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Cue Cards12/02/2009 07:29:00
As much as I’d love to stand up here present a comprehensive solution toaffordability & access, I have about 20 minutes to get through all this. Also Ididn’t get a whole lot of sleep last night so we’ll see how that goes.[slide]In 2000 the surgeon general released for the first time a report on oralhealth in America officially recognizing it’s importance to the general healthand well-being of the public.Within the report several obstacles to oral health were identified.The vast majority of these hurdles are a direct result of limitations appliedto the oral health workforce.[slide]New Zealand’s utilization of dental therapists in elementary schools has beenwell documented as a success. The program has an over 97% participationrate, and seen the virtual elimination of permanent tooth loss.Without government action, similar community programs are impossibleunder current restriction of scope of practice, workforce mobility, andflexibility.However, an audacious, but simple solution exists.[slide]Eliminate Dental & Medical Licensing[slide]State licensing boards manage the licensure process, help determine scopeof practice, investigate public complaints, discipline practitioners, and reporttheir activities to the public.The primary goal of licensing is to protect the public.
[slide]However, it has been found, not by me, that most patient protections areentirely unrelated to state licensing, state licensing efforts are redundant toefforts taken at the point of care, and as a whole works against establishedprotective measures.I know a lot of you are losing your heads right now. First thing is first,knowledge and experience, not a silly piece of paper, decide your abilities asa dentist.The sole reason for credentialing is to disclose our expertise to the public.With that in mind, I can say with absolute certainty that graduating in 4months from this school is a far more significant statement about ourcompetency than the outdated, unethical, extortion we are subjected to fortwo days in May.[slide][slide]Here is an outline of what licensing really accomplishes:It limits your professional autonomy, restricts the workforce, and controlsthe supply of oral health providers, fostering an anti-competitive culture, andartificially inflating the cost of care. The assumption that competition isdetrimental to patients and is incompatible with health care is extremelymisinformed.The system doesn’t come close to adequately addressing incompetence andshelters dentists from accountability. Self-policing creates an ethical dilemmaleading to decisions not to disclose violations, and lenient punishments.[slide]Here is an excerpt from the Dental Board of CA Disciplinary Guidelines: TheBoard requests that the ALJ clearly state factual basis his or her decision.This is especially important should the ALJ deviate from the recommendedguidelines. The rationale for the deviation should be reflected in the decisionto enable the Board to understand the reasons for the deviation and toevaluate the appropriateness of the decision.
If you go on to read the recommended punishments you’ll find that onlysexual abuse of a patient, and violation of probation result in loss of license.Otherwise, your sentenced to some unspeakable combination of mandatoryCE hours, and ethics counseling.I have some facts from medical licensing studies since the systems arecomparable and the studies highlight the issues at bar.[slide]45% of physicians with direct knowledge of an impaired or incompetentemployee did not always report.46% did not report a serious medical error on at least one occasion, andthose reporting did not necessarily report to the state board.[slide]Despite the state goal of protecting the public, licensing boards don’t evenlisten to the people. A 2004-2005 survey of licensing institutions found theydo not believe public complaints are a good indicator of problems withpractitioners.[slide]It is difficult and expensive to establish substandard care, and as a resultdisciplinary actions are most often taken to address sexual abuse, andsubstance abuse.[slide]The courts are the only venue with the funds and incentive to handlenegligence.A recent study of Florida physicians found that of physicians with malpracticepayouts above $1 million only 16% had been sanctioned by state medicalboards, and of those who had made 10 or more payouts between 1990 and2005 only one third were disciplined. Some of you might be saying thatdental licensing boards are more effective, but I doubt it.[slide]It is not just reluctance in pursuing negligent dentists that is a problem,continued competency is not evaluated whatsoever.
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