The following is my perspective of ADA resolution 65 dated September, 2016. I would welcome commentary from those who are active in the ADA and who participated in the considerations of this resolution. My perspective is based upon my knowledge of the history of this item and my interpretation of the document itself. I have attached the document as reference.
The change that we have seen the American Dental Association’s position with regard to specialty status does not signal any practical changes that we have not already been privy to. That position is that specialty status can be awarded by jurisdictions in addition to the American Dental Association. That position is an affirmation of the ruling by courts in three states, California, Florida, and Texas. It specifically refers to the successful litigation taken by the American Academy of Implant Dentistry to allow its diplomates to call themselves specialists in implant dentistry. I’ll discuss more about this ruling below. But the bottom line is that the ruling exists and is unlikely to be reversed.
What may be more important to us, as periodontists or as specialists in general, is how we respond to what is definitely a changing marketplace. This changing marketplace may seem to have everything to do with dental implants now, but could involve other specialty designations in the future. That is, if a sanctioning organization has the evidence to indicate that a particular doctor is trained in a particular specialty and possibly, that in fact that specialty could be designated as a specialty by a “jurisdiction” other than the ADA . Dental implants, as a specialty, is the first such specialty, proffered by the AAID as the sanctioning body. But there could be other designated specialties on the horizon. The AAID’s diplomate status requirements are stringent in my opinion, though not requiring a full time residency, the first time that such a specialty status is recognized without the residency requirement. You can argue the merits of such a decision, but in fact the decision is now law in three states and would likely not stand up to a challenge in other states.
The more important thing is how we respond to it. In fact, it isn’t even how we respond that is important. What is important is how we, as specialists, affirm our right to apply the highest in ethics, the highest level of treatment planning as well as the highest level of treatment to those patients who need specialty care so much. Assuming that we, as specialists, are capable of fulfilling the above, it is how we practice as diagnosticians and as entrepreneurs, as Directors of Dentistry, that may make the largest difference to our patients, our profession, and our individual practices. One thing that is increasingly clear is that we can no longer rely upon the designation of our specialty status as a selling point alone without accompanying that status with the business skills necessary to attract the patients to us that need us most without reliance upon a decreasing referral pool.
It makes it incredibly important that we broaden our skills, dental skills and business skills, in order to be able to have successful businesses in the future.
What has largely not been discussed by us regarding the ADA ruling is that the limitations of how much general dentistry specialists can practice are also now relaxed. Frankly we can practice as much as general dentistry as we would like without removing the name, “specialist,” from our monikers. “Practice limited to” is now the sole verbiage that we who limit our practice could now use to designate the semantic difference. Personally, I eliminated “practice limited to” many years ago as it provided no identification that made any difference from a public relations perspective.
I personally have never proposed that the periodontist practice general dentistry. I don’t think it’s a good idea for most. I instead continue to recommend that we broaden our base by preparing for the next inevitable phase, and that is to be Directors of Dentistry for high level group practices. Correct diagnosis, treatment planning, and communication with both patient and staff, becoming the best businessmen and women that we can, as well as practicing the individual specialty treatment that we provide is more than sufficient for nearly every one of us to have thriving practices.
What else does this ADA position point out to each of us? If we believe that the patient pool is becoming diluted by outside forces, then the message is still the same. High level ethics and high levels of predictable treatment planning and even guaranteed treatment will remain as a differentiating point for the specialist, for every high level thinker in dentistry. Those very principles move us to the top of a profession that has a shortage of such qualities. It is the shortage that differentiates us potentially to every patient who has encountered that shortage. Such prepares us as the future Directors of Dentistry.
You may be able to continue as a single practitioner for a while, but make no mistake about the future. You have to consider today to be the training ground for the future group practice, a group practice that will successfully compete with an increasingly “profit first, ethics second” group practice model that currently predominates. If you look at the medical model and the medical delivery of services in your area, you’ll see how many single practitioners there are and how many group practitioners there are. That is the way it’s going to be in dentistry.
We therefore need to hone our message to allow patients to know that there is a Director of Dentistry, a doctor who can better direct the patient’s treatment and treatment plan and that person may most likely be a periodontist. I do not at all demean the training and skills of other specialists. All must be included in the mix to provide the best for our patients. Whether the overall planning of patient care is first provided by the periodontist or by another specialist is not as important as our getting the training that is necessary to make sure that we can direct complex dental patients to a treatment plan that assures successful fruition as well as to successfully run an independent practice, a practice that is not reliant upon referrals from general practitioners. The initial phase of Director of Dentistry is aligning yourself with the highest level of restorative dentists that you can to assure successful treatment. You, as the specialist, have to be able to direct and monitor treatment to assure the result. While group thinking may have a role in the initial treatment planning, it is the ethics and the assurance of quality treatment that will fall upon the shoulders of the Director of Dentistry. That is the difference between the dental and the medical model. A single tooth can have as many as three or more specialists involved. Someone has to be the final decision maker, the final director.
In order to attract patients, we are going to have to market directly to the patient pool that so badly needs us and doesn’t know where to go for help. Either you will be doing your own marketing, an insurance company will be doing the marketing for you at a substantial discount to you (and that may not necessarily align you with the best restorative practitioners), or you’ll be working for a group practice that can provide some or all of the above.
If people are plunking down $50K to a facility that knows only one treatment, dental implants, then that patient pool needs to know that you can do that same service and in addition give that same patient options that may not be available from the implant clinic, options that may in fact prolong supporting bone while saving the dentition. That is the clear choice that we can provide.
So look at yourself. Look at your own business model. If you’re practicing a business model of the 1990’s or the 2000’s, I would suggest that you start to adjust that model, at least if you expect to compete in the marketplace that is described above.
Make no mistake about it, if you are hanging on to the referral model only, you likely have no idea as to the needful patients who are out there, who opted out of a system that has not served them well, that had poor planning, bad and even abusive treatment by practitioners who were ill-prepared to help these patients, that had treatment that concentrated on a tooth to tooth “solution” that provided no solution at all. People need the best. You trained to be the best.
Oh yes, when those patients find you, and you’ve all experienced this in your practices already, they’ll want their family and friends to find you too.
Disclosure: Dr. Lee Sheldon is the director of the American Association of Independent Periodontists, a mentoring and consulting organization for dental specialists.