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Licensure and bureaucracy
of these four offices and future re search should not duplicate present E D D A information, but rather come to terms with the basic problem of helping the dentist become more effec tive in responsible dental team man agement. JU D ITH DISNEY UN IVERSITY O F KENTUCKY COLLEGE OF DENTISTRY
Appreciates semiannual index m I think the inclusion of the semi annual index in the j a d a is an excel lent idea. The convenience of not being required to order each index is sincerely appreciated. W ILL IA M J. JASPER, DDS DALLAS
Arithmetic o f practice m The letter in the October j a d a about Medicaid deserves comment. The writer criticized dentists for dropping out when fees were reduced and coming back when fees were in creased. Either the writer attempted a giant put-on, or he does not understand the arithmetic of dental practice. Dentist ry functions as does any other busi ness, in that subacceptable fees do not permit service when overhead re mains similar. If the public has an un favorable image of this, the individual dentist or organized dentistry must forcefully inform the public that ser vice cannot be delivered when the numbers don’t work out. This always will be the case, and the sooner all involved realize this the bet ter for all concerned. TO D D W ALSH, DDS SAN JOSE, CALIF
Licensure and bureaucracy m I would like to make some com ments on E. A. Lusterman’s position on licensure (Sept j a d a , page 548). Dr. Lusterman’s indictment of fed eral bureaucracy seems to indicate he does not recognize the bureaucracy
and self-serving interests of state licensure. His suggestion that federal licen sure carries a hazard of the govern ment dictating where I might practice in the future hardly seems like a threat to me when my present state licenses limit me to two states. To relocate as a pedodontist would require testing of procedures far re moved from my area of expertise. Those who contend that a review of basic procedures is valuable are ab surd. I practice my basic skills daily. These skills fall under the area of amalgam and stainless steel restor ative procedures and minor surgical and orthodontic procedures. My own state tested me on gold restorative and prosthetic procedures. Dr. Lusterman’s appraisal of the federal government’s abilities hardly were unemotional and objective. I carry with me a license issued by the federal government and the De partment of Transportation. This li cense allows me to pilot an airplane, under instrument weather conditions, for hire. This license was issued to me with a minimum of possible bias in the application of performance standards. In fact, I must remain current in these skills and they are reviewed every 24 months. Any dentist who flies can verify the validity of the comparison. In short, the federal government certifies my skills for the public, but it doesn’t tell me where to fly in the process. This sounds like a better deal than we are getting now. It seems to me that state licensure allows too many fingers in the pie. JOHN P. STEICHEN, DDS DOW NERS GROVE, ILL
■ If not timidly accepting a status as a second-class citizen is self-serving, then Edward Lusterman is indeed very callous of my rights to migrate and set up practice in whatever juris diction I wish. Let me remind him that we are served by the same constitution, make and spend the same money, apply to the same government agency for pass ports, and also pledge allegiance to the same flag—unless, of course, den tal examiners and Dr. Lusterman pledge allegiance solely to the flags of
1252 ■ LETTERS TO THE EDITOR / JADA, Vol. 89, December 1974
their own states. By his own admission of the orig inal reasons for state licensure, the state board system is and has been obsolete for years. Why not admit that the real opponents are the “ bloc” states and they exercise too heavy an influence on the A DA. I find it difficult to follow the argu ment that national reciprocity will lead to a complete federal takeover. National licensure by itself will not do this, but the A D A ’s ineptness and dragging its feet soon will cause a split far greater than by its standing up to the local interest groups. We live in a highly mobile civiliza tion, and I seethe a little inside real izing that many other work groups can relocate far easier than dentists— members of a so-called prestigious and high-income profession. What stops the dentist from moving, let’s say, from Massachusetts to Arizona? None other than state bureaucracy, the monster that we shouldn’t tolerate on a national level but which we so readily accept as states rights. I per sonally am coming around to the view that a national monster with sensible rules is better than many small mon sters (individual states) with provin cial, political, and petty interests. If we don’t want government take over, let’s put our own house in order, and let’s start by allowing duly li censed dentists from duly accredited dental schools the same rights that an ordinary workman has—the right to work anywhere. Is it self-serving to want basic rights? Is it being intem perate and even abusive to want to be heard above the din since only by shouting do we seem to be heard? Presently, the actions of the A D A show much motion. It’s easy to make further studies and form new commit tees. Let’s get smart; all that’s needed is for the A DA to demand complete reciprocity or get a congressman to submit a bill asking for the same thing and getting a federal law passed. Doesn’t the Bill of Rights give us the same claim to equal opportunities or are we to continue to be given the privilege of second-class citizenship which seems to be fostered by the A D A ’s passivity? JOSEPH A. CROTEAU, DDS HOLYOKE, MASS
Appreciates semiannual index m I think the inclusion of the semi annual index in the j a d a is an excel lent idea. The convenience of not being required to order each index is sincerely appreciated. W ILL IA M J. JASPER, DDS DALLAS
Arithmetic o f practice m The letter in the October j a d a about Medicaid deserves comment. The writer criticized dentists for dropping out when fees were reduced and coming back when fees were in creased. Either the writer attempted a giant put-on, or he does not understand the arithmetic of dental practice. Dentist ry functions as does any other busi ness, in that subacceptable fees do not permit service when overhead re mains similar. If the public has an un favorable image of this, the individual dentist or organized dentistry must forcefully inform the public that ser vice cannot be delivered when the numbers don’t work out. This always will be the case, and the sooner all involved realize this the bet ter for all concerned. TO D D W ALSH, DDS SAN JOSE, CALIF
Licensure and bureaucracy m I would like to make some com ments on E. A. Lusterman’s position on licensure (Sept j a d a , page 548). Dr. Lusterman’s indictment of fed eral bureaucracy seems to indicate he does not recognize the bureaucracy
and self-serving interests of state licensure. His suggestion that federal licen sure carries a hazard of the govern ment dictating where I might practice in the future hardly seems like a threat to me when my present state licenses limit me to two states. To relocate as a pedodontist would require testing of procedures far re moved from my area of expertise. Those who contend that a review of basic procedures is valuable are ab surd. I practice my basic skills daily. These skills fall under the area of amalgam and stainless steel restor ative procedures and minor surgical and orthodontic procedures. My own state tested me on gold restorative and prosthetic procedures. Dr. Lusterman’s appraisal of the federal government’s abilities hardly were unemotional and objective. I carry with me a license issued by the federal government and the De partment of Transportation. This li cense allows me to pilot an airplane, under instrument weather conditions, for hire. This license was issued to me with a minimum of possible bias in the application of performance standards. In fact, I must remain current in these skills and they are reviewed every 24 months. Any dentist who flies can verify the validity of the comparison. In short, the federal government certifies my skills for the public, but it doesn’t tell me where to fly in the process. This sounds like a better deal than we are getting now. It seems to me that state licensure allows too many fingers in the pie. JOHN P. STEICHEN, DDS DOW NERS GROVE, ILL
■ If not timidly accepting a status as a second-class citizen is self-serving, then Edward Lusterman is indeed very callous of my rights to migrate and set up practice in whatever juris diction I wish. Let me remind him that we are served by the same constitution, make and spend the same money, apply to the same government agency for pass ports, and also pledge allegiance to the same flag—unless, of course, den tal examiners and Dr. Lusterman pledge allegiance solely to the flags of
1252 ■ LETTERS TO THE EDITOR / JADA, Vol. 89, December 1974
their own states. By his own admission of the orig inal reasons for state licensure, the state board system is and has been obsolete for years. Why not admit that the real opponents are the “ bloc” states and they exercise too heavy an influence on the A DA. I find it difficult to follow the argu ment that national reciprocity will lead to a complete federal takeover. National licensure by itself will not do this, but the A D A ’s ineptness and dragging its feet soon will cause a split far greater than by its standing up to the local interest groups. We live in a highly mobile civiliza tion, and I seethe a little inside real izing that many other work groups can relocate far easier than dentists— members of a so-called prestigious and high-income profession. What stops the dentist from moving, let’s say, from Massachusetts to Arizona? None other than state bureaucracy, the monster that we shouldn’t tolerate on a national level but which we so readily accept as states rights. I per sonally am coming around to the view that a national monster with sensible rules is better than many small mon sters (individual states) with provin cial, political, and petty interests. If we don’t want government take over, let’s put our own house in order, and let’s start by allowing duly li censed dentists from duly accredited dental schools the same rights that an ordinary workman has—the right to work anywhere. Is it self-serving to want basic rights? Is it being intem perate and even abusive to want to be heard above the din since only by shouting do we seem to be heard? Presently, the actions of the A D A show much motion. It’s easy to make further studies and form new commit tees. Let’s get smart; all that’s needed is for the A DA to demand complete reciprocity or get a congressman to submit a bill asking for the same thing and getting a federal law passed. Doesn’t the Bill of Rights give us the same claim to equal opportunities or are we to continue to be given the privilege of second-class citizenship which seems to be fostered by the A D A ’s passivity? JOSEPH A. CROTEAU, DDS HOLYOKE, MASS