Licensure, dental office wastewater, third-party interference with dentist/patient relationships—these are "real" issues guaranteed to grab the interest of the rank-and-file dentist. It’s doubtful that the issue of the declining number of dentists choosing to become ADA members would elicit similar concerns.

But dentistry’s leaders believe otherwise. They know that only through high membership percentages can an organization exert its strength and power, especially in its advocacy initiatives.

This was recently illustrated during the ADA’s testimony on ergonomics to Occupational Safety and Health Administration officials. At the conclusion of the spokesperson’s remarks, OSHA was informed of the high percentage of dentists the ADA represents. OSHA’s response acknowledged that "by working with [the ADA, they] could reach the vast majority of dentists."

It’s understandable why the U.S. Department of Labor officials were impressed. With membership currently at just over 70 percent of eligible dentists, the ADA has earned the distinction as the gold standard for national professional organizations. Neither the American Medical Association nor the American Bar Association, with membership percentages in the 40 percent range or less, can compete.

Whether we are able to maintain this strength in numbers is questionable. The last seven years have seen a continuing decline in the ADA’s membership market share. Additionally, there have been major increases in the absolute numbers of dentists located in categories that have demonstrated less-than-average membership histories.

For example, the ADA’s minority dentist market share for membership purposes fell from 61.7 percent of those eligible in 1993 to 55.6 percent last year. Specifically, the year 2000 market share for those groups contained in the minorities category was 38.8 percent for African-Americans, 51.7 percent for Hispanics and 62.6 percent and 61.6 percent for Asian or Pacific Islanders and American Indians, respectively. As for women, a major component of the minority category, less than 63 percent have joined the ADA.

The impact of lowered female market share could signal even more difficulty in the future as the older age groups of dentists, which are predominantly male, retire.

The ADA’s membership staff is well aware of the importance of courting the emerging and older nonmember dentists. They have directed similar efforts to those dentists who, for a variety of reasons, chose not to renew their membership. Unlimited energies and creative solutions abound; still the market share falls.

Apparently what is being offered is insufficient to affect commitment. Dentists of my era, to whom I have proudly referred as the "pledge-allegiance" generation, dutifully and without question opened each school day with a pledge to the American flag. There was never a discussion as to why we recited this pledge or why America needed or deserved our loyalty.

This willingness to make unqualified commitments to the country translated years later to professional membership in the American Dental Association. Here, too, there was no question as to the benefits of membership. Joining was value in itself. Close to 90 percent of this age group choose to belong to the ADA.

Obviously, this philosophy does not exist today. Dentists now want to know what the organization does for them; otherwise, why join?

So the ADA offers insurance, credit cards, home mortgages and a host of other financial services. Good, but not good enough. I’ve always believed that loyalty for financial services was only as deep as a one-half percent reduction in interest rates.

No, our dentists want more, and by emphasizing highly relevant, practice-directed benefits, we can deliver it.

Advocacy, for example, is probably the ADA’s strongest suit. The aforementioned activity in the ergonomics field has prevented unbelievable punitive actions against the dentist by OSHA. Its new legal initiative, filing a class-action lawsuit (for reduction of benefits to providers) against one of the nation’s major dental insurance companies, represents a milestone in the ADA’s continuing attempt to preserve the dentist/patient relationship.

Unfortunately, for the same reasons unions demanded closed shops, the value from the ADA advocacy efforts works for members and nonmembers alike. "Why join?" the nonmember might think. "I can get all the benefits without spending a penny."

Sad, but true. Localizing the ownership of advocacy ranges from difficult to impossible. More tangible programs are needed to attract potential members. Since dentists like hands-on action, let’s give them hands-on reasons to be members of the ADA. To do that will require moving two of the ADA’s already successful initiatives to the next level.

Continuing education, for example. Today, outstanding clinicians are made available to members at the ADA’s national meeting. With the assistance of industry, more than 50 seminars have been made available to individual dentists and dental organizations. Online educational instruction has been added recently, and the JADA continuing education program counted more than 18,000 dental enrollments last year.

Adding value to this educational focus is the ADA’s Continuing Education Recognition Program, or CERP, which provides guidance to the profession by scrutinizing educational programs for their content.

Once again, I would like to ask the ADA to step up and take a leadership role in formulating the direction of continuing education in dentistry. The suggestion here is to move from the present approval of courses through CERP to a new educational role of advising and mentoring dentists in their educational progress. These activities should be coupled with the development and administration of a suitable reward system that is capable of publicly acknowledging professional growth.

Lectures, hands-on instruction, fellowships, even perhaps a virtual university that grants continuing education degrees—all could become integral components of this new ADA initiative.

No need to develop new courses. The majority of educational offerings would come from educational presentations already offered by universities, dental societies, study clubs and industry.

The membership payoff would be a visible, ongoing, educational experience only for ADA members. Conceivably, thousands of ADA members would find themselves inextricably linked to the ADA.

I would propose a similar type of program for the science and dental practice areas. Our members say they want more information on dental products—a reasonable request, since new generations of dental materials are coming onto the market constantly.

Why not link thousands of dental offices electronically so that dentists can share product usage information with their fellow dentists? Most dental offices easily could be joined to provide this information, with dentists acting both as clinical researchers and recipients of "hot" information on a daily basis.

Now that would be a membership benefit!

Finally, I would like to address the oft-stated concern that the ADA is not appropriately addressing the needs of its minority and female members, with a proposal for a structural change in the ADA. The initiative would give minority and female members the opportunity to develop special-interest groups within the ADA structure. This would not mean abandoning their present organizations. On the contrary, they could use this format to bring the thoughts of these external organizations directly to the ADA through the special-interest mechanism, thus ensuring that their voices would be heard at the highest levels.

This is not a radical proposal. Organizations such as the American Association for Dental Research and the American Dental Education Association have structured their organizations to acknowledge and give voice to their constituents.

Membership is the foundation of a strong organization. We in the ADA have been fortunate to introduce ourselves as the voice of dentistry. Will it continue? Only if the ADA is ready to programmatically move to new levels that link members on a daily basis with the organization.

Remember: with numbers comes strength!