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An Easterner Looks at the American Dental Association
SPECIAL CONTRIBUTION
An Easterner looks at the American Dental Association
George E. Mullen, DDS, B ro o klyn
T h e g ro w th o f th e A m e ric a n D e n ta l A s s o c ia tio n is c o m p a re d w ith in c re a s e d a d va n ta g e s a n d b e n e fits to th e p u b lic and to th e p ro fe s s io n . S p e c ific a n d g e n e ra l are as o f c o n c e rn are d is c u s s e d in w h ic h th e AD A c o u ld le n d g re a te r e ffo r ts an d ta le n t, n o t o n ly fo r th e East, b u t fo r th e c o u n try as a w h ole . T h e p a p e r w as p re s e n te d a t th e F o u rth A m e ri c a n D e ntal A s s o c ia tio n R e g io n a l M e e tin g in P h il a d e lp h ia in S e p te m b e r 1 9 7 1 . A c tio n th a t h a s been ta k e n s in c e th e p a p e r w as p re s e n te d is g iv e n in b ra c k e ts w h e re a p p lic a b le .
The title is somewhat provocative because I’m sure it conjures in your mind the obvious, why an Easterner? Do the commendations, condemna tions, salutations, and aspirations aimed at the American Dental Association differ from East to West, from North to South? This Easterner would think not. Perhaps there are certain problems indigenous to the East because of the high popu lation concentration of this area The three trust ee districts present at this conference represent approximately 22% ofthemembershipoftheADA. But this Easterner would prefer not to discuss the growth or size of this section. Rather let us con sider the rapid growth of the ADA during the professional lifetime of this speaker, a span of time that seems too short and seems to have fled too fast. Let us consider the years 1940 to 1970. When I had the delight of sending my first letter to 212 East Superior St, the headquarters of our Association, we had a staff of 21, headed by the famous Dr. Gerald Timmons as executive secre tary. We occupied 12,500 sq ft; we operated on a budget of $347,532, covering a membership of 49,731. A short—in terms of any organization— 30 years later, we possess our own building, measur ing 135,968 sq ft, plus a Washington, DC, office, administered to by a staff of 321, with a budget that reached $10,064,000 this year, covering a membership that is slightly in excess of 100,000. Dues in 1940 were $4; today they are $70. One must assume that these increases of approximate ly 1,081% to 2,859% were necessary and vital to the services rendered by our national organiza tion. Yet, ever conscious of the evil of inflation, what general services do the grass-root dentists JA D A , v o l. 8 4 , A p r il 1 9 7 2 ■ 7 3 5
or, as Harry Klenda liked to call them, the wet finger dentists receive today that were denied them in 1940? Have the services, advantages, and benefits increased to our members to the same percentage degree that the dues, footage, and staff have increased? If not, again subtracting in flation, why not? One must wonder why the dues, staff, square footage, and budget have increased from 1,081% to 2,859%, although the member ship during this same time has increased but 105%. Like Topsy or the federal government, we seem to have grown awfully fast, at least in the profes sional life of this Easterner, with some question as to whether the growth has been commensurate with increased advantages and benefits to our membership.
Specific areas of concern
Let us consider some areas where greater empha sis and possible change could merit the vast ex pansion of our physical, financial, and person nel factors. ■ Communications at all levels: A good place to start is in the area of communications—public, professional, and interprofessional relations— at all levels. This has shown marked expansion in 30 years, and rightly so. In spite of the good rela tionship that the East has with the ADA on com munications, there is, as always, room for im provement. At times our sector feels “provincial” and a little out in left field because of lack of a sort of early warning system in which we might anticipate problems, with an understanding of the ADA’s attitudes toward than. This can be done on a short-range basis through monos and on a long-range basis through meetings to ex change views. We believe that the ADA would be helped as much as we would by being more closely informed on PR problems and PR ap proaches in the “provinces.” Our unified thinking, between the East and other constituent societies, on such long-term matters as continuing education, third party pro grams in all their aspects, quality control, and peer review, as examples, is essential. New York, and the East in general, are the headquarters for so many of the communications media that serve the entire nation— wire services, networks, magazines, and publishing houses. To day, when the entire nation is confronted by 7 3 6 ■ JA D A , v o l. 8 4 , A p r il 1 9 7 2
sweeping changes in every quarter of dentistry, both evolutionary and revolutionary, an ADA facility in New York City to maintain day-to-day direct availability to the media seems worthy of study. ■ Specialist headquarters: The East is the geo graphical headquarters of the specialists. More specialists practice in the three trustee districts represented here today than in any similar divi sion of the ADA. Yet both specialists and gen eral practitioners must pause and wonder if the ADA has a truly realistic evaluation of the spe cialty practice. It would seem that the criterion of the specialist is competency, not limitation of practice. Permit me to quote Phillips1: . . . the policy developments adopted by the House of Delegates have introduced a factor which I can not accept as either rational or logical, nor can they be accepted, in my opinion, as being in the best interests of the dental profession or the public. The factors under discussion are the introduction of eco nomic sanctions against the uncertified speciallyskilled dentist, who does limit his practice and the generalist who has special skills—certified or uncer tified—but does not limit his practice; and the con comitant introduction of special privileges in the conduct of his practice for the qualified dentist who does limit his practice.. . . I believe that specialty status, if our people are to be served properly, must depend upon one thing solely, competency. Limitation of practice, econom ics, and other similar regulations can never be true evaluations of specialty status. Sound concepts are with us always. ■ R elief appeals: O’Connell,2 chairman of the ADA Council on Relief, wrote an excellent ar ticle on the history of the Relief Fund. It is rather interesting that the Relief Fund was started as a result of the San Francisco earthquake and fire. It was stated at that time “that the principal be retained for disaster relief; the interest was to be used for the relief of superannuated dentists in distressed circumstances.”2 However, in 1969, we had to set up another appeal mechanism to answer the needs of the victims of hurricane C a mille. The House was informed then that the present Indenture of Trust did not permit the re lease of funds for this purpose. The reason there are currently, and have been for many years, mil lions of dollars in the Relief Fund, we have been
informed, is in case of a national emergency. H ur ricane Camille was declared a national emergen cy, but the Fund could not be used. This is al most as confusing as the Fund itself. One must wonder why the annual goal is $125,000 when the Fund had, according to the report of audit, assets over liabilities of $3,241,000 in the year ending June 30, 1970. The Indenture of Trust may be amended by corporate action of the As sociation. May I call to your attention that in 1970 the House of Delegates recommended study in this area. Let us hope this study will soon be fruitful, and different in final form from that to be pre sented to the House of Delegates next month by the Council on Relief. [Two resolutions dealing with the Indenture of Trust were referred by the House of Delegates to the Council on Relief for further study; one resolution was rejected.] Perhaps a moratorium should be placed on the initiation of appeals, for besides the aforemen tioned Relief Fund and hurricane Camille, we have the American Fund for Dental Education, the Fine Arts Fund, the Harold Hillenbrand Fel lowship Fund, Merritt Rare Book Fund, ADA Foundation, and Perry J. Sandell M anorial Schol arship Fund. These are all fine and worthy causes, but perhaps a United Fund or Red Feather Cam paign approach might be a more practical plan for solicitation of funds from our members. ■ Legislative representation: Legislation is an area of which this Easterner believes all members of the ADA can be proud. The fine efforts of our Washington Office plus the endeavors of our Council on Legislation merit the compliments to all. There are goals that are not attained, but this does not detract from the efforts of those involved. It follows, too, that the American Dental Po litical Action Committee (ADPAC) merits the support of the ADA. In some fashion a more con centrated effort of aid should be engendered for this activity. Perhaps ADPAC could be added to the United Fund or Red Feather Campaign list of the aforementioned appeals. ■ Policy control: One concern of many den tists is the question of some representatives of the ADA appearing before legislative bodies and of fering statements that may not reflect the policy of the ADA. The House of Delegates is the pol icy-making organization of our Association, and it seems rather obvious that only its commitments, not personal opinions, should be offered. As
Veale3 stated, addressing the ADA Second R e gional Conference: “None of us here is so naive as to think that the present control of this Asso ciation rests in the House of Delegates. For in stance, action in San Francisco didn’t kill the Sur vey o f Dentistry . . . it only drove it underground. The material still seems to surface for every Con gressional hearing.” One must wonder, too, how much control of our policy-making machinery rests in the hands of the Board of Trustees of the ADA. This East erner has been consistently amazed over the years at the number of constituent resolutions rejected by the Board This year is no différait. Nineteen constituent resolutions were submitted, and two were approved. One is the change in the name of the Rhode Island association. The other is no more terrifying: the Massachusetts Resolution on Re-Evaluation of Advisory Opinion No. 2 under Section 20 of the Principles o f Ethics. If the House of Delegates is still the policy making body of our Association, it would seem that constituent resolutions should be passed by the Board of Trustees without comment if they are not in conflict with the Constitution, Bylaws, or Principles o f Ethics of the ADA. As a corol lary, it is also rather interesting that the Board of Trustees consistently approves resolutions sub mitted by the Councils. Again, this year is no différait. Board Reports, Report 2 covers 26 res olutions submitted by ADA Councils. Twentyfour are marked for approval; one is amended, and one the Board recommended be postponed indefinitely. Are constituent societies that poorly informed and advised about what is best for the ADA? Are the Councils that knowledgeable and astute in policy-making areas? Or are there other reasons? ■ States’ rights and auxiliaries: Represented at this conference today are the states of Delaware, Maryland, New Jersey, New York, and Pennsyl vania, as well as the District of Columbia. In 1967, all of you were told by the House of Dele gates to determine if you wished, and in what manner, to expand the duties of auxiliaries. You were directed by the House to work in concert with state dental examining boards to consider recommending changes in the dental practice acts. Hillenbrand4 has stated: “The problan of states’ rights is traditional in this country. It isn’t going to change and I am not sure it should be changed.” Timmons5 also has stated: “Problems will be solved at the local level and not by the M u lle n : AN E A S T E R N E R L O O K S A T T H E A D A ■ 7 3 7
leaders in dentistry.” The evidence emanating from the ADA, and even this program itself, sug gest there are those who do not wish to leave this to the states. One must wonder why. If the ADA insists on injecting itself into this states’ rights matter, this Easterner would suggest it de velop some new concept other than fear and man power shortage to utilize, as well as to encourage, better trained hygienists and assistants. Present statistics and reliable studies do not substantiate a shortage of dentists, at least in New York state. There is, of course, a maldistribution of dentists throughout the country. But the rem edy of this problem is certainly not the fragmenta tion of our profession. Permit me a quote from Warnecke,6 a member of the council on education of the Dental Society of the State of New York: In spite o f the evidence, the government (HEW), the dental schools (with the threat o f withholding o f funds if they fail to participate in pilot projects) and the American Dental Association have been rushing headlong into an ever increasing drive for a broad delegation o f duties for auxiliaries. A close scrutiny o f the pilot programs and studies leaves no doubt as to the frightening scope o f the ultimate aims. Their aim is great and envisions a large army o f “tooth carpenters.” I f this m ost vocal group (aided by the resources o f the American Dental Association public information office and publications) continues on its present course, the dental profession will have presented the American public with a plethora o f substandard den tistry and will have forever relinquished its previous goal o f excellence in dental treatment.
■ Third party programs: I am sure that those of you who play such an active role in organized dentistry would agree with me that no area of concern has taken more of your time than what we call third party programs. If ever constituent and component societies were facing agonizing questions and problems, if ever constituent and component societies were in need of sound ad vice from the national level (for basically these are national problems), it is in this area of the third party. The ADA Task Force Report on National Health Programs will soon be considered by the House of Delegates. The 93 recommendations contained in the report hopefully will be re solved as a pattern of compliance for methods of approach in third party negotiations.Intrinsic problems of our profession frequently can be re 7 3 8 ■ JA D A , V o l. 8 4 , A p r il 1 9 7 2
solved with a minimum o f time and debate. The extrinsic problems become quite another matter. For in the immediate past and as far in the future as one dares to look, the relationship is no longer a romance of dentist and patient. We now have become a triangle, and this, as in most phases of life, has great inherent problems. Whether you are content or saddened by this professional change of life, I submit that no panacea or magic formula can be offered to stop it. Never more in my life do I wish I were wrong. [Guidelines for Dentistry’s Position in a National Health Program was adopted by the House of Delegates at the 1971 annual session.] If the ADA also accepts third party interven tion as a fact of life and it’s obvious that it does, every energy and resource at its command should be directed to making certain that the rights, duties, and obligations of the profession are pro tected Only through a strong, viable profession can the dental health of this nation be main tained as the finest in the world Only through an informed dedicated membership, which comes from an informed dedicated leadership, can all who need dentistry be granted the right to den tal health, which we now are told is actually a right, not a privilege. The American dentist has it within his capac ity to deliver dental care, to resolve the oral prob lems, and to promote the general objectives of our profession if he is informed properly and is motivated correctly. This is a tall order to place on the shoulders of the leadership of the ADA, but to whom else do we turn? The alternatives are terrifying. Let us be certain they never have to be faced
Other specific areas of concern Time does not permit the elaboration of other areas of activity to which many Easterners would hope the ADA could give greater attention. Per mit me to list without comm a it some of them: — Better concepts for the broader acceptance of continuing education, even if it is made man datory. — The importance of honest cost analysis for the determination of equitable remuneration in private practice and funded health care programs. — The importance of utilization of legal coun sel in all public relations. — Possible change in ADA annual sessions format by the addition of an extra day for dele
gate caucus evaluation o f reference committee re ports before they reach the floor. The physical mechanics now limit proper study in conference and lead to a sloppy “House.” [The 1972 annual session will begin a day earlier than usual. See AD A News, Dec 20, 1971.] — Added concern for the member in Associ ation-sponsored insurance programs. Thus are offered for your consideration specific areas of concern in which this Easterner believes the ADA could lend greater efforts and talents.
General areas of concern There are, however, general areas of concern that are more frightening. This is probably due to a national malady of utter lack of regard or in terest and general apathy in all things. I do be lieve we are becoming a nation and, yes, a pro fession that is willing and eager to let others shoulder the load. I do believe we are a nation suffering from a lack of individual responsibility. This is expe dited in its development by those who say: “Give me the money, and I’ll do it for you or take care of you.” As we visualize the disproportionate growth of the ADA, one must wonder if we are also guilty. History tells us that a system of feudalism de veloped between the ninth and fifteenth centuries wherein the serfs and vassals looked to their lord for care and protection. Somewhat the same sys tem is developing today as we abandon the rigors of individual responsibility for the assurance of others that “they” will take care of us. I fear we are heading toward professional serfdom. Professionally educated people should know that abandonment of responsibility and duty to others is a certain way to lose freedom. The free dom of a profession is proportionate to its assump tion of responsibility. A certain way for the pro fessional individual to lose his privileges and prerogatives is to assign or to abandon his duties and responsibilities to a hired staff, such as the ADA, or to a government bureau.
Principles of staff functions The staffs of ADA and of government have dif ferent perspectives from those of the individual
professional. By the very nature of their duties this must be so. There develops a tendency to reduce the number of variables in a given situ ation so that it can be better managed. This is a first principle of administration. With such reduc tion of variables the freedom to be different, in other words, to be an individual, is lost. Such loss of freedom is not a complicated process— but it is a gradual one. The past 30 years is sufficient history of the world to prove this point. I think everyone today is well intentioned. No one has ulterior motives. I f there is a conviction in our society that certain systems are better than others, if some areas are to be protected from en croachment, then there must be a resistance at some point. This begins with the individual and his willingness to shoulder responsibilities and to do his duty. Apathy, indolence, and self-interest are the precursors of professional default.
Self-appraisal The profession should look at research, at edu cation, and at the delivery of services and should determine whether the money spent for dental research in all areas has been of benefit and whether dental education has been meeting its obligations or has been developing systems of self-interest. The researchers look at research, the educators look at education, the practition ers look at practice, and all agree that what is needed is more money. We have spent more money in the past ten years than in any prior time, yet all say we are worse off in every dimen sion. How come? What is needed is a peer re view of the entire profession to test its perfor mance in society—not to describe it. I think the profession should devise a performance apprais al of dentistry, including in it: its own organiza tional systems; the ADA and the constituent and component societies; the specialities; the demand for and the performance of dental services in private practice, in federal services, and in other delivery systems; the effectiveness of research programs; and the qualities of the dental educa tional system. Such a report would reflect the competency of the profession and would assure society that we have made a composite peer review of our over all performance and are professionally respon sible to society. If such a task is too big for the profession, if it is afraid of what it might learn about itself, then M u lle n : AN E A S T E R N E R L O O K S A T T H E A D A ■ 7 3 9
I question its right to continue as a profession within the design of our society. The pluralistic nature of our society structure demands that we have a free system of profes sions, as this is the “best buy” for the public. It is a prime responsibility of a free profession to monitor its own metabolism and not to enhance its own interests, but to better serve the public. Being free and responsible, it can do this; by doing so, it can continue to be free and respon sible. In this brief presentation are offered some ran dom thoughts collected over a short period of 30 years, representing personal as well as colleagues’ opinions as we look at the ADA. Obviously we would be remiss not to offer the gratitude of these three trustee districts to those within our geographical areas who have served us so well. To the presidents of the ADA, trust ees, delegates, council members, and all who have accepted responsibility on a national level,
7 4 0 ■ JA D A , V o l. 8 4 , A p r il 1 9 7 2
you have the personal satisfaction of service to your profession as well as esteem of all members of the ADA for your devotion to the cause of dental health.
Dr. Mullen is president of the Dental Society of the State of New York. His address is 283 E 17th St, Brooklyn, NY 11226.
1. Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 2. O'Connell, T.J. “ Help thy neighbor.” A treatise on re lief. NY State Dent J 37:234 April 1971. 3. Veale, J.B., Jr. A Southwesterner looks at the Ameri can Dental Association. Second ADA Regional Conference, New Orleans, March 1971. 4. Hillenbrand, H. Cited in Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 5. Timmons, G. Cited in Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 6. Warnecke, R. Personal communication.
An Easterner looks at the American Dental Association
George E. Mullen, DDS, B ro o klyn
T h e g ro w th o f th e A m e ric a n D e n ta l A s s o c ia tio n is c o m p a re d w ith in c re a s e d a d va n ta g e s a n d b e n e fits to th e p u b lic and to th e p ro fe s s io n . S p e c ific a n d g e n e ra l are as o f c o n c e rn are d is c u s s e d in w h ic h th e AD A c o u ld le n d g re a te r e ffo r ts an d ta le n t, n o t o n ly fo r th e East, b u t fo r th e c o u n try as a w h ole . T h e p a p e r w as p re s e n te d a t th e F o u rth A m e ri c a n D e ntal A s s o c ia tio n R e g io n a l M e e tin g in P h il a d e lp h ia in S e p te m b e r 1 9 7 1 . A c tio n th a t h a s been ta k e n s in c e th e p a p e r w as p re s e n te d is g iv e n in b ra c k e ts w h e re a p p lic a b le .
The title is somewhat provocative because I’m sure it conjures in your mind the obvious, why an Easterner? Do the commendations, condemna tions, salutations, and aspirations aimed at the American Dental Association differ from East to West, from North to South? This Easterner would think not. Perhaps there are certain problems indigenous to the East because of the high popu lation concentration of this area The three trust ee districts present at this conference represent approximately 22% ofthemembershipoftheADA. But this Easterner would prefer not to discuss the growth or size of this section. Rather let us con sider the rapid growth of the ADA during the professional lifetime of this speaker, a span of time that seems too short and seems to have fled too fast. Let us consider the years 1940 to 1970. When I had the delight of sending my first letter to 212 East Superior St, the headquarters of our Association, we had a staff of 21, headed by the famous Dr. Gerald Timmons as executive secre tary. We occupied 12,500 sq ft; we operated on a budget of $347,532, covering a membership of 49,731. A short—in terms of any organization— 30 years later, we possess our own building, measur ing 135,968 sq ft, plus a Washington, DC, office, administered to by a staff of 321, with a budget that reached $10,064,000 this year, covering a membership that is slightly in excess of 100,000. Dues in 1940 were $4; today they are $70. One must assume that these increases of approximate ly 1,081% to 2,859% were necessary and vital to the services rendered by our national organiza tion. Yet, ever conscious of the evil of inflation, what general services do the grass-root dentists JA D A , v o l. 8 4 , A p r il 1 9 7 2 ■ 7 3 5
or, as Harry Klenda liked to call them, the wet finger dentists receive today that were denied them in 1940? Have the services, advantages, and benefits increased to our members to the same percentage degree that the dues, footage, and staff have increased? If not, again subtracting in flation, why not? One must wonder why the dues, staff, square footage, and budget have increased from 1,081% to 2,859%, although the member ship during this same time has increased but 105%. Like Topsy or the federal government, we seem to have grown awfully fast, at least in the profes sional life of this Easterner, with some question as to whether the growth has been commensurate with increased advantages and benefits to our membership.
Specific areas of concern
Let us consider some areas where greater empha sis and possible change could merit the vast ex pansion of our physical, financial, and person nel factors. ■ Communications at all levels: A good place to start is in the area of communications—public, professional, and interprofessional relations— at all levels. This has shown marked expansion in 30 years, and rightly so. In spite of the good rela tionship that the East has with the ADA on com munications, there is, as always, room for im provement. At times our sector feels “provincial” and a little out in left field because of lack of a sort of early warning system in which we might anticipate problems, with an understanding of the ADA’s attitudes toward than. This can be done on a short-range basis through monos and on a long-range basis through meetings to ex change views. We believe that the ADA would be helped as much as we would by being more closely informed on PR problems and PR ap proaches in the “provinces.” Our unified thinking, between the East and other constituent societies, on such long-term matters as continuing education, third party pro grams in all their aspects, quality control, and peer review, as examples, is essential. New York, and the East in general, are the headquarters for so many of the communications media that serve the entire nation— wire services, networks, magazines, and publishing houses. To day, when the entire nation is confronted by 7 3 6 ■ JA D A , v o l. 8 4 , A p r il 1 9 7 2
sweeping changes in every quarter of dentistry, both evolutionary and revolutionary, an ADA facility in New York City to maintain day-to-day direct availability to the media seems worthy of study. ■ Specialist headquarters: The East is the geo graphical headquarters of the specialists. More specialists practice in the three trustee districts represented here today than in any similar divi sion of the ADA. Yet both specialists and gen eral practitioners must pause and wonder if the ADA has a truly realistic evaluation of the spe cialty practice. It would seem that the criterion of the specialist is competency, not limitation of practice. Permit me to quote Phillips1: . . . the policy developments adopted by the House of Delegates have introduced a factor which I can not accept as either rational or logical, nor can they be accepted, in my opinion, as being in the best interests of the dental profession or the public. The factors under discussion are the introduction of eco nomic sanctions against the uncertified speciallyskilled dentist, who does limit his practice and the generalist who has special skills—certified or uncer tified—but does not limit his practice; and the con comitant introduction of special privileges in the conduct of his practice for the qualified dentist who does limit his practice.. . . I believe that specialty status, if our people are to be served properly, must depend upon one thing solely, competency. Limitation of practice, econom ics, and other similar regulations can never be true evaluations of specialty status. Sound concepts are with us always. ■ R elief appeals: O’Connell,2 chairman of the ADA Council on Relief, wrote an excellent ar ticle on the history of the Relief Fund. It is rather interesting that the Relief Fund was started as a result of the San Francisco earthquake and fire. It was stated at that time “that the principal be retained for disaster relief; the interest was to be used for the relief of superannuated dentists in distressed circumstances.”2 However, in 1969, we had to set up another appeal mechanism to answer the needs of the victims of hurricane C a mille. The House was informed then that the present Indenture of Trust did not permit the re lease of funds for this purpose. The reason there are currently, and have been for many years, mil lions of dollars in the Relief Fund, we have been
informed, is in case of a national emergency. H ur ricane Camille was declared a national emergen cy, but the Fund could not be used. This is al most as confusing as the Fund itself. One must wonder why the annual goal is $125,000 when the Fund had, according to the report of audit, assets over liabilities of $3,241,000 in the year ending June 30, 1970. The Indenture of Trust may be amended by corporate action of the As sociation. May I call to your attention that in 1970 the House of Delegates recommended study in this area. Let us hope this study will soon be fruitful, and different in final form from that to be pre sented to the House of Delegates next month by the Council on Relief. [Two resolutions dealing with the Indenture of Trust were referred by the House of Delegates to the Council on Relief for further study; one resolution was rejected.] Perhaps a moratorium should be placed on the initiation of appeals, for besides the aforemen tioned Relief Fund and hurricane Camille, we have the American Fund for Dental Education, the Fine Arts Fund, the Harold Hillenbrand Fel lowship Fund, Merritt Rare Book Fund, ADA Foundation, and Perry J. Sandell M anorial Schol arship Fund. These are all fine and worthy causes, but perhaps a United Fund or Red Feather Cam paign approach might be a more practical plan for solicitation of funds from our members. ■ Legislative representation: Legislation is an area of which this Easterner believes all members of the ADA can be proud. The fine efforts of our Washington Office plus the endeavors of our Council on Legislation merit the compliments to all. There are goals that are not attained, but this does not detract from the efforts of those involved. It follows, too, that the American Dental Po litical Action Committee (ADPAC) merits the support of the ADA. In some fashion a more con centrated effort of aid should be engendered for this activity. Perhaps ADPAC could be added to the United Fund or Red Feather Campaign list of the aforementioned appeals. ■ Policy control: One concern of many den tists is the question of some representatives of the ADA appearing before legislative bodies and of fering statements that may not reflect the policy of the ADA. The House of Delegates is the pol icy-making organization of our Association, and it seems rather obvious that only its commitments, not personal opinions, should be offered. As
Veale3 stated, addressing the ADA Second R e gional Conference: “None of us here is so naive as to think that the present control of this Asso ciation rests in the House of Delegates. For in stance, action in San Francisco didn’t kill the Sur vey o f Dentistry . . . it only drove it underground. The material still seems to surface for every Con gressional hearing.” One must wonder, too, how much control of our policy-making machinery rests in the hands of the Board of Trustees of the ADA. This East erner has been consistently amazed over the years at the number of constituent resolutions rejected by the Board This year is no différait. Nineteen constituent resolutions were submitted, and two were approved. One is the change in the name of the Rhode Island association. The other is no more terrifying: the Massachusetts Resolution on Re-Evaluation of Advisory Opinion No. 2 under Section 20 of the Principles o f Ethics. If the House of Delegates is still the policy making body of our Association, it would seem that constituent resolutions should be passed by the Board of Trustees without comment if they are not in conflict with the Constitution, Bylaws, or Principles o f Ethics of the ADA. As a corol lary, it is also rather interesting that the Board of Trustees consistently approves resolutions sub mitted by the Councils. Again, this year is no différait. Board Reports, Report 2 covers 26 res olutions submitted by ADA Councils. Twentyfour are marked for approval; one is amended, and one the Board recommended be postponed indefinitely. Are constituent societies that poorly informed and advised about what is best for the ADA? Are the Councils that knowledgeable and astute in policy-making areas? Or are there other reasons? ■ States’ rights and auxiliaries: Represented at this conference today are the states of Delaware, Maryland, New Jersey, New York, and Pennsyl vania, as well as the District of Columbia. In 1967, all of you were told by the House of Dele gates to determine if you wished, and in what manner, to expand the duties of auxiliaries. You were directed by the House to work in concert with state dental examining boards to consider recommending changes in the dental practice acts. Hillenbrand4 has stated: “The problan of states’ rights is traditional in this country. It isn’t going to change and I am not sure it should be changed.” Timmons5 also has stated: “Problems will be solved at the local level and not by the M u lle n : AN E A S T E R N E R L O O K S A T T H E A D A ■ 7 3 7
leaders in dentistry.” The evidence emanating from the ADA, and even this program itself, sug gest there are those who do not wish to leave this to the states. One must wonder why. If the ADA insists on injecting itself into this states’ rights matter, this Easterner would suggest it de velop some new concept other than fear and man power shortage to utilize, as well as to encourage, better trained hygienists and assistants. Present statistics and reliable studies do not substantiate a shortage of dentists, at least in New York state. There is, of course, a maldistribution of dentists throughout the country. But the rem edy of this problem is certainly not the fragmenta tion of our profession. Permit me a quote from Warnecke,6 a member of the council on education of the Dental Society of the State of New York: In spite o f the evidence, the government (HEW), the dental schools (with the threat o f withholding o f funds if they fail to participate in pilot projects) and the American Dental Association have been rushing headlong into an ever increasing drive for a broad delegation o f duties for auxiliaries. A close scrutiny o f the pilot programs and studies leaves no doubt as to the frightening scope o f the ultimate aims. Their aim is great and envisions a large army o f “tooth carpenters.” I f this m ost vocal group (aided by the resources o f the American Dental Association public information office and publications) continues on its present course, the dental profession will have presented the American public with a plethora o f substandard den tistry and will have forever relinquished its previous goal o f excellence in dental treatment.
■ Third party programs: I am sure that those of you who play such an active role in organized dentistry would agree with me that no area of concern has taken more of your time than what we call third party programs. If ever constituent and component societies were facing agonizing questions and problems, if ever constituent and component societies were in need of sound ad vice from the national level (for basically these are national problems), it is in this area of the third party. The ADA Task Force Report on National Health Programs will soon be considered by the House of Delegates. The 93 recommendations contained in the report hopefully will be re solved as a pattern of compliance for methods of approach in third party negotiations.Intrinsic problems of our profession frequently can be re 7 3 8 ■ JA D A , V o l. 8 4 , A p r il 1 9 7 2
solved with a minimum o f time and debate. The extrinsic problems become quite another matter. For in the immediate past and as far in the future as one dares to look, the relationship is no longer a romance of dentist and patient. We now have become a triangle, and this, as in most phases of life, has great inherent problems. Whether you are content or saddened by this professional change of life, I submit that no panacea or magic formula can be offered to stop it. Never more in my life do I wish I were wrong. [Guidelines for Dentistry’s Position in a National Health Program was adopted by the House of Delegates at the 1971 annual session.] If the ADA also accepts third party interven tion as a fact of life and it’s obvious that it does, every energy and resource at its command should be directed to making certain that the rights, duties, and obligations of the profession are pro tected Only through a strong, viable profession can the dental health of this nation be main tained as the finest in the world Only through an informed dedicated membership, which comes from an informed dedicated leadership, can all who need dentistry be granted the right to den tal health, which we now are told is actually a right, not a privilege. The American dentist has it within his capac ity to deliver dental care, to resolve the oral prob lems, and to promote the general objectives of our profession if he is informed properly and is motivated correctly. This is a tall order to place on the shoulders of the leadership of the ADA, but to whom else do we turn? The alternatives are terrifying. Let us be certain they never have to be faced
Other specific areas of concern Time does not permit the elaboration of other areas of activity to which many Easterners would hope the ADA could give greater attention. Per mit me to list without comm a it some of them: — Better concepts for the broader acceptance of continuing education, even if it is made man datory. — The importance of honest cost analysis for the determination of equitable remuneration in private practice and funded health care programs. — The importance of utilization of legal coun sel in all public relations. — Possible change in ADA annual sessions format by the addition of an extra day for dele
gate caucus evaluation o f reference committee re ports before they reach the floor. The physical mechanics now limit proper study in conference and lead to a sloppy “House.” [The 1972 annual session will begin a day earlier than usual. See AD A News, Dec 20, 1971.] — Added concern for the member in Associ ation-sponsored insurance programs. Thus are offered for your consideration specific areas of concern in which this Easterner believes the ADA could lend greater efforts and talents.
General areas of concern There are, however, general areas of concern that are more frightening. This is probably due to a national malady of utter lack of regard or in terest and general apathy in all things. I do be lieve we are becoming a nation and, yes, a pro fession that is willing and eager to let others shoulder the load. I do believe we are a nation suffering from a lack of individual responsibility. This is expe dited in its development by those who say: “Give me the money, and I’ll do it for you or take care of you.” As we visualize the disproportionate growth of the ADA, one must wonder if we are also guilty. History tells us that a system of feudalism de veloped between the ninth and fifteenth centuries wherein the serfs and vassals looked to their lord for care and protection. Somewhat the same sys tem is developing today as we abandon the rigors of individual responsibility for the assurance of others that “they” will take care of us. I fear we are heading toward professional serfdom. Professionally educated people should know that abandonment of responsibility and duty to others is a certain way to lose freedom. The free dom of a profession is proportionate to its assump tion of responsibility. A certain way for the pro fessional individual to lose his privileges and prerogatives is to assign or to abandon his duties and responsibilities to a hired staff, such as the ADA, or to a government bureau.
Principles of staff functions The staffs of ADA and of government have dif ferent perspectives from those of the individual
professional. By the very nature of their duties this must be so. There develops a tendency to reduce the number of variables in a given situ ation so that it can be better managed. This is a first principle of administration. With such reduc tion of variables the freedom to be different, in other words, to be an individual, is lost. Such loss of freedom is not a complicated process— but it is a gradual one. The past 30 years is sufficient history of the world to prove this point. I think everyone today is well intentioned. No one has ulterior motives. I f there is a conviction in our society that certain systems are better than others, if some areas are to be protected from en croachment, then there must be a resistance at some point. This begins with the individual and his willingness to shoulder responsibilities and to do his duty. Apathy, indolence, and self-interest are the precursors of professional default.
Self-appraisal The profession should look at research, at edu cation, and at the delivery of services and should determine whether the money spent for dental research in all areas has been of benefit and whether dental education has been meeting its obligations or has been developing systems of self-interest. The researchers look at research, the educators look at education, the practition ers look at practice, and all agree that what is needed is more money. We have spent more money in the past ten years than in any prior time, yet all say we are worse off in every dimen sion. How come? What is needed is a peer re view of the entire profession to test its perfor mance in society—not to describe it. I think the profession should devise a performance apprais al of dentistry, including in it: its own organiza tional systems; the ADA and the constituent and component societies; the specialities; the demand for and the performance of dental services in private practice, in federal services, and in other delivery systems; the effectiveness of research programs; and the qualities of the dental educa tional system. Such a report would reflect the competency of the profession and would assure society that we have made a composite peer review of our over all performance and are professionally respon sible to society. If such a task is too big for the profession, if it is afraid of what it might learn about itself, then M u lle n : AN E A S T E R N E R L O O K S A T T H E A D A ■ 7 3 9
I question its right to continue as a profession within the design of our society. The pluralistic nature of our society structure demands that we have a free system of profes sions, as this is the “best buy” for the public. It is a prime responsibility of a free profession to monitor its own metabolism and not to enhance its own interests, but to better serve the public. Being free and responsible, it can do this; by doing so, it can continue to be free and respon sible. In this brief presentation are offered some ran dom thoughts collected over a short period of 30 years, representing personal as well as colleagues’ opinions as we look at the ADA. Obviously we would be remiss not to offer the gratitude of these three trustee districts to those within our geographical areas who have served us so well. To the presidents of the ADA, trust ees, delegates, council members, and all who have accepted responsibility on a national level,
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you have the personal satisfaction of service to your profession as well as esteem of all members of the ADA for your devotion to the cause of dental health.
Dr. Mullen is president of the Dental Society of the State of New York. His address is 283 E 17th St, Brooklyn, NY 11226.
1. Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 2. O'Connell, T.J. “ Help thy neighbor.” A treatise on re lief. NY State Dent J 37:234 April 1971. 3. Veale, J.B., Jr. A Southwesterner looks at the Ameri can Dental Association. Second ADA Regional Conference, New Orleans, March 1971. 4. Hillenbrand, H. Cited in Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 5. Timmons, G. Cited in Phillips, P.T. This I believe. NY J Dent 33:96 March 1963. 6. Warnecke, R. Personal communication.