Flecker CA (1977), Letter to the Editor, Operative Dentistry, 2(3) 126-127.
I read with mixed emotions your editorial, “Expanded Duties: An Economic Fallacy” in the Winter issue. Since Operative Dentistry is a journal of potentially great value to practicing general dentists, I feel obliged to comment on your remarks.
Proponents of expanded duties are not “mainly government employees and academics” as you wrote. One need only talk to practicing dentists everywhere and listen to their thoughts and needs about expanded duty auxiliaries. Talk to those dentists who are seriously grappling with the problems of keeping fees in line, managing tremendously increasing office overheads while providing more efficient services, and treating greater numbers of patients. Do not talk to the men who have never spent the late hours desperately seeking the answers, nor to those who have simply given up, cut their staffs, their overhead, and their availability to 3½ or 4 days a week.
In your thoughts on the cost of training an auxiliary vs. the cost of training a dentist you rely heavily on the current working life of a dental auxiliary-a generous four years by your estimate. For 1977 that is true. But we may also assume that right now there is very little incentive and motivation for a person to attempt to make a career as a dental office auxiliary. Pay is low, hours long and hassled, and serious, well-thought-out responsibility seldom delegated. The ability to advance in the job is practically nil. Why should anyone aspire to a career in such an environment?
On the other hand, travel the country and visit some of the more progressive offices. Visit them and see the auxiliaries who are alive, fresh, exciting, and interested in their work. Watch them work. Listen to them tell about their job. Understand that they have well-delegated authority and they accept total responsibility for their tasks; understand that it is possible for them to think in terms of long-range career. Visit these offices in the cities, suburbs, and rural areas and realize that they are organized by honest, dedicated dentists who are seriously meeting the contemporary challenges head-on. Yes, you are right. Presently the work-life of a dental auxiliary is short, the turnover great. But it’s beginning to change and will continue to do so.
Your reference to Adam Smith and his wisdom in identifying the problems of overspecialization is worthy of consideration. But Adam Smith was speaking, writing, and teaching about the manufacturing industry. Dentistry is a service industry. As a nation we have just begun to apply the principles of specialization to services. The problems will undoubtedly surface with time. However, our ability to deal with those problems will also improve with time. The end result will be a vastly more efficient industry than we now see. Not one without new problems, but at least one that has responded to the needs of the time.
You are right when you say that “in the final analysis, there are human beings attached to teeth, and, in any event, human beings are not machines.” But the doctor’s role is working with those human beings; in communicating with them, in organizing a continuum of care for them, and in making the all-important judgment decisions relative to that human being’s dental treatment. Many of the mechanical tasks can be, and presently are, in many areas, dele-gated to less expensive operators without the loss of the respect and dignity the patient deserves.
Better methods of organizing new technology must evolve hand-in-hand with the technology itself. One of those means will be the delegation of chairside tasks to expanded duty auxiliaries. Fortunately-because it’s the patients’ only hope in receiving faster, more efficient dental care at a reasonable fee.
Carl A Flecker, Jr
760 Medical Center East Pittsburgh, PA 15206