"The Perfect Patient" by Dr. Meskin illustrates the continued difficulties practitioners have with licensing. Of course, another letter, another editorial, another question of nonsensical outdated practices will not produce positive improvement or change, just as previous efforts have been ineffectual.
Dentistry as a "profession" is actually more closely allied with cobblers and barbers, requiring apprenticeships and clinical licensing examinations in each district. Few states have implemented true licensure by credential and all require a patient-based clinical exam at some level, just like barbers. Our apprenticeship to the trade, that is, dental school, is not deemed sufficient training to perform the manual tasks associated with dentistry.
In fact, the very definition of dentistry lacks uniformity. Many states (California, New York, Montana and South Dakota, to name a few) have a definition of dentistry that is not consistent with that of the ADA, instead utilizing antiquated definitions that do not reflect the current practices of the profession.
A colleague who is a board-certified oral and maxillofacial surgeon wished to relocate to a western state. He was informed by the state board that "we license everyone as a general dentist" and he would be required to pass a dental examination that included amalgam and composite restorations, periodontics, denture fabrication and crown preparation.
The fact that he was limited to the practice of surgery and was not even credentialed to perform these dental procedures in his own hospital was of no interest. Of course, his medical colleagues found this ludicrous as well as humorous. Our friend found it only embarrassing.
Such a lack of insight, knowledge and most importantly common sense within the dental profession is not something of which any of us should be proud. We must standardize our license requirements, embrace true licensure by credential, implement specialty licensure and establish ourselves as a true health care profession worthy of the designation of doctor.
Predictably, our friend, the board-certified oral and maxillofacial surgeon, failed to pass the dental examination. This came as no surprise as he was, after all, a surgeon and had not performed general dental procedures in nearly a decade. He relocated nonetheless and now has a fine business of cutting hair in the mornings and fixing shoes in the afternoon.
