LAUSR

Oral medicine is defined by the American Academy of Oral Medicine as the discipline of dental medicine concerned with the oral health care of patients with medically complex conditions, including the diagnosis and management of medical disorders that affect the oral maxillofacial region. This field of oral health care has advanced worldwide in the past 80 years. Accredited training programs with established goals, competencies, and experiences now exist in several parts of the world. As members of an interdisciplinary team, oral medicine practitioners must be knowledgeable of the principles of internal medicine, dermatology, rheumatology, infectious diseases, and pharmacology, among others, to be able to provide appropriate care to complex cases. Our training provides opportunities to work in changing environments in a medical center, in an educational institution, or in private practice. Many of us merge our clinical skills with a passion for teaching and research. Although this has been an established model for oral medicine practitioners, morphing patient populations, increasing medical complexities, and evolving compensation patterns (i.e., bundled payments, value-based payment) in the medical/dental field have attracted a new group of young clinicians who are interested in the clinical practice of oral medicine in a community setting. We observe these fledgling dentists and junior residents approaching us at professional meetings with a genuine drive toward pursuing oral medicine training. A common question they pose is “What will I do as an oral medicine clinician?” Not everyone enjoys or wants an academic career. Some of our colleagues relish clinical practice and would love to establish themselves in their community as referring oral medicine providers. This scenario presents a significant challenge to the field because we believe that growth of our field demands that these individuals be able to inform and educate multiple stakeholders on the value-added proposition of our practice to overall health care. We believe that dentists with oral medicine training are now in high demand, not only in the academic and hospital environments but also in clinical practice. It is in clinical practice that translational discoveries presented in scientific forums move to population-level scenarios. Moreover, health care systems need clinicians who are able to uphold the patient’s comprehensive and continuous health care and act in an interprofessional collaborative manner to enhance the patient’s health status and quality of life. Therefore, we see an increased interest in young clinicians to establish practice opportunities for oral medicine that may include management of chronic pain, salivary gland disorders, medically complex cases, and mucosal diseases. As senior academic oral medicine clinicians with a combined clinical experience of more than thirty years, we view this as an opportunity to prove the value of interprofessional team practice to third-party payers, organized dentistry, and our communities. However, as with any enterprise, we must address the viability of such a proposal in light of massive student and personal debt that our young colleagues may accrue during training. What is the future of private practice of oral medicine? Is it sustainable, and how is the compensation algorithm established and forecast done for growth and maintained return? This editorial will address the basic tenets of what we consider is the business model for this diagnostic discipline. We hope to provide fundamental principles to consider when establishing a practice model for oral medicine. Before we consider a business model for oral medicine, we must assess standard models for dental practice. Most general practices assume a business-to-consumer (B2C) model, where the oral health professional offers multiple services and comprehensive oral care to target markets. These markets may be neighborhoods, professional societies, age-segmented markets, or others. Specialty practice uses the business-to-business model (B2B), where specialists cater to general practitioners and other specialists for referrals. Given the interprofessional nature of the field, one might think that oral medicine may fit into this model. But does it? Oral medicine may, in fact, be in the perfect position to pave the way to a new disruptive paradigm. This paradigm merges the demands of both existing market (s) and stakeholders and creates a new market sustained by a new set of core values as its founding pillars: integration of general medicine and dental medicine, personalized medicine/dental medicine and collaborative care practice—translated outside the walls of the academia. The theory of “disruptive innovation” developed by Clayton Christensen (Kim B. Clark Professor of Business