Doing the Right Things

The December 1998 "Views" column of Journal of the American Dental Association Editor Lawrence Meskin brought forth some very positive news. Dr. Meskin noted that "After years of flat or even decreasing take-home income (for dentists), substantial increases recently have been noted." He reported increases of 31 percent for general practitioners and 40.9 percent for specialists since 1986. Further, he noted that these increases exceed income growth in other health professions, with the average real income of dental GPs surpassing that of physician family practitioners! Meskin's data also suggests that the smaller, traditional dental office demonstrates economic advantages not seen in the larger multidentist practices. The economies of a larger scale operation apparently are more difficult to achieve in dentistry than in other fields.

This positive news will undoubtedly disappoint the gloom and doomsayers we encounter from time to time who allege that dentistry has retreated from the position of prestige and income expectation it once enjoyed. The point to be made here is that dentistry and many colleagues individually and collectively must be doing the right things! As examples, we list education of the public (the dental patient) about the importance and value of the service dentistry provides, fluoridation, and the continuing efforts of the organized profession to support a strong code of professional ethics and develop appropriate standards of care. Without these strengths, the private practice of dentistry would certainly not be sought after by increasing numbers of dental school applicants, nor would the statistics discussed by Dr. Meskin be possible.

Another one of the "right things" the profession must ultimately come to an agreement on if dentistry is to continue to experience the status of income and respect that it has earned, is the concept of continuing competency assessment. For more than four years, leadership and a dedicated committee of the California Dental Association have actively debated this issue and its many ramifications. These deliberations resulted in a voluntary assessment program (QUIL3) and, most recently, a CDA position paper titled "Concepts of Continued Competency," which was approved by the 1998 CDA House of Delegates.

It is doubtful this position paper will slow public interests outside of dentistry and other health professions from seeking active mechanisms to periodically evaluate the competency of health care practitioners. As an example of efforts on behalf of the public interest, in November 1998, the Pew Health Professions Commission released a proposal that, if carried forward, would require a written examination and require state regulators to conduct in-office inspection of treatment procedures and patient records at least every six years for physicians and "other health workers." The chairman of this independent commission, which has no power beyond persuasion, is George Mitchell, a former U.S. Senate majority leader. He stated that "Once you are in the club, you are in forever. We became convinced there is today, a public system which isn't protecting the public."

Whether or not the initiatives of "persuasion" from this commission are successful in achieving the stated goal, this issue will continue to confront the dental profession. The position statement recently approved by the CDA House was the latest compromise affecting association policy on this controversial issue. It takes a position that must be more visible than secluded residence in the CDA Policy Manual! It does acknowledge that activities such as the aforementioned Pew Commission report will be occurring and must be monitored: "Given present trends related to post-licensure competency assessment, the association will best serve its members by closely monitoring regulatory and legislative bodies and managed care organizations which may seek to impose mandatory continued competency."

Many CDA resources were expended in developing standards and methodologies that could serve as a model. While QUIL3 resulted from these efforts, even the recent position statement had to survive numerous revisions over a two-year period before gaining approval.

Given the high level of dissatisfaction in dental circles with any discussion of "continuing competency" (yes, some colleagues even sought to adopt alternative terminology to use for "continuing competency," deeming its very mention unacceptable), the final sentence in the position statement is the most important and far-reaching: "California Dental Association should make every effort possible to have a proactive and participatory role in the process of researching, defining, and developing such programs [continuing competency assessment]."

If the good news discussed by JADA Editor Meskin is to be continued into the future, the profession will need to reject the complacent approach of the position paper and instead seek to carry out the proactive intent of its final passage.

To date, the proactive approach to this issue has been controversial within the profession. However, we believe it to be the "right thing" in shaping a successful future for the dental profession.