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New Survey of Dentists
THE J O U R N A L of the
AMERICAN DENTAL ASSOCIATION M id -M o n th ly Issue V ol. 30
F E B R U A R Y 15, 1943
No. 4
P r o c u r e m e n t and A ssig n m e n t S e r v ic e P l a n s N e w S u r v e y an d C l a s sif ic a t io n o f D e n t ist s
T h e Procurement and Assignment Service has requested new state surveys in order to determine “ the status of the dentists remaining in civilian life.” Four new classifications, based on whether a dentist is “ available” or “ essential,” have been created. In addition, criteria have been established for determining the es sentiality of dentists who provide com munity dental care and of those who serve institutions and related groups. T h e following statement covering the details of the survey and classification was issued by the Directing Board of the Procurement and Assignment Service, January 15 :
SURVEY .— In
order that the Procurement and Assignment Service may have accurate in formation as to the status of the dentists re maining in civilian life, it is essential that an immediate appraisal of these dentists be made and a summary report submitted to the Cen tral Office in Washington. Such a report will be requested from all state chairmen within the next month. Before that time, records
should be set up in the State Procurement and Assignment Service offices that will furnish the information necessary for rede termination of availability and for establish ment of the order of call for dentists who will be asked to seek commissions during 1943. As soon as the cards are complete, the state chairmen will be in a position to compile reports to be sent to the Central Office when requested some time in Febru ary 1943.
c l a s s i f i c a t i o n . — For the purpose of this nation-wide report each dentist should be classified in one of the following categories: Class I. Available A. Potentially qualified for service, i. e., has not been rejected by Army. 1. Unmarried, or married but not main taining a home with wife and/or children. 2. Married and maintaining a bona fide home with wife and/or children. a. Married with no children. b. Married with 1 child. c. Married with 2 children. d. Married with 3 children. B. Not eligible, on account of age, physi-
Contents Government . . . ............ ................... 349 New Survey of Dentists........................... 34! Bureau of Public Relations....................... 350 W ar Service Committee...........................344 Central Office ..................................... 347 Committee on Legislation.......................... 351 Dental Societies ....................................348 Medicine .............................................. 351 British Dental Association........................ 352
341
342
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A sso c ia t io n
cal disability, or other reason, for service with armed forces, but considered available for civilian dental services associated with the war effort. Class II. Essential for limited duration or until a replacement can be secured. A. For community dental care. B. For dental teaching or war research. C. For hospital service. D. For public health. E. For industry. Class III. Essential for unlimited dura tion. A. For community dental care. B. For dental teaching or war research. C. For hospital service. D. For public health. E. For industry. Class IV . Dentists not available for either military or emergency civilian services be cause of: A. Physical disability or age. B. Ethical and professional shortcomings. C. Retirement or engagement in work not directly or indirectly connected with the field of dentistry.
DEFINITIONS OF c l a s s e s . — Class
I. Den tists considered available during the war for service other than in their present situations. Class IA. Male dentists under 45 years of age presumably physically qualified for serv ice, with sub-classes 1 and 2 indicating the order of call in conformity with Selective Service laws and regulations. For example, a dentist, considered available, who is under 45 years of age and maintaining a home with wife and two children would be clas sified as IA-2C. Class IB. M ale dentists under 45 years of age who have been rejected for military duty but who are able to carry on civilian work; males over 45 who might be willing to relocate; females and aliens not included in other classes. Class II. Dentists' for whom it is assumed that satisfactory substitutes may be obtained and those who may be released as a result of changes in their personal situations or in conditions affecting the institutions employ ing them. Class HI- Essential dentists for whom, ac cording to present conditions, the chances
are small of finding a satisfactory replace ment. Class IV . Dentists who cannot be ex pected to contribute to dental service. Class IV A . Dentists with marked physical disabilities, including old age, which make them incapable of practicing their profes sion. Class IVB. Dentists who, because of un ethical conduct or professional incompe tence, are not acceptable for service in the community or elsewhere. Class IV C . Dentists who are retired from activities connected with dental care and those who have been engaged in occupations unrelated to dentistry for so long that their return to dental work is not feasible.
COMMUNITY DENTAL CARE.— As
a basis of planning on a national scale, an over all ratio of one effective practitioner of dentistry to 2,500 population has been adopted by the Directing Board of the Pro curement and Assignment Service as the minimum below which it would be unsafe to reduce civilian dental service. In any specific area of dental practice the ratio should, as a rule, be not more than 5,000 population to one effective practitioner, par ticularly in military and war production areas. Obviously, the ratio of 1 ¡2,500 cannot be applied to local communities or even to all states. There are many portions of the country and even some states which never have had this ratio of dentists to popula tion. Many of these areas could not support more dental service than they have had, which, in some instances, has been not more than one dentist to 4,000 or 5,000 popu lation. From such areas obviously no den tists should be withdrawn or permitted to enter the armed services unless replacements can be obtained. Indeed, in some of these areas dentists should be added. In general, the basis for the designation of dentists in private practice as available or essential will vary with the number of dentists in the community, the area of the community and the population thereof. Rural and Isolated Communities with Less Than Ten Private Practitioners. The following elements are to be considered: (1) number and age of other private prac
M id - M o n t h l y I s s u e titioners in the community; (2) the dentist’s specialty, if any, and (3) distance from other communities with available dental facilities. Among the practitioners under 45 years of age, the only specialist of a kind in the community should be considered essential (IIA or IIIA ) unless the distance between the community in question and another possessing similar specialists is small enough to permit these specialists to serve both communities. (In general, it is to be ex pected that the only specialist will be de clared essential even though under 45 years of age.) Aside from the only specialists, none of the practitioners under 45 years of age should be considered essential either tem porarily or permanently for civilian dental care (Classes IIA or IIIA ) except those who are needed to keep the patient-load of the remaining dentists at a feasible level. This level will vary from place to place depending upon the prewar status of dental facilities in the particular community. If any dentists are to be withdrawn from such communities, their selection should be made from the dentists under 45 years of age in accordance with the order of call outlined previously (see IA — 1 and 2). In case an isolated rural community possesses only one effective practitioner, he should be declared essential irrespective of his age and placed in Class IIA or IIIA . If there are two effective practitioners in a community for which one is adequate and both are under the age of 45, the one who would be subject to earliest call by Selective Service should be declared available. For example, if one of two practitioners under 45 is single and the other married with two children, the former dentist is to be declared available. For communities which are not within the transportation system of an urban center and which contain less than ten practition ers, the same considerations hold as for the rural and isolated communities. However, if the distance to the urban center can be easily traversed, the only specialist of a kind need not in all cases be classed as essential. An additional element to be considered is the flow of patients from rural and suburban communities to urban centers. As a result of this flow, communities with an inflow of
343
patients require more dentists relatively than do those with an outflow. Communities with Ten or More Private Practitioners. The factors to be taken into account include: (1) number and age of effective private practitioners; (2) geo graphic distribution of practitioners (es pecially in the large cities); (3) inflow of patients from outside the city and (4) the dentist’s specialty. T he inflow of patients to urban com munities for dental care may in certain cases be considerable, and allowance should be made for this in determining the poten tial patient-load of the dentists of the com munity. Practicing dentists under 45 years of age who are not essential to dental schools, hos pitals, public health services or war indus tries will be considered available in Class IA or IB except for the number needed to carry the patient-load in excess of that which the dentists 45 years and older can handle. If some dentists under 45 are to be consid ered essential, they should be selected in conformity with the order of call, outlined previously. Specialists under 45 years of age in urban communities are usually available unless they are on the essential lists of hospitals or dental schools or unless their practice is limited to outlying districts or circumscribed communities within the city which cannot be adequately served by other practitioners in the same specialty.
INSTITU TIO NS. — In
determining the essenti ality of a dentist whose professional activities are part of those performed by an organized dental group, whether hospital, dental school, industrial organization or independent group clinic, due consideration should be given to the dentist’s contribution to the completeness of the service given by the group. An organization is more than the sum of its component parts; dentists who work together must therefore be considered in relation to the importance of the individual dentists to the adequacy of the dental service given by the institution. The total contribution of the dental service given by the institution or organization shall also be considered in rela tion to the total population served by the
344
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A sso c ia t io n
institution, clinic or organization, compared with the contribution of other dental facili ties and the population served. Criteria of Essentiality for Dental Teaching and Research. The Procurement and As
signment Service has recommended that dental schools should limit the size of their faculties to the minimum number essential for the conduct of an adequate teaching program. Lists of faculty members con sidered essential on this basis have been submitted to the Procurement and Assign ment Service by the deans of the respective dental schools (form No. 131, September 18, I942 ).
H OSPITALS. — Full-Time
Staff Interns. Un der authorization of the Surgeon General of the Navy, dental school graduates are allowed one year of internship to be completed within the twelve months following graduation be fore being called to active duty. During this period they need not be considered with the essential hospital staff unless their number affects the number of other staff members required by the hospital. Part-Time Staff. Following the same line of reasoning, a dentist giving only part-time service to a hospital or one designated as visiting dentist may be regarded as essen tial to a particular hospital only i f . he is rendering necessary services which cannot be supplied by other dentists in the com munity.
WAR SERVICE COMMITTEE P r o p o s e T e m p o r a r y L icen sin g t o R e l ie v e P e rso n n e l S h o r t a g e
T h e tem porary licensing of profes sional persons during the emergency has been proposed to relieve the critical shortage of m edical and dental personnel in certain areas of the United States. This shortage is more serious in the case of medical personnel, but preparations to extend such licensing to dentistry if
the need arises are being made in certain areas. C. W illard Cam alier, chairman of the W ar Service Committee, has issued a statement to officers and military com mittees of the state societies in which he outlines the present status of the program. His statement follow s: The matter of the critical shortages of medical and dental personnel in certain areas of the United States has been discussed by the Procurement and Assignment Service for a considerable time, and as a result thereof, this agency felt it necessary to assist the states by formulating a draft of legislation for temporary licenses during the emergency, to be used in the event the ne cessity arose. A preliminary draft of such legislation was circulated by the Council of State Governments including therein a spe cific reference to dentistry. This was based on an original action by the Procurement and Assignment Service which was subse quently amended to omit dentistry, pending further consideration. The discussions very quickly developed the fact that it would be better to prepare separate drafts of legisla tion for medicine and for dentistry and, ac cordingly, at the request of the dental mem ber of the Directing Board of Procurement and Assignment Service, a meeting was held with the Directing Board by the Executive Committee of the War Service Committee, representatives of the National Association of Dental Examiners, the chairman of the Committee on Legislation and the President Elect of the American Dental Association. As a result of this conference, the draft of legislation published later, in this article was adopted. This was subsequently approved by the Directing Board of the Procurement and Assignment Service, but, at the request of the dental member of the Board, no fur ther action is to be taken unless future de velopments absolutely require it, and then it will be left to each state. In the case of medicine, the need of such legislation is more urgent and it is likely that any steps taken in the immediate future will apply to that profession. It is recommended that each state board use the proposed material whenever in the judgment of the Board it is felt that there
AMERICAN DENTAL ASSOCIATION M id -M o n th ly Issue V ol. 30
F E B R U A R Y 15, 1943
No. 4
P r o c u r e m e n t and A ssig n m e n t S e r v ic e P l a n s N e w S u r v e y an d C l a s sif ic a t io n o f D e n t ist s
T h e Procurement and Assignment Service has requested new state surveys in order to determine “ the status of the dentists remaining in civilian life.” Four new classifications, based on whether a dentist is “ available” or “ essential,” have been created. In addition, criteria have been established for determining the es sentiality of dentists who provide com munity dental care and of those who serve institutions and related groups. T h e following statement covering the details of the survey and classification was issued by the Directing Board of the Procurement and Assignment Service, January 15 :
SURVEY .— In
order that the Procurement and Assignment Service may have accurate in formation as to the status of the dentists re maining in civilian life, it is essential that an immediate appraisal of these dentists be made and a summary report submitted to the Cen tral Office in Washington. Such a report will be requested from all state chairmen within the next month. Before that time, records
should be set up in the State Procurement and Assignment Service offices that will furnish the information necessary for rede termination of availability and for establish ment of the order of call for dentists who will be asked to seek commissions during 1943. As soon as the cards are complete, the state chairmen will be in a position to compile reports to be sent to the Central Office when requested some time in Febru ary 1943.
c l a s s i f i c a t i o n . — For the purpose of this nation-wide report each dentist should be classified in one of the following categories: Class I. Available A. Potentially qualified for service, i. e., has not been rejected by Army. 1. Unmarried, or married but not main taining a home with wife and/or children. 2. Married and maintaining a bona fide home with wife and/or children. a. Married with no children. b. Married with 1 child. c. Married with 2 children. d. Married with 3 children. B. Not eligible, on account of age, physi-
Contents Government . . . ............ ................... 349 New Survey of Dentists........................... 34! Bureau of Public Relations....................... 350 W ar Service Committee...........................344 Central Office ..................................... 347 Committee on Legislation.......................... 351 Dental Societies ....................................348 Medicine .............................................. 351 British Dental Association........................ 352
341
342
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A sso c ia t io n
cal disability, or other reason, for service with armed forces, but considered available for civilian dental services associated with the war effort. Class II. Essential for limited duration or until a replacement can be secured. A. For community dental care. B. For dental teaching or war research. C. For hospital service. D. For public health. E. For industry. Class III. Essential for unlimited dura tion. A. For community dental care. B. For dental teaching or war research. C. For hospital service. D. For public health. E. For industry. Class IV . Dentists not available for either military or emergency civilian services be cause of: A. Physical disability or age. B. Ethical and professional shortcomings. C. Retirement or engagement in work not directly or indirectly connected with the field of dentistry.
DEFINITIONS OF c l a s s e s . — Class
I. Den tists considered available during the war for service other than in their present situations. Class IA. Male dentists under 45 years of age presumably physically qualified for serv ice, with sub-classes 1 and 2 indicating the order of call in conformity with Selective Service laws and regulations. For example, a dentist, considered available, who is under 45 years of age and maintaining a home with wife and two children would be clas sified as IA-2C. Class IB. M ale dentists under 45 years of age who have been rejected for military duty but who are able to carry on civilian work; males over 45 who might be willing to relocate; females and aliens not included in other classes. Class II. Dentists' for whom it is assumed that satisfactory substitutes may be obtained and those who may be released as a result of changes in their personal situations or in conditions affecting the institutions employ ing them. Class HI- Essential dentists for whom, ac cording to present conditions, the chances
are small of finding a satisfactory replace ment. Class IV . Dentists who cannot be ex pected to contribute to dental service. Class IV A . Dentists with marked physical disabilities, including old age, which make them incapable of practicing their profes sion. Class IVB. Dentists who, because of un ethical conduct or professional incompe tence, are not acceptable for service in the community or elsewhere. Class IV C . Dentists who are retired from activities connected with dental care and those who have been engaged in occupations unrelated to dentistry for so long that their return to dental work is not feasible.
COMMUNITY DENTAL CARE.— As
a basis of planning on a national scale, an over all ratio of one effective practitioner of dentistry to 2,500 population has been adopted by the Directing Board of the Pro curement and Assignment Service as the minimum below which it would be unsafe to reduce civilian dental service. In any specific area of dental practice the ratio should, as a rule, be not more than 5,000 population to one effective practitioner, par ticularly in military and war production areas. Obviously, the ratio of 1 ¡2,500 cannot be applied to local communities or even to all states. There are many portions of the country and even some states which never have had this ratio of dentists to popula tion. Many of these areas could not support more dental service than they have had, which, in some instances, has been not more than one dentist to 4,000 or 5,000 popu lation. From such areas obviously no den tists should be withdrawn or permitted to enter the armed services unless replacements can be obtained. Indeed, in some of these areas dentists should be added. In general, the basis for the designation of dentists in private practice as available or essential will vary with the number of dentists in the community, the area of the community and the population thereof. Rural and Isolated Communities with Less Than Ten Private Practitioners. The following elements are to be considered: (1) number and age of other private prac
M id - M o n t h l y I s s u e titioners in the community; (2) the dentist’s specialty, if any, and (3) distance from other communities with available dental facilities. Among the practitioners under 45 years of age, the only specialist of a kind in the community should be considered essential (IIA or IIIA ) unless the distance between the community in question and another possessing similar specialists is small enough to permit these specialists to serve both communities. (In general, it is to be ex pected that the only specialist will be de clared essential even though under 45 years of age.) Aside from the only specialists, none of the practitioners under 45 years of age should be considered essential either tem porarily or permanently for civilian dental care (Classes IIA or IIIA ) except those who are needed to keep the patient-load of the remaining dentists at a feasible level. This level will vary from place to place depending upon the prewar status of dental facilities in the particular community. If any dentists are to be withdrawn from such communities, their selection should be made from the dentists under 45 years of age in accordance with the order of call outlined previously (see IA — 1 and 2). In case an isolated rural community possesses only one effective practitioner, he should be declared essential irrespective of his age and placed in Class IIA or IIIA . If there are two effective practitioners in a community for which one is adequate and both are under the age of 45, the one who would be subject to earliest call by Selective Service should be declared available. For example, if one of two practitioners under 45 is single and the other married with two children, the former dentist is to be declared available. For communities which are not within the transportation system of an urban center and which contain less than ten practition ers, the same considerations hold as for the rural and isolated communities. However, if the distance to the urban center can be easily traversed, the only specialist of a kind need not in all cases be classed as essential. An additional element to be considered is the flow of patients from rural and suburban communities to urban centers. As a result of this flow, communities with an inflow of
343
patients require more dentists relatively than do those with an outflow. Communities with Ten or More Private Practitioners. The factors to be taken into account include: (1) number and age of effective private practitioners; (2) geo graphic distribution of practitioners (es pecially in the large cities); (3) inflow of patients from outside the city and (4) the dentist’s specialty. T he inflow of patients to urban com munities for dental care may in certain cases be considerable, and allowance should be made for this in determining the poten tial patient-load of the dentists of the com munity. Practicing dentists under 45 years of age who are not essential to dental schools, hos pitals, public health services or war indus tries will be considered available in Class IA or IB except for the number needed to carry the patient-load in excess of that which the dentists 45 years and older can handle. If some dentists under 45 are to be consid ered essential, they should be selected in conformity with the order of call, outlined previously. Specialists under 45 years of age in urban communities are usually available unless they are on the essential lists of hospitals or dental schools or unless their practice is limited to outlying districts or circumscribed communities within the city which cannot be adequately served by other practitioners in the same specialty.
INSTITU TIO NS. — In
determining the essenti ality of a dentist whose professional activities are part of those performed by an organized dental group, whether hospital, dental school, industrial organization or independent group clinic, due consideration should be given to the dentist’s contribution to the completeness of the service given by the group. An organization is more than the sum of its component parts; dentists who work together must therefore be considered in relation to the importance of the individual dentists to the adequacy of the dental service given by the institution. The total contribution of the dental service given by the institution or organization shall also be considered in rela tion to the total population served by the
344
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A sso c ia t io n
institution, clinic or organization, compared with the contribution of other dental facili ties and the population served. Criteria of Essentiality for Dental Teaching and Research. The Procurement and As
signment Service has recommended that dental schools should limit the size of their faculties to the minimum number essential for the conduct of an adequate teaching program. Lists of faculty members con sidered essential on this basis have been submitted to the Procurement and Assign ment Service by the deans of the respective dental schools (form No. 131, September 18, I942 ).
H OSPITALS. — Full-Time
Staff Interns. Un der authorization of the Surgeon General of the Navy, dental school graduates are allowed one year of internship to be completed within the twelve months following graduation be fore being called to active duty. During this period they need not be considered with the essential hospital staff unless their number affects the number of other staff members required by the hospital. Part-Time Staff. Following the same line of reasoning, a dentist giving only part-time service to a hospital or one designated as visiting dentist may be regarded as essen tial to a particular hospital only i f . he is rendering necessary services which cannot be supplied by other dentists in the com munity.
WAR SERVICE COMMITTEE P r o p o s e T e m p o r a r y L icen sin g t o R e l ie v e P e rso n n e l S h o r t a g e
T h e tem porary licensing of profes sional persons during the emergency has been proposed to relieve the critical shortage of m edical and dental personnel in certain areas of the United States. This shortage is more serious in the case of medical personnel, but preparations to extend such licensing to dentistry if
the need arises are being made in certain areas. C. W illard Cam alier, chairman of the W ar Service Committee, has issued a statement to officers and military com mittees of the state societies in which he outlines the present status of the program. His statement follow s: The matter of the critical shortages of medical and dental personnel in certain areas of the United States has been discussed by the Procurement and Assignment Service for a considerable time, and as a result thereof, this agency felt it necessary to assist the states by formulating a draft of legislation for temporary licenses during the emergency, to be used in the event the ne cessity arose. A preliminary draft of such legislation was circulated by the Council of State Governments including therein a spe cific reference to dentistry. This was based on an original action by the Procurement and Assignment Service which was subse quently amended to omit dentistry, pending further consideration. The discussions very quickly developed the fact that it would be better to prepare separate drafts of legisla tion for medicine and for dentistry and, ac cordingly, at the request of the dental mem ber of the Directing Board of Procurement and Assignment Service, a meeting was held with the Directing Board by the Executive Committee of the War Service Committee, representatives of the National Association of Dental Examiners, the chairman of the Committee on Legislation and the President Elect of the American Dental Association. As a result of this conference, the draft of legislation published later, in this article was adopted. This was subsequently approved by the Directing Board of the Procurement and Assignment Service, but, at the request of the dental member of the Board, no fur ther action is to be taken unless future de velopments absolutely require it, and then it will be left to each state. In the case of medicine, the need of such legislation is more urgent and it is likely that any steps taken in the immediate future will apply to that profession. It is recommended that each state board use the proposed material whenever in the judgment of the Board it is felt that there