M.A. JOHNSON (SPRING 1978), A PLAN FOR CHAOS, OPERATIVE DENTISTRY, VOL3(2), PP. 73-74
POINT OF VIEW
A Plan for Chaos: Improvements in dental service should be made by those with knowledge and experience of dental practice—not by educators and the government.
It has become increasingly fashionable for dental educators to publish articles about the failures of dentistry and dental education. The educators reason that as leaders in the dental profession they are the ones that are best qualified to effect the appropriate changes for the advancement of dentistry. Anyone with a knowledge of dental education today knows that federal grants and controls allow little if any independent thinking or planning by the educators. Consequently “they” in the above sentence becomes not only the educators but also the federal government, and the planning includes not just education but the entire system of
delivering dental care.
The spectre of this combination making plans for dental health in this nation is enough to give any thinking man a continuous nightmare. The track record of the government in delivering anything is one of inefficiency and waste, expediency and corruption. A check of government operations in agriculture, commerce, procurement of armed forces, the Veterans Administration, or the environment makes this vividly clear. Combine these inadequacies with the contributions of educators, most of whom have never delivered any care to a patient outside the walls of an institution but nevertheless suddenly become authorities on the delivery of dental care, and the possibilities for chaos are astronomical.
No one can deny that a large segment of our population is without dental care, but explanations for this can be deceptive. In the armed services, where dental care is offered free, the proportion that takes advantage of the service is almost identical to that in the civilian population, who must pay for it. Cost is not the only factor—and probably not the main one—limiting dental service as it is now supplied. On the other hand, cost could become a very limiting factor if our planners decide to adopt an institutional system of delivery such as used today by the armed forces and the Veterans Administration. If principles of cost accounting were applied at our military centers of treatment we could reduce costs of administration, salaries, education, equipment, supplies, real estate, retirement, and fringe benefits to an hourly figure. These figures are not available to anyone outside of government but to those of us that have spent any time at one of these centers the result would be obvious—true cost of treatment at a government dental center is much higher than in a private practice. As taxpayers we cannot afford such high-cost dental treatment.
Planners as a group have failed to consider one of the important facets of the private practice of dentistry that has attracted many of our most qualified people to the profession. Historically, dentists have been rugged individualists, attracted to a profession where there were continued options. Dentists could be part of a group or practice solo and still excel. Many of our greatest contributors have been of this type—Fauchard, Hollenback, Woodbury, Wedelstaedt, Ferrier, Jones, and Stibbs, to name just a few. It is questionable how many of these men would be interested in practicing dentistry as our planners foresee it. Any plans for dentistry must include a place for solo private practice as an option, with monetary incentives for quality, efficiency, and dedication.
Perhaps a different point of view is needed in our planning. Politicians, whose views change with pressures from the electorate and from lobbies, even though honest and concerned are not in a position to plan for dentistry or the dental health of the nation. This does not mean that politicians are without value in dental health. They should be aware of measures in public health that could be implemented for the benefit of everyone. National fluoridation of water and preventive dental education on television and in the public schools would be good beginnings. Mandatory peer review and mandatory continuing dental education for licensure are other measures that could help. Increased commitment of funds is needed for legitimate basic research into the causes of disease. We need methods of alleviating costs to low-income groups and increased support of dental education without the strings that are presently attached. These are measures that the political planners could institute without draining the national treasury, enslaving the profession, or doing anything but good. Dental educators could then turn their entire attention to dental education and research, dismiss their public relations staffs, and cover their crystal balls. The time that deans of dental schools spend in public relations, politics, social welfare conferences, and grant acquisitions could be more profitably spent in research and clinical supervision. Their planning could be directed toward overall improvement of the products of their schools. Concepts of team practice should be emphasized, but planning a system that would eliminate private practice would be tragic. Not every good practitioner will fit into the neat “zoo” type designs for Health Maintenance Organizations currently in vogue, and many of our small communities cannot or will not support even a single practitioner. Ignoring the age-old relationship of doctor and patient could result in a loss of quality, personal pride, and communication. There is no doubt that the best dental care in the world comes from some of the small dental offices in this country; there is little doubt that some of the poorest care is rendered in others. The complete resources of planning for dental health should be directed toward bringing all care up to the highest levels, not trying to fit everyone into a system to deliver mediocrity to all.
9101 Bridgeport Way, Tacoma, WA 98499, USA
MARVIN A JOHNSON, DDS, conducts a private practice and is an assistant professor part-time at the University of Washington School of Dentistry. He is a member of the American Academy of Crown and Bridge Prosthodontics and the Tacoma Operative Seminar.