Who Is Driving and Where Are We Going?

Any words about “being taken down a path” have to begin with where we came from. The Pacific Coast Society of Orthodontists (PCSO) is a professional organization of orthodontists. As we approach the milestone of being in existence for 100 years, the practice of orthodontics is better than ever. Advances in technology and modern concepts of practice style keep us moving in a forward direction.

However, what about the professionalism of orthodontics? Thirty-plus years ago, when I began my dental/orthodontic career, dentistry and dentists ranked near the top in the list of professions and professionals most trusted by the public. Recent surveys of public respect indicate our status is sliding down the scale of trust. Who is driving, and where are they taking us?

DIRECTION AND MISDIRECTION

I raise the point of failing trust because many of us see problems beginning to show in both the ethics and the direction—or misdirection—of our wonderful profession. The PCSO's 71st Annual Session, recently held in Monterey, California, was a huge success. The Annual Session Planning Committee, under the direction of PCSO past-president Jim Peck and president Howard Hunt, combined an educational doctors' program along with a staff program that attendees raved about. The scientific and practice programs for both doctors and staff demonstrated a sharing of knowledge, experience, and skills in wonderful presentations. The camaraderie and social interactions were remarkable.

The postmeeting surveys reflect an extremely positive experience for our members. PCSO history was made with the election of Dr Lili Horton as secretary-treasurer for this upcoming year. When she becomes president, Dr Horton will be the first woman to lead the PCSO and the first female representative from the component society of Hawaii.

However, despite our stellar meetings, the PCSO is competing for attendance of orthodontists and their staff. Almost all of the major orthodontic supply or service companies contribute to and graciously support our meetings. Yet these same companies hold their own stand-alone meetings that attract a percentage of our members' continuing education dollars.

My plea is not to judge the value of these corporate meetings but to acknowledge their successful approach to team and product marketing as they promote their products and technology. This is obvious as they continue to attract higher numbers of doctors and staff.

Many years ago, when our profession stood high on the list of trust, respected clinicians, academicians, and educators gave lectures and their ingenuity and time to share scientific knowledge with all of us. Now, there is a price to pay for science. There is a price to pay for knowledge. This is because we, the professionals, are no longer driving.

The corporations, while greatly enhancing our field with their own research and development mainly provided by those outstanding clinicians, are recovering their millions of dollars from orthodontists, the consumers. To have these experts share their information, the corporations affect the cost of lecturers and, subsequently, the cost to the professional associations, such as the PCSO. We are naive to think that clinicians associated with companies are not reimbursed through gifting of product, funding of family members, trips, and donations in name for tax benefits or other perks. In this environment, we are competing for speakers' fees and time commitments.

I remember going to the PCSO's own scientific sessions and listening to clinicians present concepts of treatment, new techniques, and new products. These clinicians conducted scientific trials and then shared their information. Then I'd walk into the exhibit hall for a hands-on experience and to discuss the concepts further. The salespeople were knowledgeable about their products, and it was their opportunity to interact with the doctors and staff and share their knowledge and wares. Now, if one chooses, one does not even have to walk into a lecture room. Orthodontists and staff can hear the lecture from corporate-sponsored clinicians at or near an exhibit booth in the exhibit hall. Again, I ask, Who is driving here?

A NEW ERA

Years ago, when our profession ranked high in trust, a patient would present with a concern, chief complaint, or a problem, and the doctor would assess the signs and symptoms, formulate a diagnosis, and make a trusted recommendation based on training, knowledge, and experience. Today, we live in a new era. Not only has commercialism told the public what the diagnosis is, it also arms the public with the advertised branding to ask for the treatment. All one has to do is notice how much time is spent identifying the side effects and contraindications and outlining disclaimers. Still, at the end, the branding is so ingrained that it makes one feel that a specific medication or type of braces is what they should have. The trust has definitely shifted away from the doctor to the media or Internet.

The promotion of one product or technique as being the one that is going to provide superior results has even driven us to act unethically toward each other. Granted, we are all trained and certified to practice our profession. We have unfortunately been exposed to such strong persuasion that an accusation of one practitioner's method or skills falling short of another if he or she doesn't follow a particular method is too commonplace. Somehow, we are being driven down the wrong path in our profession. The public is recognizing it and lowering their trust in us.

Can we jump back into the driver's seat? I know we can, and we have already started to. The prime example is our own AAO Public Awareness program. This program has no commercial input and has been developed solely by orthodontists for orthodontists about orthodontists. We are literally taking it to the street. The message is about who orthodontists are and not what techniques or products are being used. This is where we belong—in the driver's seat. In planning PCSO's continuing education, the Continuing Education Committee is careful in selecting the most dependable information for the PCSO members. While driving along that bumpy road, it is a significant challenge to keep our members up to date and to keep the programs based on scientific experience and evidence. The Non-Dues Revenue-Corporate Sponsorship Committee has a direct charge to seek sponsorship of those nonscientific portions of our meetings. We are trying to stay the course.

Every car has room for a driver and a passenger. I ask, couldn't the corporate dollars be partnered with educational research and our professional associations in working toward a common goal? I suggest that corporate profits will increase if the public is better educated on the benefits of orthodontic treatment and the skills of the experts rendering the treatment. Just think of the increase in numbers of patients seeking orthodontic care, for which there will still exist varied treatment protocols and systems of delivery. If the dollars spent are combined, there will be an exponential and positive impact on the bottom line of the companies and the practitioners. Most important, our patients will benefit from the best treatments available and will not be caught in a world driven by corporate advertising as they attempt to access care for themselves and their children. Ultimately, we want what is best for our patients and for our profession.

There are other dangerous curves on this road. Education and accreditation come to mind. Through your leadership's advocacy at the PCSO and AAO, work is being done in these areas. My words of confidence and gratitude are expressed to those members who take the challenge and make the commitment to keep orthodontists in the driver's seat. It is my hope that our terrific orthodontic profession will continue to rank high on the list of trusted professions.

Reprinted from the PCSO Bulletin, Winter 2007;4–5.