The Associate Editor

The Right Time … At Last

You might as well expect the rivers to run backward as that any man who was born free should be contented to be penned up and denied liberty to go where he pleases. -- Chief Joseph, Nez Percé

The March 2001 CDA Board of Trustees meeting witnessed a landmark decision. Trustees passed a resolution outlining support for licensure by credential in the state of California. This would bring us one step closer to true "freedom of movement" for all licensed dentists. While there is some doubt as to whether Chief Joseph was referring to dentists in the United States, there is no doubt that it is the right time for licensure by credential to become a reality.

For those unfamiliar with the issue, licensure by credential really means licensure without further examination. If implemented in the state of California, it would mean that dentists with a license in good standing in another state could obtain a license to practice in California without taking the state board exam. Similarly, dentists licensed in California could, without further examination, obtain licenses in other states that recognize licensure by credential. The desire would be to eventually have reciprocity between all states, and the adoption of licensure by credential in California would certainly be an important step toward that end.

Currently, more than two-thirds of all states recognize some form of licensure by credential.

The dental profession in California historically has been opposed to this concept, citing that a state’s right to maintain the standard of care by controlling dental licensure should not be compromised by reciprocating agreements to recognize and award licenses to dentists from other states. The premises of this argument are that the dental licensing exam is an absolute measure of competency and that the quality of dentistry is better in California than in other states. This antiquated belief of superiority is not unlike Ptolemy’s conclusion that the universe revolved around the earth. For while it is obvious that there exist differences in techniques taught in dental schools across the country, there is no evidence that dentistry done in California serves its public any better than dentistry done elsewhere in the country.

However, many feel the real reason for such opposition to licensure by credential is not the noble cause of upholding the standard of care but rather fear -- fear of adverse economic consequences by a massive influx of dentists into California should the state board exam be waived for dentists licensed elsewhere. Do we really believe that people everywhere so envy the weather and lifestyle in California that they would uproot any ties to their communities and families to live here? If so, then why haven’t other professions that don’t have a state licensing examination been inundated by such an economically disastrous westward migration?

The fact is we do live in a more mobile society today than we did 50 or even 15 years ago. Dental students and young dentists unsure of where they will practice are concerned about the prospect of having to take multiple examinations to prove competency and receive licensure. Perhaps the group that is most unfairly affected by current licensing restrictions is specialists. Consider the case of an oral surgeon from Texas who has been practicing for 20 years with an impeccable record and standing in his community and profession. Should he desire to relocate to California, he would have to prove his competence on, among other procedures, a class II amalgam, which he likely has not done since entering his oral surgery residency. Assuming he passes the licensure exam, he would then have to promise not to do any of these amalgams so that he may ethically announce his specialty as an oral surgeon. Now compare this situation to a practicing neurosurgeon, who is not required to take a clinical examination to practice in California. Why is it that we let someone do brain surgery in this state without further examination? Is dentistry more complicated?

Licensure by credential will become a reality in California. Assemblyman Sam Aanestad, as many of you know, is the only dentist in the state legislature. He is sponsoring legislation, Assembly Bill 1428, that will make licensure by credential California law, and he has promised he will get this legislation passed. He is not only a CDA member but also a champion for the dental profession and is maintaining close communication with CDA leaders on this issue, all of which will ensure that dentistry’s best interest is represented in the new law.

It is the right time for licensure by credential. The majority of CDA dentists say they want it, as reflected by the action of the Board of Trustees and a similar resolution passed by the House of Delegates. Perhaps the strongest argument for pursuing licensure by credential at this time is that if dentistry doesn’t act to guide this legislation, there are other individuals and groups that will do it for us; and they may do so in a design that is unfavorable to the dental profession.

We support Sam Aanestad as he works to make licensure by credential a reality in California. After all, it’s not just a matter of obtaining a dental license. It’s about doing what is best for the profession. It’s about freedom to live and practice where we want. And, it’s about time.