Patient Assurance of Quality Orthodontic Care
Imagine yourself as a prospective patient—wanting quality orthodontic care and facing the task of finding it. What will be your strategy? What resources are available to assure you that the office you select will provide state-of-the-art care?
Most prospective patients probably use the same tools you do when seeking professional help in a field where you lack expertise—they ask a friend or neighbor about their experiences. This can be helpful, but you always run the risk of finding someone who is personally likable but not necessarily an expert in the field.
Increasing numbers of people are turning to the Internet as a resource. The Internet has immense amounts of information, but it is not easy to sort out quality professional services amid the commercial clatter. The Internet, just as with referrals from friends, gives no guarantee of expertise or quality control in the office selected.
One time-honored approach has been to examine the qualifications of the practitioner. Is the doctor a licensed professional? Licenses are granted by the state as a part of the state's mission to assure quality professional care for their citizens. What does licensure really tell the prospective patient?
A license tells the patient that you passed an examination in general dentistry. In fact, less than half the states make any attempt to even assess the orthodontic credentials of a candidate. This potentially sticky question is addressed by telling the prospective patient that anyone with a valid dental license can legally practice orthodontics, but in order to meet the ADA criteria for limiting your practice to orthodontics, you must have graduated from an accredited advanced orthodontic program. This nuance may not be helpful to the layperson, because it is very difficult for the prospective patient to determine whether the certificate on the wall represents an academic degree, completion of a continuing education course, or the guarantee for my car battery.
A sophisticated consumer might ask if you are board-certified in your field. This opens up more questions. If the boards are to represent a criterion for the public to use to find orthodontic expertise, they need to be fairly ubiquitous. Only about one-quarter of the educationally qualified orthodontists are, in fact, board-certified. If the purpose of the boards is to provide criteria for public use to find practitioners with proper training, the boards need to be held by most orthodontists who are qualified to limit themselves to the practice of orthodontics. On the other hand, if the purpose of the boards is to act as a refresher or a professional renewal for the orthodontist in practice, then there will always be a large number of good orthodontists who are not yet ready for renewal and, therefore, invisible to those using board certification as a criterion for quality care.
Some prospective patients will use the traditional approach of seeking a second opinion. Those who go to universities because they believe institutions will be least biased and those who simply visit several other offices all have the same risk of finding conflicting opinions. Without good explanations, diverse opinions can create more questions than they answer. Second opinions can be helpful, but when they are conflicting opinions, they may do little toward solving the dilemma of how prospective patients may assure themselves of quality care.
The media is an increasingly important source of information for American consumers today. Marketing methods have now bypassed the practitioner, and commercial firms are advertising directly to the public. Witness the pharmaceutical ads on television telling consumers to ask their doctor for a particular drug manufactured by that company. In orthodontics we now have commercial appeals directly to the public that instruct prospective patients to call a company representative for a referral to an orthodontist qualified to use that company's product. This latest twist in consumer protection results in the firm that produces the commercial product referring the patient to doctors the firm itself has certified to use its product.
The bottom line is that the selection of professional services, like most forms of personnel work, is an imperfect science. The licensure process that allows you to limit your practice to orthodontics is a process that can obviously be improved. Wouldn't it be helpful to the prospective patient to be able to easily establish who is educationally qualified for the limited practice of orthodontics from a dentist practicing orthodontics? Could the boards have one process that certifies the practitioner right out of school and a second process for professional renewal that function as a part of Board recertification? This latter approach has been adopted by other specialty organizations.
It is in the best interest of both the patient and orthodontics for us to do what is necessary to assist the prospective patient in finding quality orthodontic care. It is doubtful that anyone except us will be willing to work toward this goal, and steps that parallel other health care disciplines and have credibility to the public will serve everyone. What can you do to help?Robert J. Isaacson