Create your own stimulus package and improve access to care
2009; Elsevier BV; Volume: 136; Issue: 1 Linguagem: Inglês
10.1016/j.ajodo.2009.05.003
ISSN1097-6752
Autores Tópico(s)Pharmaceutical industry and healthcare
ResumoAccess to orthodontic care is something the American Association of Orthodontists (AAO) takes very seriously. For years, the AAO leadership has encouraged members to establish office policies that include treatment for patients who cannot pay and has worked tirelessly with referring offices and charitable organizations to provide greater access to treatment. A 2006 AAO task-force report emphasized the ongoing need to develop new ways to expand access to care.1Access to orthodontic care: a white paper for the American Association of Orthodontists adopted November 17-18, 2006. Available at: http://www.aaomembers.org/legal/index.cfm.Google ScholarThe AAO surveyed members and determined that 87% provide free and discounted care, with many providing more than $20,000 in pro-bono treatment annually. This totals over $62,000,000 of treatment each year to those in need. The AAO also encourages member participation in programs such as Smiles Change Lives, the American Dental Association's Give Kids a Smile, and Donated Dental Services, a program overseen by the National Foundation of Dentistry for the Handicapped. But one must wonder whether we will ever reach the elusive goal of 100% success. Most—including me-—believe that we still have a long way to go.Nearly every month, I receive correspondence from an AAO member stressing that our specialty should enforce its professional ethics. But I sometimes get the idea that their interpretation of "ethics" somehow guarantees us the right to earn a comfortable living with little or no interference from outside the specialty. The last time I looked, my state's dental practice act charges all licensed dentists with the responsibility for providing quality dental care to meet the needs of the public.2Washington State Legislature. Purpose of health care professions. Available at: http://apps.leg.wa.gov/RCW/default.aspx?cite=18.32.002.Google Scholar It could be assumed that, if we don't meet this challenge for whatever reason, the state has the right to find someone else who will. That is exactly what happened in Washington state, when denturist legislation was passed in November 1994. Voters approved Initiative 607, which allows persons other than dentists to manufacture and sell dentures directly to the public. This new professional is called a denturist. After the passage of this legislation, denturists in Washington were licensed, and, today, they are recognized as a part of the health care profession.3Washington Revised Code RCW 18.30.050: Board of Denturists. Available at: http://law.justia.com/washington/codes/title18/18.30.050.html.Google Scholar Similar efforts succeeded in Oregon and Wyoming as well as Canada.4Oregon State Denturist Association. Available at: http://www.ordenturist.org/.Google Scholar, 5Wyoming State Denturist Association. Available at: http://www.wyomingstatedenturistassociation.org/Membership%20application.pdf.Google Scholar, 6The Denturist Association of Canada. Available at: http://www.dacnet.ca/pdf/announcementE.pdf.Google ScholarWhy am I making an issue of this change in the dental practice act by a few jurisdictions? I have always believed the denturists were successful because some people who need dentures either could not afford them or could not find a licensed dentist who would treat them. Forced by the peoples' initiative, the state changed the dental practices act, creating a new class of providers regulated by the state. History shows that the lack of access to care sometimes spurs legislative action.In a different but perhaps related event, Minnesota took legislative action to create a new level of dental health care provider with skills somewhere between those of a dental hygienist and a general dentist.7University of Minnesota School of Dentistry, Dental Therapy Programs. Available at: http://www.dentistry.umn.edu/programs_admissions/home.html.Google Scholar As I said before, the state can determine who is qualified to deliver the dental care demanded by the public—and if we don't assume that responsibility, someone else will do the job. In this case, no one is arguing that the quality of dental care will improve, but some members of the Minnesota legislature must believe access to care will go up. Changes in Alaska preceded those in Minnesota; defined populations searched for alternatives to traditional care, and their respective communities responded in new and creative ways.8American Dental Association and the Alaskan Native Tribal Health Consortium Issue Joint Statement on Litigation Settlement. Available at: http://www.medicalnewstoday.com/articles/76823.php.Google ScholarWhen it comes to busyness and the capacity of orthodontic practices to do more work, I'm sure you have noticed the results of the recent AAO all-member survey regarding the economy and its effect on practice growth. Nearly two-thirds of our members who participated in the survey said that their patient starts were down from a year ago, compared with 21% who experienced growth. Most orthodontic specialists probably could increase their patient starts by 5% to 10%. How could that happen? I see several options, and you might have a few more to offer. We could increase our funding of the AAO Consumer Awareness Campaign by several million dollars a year and wait for the consumer web site and its "Orthodontist Locator" to direct new patients to your office. The AAO 2009 House of Delegates defeated the increased spending because most delegates thought it unwise to impose a large dues increase on members under current economic conditions. (AAO dues have not increased since 1999.) The AAO campaign will continue with a smaller dues increase and by taking funds from excess reserves, but there will be no major increase in this activity to promote orthodontic treatment.Is there another option for putting people in the empty chairs, one that will help address the desire for improving access to care? I believe there is. Perhaps members could volunteer to work up to a half day per week as a charitable gesture to improve access to care nationwide. This could be promoted in the private-practice environment as a volunteer program offered by individual offices with limited coordination by the AAO on a temporary basis, perhaps until the economy improves by a measurable amount. Just count the benefits: overall improvement in children's oral health, and a show of national loyalty in helping to meet the needs of our people during an economic recession, not to mention the goodwill that will come our way. One of our AAO members, Benjamin Burris, of Jonesboro, Arkansas, received national appreciation when his program for charitable treatment was honored by Brian Williams in the "Making a Difference" segment on the NBC Evening News on March 23.9Brian Williams NBC Nightly News. Smile for a Lifetime Foundation. "Making a Difference." Available at: http://www.smilecsra.com/wordpress/?p=143.Google Scholar The program, "Smile for a Lifetime," will receive an assist in funding from the Martin "Bud" Schulman Foundation as it plans future expansion.When sincerely offered, free orthodontic care for those in need touches everyone. Are there other ways you can respond to the economic downturn and fewer patient starts? Of course. You can always reduce staff hours and spend another afternoon a week playing golf. But I ask you to compare the personal payoff and consider an opportunity to do something truly great for your community and yourself. What do you think?Disclaimer: This idea is solely my own and has not been reviewed by the AAO, its Board of Trustees, councils, or staff. Only a grassroots surge of enthusiasm by our members could ever make this more than just the dream of an aging editor. Access to orthodontic care is something the American Association of Orthodontists (AAO) takes very seriously. For years, the AAO leadership has encouraged members to establish office policies that include treatment for patients who cannot pay and has worked tirelessly with referring offices and charitable organizations to provide greater access to treatment. A 2006 AAO task-force report emphasized the ongoing need to develop new ways to expand access to care.1Access to orthodontic care: a white paper for the American Association of Orthodontists adopted November 17-18, 2006. Available at: http://www.aaomembers.org/legal/index.cfm.Google Scholar The AAO surveyed members and determined that 87% provide free and discounted care, with many providing more than $20,000 in pro-bono treatment annually. This totals over $62,000,000 of treatment each year to those in need. The AAO also encourages member participation in programs such as Smiles Change Lives, the American Dental Association's Give Kids a Smile, and Donated Dental Services, a program overseen by the National Foundation of Dentistry for the Handicapped. But one must wonder whether we will ever reach the elusive goal of 100% success. Most—including me-—believe that we still have a long way to go. Nearly every month, I receive correspondence from an AAO member stressing that our specialty should enforce its professional ethics. But I sometimes get the idea that their interpretation of "ethics" somehow guarantees us the right to earn a comfortable living with little or no interference from outside the specialty. The last time I looked, my state's dental practice act charges all licensed dentists with the responsibility for providing quality dental care to meet the needs of the public.2Washington State Legislature. Purpose of health care professions. Available at: http://apps.leg.wa.gov/RCW/default.aspx?cite=18.32.002.Google Scholar It could be assumed that, if we don't meet this challenge for whatever reason, the state has the right to find someone else who will. That is exactly what happened in Washington state, when denturist legislation was passed in November 1994. Voters approved Initiative 607, which allows persons other than dentists to manufacture and sell dentures directly to the public. This new professional is called a denturist. After the passage of this legislation, denturists in Washington were licensed, and, today, they are recognized as a part of the health care profession.3Washington Revised Code RCW 18.30.050: Board of Denturists. Available at: http://law.justia.com/washington/codes/title18/18.30.050.html.Google Scholar Similar efforts succeeded in Oregon and Wyoming as well as Canada.4Oregon State Denturist Association. Available at: http://www.ordenturist.org/.Google Scholar, 5Wyoming State Denturist Association. Available at: http://www.wyomingstatedenturistassociation.org/Membership%20application.pdf.Google Scholar, 6The Denturist Association of Canada. Available at: http://www.dacnet.ca/pdf/announcementE.pdf.Google Scholar Why am I making an issue of this change in the dental practice act by a few jurisdictions? I have always believed the denturists were successful because some people who need dentures either could not afford them or could not find a licensed dentist who would treat them. Forced by the peoples' initiative, the state changed the dental practices act, creating a new class of providers regulated by the state. History shows that the lack of access to care sometimes spurs legislative action. In a different but perhaps related event, Minnesota took legislative action to create a new level of dental health care provider with skills somewhere between those of a dental hygienist and a general dentist.7University of Minnesota School of Dentistry, Dental Therapy Programs. Available at: http://www.dentistry.umn.edu/programs_admissions/home.html.Google Scholar As I said before, the state can determine who is qualified to deliver the dental care demanded by the public—and if we don't assume that responsibility, someone else will do the job. In this case, no one is arguing that the quality of dental care will improve, but some members of the Minnesota legislature must believe access to care will go up. Changes in Alaska preceded those in Minnesota; defined populations searched for alternatives to traditional care, and their respective communities responded in new and creative ways.8American Dental Association and the Alaskan Native Tribal Health Consortium Issue Joint Statement on Litigation Settlement. Available at: http://www.medicalnewstoday.com/articles/76823.php.Google Scholar When it comes to busyness and the capacity of orthodontic practices to do more work, I'm sure you have noticed the results of the recent AAO all-member survey regarding the economy and its effect on practice growth. Nearly two-thirds of our members who participated in the survey said that their patient starts were down from a year ago, compared with 21% who experienced growth. Most orthodontic specialists probably could increase their patient starts by 5% to 10%. How could that happen? I see several options, and you might have a few more to offer. We could increase our funding of the AAO Consumer Awareness Campaign by several million dollars a year and wait for the consumer web site and its "Orthodontist Locator" to direct new patients to your office. The AAO 2009 House of Delegates defeated the increased spending because most delegates thought it unwise to impose a large dues increase on members under current economic conditions. (AAO dues have not increased since 1999.) The AAO campaign will continue with a smaller dues increase and by taking funds from excess reserves, but there will be no major increase in this activity to promote orthodontic treatment. Is there another option for putting people in the empty chairs, one that will help address the desire for improving access to care? I believe there is. Perhaps members could volunteer to work up to a half day per week as a charitable gesture to improve access to care nationwide. This could be promoted in the private-practice environment as a volunteer program offered by individual offices with limited coordination by the AAO on a temporary basis, perhaps until the economy improves by a measurable amount. Just count the benefits: overall improvement in children's oral health, and a show of national loyalty in helping to meet the needs of our people during an economic recession, not to mention the goodwill that will come our way. One of our AAO members, Benjamin Burris, of Jonesboro, Arkansas, received national appreciation when his program for charitable treatment was honored by Brian Williams in the "Making a Difference" segment on the NBC Evening News on March 23.9Brian Williams NBC Nightly News. Smile for a Lifetime Foundation. "Making a Difference." Available at: http://www.smilecsra.com/wordpress/?p=143.Google Scholar The program, "Smile for a Lifetime," will receive an assist in funding from the Martin "Bud" Schulman Foundation as it plans future expansion. When sincerely offered, free orthodontic care for those in need touches everyone. Are there other ways you can respond to the economic downturn and fewer patient starts? Of course. You can always reduce staff hours and spend another afternoon a week playing golf. But I ask you to compare the personal payoff and consider an opportunity to do something truly great for your community and yourself. What do you think? Disclaimer: This idea is solely my own and has not been reviewed by the AAO, its Board of Trustees, councils, or staff. Only a grassroots surge of enthusiasm by our members could ever make this more than just the dream of an aging editor.
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