- Email: [email protected]
Authors’ response
COMMENTARIES
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than 5 references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within 2 months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. Letters regarding articles published online ahead of print will be published after the article appears in print if the letter is selected for publication. You may submit your letter via e-mail to [email protected]; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, IL. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
GENDER WAGE GAP
I am very concerned about the April JADA commentary by Dr. Vujicic, Ms. Yarbrough, and Mr. Munson titled “Time to Talk About the Gender Gap in Dentist Earnings” (JADA. 2017:148[4];204-206). I believe JADA has done a great disservice to its readers by publishing this commentary, and I am very surprised Dr. Vujicic is associated with it. You rightly point out that the common myth that women make 77% to 79% of what a male counterpart makes is actually more around 5% after taking in account hours worked, education, and occupation. However, you stop there and declare that there are no more possibilities to account for this remaining 5% wage gap and that is where you are concerned. This is also not true. There are more possibilities, and you simply have no proof that this 5% is truly the bottom line wage gap. What is even more disturbing is that you have highlighted the sentence “The size of the gender gap in dentist earnings is striking.” You then proceed to actually list all of the reasons why there may be a wage gap. You end by saying you
630 JADA 148(9) http://jada.ada.org
need to attract more women to the profession and you need more research. From my personal experience, the most recent dental school classes are 50/50 men and women. Why do we need to attract more women to the profession? You stated that women tend to accept Medicaid and accept lower compensation packages for their first jobs. Are you actually saying we need more women to accept more Medicaid patients and lower compensation? That may not have been your intention but it certainly sounds this way. I think it was very careless to end the commentary this way or to publish something like this at all. I hope if you continue to report on this topic, you are less misleading. Since you pointed to The Washington Post as a nice summary for your points, I will leave this nice summary in support of my points: https://www.youtube.com/watch? v¼QcDrE5YvqTs
Authors’ response: Our opinion that the gender wage gap is striking is just that—an opinion. This is the essence of editorials and commentaries. We came to that opinion after comparing the gender wage gap in dentistry to those in medicine and law, as well as the gender wage gap for dentists who are the same age, in the same specialty, work similar hours, and own their practice. In labor economics, these are critical factors that account for earnings differences between men and women and must be controlled for. But how we came to our opinion is not that important, and other readers, like Dr. Iocca, will come to different opinions. This is what debate is all about. Unlike opinions, however, facts are not open to debate. Dr. Iocca states we argue that we need more women in dentistry. We do not say this. We also certainly do not argue that women dentists’ accepting lower paying jobs is a good thing. More importantly, however, we want to restate that our statistical analysis shows there is a gender wage gap that remains after you account for gender differences in variables such as age and hours worked. That is the main contribution of our research—to statistically measure the difference in earnings between male and female dentists that cannot be explained by really important factors included in our dataset. We then simply offer our viewpoint on what other variables not included in our dataset might account for the “unexplained” difference in earnings between male and female dentists. We are extremely transparent about this in both our commentary, as well as the article in the same issue summarizing the research.1 There is nothing misleading about that.
Elizabeth Iocca, DDS Associate Dentist Mark E. Iocca DDS Family Dentistry Jackson, MI
Marko Vujicic, PhD Chief Economist & Vice President Health Policy Institute American Dental Association Chicago, IL
http://dx.doi.org/10.1016/j.adaj.2017.07.015
http://dx.doi.org/10.1016/j.adaj.2017.07.016
Copyright ª 2017 American Dental Association. All rights reserved.
September 2017
Copyright ª 2017 American Dental Association. All rights reserved.
COMMENTARIES
1. Nguyen Le TA, Lo Sasso AT, Vujicic M. Trends in the earnings gender gap among dentists, physicians, and lawyers. JADA. 2017; 148(4):257-262.
ETHICS AND THIRD-PARTY PAYERS
I am writing in response to the June JADA article by Dr. Dave Preble on ethics titled “Ethical Considerations in Dental Plan Claims Adjudication” (JADA. 2017;148[6]:407-409). Is anyone else bored with discussions of honoring ethical standards while working with insurance plans? These essays are meaningless as long as we as a profession continue to be subservient to third-party payers and try to maintain our ethics. My friends, if you participate in “plans,” that ship has sailed, the genie is out of the bottle, and the horse has left the barn. There is no way that you can contractually agree to clauses like the “disallow” provision mentioned in the article and practice in an ethical manner. I might argue the same view of participation in any plan although 95% of the profession disagrees with me. By participating, you have just given the patient’s and
your autonomy to a faceless, disinterested third party. If you refuse to participate, the carriers spend a great deal of money to paint you as “not preferred,” not competent, or motivationally suspect. This should give you pause to reevaluate your purpose for practicing dentistry. The profession theoretically has the knowledge and experience to help people with their dental health. Has the consulting dentist ever examined the person needing assistance? Is this consultant aware of the patient’s circumstances, hygiene, occlusion, and level of anxiety or dental awareness? Discussions on ethics should begin with the simple question, “Am I here to provide the best health care of which I am capable, and by doing so receive remuneration, or am I here to work the system for money and maybe provide some service to the trusting public?” We have lost our way, as have most of the healing arts. Until we gain some perspective as to the place of third parties and their relationship with the profession, do not bother me with academic discussions on “working the system” and being ethical.
James S. Craig, DDS Lenexa, KS
http://dx.doi.org/10.1016/j.adaj.2017.07.017 Copyright ª 2017 American Dental Association. All rights reserved.
Author’s response: My article was written to elicit responses and dialogue on the very points you make. Far from being boring and meaningless, this is a topic that must be discussed by the profession in order to increase awareness of the gravity of these decisions and to formulate a plan to maintain our ethics and take responsibility for our actions. Responsibility must be taken for contracting decisions made by practicing dentists and by consultants and companies for the decisions they make that go beyond legitimate claims adjudication. It seems to me that you agree with that, and I appreciate you taking the time to express your opinion. Dave Preble, DDS, JD Vice President Practice Institute American Dental Association Chicago, IL
http://dx.doi.org/10.1016/j.adaj.2017.07.018 Copyright ª 2017 American Dental Association. All rights reserved.
JADA 148(9) http://jada.ada.org
September 2017 631
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than 5 references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within 2 months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. Letters regarding articles published online ahead of print will be published after the article appears in print if the letter is selected for publication. You may submit your letter via e-mail to [email protected]; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, IL. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
GENDER WAGE GAP
I am very concerned about the April JADA commentary by Dr. Vujicic, Ms. Yarbrough, and Mr. Munson titled “Time to Talk About the Gender Gap in Dentist Earnings” (JADA. 2017:148[4];204-206). I believe JADA has done a great disservice to its readers by publishing this commentary, and I am very surprised Dr. Vujicic is associated with it. You rightly point out that the common myth that women make 77% to 79% of what a male counterpart makes is actually more around 5% after taking in account hours worked, education, and occupation. However, you stop there and declare that there are no more possibilities to account for this remaining 5% wage gap and that is where you are concerned. This is also not true. There are more possibilities, and you simply have no proof that this 5% is truly the bottom line wage gap. What is even more disturbing is that you have highlighted the sentence “The size of the gender gap in dentist earnings is striking.” You then proceed to actually list all of the reasons why there may be a wage gap. You end by saying you
630 JADA 148(9) http://jada.ada.org
need to attract more women to the profession and you need more research. From my personal experience, the most recent dental school classes are 50/50 men and women. Why do we need to attract more women to the profession? You stated that women tend to accept Medicaid and accept lower compensation packages for their first jobs. Are you actually saying we need more women to accept more Medicaid patients and lower compensation? That may not have been your intention but it certainly sounds this way. I think it was very careless to end the commentary this way or to publish something like this at all. I hope if you continue to report on this topic, you are less misleading. Since you pointed to The Washington Post as a nice summary for your points, I will leave this nice summary in support of my points: https://www.youtube.com/watch? v¼QcDrE5YvqTs
Authors’ response: Our opinion that the gender wage gap is striking is just that—an opinion. This is the essence of editorials and commentaries. We came to that opinion after comparing the gender wage gap in dentistry to those in medicine and law, as well as the gender wage gap for dentists who are the same age, in the same specialty, work similar hours, and own their practice. In labor economics, these are critical factors that account for earnings differences between men and women and must be controlled for. But how we came to our opinion is not that important, and other readers, like Dr. Iocca, will come to different opinions. This is what debate is all about. Unlike opinions, however, facts are not open to debate. Dr. Iocca states we argue that we need more women in dentistry. We do not say this. We also certainly do not argue that women dentists’ accepting lower paying jobs is a good thing. More importantly, however, we want to restate that our statistical analysis shows there is a gender wage gap that remains after you account for gender differences in variables such as age and hours worked. That is the main contribution of our research—to statistically measure the difference in earnings between male and female dentists that cannot be explained by really important factors included in our dataset. We then simply offer our viewpoint on what other variables not included in our dataset might account for the “unexplained” difference in earnings between male and female dentists. We are extremely transparent about this in both our commentary, as well as the article in the same issue summarizing the research.1 There is nothing misleading about that.
Elizabeth Iocca, DDS Associate Dentist Mark E. Iocca DDS Family Dentistry Jackson, MI
Marko Vujicic, PhD Chief Economist & Vice President Health Policy Institute American Dental Association Chicago, IL
http://dx.doi.org/10.1016/j.adaj.2017.07.015
http://dx.doi.org/10.1016/j.adaj.2017.07.016
Copyright ª 2017 American Dental Association. All rights reserved.
September 2017
Copyright ª 2017 American Dental Association. All rights reserved.
COMMENTARIES
1. Nguyen Le TA, Lo Sasso AT, Vujicic M. Trends in the earnings gender gap among dentists, physicians, and lawyers. JADA. 2017; 148(4):257-262.
ETHICS AND THIRD-PARTY PAYERS
I am writing in response to the June JADA article by Dr. Dave Preble on ethics titled “Ethical Considerations in Dental Plan Claims Adjudication” (JADA. 2017;148[6]:407-409). Is anyone else bored with discussions of honoring ethical standards while working with insurance plans? These essays are meaningless as long as we as a profession continue to be subservient to third-party payers and try to maintain our ethics. My friends, if you participate in “plans,” that ship has sailed, the genie is out of the bottle, and the horse has left the barn. There is no way that you can contractually agree to clauses like the “disallow” provision mentioned in the article and practice in an ethical manner. I might argue the same view of participation in any plan although 95% of the profession disagrees with me. By participating, you have just given the patient’s and
your autonomy to a faceless, disinterested third party. If you refuse to participate, the carriers spend a great deal of money to paint you as “not preferred,” not competent, or motivationally suspect. This should give you pause to reevaluate your purpose for practicing dentistry. The profession theoretically has the knowledge and experience to help people with their dental health. Has the consulting dentist ever examined the person needing assistance? Is this consultant aware of the patient’s circumstances, hygiene, occlusion, and level of anxiety or dental awareness? Discussions on ethics should begin with the simple question, “Am I here to provide the best health care of which I am capable, and by doing so receive remuneration, or am I here to work the system for money and maybe provide some service to the trusting public?” We have lost our way, as have most of the healing arts. Until we gain some perspective as to the place of third parties and their relationship with the profession, do not bother me with academic discussions on “working the system” and being ethical.
James S. Craig, DDS Lenexa, KS
http://dx.doi.org/10.1016/j.adaj.2017.07.017 Copyright ª 2017 American Dental Association. All rights reserved.
Author’s response: My article was written to elicit responses and dialogue on the very points you make. Far from being boring and meaningless, this is a topic that must be discussed by the profession in order to increase awareness of the gravity of these decisions and to formulate a plan to maintain our ethics and take responsibility for our actions. Responsibility must be taken for contracting decisions made by practicing dentists and by consultants and companies for the decisions they make that go beyond legitimate claims adjudication. It seems to me that you agree with that, and I appreciate you taking the time to express your opinion. Dave Preble, DDS, JD Vice President Practice Institute American Dental Association Chicago, IL
http://dx.doi.org/10.1016/j.adaj.2017.07.018 Copyright ª 2017 American Dental Association. All rights reserved.
JADA 148(9) http://jada.ada.org
September 2017 631