Orthodontic Faculty—A Modest Proposal
The “A Modest Proposal” portion of the title is from Jonathan Swift's 18th century essay of the same name, which suggests eating infants as a solution to Ireland's famine. Certainly, when it comes to orthodontic faculty, we also have a famine, and any permanent solution to this issue may also require radical and drastic changes in our thinking and behavior.
The appeal of orthodontics as a career has never been better. Applications to orthodontic programs have never been more competitive. Programs commonly receive 50 applications for each available position, and students in the middle and lower tiers of their graduating classes don't even bother to apply. The marketplace is allowed to select the best qualified candidates.
Orthodontic students are extraordinarily talented people, often idealistic and goal oriented. Certainly, there must be among this group those who would be attracted to a career in academic orthodontics. What deters them? Why is the practice of orthodontics so overwhelmingly attractive, yet we cannot recruit a handful of faculty from the 275 orthodontists graduating annually?
There is no reason to believe that students are any different today than they were in the past. In fact, they are substantially better prepared. Orthodontics has always had difficulty attracting our brightest and best to academic careers. Why? The predominant reason may well be that we have never allowed the marketplace to function. Under a free market system, shortages of faculty should drive the incentives up and increase the available supply. The reality is that the salary of almost all orthodontic faculty is less (very often far less) than the mean salary of a practicing general dentist.
Is the availability of orthodontic faculty truly a marketplace issue? What are the constraints or regulations that inhibit young orthodontists from choosing academic careers? What incentives exist to influence the graduate's career choice?
Perhaps the most common denominator among students going into orthodontics is the desire to work for themselves. The practice environment requires a license, an office, and a supply of patients. Any constraints on working conditions are a function of the kind of practice situation where the graduate works. The rewards are the opportunity to be as good as you can be.
The regulation of academic orthodontic positions is considerably broader. An academic position requires young orthodontists to forego the desire to work for themselves. Equally important, opportunities for treating patients are also sharply limited. Most institutions view patient care as a privilege for salary supplementation and sharply curtail the activity in both time and earnings. The concept that the academic program needs to have faculty who enjoy patient care and understand clinical excellence does not seem to be considered relevant.
What is the rationale behind an institutional policy that seeks excellent clinicians to teach clinical orthodontics and then sharply curtails their involvement in private patient care? The department chair—not some aging institutional policy—is responsible for the young faculty's academic development and should monitor their professional activities. The faculty who are significantly involved in patient care become highly skilled clinicians and better teachers, and they can prepare for the American Board more readily and earn more income and revenue that will substantially add to departmental resources. The balance between the time spent in patient care and other academic activities should be controlled by and become a responsibility of the department chair. The institution should evaluate the department chair's outcome, not prescribe the process to be used. If an outcome assessment shows that the department's activities are imbalanced, then the department chair should be held accountable.
It is common today for elected officials to demand accountability from the educational system. This is appropriate, and orthodontics is no exception. However, in order to bear responsibility, the orthodontic program must have the necessary authority. It has been shown repeatedly that academic orthodontic programs are very capable of generating substantial revenues. The problem is that too often the resources generated by orthodontic programs—resources that could be used to improve the program or to attract talented faculty—are diverted away from the orthodontic program to other school-wide needs. Indeed, some orthodontic chairs have wondered why they should generate revenue when it is just used to support other programs. This is a potentially major resource unrealized and wasted.
The trend in this country has been toward deregulation. Communications have been deregulated. Airlines have been deregulated. The reason for deregulation is that regulation by administrative bodies has proven to be an ineffective way to control a supply and demand problem. The fundamental tenet of our society is that the marketplace is a far more sensitive and effective way to control these issues. It is hard to argue against the idea that the shortage of orthodontic faculty is a supply and demand question.
If we want a few good people to join the academic community, the community must be able to compete and have the same ability as practice to attract a few special people from the pool of orthodontists graduating each year. Orthodontic faculties must not be limited to orthodontists who are financially independent, retired from private practice or the military, or not eligible to obtain a license to practice. Yet when a department advertises for faculty, the great majority of the applicant pool is people in these categories.
If we are to have quality programs, the majority of our faculties must be composed of persons who are equally qualified to be in practice or working in a faculty position. Academic orthodontics needs an equal opportunity to attract the brightest and the best in order to ensure the quality of both our future practitioners and our future academicians.