Yesterday, in one of his most eloquent daily briefings, New York Governor Andrew Cuomo outlined a mindset for our national reopening in the wake of COVID-19.
He said, “I don’t want to say that we spent all this time, all this pain, all this suffering, lost all these deaths, only to go back to where we were-go back to a better place!”
A small cadre of Governors like Cuomo have been the heroes in our fight against the pandemic and necessity has been the mother of their invention. In those states with forward-thinking leadership like New York and my home state of Massachusetts, arbitrary and seemingly anti-competitive restrictions on telehealth that had been imposed by state professional licensing boards and legislatures were quickly lifted by these brave governors. As telemedicine became ubiquitous, teledentistry was able to come out of the shadows, shed its training wheels and begin to slowly pedal up the mountain.
The national mitigation strategy of social distancing and stay-in-place orders effectively closed down bricks and mortar dental practices, closed dental schools, cancelled dental licensing examinations and all other in-person dental meetings. While closely reading all the emails and dental publications that I have received in the past two months and listening to many zoom meetings held by various dental trade organizations, I conclude that many of the challenges that emerged during COVID-19 are largely due to our profession being mired in Victorian traditions and laws made for a bygone era. There is no better time than now for the dental profession to build back better and join the rest of 21st century healthcare. Here are 5 essential components of the reboot:
Dental trade organizations need to stop asking state dental boards and legislatures to create statutes that limit the practice of teledentistry. No in-person examination is needed prior to seeing a patient with teledentistry. No universal requirement to take unnecessary x-rays before treating a patient is needed. No geographic proximity rule forcing the patient to physically live a fixed distance to the provider is needed. Arbitrary and capricious rules will severely limit access to care for patients and quash technological innovation for the profession.
- Live patient dental licensing examinations
All dental schools in the United States are accredited by the Commission on Dental Accreditation of the American Dental Association. Central to that accreditation is examining and certifying that a graduating dentist is competent in the practice of dentistry. If the CODA accreditation process is internally and externally valid, an additional one-day of clinical dentistry on live patients in order to judge a dentist’s fitness to practice is not needed and creates an unnecessary expense to the already debt burdened graduate.
- National dental licensure
Dental disease does not present differently nor is it treated differently across state borders. As mentioned above, graduates of accredited dental schools must all receive and pass the same curricular requirements. Licensure should encompass all 50 states.
- Expanded function auxiliaries
Not all oral health interventions need be performed by a dentist or with a dentist physically present onsite. In fact, by freeing up the dentist to perform procedures that require a deeper knowledge base and a set of more complex clinical skills will allow for greater access to care, greater efficiency of care, and lower the cost of care.
- Dental schools and hospital-based residencies
Dental schools and hospital-based residencies are for the most part not self-sufficient and most of them use a business model that is not sustainable without exorbitant tuition or tremendous subsidies. It’s time to look critically at the number of dental schools and hospital-based residencies to assess their viability. Some data already suggest that the number of graduating dentists in America exceed the number of graduating dentists actually needed. Private and public tax payer monies should not be spent if a school or residency cannot break even.
Marc Bernard Ackerman, DMD, MBA, FACD
Executive Director, American Teledentistry Association