Ergonomic orthodontics

Ergonomic orthodontics M o NE Y is only one of the resources that limit the demand for orthodontic treatment and the utilization of health services in general. Other important factors are the availability of professional personnel and the consumer’s appreciation of health care. Under our present economy, money can always be obtained by increased taxation. Professional personnel cannot be increased by statute. To increase the productivity of professional personnel, it is recommended that employment of subprofessional or auxiliary personnel be widened. Group practice to replace the solo practice that now prevails among the health professions is another recommendation. Increased use of auxiliary dental personnel is advocated by the American Dental Association, the President’s Commission on Health Manpower, and public health agencies in general. All urge that more auxiliary personnel be trained to relieve the manpower shortage. The American Dental Association’s Council on Dental Education has rcported expanded utilization of auxiliary personnel. Of thirty-six state dental examining boards reporting, ten indicated that thedr state laws have been modified to allow dentists to assign additional duties to dental hygienists and dental assistants. The other twenty-six boards indicated that no action had yet been taken, although seven st.ated that changes in the dental practice act were being considered. In a letter to the editor of the British DentaE Journal (November, 1967), H. I. Phillips discusses “ergonomic dentistry,” a term he applies to the efficient organiza,tion and physical layout of the dental surgery and the employment of an expanded office staff a.nd auxiliary personnel that will make possible increased output. He speaks of four-handed dentistry and even of six-handed dentistry. He stat.es, in rebuttal: “Let us make no mistake, there is a lot (cash and ca.rry) in four-handed dentistry and even more in six-handed dentistry.” While Phillips may have written the foregoing with “tongue in cheek,” there is more truth than poetry in his observations, We wonder what is to become of the intimate doctor-patient relationship under the ergonomic dentistry type of practice. One of the chief complaints of patients is that the physician or dentist. is too busy to listen. The computer may be useful in diagnosis, but it offers scant comfort to the patient. It is worth our while to consider whether the depersonalization of the dental profession will benefit either the paGent, or the dentist and whether it will answer the problem of maintaining a.high quality of service while reducing costs. The President’s Advisory Commission on Health Personnel reported, in November, 1967, that experience over the past decade with the increase in popu626

Volume Number

54 8

Editorials

6 27

lation indicates that the demand for dental service will increase between 100 and 125 per cent by 1975. The number of dentists during this period is expected to increase by only about 16 per cent. On the basis of the foregoing, it would be necessary to more than double the present number of dentists being graduated annually to meet the manpower requirements. In dentistry, as in other fields of health service and social welfare, the promise is not related to performance, personnel resources, or even to funds. The development of subprofessional personnel to ameliorate the shortage of professional men and women also has its limitations. The belt-line method of manufacturing automobiles is being adapted now to other highly technical fields by fractionation of techniques into semiskilled jobs. We do not feel that the provision of funds for dental service by public or private agencies will result immediately in an overwhelming increase in the number of patients applying for treatment. At present there is little published information on utilization of health service when payment no longer is the direct responsibility of the patient. The average annual utilization among insured groups is only slightly above the 42 per cent use rate reported for the national average. The average annual use rates for the American Dental Association employees’ coverage have ranged from 52 to 60.6 per cent. Low utilization rates are disappointing. To the dental insurer, higher use rates mean deficits or higher premiums. It is not to be expected that orthodontists’ offices will be overrun by a tidal wave of patients. The demand for dental care is more elastic in relation to income than the demand for medical service. Although the cost of producing dental service has increased materia,lly, the dental share of the health dollar has actually shown a decrease in recent years. Expenditure for dental care is related to (1) education, (2) environment, (3) ways of life, and (4) genetic background. The subjective determinants that affect the degree of utilization of or-thodontic service do not necessarily apply to dental treatment in general. No one goes to the orthodontist because of an “acute attack of crooked teeth.” The demand for orthodontic treatment is motivated by the esthetic value of a pleasant smile and the general tooth consciousness of the American people which has been increased by watching television. Orthodontic service is now available for the asking under Medicaid, fringe benefits of labor unions, and, at very little extra expense, many prepaid dental service and insurance programs. Group practice is being fostered by the United States Public Health Service. The Department of Health, Education, and Welfare is now helping to finance group practices. However, there are a.syet no factual data to indicate that group practice or clinic practice significantly reduces the cost of medical care. The sa.me holds true for dental treatment. We have repeatedly pointed out that reduction of the expense involved in producing dental service is limited. There is an irreducible minimum below which dental treatment cannot be rendered. The minimum cost may yet prove to be higher in group or clinic practice than in solo practice. Studies, based on factual data, are needed to document the effects on costs, efficiency, and quality of service of group and clinic practice as compared to solo practice.

J. A. Salzmann