Bill Klaproth (Host): This is an AAOMS On the Go Podcast. I'm Bill Klaproth. And joining me today is Dr. David Bitonti to discuss a legislative advocacy success on behalf of AAOMS Military members. Dr. Bitonti, great to talk with you again. Welcome. 

Dr. David Bitonti: Hi, Bill. Thanks for having me. 

Host: You bet. So, before we get into this, can you please tell us a little bit about your background and how you got involved in advocacy? 

Dr. David Bitonti: So, I did my residency through the Navy. They sent me for out-service training. And following my residency, I became an AAOMS member and was eventually stationed in the Washington, D.C. area. During that time, I had the opportunity to become acquainted with AAOMS and the things that it does and how it supports AAOMS members. And one of the things was the AAOMS advocacy as it related to interacting with members of Congress and the Senate. And so, having been stationed in the Washington, D.C. area, I had the opportunity to become a part of that. I had a wonderful Navy career that not only am I proud of, but I miss every day. And it was a great opportunity for me and my family.

Host: Yeah, I'm looking at my notes here. You were a captain. You were part of the National Naval Medical Center, Walter Reed Bethesda, Wounded Warrior Care. You did congressional briefings for AAOMS, and you also did Day on the Hill as well. So, thank you for your work and effort in these areas, and thank you for your service.

Dr. David Bitonti: Thank you so much. It's my pleasure.

Host: You bet. Yeah. So, Dr. Bitonti, I understand there was a time when oral and maxillofacial surgeons in the Military were not paid on par with their physician colleagues in the Military. So, when we use the term pay parity, can you explain what that means and how it affected OMSs?

Dr. David Bitonti: Certainly, the best way that I can describe it is by considering the three, what I would call, head and neck specialties, which is Plastic and Reconstructive surgery, Otolaryngology, Head and Neck Surgery, and Oral and Maxillofacial Surgery. At the time before ISP came into effect for Military OMSs, both of our Plastic Surgery colleagues and our ENT colleagues were eligible for ISP, which stands for Incentive Special Pay. And at the time that this was going on, Military OMSs were some of the most forward deployed head and neck specialists during Operation Iraqi Freedom and Operation Enduring Freedom. And yet, we were not getting paid on parity with our other head and neck specialty colleagues like those in Plastic Surgery and those in Otolaryngology head and neck surgery. And so, that would be, I would say, the simplest but yet most direct way to be able to explain the parity issue.

Host: That's really interesting. So, this is going to be a really dumb question. You're going to be like, "Bill, duh, of course." You know, when I think of frontline medical surgeons, doctors, taking care of our troops. I guess I never thought of OMSs being on the front lines, but that's a regular part, right? Because people need facial reconstructions. People, obviously, get wounded in their head and neck area. Is that correct?

Dr. David Bitonti: Yes, that's exactly correct. And it was even more so with OIF and OEF, I'm using the abbreviations for Operation Iraqi Freedom and Operation Enduring Freedom, because of the beginning uses of body armor, so the chest area was certainly more protected. There's always been a helmet for the head, but there was nothing for the face and neck region. And so, especially with IED blasts and the scatter that goes on with those, the head and neck region was very susceptible to injury.

Host: So, when you discovered there was not paid parity, I should say, what did you do? 

Dr. David Bitonti: First, one of the things that would be interesting to understand is, and it kind of goes in parallel with when I was discussing about being the most forward deployed head and neck surgeons, is that in the Navy specifically, every aircraft carrier is required to have an oral and maxillofacial surgeon on board when she's deployed. The only other surgical specialty that deploys with them on the carrier is a general surgeon. And so, using that example and then broadening that to what our experience was in OIF and OEF, it became what seemed like a common sense discussion that we should also be eligible for ISP. At that point in time, we had the opportunity to talk to some of our AAOMS colleagues and say, “what could AAOMS do to help us get this sort of pushed forward and get us on parity?” And so, that's sort of where the discussion started.

Host: So, you were not eligible for ISP, Incentive Special Pay. And then you discovered, "Wait a minute, we should be eligible for this too." Is that right?

Dr. David Bitonti: Yes, exactly.

Host: Very interesting. So, when you found this out and started to bring this up, did you encounter opposition? And if you did, how did you address the opposition?

Dr. David Bitonti: I wouldn't necessarily call it opposition. I would like to recategorize it maybe as not a complete understanding. And so, it took some time and through the efforts of AAOMS and our other service colleagues. At the time, I was the specialty leader for Oral and Maxillofacial surgery for the Navy. And my counterpart colleagues who were the specialty leaders, the other two services, call them consultants, for the Army and for the Air Force. The discussion started with the three of us. And then, in our roles individually within our services, the plan was to run it up the chain of command to our individual service chiefs so that then when the three service chiefs got together and would talk about issues, they were getting the same information sort of across the breadth of services from Army, Navy, and Air Force. And when I say forward-deployed specialties, the Army was right in there and so was the Air Force forward-deployed in-country at the hospitals in Iraq. And so, it was literally one team, one effort.

Host: And I'm sure that helped all three branches of the Military coming to leadership with the same message. Is that right?

Dr. David Bitonti: Yes.

Host: So, let me set the stage here. So, you're on a ship, Dr. Bitonti, is that right? Were you on a battleship or an aircraft carrier?

Dr. David Bitonti: I had done two tours on an aircraft carrier previously. But at the time that this initiative was going on, I was actually stationed at the National Naval Medical Center in Bethesda. And so, I was able to work on it based on my role there. And then also, at that time, I was the specialty leader for Oral and Maxillofacial Surgery for the Navy.

Host: Okay. So you find out that, "Hey, we're not getting ISP," which is Incentive Special Pay. "This is not right. We should have parity among the surgeons." Is that right?

Dr. David Bitonti: Yes.

Host: So then, you decided to run it up the flagpole. How did you then coordinate with the Army and the Air Force? Did you know of the same people in the same positions in those branches to say, "Hey, we need to come together on this?"

Dr. David Bitonti: Yes. We were all acquainted. Two of us had done our residency while I was in the civilian residency program at the University of Texas Health Science Center at San Antonio. My counterpart, Mike Will, was in residency at that time, what was called Brook Army Medical Center. And so, he and I had been friends for a long time. And then, both of us were stationed in the Washington, D.C. area. He was at Walter Reed Army Medical Center in the OMS program. I was at Bethesda in the OMS program as an attending like he was. And so, we were acquainted. And at the time, our residency program was the National Capital Consortium, which was a combined residency program. So, we saw each other frequently and interacted frequently. The specialty leader for the Air Force initially was Dr. Les Davenport. And then, it was Chris Medley. They were in San Antonio. But at least once a year, the specialty leaders for all the different dental specialties would get together for a meeting. And that was where we had the opportunity to discuss what our approach was going to be and how we were going to try to approach this.

Host: And you said it wasn't necessarily opposition, it was more education and understanding. How long did the process take then from when you first brought this issue up and were advocating for pay parity? How long did it take before OMSs did achieve pay parity?

Dr. David Bitonti: Well, it took us approximately five to six years. Now, that period was about how long it took until the actual first ISP was distributed to Military oral and maxillofacial surgeons. The discussions I would say started early, you know, around 2000-2001 timeframe if my memory is serving me correctly. And we started talking about it. And then, as we looked into it more, we realized that not only were we going to be able to do this from within the services, but we needed the help and assistance of AAOMS and our AAOMS colleagues to push this another way. Because ultimately, anything that affects Military pay has to be approved through Congress. So, we had to get each of the services to sponsor the change, but then we had to get Congress to approve the change.

Host: Okay, got it. So, five to six years, but then the change finally was approved. So, AAOMS, working together with the OMS community in the three branches of service, you were able to finally make this happen, which obviously is very good news. So, Dr. Bitonti, since achieving pay parity, can you explain or share with us what tangible impacts have you observed on Military OMSs’ careers and professional satisfaction as well?

Dr. David Bitonti: Well, I think probably one of the biggest things is obviously, you know, the professional satisfaction of being recognized on par with your other head and neck specialty colleagues that you were working side by side with and now being recognized at least from a financial perspective in the same or very similar way. 

I think one of the other tangible aspects of it was, I think, that it helped with recruiting and retention because for those Military surgeons, or those Military OMSs when they look at what ISP brought to the table for them, certainly they may not have been exactly on par with what some of their civilian colleagues may have been making from a financial perspective, but they were certainly closer. And so, that made a difference and that also made it interesting to them to consider staying longer beyond just their payback for their residency program.

Host: Yeah. So, benefits in several different ways. So, were there key lessons that you learned from this advocacy effort that you feel could be applied to future advocacy initiatives?

Dr. David Bitonti: Yeah. I think the most important thing is, number one, to know your audience and know the perspective where your audience is coming from. I would say number two is to speak to your audience in a language that they understand and take your message and put it in the right terminology that it makes sense to your audience and that they can understand it and then hopefully they can advocate for it.

Host: Those are some really good points. So, one, know your audience and, two, speak their language. So, some really important things that obviously you learned that certainly can move forward for future advocacy efforts. So, what's your advice to other OMS colleagues about getting involved in advocacy? Obviously, it feels like this was very rewarding for you.

Dr. David Bitonti: Yeah. I would say that, really, it's incumbent upon all of us to be involved. This happened to be something that was particularly focused at the Military OMS community, but there are so many other things that come up that impact the entire OMS community, whether you are an active duty service member or in private practice or in academics. And then, eventually everybody has to leave the Military at some point, and you're going to transition to the private sector in some way. And so, in that regard, everything that AAOMS and OMSPAC do in advocacy for our specialty ultimately impacts every OMS. And I would strongly encourage every OMS to get involved. Understand and know what goes on at Day on the Hill. Find out how Day on the Hill works and how that advocacy works for you as a practicing OMS, regardless of where you happen to be practicing. 

And then, there's the collegial part of it. You know, some of my best friends when I get to see them, it's the once a year at the AAOMS Day on the Hill. And so, there are multiple benefits that one can participate in simply becoming active. And it doesn't only have to be at the national level. At the local level and at the state level, there are critical things that are going on within the individual states that every OMS in that state should be involved with advocating for the specialty. Because at one time, it may affect state A, but two years from then, it may be affecting state B, and not only the lessons learned that state A would have, they can then help state B. And so, it's really critical.

Host: Yeah. That's a good point about getting involved locally, getting involved in statewide as well, in addition to national. So, those are really good points, Dr. Bitonti. Well, this has really been interesting. I love this story. This legislative advocacy success, if you will. Thank you so much for sharing this with us. We appreciate it. Before we wrap up, is there anything else you want to add?

Dr. David Bitonti: I did want to add one thing. It sounds minor, but it's actually a major thing, particularly when you're involved with Day on the Hill, and when you're advocating with various either congressional or senate staffers. Oftentimes, those staffers, you need to understand them and you need to respect them because they have the ear of the member. And so, how you present yourself and how you present your message to them is as critical, if not more critical sometimes, than how you present your message to the particular House member or Senate member. And so, oftentimes, they're young, and they're certainly younger than a lot of us are, but that doesn't mean that they're not smart, they don't understand what's going on, and most importantly, they can advocate for you to the member in ways that you can't.

Host: So, get to know the staffer, that's a great message because you probably have more time with the staffer than you actually do with your legislator, I would suppose. Is that right?

Dr. David Bitonti: Absolutely correct.

Host: Wow, that's wonderful. Dr. Bitonti, this has really been fascinating, a very interesting story. Again, thank you for sharing this legislative advocacy success story with us. We appreciate it, and thank you again.

Dr. David Bitonti: Thanks for having me. I really appreciate the opportunity.

Host: You bet. And once again, that is Dr. David Bitonti. And learn more and get involved in AAOMS's advocacy efforts by visiting aaoms.org/advocacy. And if you found this podcast helpful, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.