe. 

As far as the business side of oral surgery goes, there's going to be consolidation in the market. I do think the larger practices that are going to be surgeon-led and focused on optimal outcomes in patient care are going to be the practices that overall are going to win out in this consolidation period. As smart as private equity guys and large corporate-owned dental organizations are, to understand oral maxillofacial surgery as being something very different than most other businesses in terms of its referral, relationship-based model, you need to be really good at communicating with your referring dentists. You need to be really good at communicating with the patients and communities you serve to understand why you are the optimal oral maxillofacial surgery practice to go to and I do think you're going to see that become more and more of a focus for practices.

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