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Specialism in a modern world
Specialism in a modern world* HAROLD Chicago,
HILLENRRAKD,
D.TI.R.
Ill.
A LITTLE less than three and one half decades ago, at the annual meeting of the Dental Society of the State of New York, an address on “Orthodontia and Its Relation to Dentistry” was delivered by John V. Mershonl of Philadelphia. In additional proof of the French proverb that “the more the world changes, the more it remains the same,” I now find myself addressing you on an almost identical topic in the sixth John Valentine Mershon Memorial Lecture. This Lecture was established in 1959 by the late Mrs. Harriet Worral Mershon, and I am honored to participate in this renewal of the annual tribute to the distinguished dentist who left such an enduring mark on the practice of orthodontics. Waugh2 says that Dr. Mershon ’ ‘ originated and developed the removable lingual arch, combined with a treatment philosophy and technique, that has continued in use for a greater number of years without basic change than has any orthodontic appliance except the plain labial arch.” Dr. Mershon left a rich heritage to his profession and his specialty of orthodontics, and it is most appropriate that he should be memorialized by the establishment of a forum from which the progress of orthodontics can be annotated, it,s present evaluated, and its future envisioned. It is also appropriate that, in this Memorial Lecture, I should have the topic of “Specialism in a Modern World” for, in a very real sense, Dr. Mershon was one of the pioneers of a dental specialty and gave much thought to the way in which orthodontics could best relate itself to the practice of dentistry and to the society which it would serve. The title of Dr. Mershon’s talk 34 years ago, “Orthodontia in Its Relation to Dentistry, ” indicated his concern that the specialist in orthodontics relate himself to the general practice of dentistry so that he could exercise his skills within the broad framework of his profession. John W. C:ardner,3 in his recent book entitled Self-Renewal, has restated Dr. Mershon’s thesis in an excellent and provocative way : *The John Valentine session of the American
566
Mershon Memorial Association of
Lecture, Orthodontists,
delivered at the Chicago, Ill.,
sixtieth annual May 4, 1964.
I~olwm? ci0 Nuw~ber
8
sp4CiN/iSnl
i-j (i 7
Specialization is a universal feature of biological functioning, observable in the ~+~ll structure of any complex organism, in insect societies, and in human social organization. /II human societies, division of labor is older than recorded history and has flourished whc~~:vr~r urban civilization has existed. Specialization involves selective emphasis on certain functions and the dropping of oih~:r functions. The human organism is capable of an unimaginably hroad range of behavioral v:~vany individual can develop only a small fraction of 111~ ation. Out of this vast range, totill.
. . .
short, specialization is biologically, socially and intellectually necessary. rcac>hes of education will always involve learning one thing in great depth. The or sc4rntist often achieves the heights of performance through intensive cultivation row sector of his potentialities. . . .
‘l’lrcl hi&d grcsxt art 1st of a WI
Tn
With this spirited defense of the specialist and of specialization, Gardner warns, as Mershon did, that the specialist must retain some of the qualities z~rtt\ characteristics of the generalist : Clearly, then, we cannot do away with specialization, nor would we wish to. Rut in III\, modern world it has extended far beyond anything we knew in the past. had, unfort,unat.c~ly. there are many tasks that can be effectively performed only I)y men and women who h:iv~ retained some capacity to function as generalists. . . Sot,e that it is not a question of doing away with the specialist,. Tt is a question of’ I’,’ taining some capacity as a generalist. . . . In human societies there is no reason why the specialist should not retain the capwit> to function as a generalist. Whether he actually does so depends partly on his mot,ivation, partly on the manner in which he was educated and partly on the nature of the organization or society in which his abilities mature.
(iardner also tells us how the delicate balance hctwecn and a generalist may be struck:
being
Education can lay a broad and firm base for a lifetime of learning and individual who begins with such a broad base will always have some capacity as a generalist, no matter how deeply he chooses to specialize. Education at develop the individual’s inner resources to the point where he can learn (and learn) on his own. It will equip him to cope with unforeseen challenges and to vcrsatilc individual in an unpredictable world. Individuals so educated will keep itself flesiblc, adaptive and innovative.
a
sp&alist
growth. ‘rhe t,o fum:tion its best will will want to survive a. a the soc*i~t!
Roth Mershon and Gardner, then, ha\c urged ~-on to be good sptcialists but not to turn away from the larger background against which you must, pr;r~tice and live. You must know deeply both the problems and the objrctivcs 01 orthodontics and of dentistry itself. And it would be of interest, to know ho\\ each member of this audience would assess his knowledge of some of the following issues which confront the specialty and the dental profession today. EDIJCATIOS. As members of the American Associat,ion of Orthodontists, you will he aware of the continuing interest your society has taken in orthodont,ic education. The recently issued brochure entitled Orthodontics: Pritwipks and Yolicics, Educational Bequiremcnts, Orgonixationnl Structure is an c~xc~ell~nt statement and one t,hat should be emulated by- a11 of the other spc<?groups. Orthodontists have shown perception in recognizing sonic of the defeci N ol the prcccptorship program, and this is the first and only group to c~stabiish a mc~chanism for regularizing and improving it,. You have also had the contq~~ to fact up to the reality that, this form of trainin g must, one day be phased out.
thus committing orthodontics, along with other learned specialties and professions, to the recognition of the necessity of formal education. With this development, it is essential that standards be sought for graduate and postgraduate education in dental educational institutions. In 1963 the House of Delegates of the American Dental Association authorized Requirements for the &p-oval of Postgraduate Programs in Dentistry to be administered by the Council on Dental Education. This will be an uncommonly difficult assignment and one which will require the full cooperation of your Council on Orthodontic Education if it is to succeed in the area of your specialty.” There are now only 39 graduate and postgraduate programs in orthodontics in 47 of the dental schools” and this number will need to be increased substantially if orthodontists in sufficient number to meet the increasing demands of a growing national population are to be produced, NUMBER AND DISTRIBUTION OF ORTHODONTISTS. As 1 have indicated, there should be concern with the total number of qualified orthodontists, as there is in the American Dental Association with the total number of dentists. You should also share the profession’s concern about the distribution of orthodontists and dentists so that these services may be available to all persons who need and want them. In this connection, you should be aware of the needlessly high barriers erected by some states, which retard the natural flow of dentists and dental hygienists from one state to another. This flow should be facilitated by the profession before an aroused public demands that corrective measures be initiated by legislative means. The dental profession in the United States should observe, and learn from, the example being given it by the European Common Market. In 1957 the Treaty of Rome bound six countries of Europe together in a Common Market whose principal purpose was to establish unity among the countries in social, economic, and political areas. At present, the treaty countries are France, Germany, Belgium, Netherlands, Italy, and Luxembourg. Many will recall that 2 years ago General de Gaulle, in effect, vetoed the entrance of the United Kingdom, thus negating the membership applications of Norway, Denmark, Sweden, Spain, and Switzerland. The 1957 treaty provides that in 12 years there will be free movement of dental and medical practitioners among the six countries and that there will be mutual recognition of each country’s diplomas and other qualifications for the practice of medicine and dentistry. This means that by the end of 1967 (the deadline has been advanced 2 years), a stomatologist graduating in Italy or France with a degree in medicine and practicing dentistry will have the right to locate and practice dentistry in Germany, where the required degree is comparable to the dental degree in the United States. I believe, with many others, that the arrangements for such six-country reciprocity will be extremely difficult to make; yet their completion is compelled by law under the treaty. If the professions cannot come to a satisfactory agreement, a solution will be imposed by the supreme authority of the European Common Market. I believe that if six countries of Europe-with different languages, different systems of education, and a historic tradition of conflict and rivalry-can effect
l~olu~lre.io Yuntber
8
Spec~i(lli.s,)r T,(i!l
a complete exchange of professional personnel, WC:in this country ought to 11~~ warned to adopt voluntarily some measures which will increase the flow of d(kllt,ists and orthodontists between the st,ates. DENTAL PREPAYMENT PLANS. One of the most significant breakthroughs in dentistry in the past decade has been the development of mechanisms for appl:,ing prepayment principles to the costs of dental care. For many years there wi:q an honest feeling in dentistry and in insurance circles that the very nature of dental diseases and malformations prevented the application of this princ:ip!!c on a sound financial and actuarial basis. This view is IJO longer tenable, since It is contradicted by a growing number of prepayment and insurance program;. In my view, the profession will be compelled to cooperate in the developnltll~t. of these programs to fulfill the growing demands of many groups for drntal health care which they now consider to be an essential part of tot,al health (‘ZIIY and a benefit of the American way of life. At the moment there are at least three mecha,nisms available for the grollp purchase of dental care: (1) the dental serrice corporation established on a not,-for-profit basis by state dental societies ; (2) the commercial insurance C:II.riers; (3) the closed panel in which a group employs dentists to provide WVvices for its members on a salary or commission basis. The American rk?Jli:ll Association believes that it is as yet too early to decide on which basis the ncc~l~ of groups can best be met and encourages further experimentation with tl~~ dental service corporation, the commercial insurance carrier, and, under limii t (1 circumstances, the closed panel. The American Dental Association has pioneered in this area by providing a comprehensive dental health care program for its employees and their ticpendents under a plan underwritten by a commercial insurance carrier. This type of program was selected because the dentists of Illinois have not yet established a dental service corporation. When such a corporation is established, the Association will review its program to determine whether better administraticirr and increased benefits can be made available through the not-for-profit,, profrssionally sponsored dental service corporation. The plan has been in effect for only 2 years, and experience already irrtlicates that some of the safeguards placed in the beginning pr0gra.m can SOC~II 1)~ removed or minimized. The program has won excellent acceptance from tl~e dentists of the Chicago area and from Association employees. The program began with a maximum benefit of $200.00 per individual and $500.00 for the entire family in the first, year. These limits have JJOW 1wt~JJ doubled to $400.00 .for the individual and $l,OOO.OO for the entire fanG1.v 1~” year. During t,he first year the deductible amount, paid by the employee as Winsurance, was $25.00 for the individual and not more than $75.00 for the i%lrlily. The deductible amount decreases in the second pear to $10.00 for thti individual and not more than $30.00 for the entire family. The insurance premium is paid by the American Dental Association and approximates $20,000.00 pl*r vear .I . The plan provides, without a deductible amount, for a semiannual ora.l examination which includes prophylaxis, oral examination, x-rays if ~iecdml.
diagnosis, and preparation of a treatment plan. Other basic bencfits are fillings, crowns and bridges, partial dentures, initial complete dentures, extraction of teeth and other oral surgery, x-rays, and periodontal treatment. The dentist receives his “usual or customary fee” for these services, and, of ctourse, the participant is permitted free choice of dentist. For basic benefits, the program pays for 80 per cent of the cost up to the annual maximum, The orthodontic benefit is an addition t,o the basic benefits and is pa.yable, after satisfaction of the deductible amount, for the reasonable expenses incurred for necessary orthodontic treatment. The treatment must commence within 90 days after the date the treatment plan is submitted. The maximum orthodontic benefit for any one individual is $400.00 during any one period of treatment, and it appears that this amount may be increased on t,he basis of experience. While dental prepayment programs under dental service corporations and commercial carriers are being developed, the cooperation of the participating dentists is most essential if the programs are to be sound and enlarge their coverage and their benefits. Certainly, it is one of the good phenomena of oui times that dental prepayment plans should be working effectively in spite of the dire predictions that were made. Yet every dentist should be aware that a savage attack is being made on dental service corporations by two organizations of dentists-the Association of American Dentists (A.A.D.) and the Council on Dental InformaGon (C.D.I.). Both are right-wing groups, and t,here is evidence that the A.A.D. is the dental arm of the John Birch Society. Neither the membership nor the financial support of either organization has ever been disclosed. Both use vicious propaganda to attack dental service corporations, and they seek to infiltrate dental societies in order to establish programs more suited to their ultraconservative philosophy. It appears to this observer that both groups are using the dental profession as a medium through which to obtain announced and unannounced objectives which are more politically than dentally oriented. As specialists and as generalists, you should be aware of this problem and assist the profession in withstanding this ideologically motivated assault, JOINT COMMISSION ON ACCREDITATION 0~ DENTAL LABORATORIES. The Arncrican Association of Orthodontists has recognized its responsibility as an important segment of the dental profession by taking membership in the Joint Commission for the Accreditation of Dental Laboratories. The Commission is composed of representatives of nine dental organizations, and its program is t,o inspect and accredit commercial dental laboratories on a national and volun tary basis. Such a program for the recognition of the competent, ethical dental laboratory has long been needed and can eventually be of great service to the profession in blunting both the illegal practice of dentistry and the drive of some dental laboratories for recognition through licensure and registration by legislative enactment. Participation in the activities of the .Joint Commission is an assuring rerninder that the American Association of Orthodontists is aware of the continuing obligation it has to the dental profession as a whole. KINGANDERSON BILI,. As generalists, orthodontists must also be aware of
legislative proposals which will affect the entire practice of dentistry. One pcntling proposal is the King-Anderson bill, which would provide hospital and nursing home benefits under the Old Age and Survivors’ Insurance (0.A.S. I). 1.1 provisions of the Social Security Act. The American Dental Associat,ion, tli(? Amcricau Medical Association, and a host of other health-related ng:cXn(JicSs are unalterably opposed to this legislation, and all of you should be in ~o\ic~h with your representatives in the Congress, advising them of your att itucl[,. If this bill is not defeated, it seems to me inevitable that, the Federal Governsmerit will expand health benefits under tht? Social Security Act and that. (:w~It nally dentistry and medicine will be overwhelmed in a federalized progr:m~. To ofkt this possibility, you should advise your representatives in your st:lt 0 legislatures that expansion of the voluntary Kerr-Mills legislat,ion, which pf’l)vidrs hc;~lt,lr benefits for the aging, should be accomplished as soon as possiblts. OTHER ITEMS. There are many other areas in which you, as specialists, should retain contact with and influence on the programs of the generalists n.s w~~I’~‘sented by the American Dental Association. The American Association of Orthodontists is to be congratulated on tile purchase of a building for its headquarters in St. Louis, for this is an achicviamerit of which you should be proud. But you should also be proud of tho 213 stor>T, 1-l million dollar headquarters building which the American Ikntal -ISsociation is erecting in Chicago. Both will have great significance in the? slat1~1~‘ of dentistry as one of the leading health professions. Your interest in the Association’s recruitment, program, its health c&cat icln program, its science fair program, its educational and research programs, alid in it)s public relations programs is eagerly solicited. By participation in ihcisr programs, as individuals and as members of the Xmerican Associat,ion of Orthotlont,istjs, you will give continuing evidence ot’ your interest in the VNIISW 01 the cntirc profession. You will demonstratc~ unequivocally that whil(J yo11 R:‘c orthodoiltisk3 and specialists, you remain l’lill~l~ll~l~~llti~ll~ gPncWrlists :rrttl dt‘!lt.ist,s.
‘l’bis catalog of problems which you ant1 thcl dental profession fact> is it\ no means a complete one, but it will suffice to show that all of us face challengcls and decisions in our specialty and in our profession. A recent statement on tltc* Pomr of the Democratic Idea indicates the faith that WC should have as dctltists and as Americans that solutions for these problems can be found and t.hat when they are they will result in a greater stature for the profession and ii1 a better dental health service for all of the people of this nation”: In the past, Americans have responded well when confronted by immediate emergencies. . The great question is whether a comfortable people can respond to an emergency tl~at is chronic: and to problems that will require a long c+fort and a sust,aincd axewise (11’ t !I(’ will and imttgination. . . . There is no alchrmy which will make the problems of the contemporary world sin~l~lw tImI they arc. . . . For nearly two centuries American tlemocrac*y provide~l the’ rrst of thP wwltl will3 a testing place for democratic principles.
572
Hillenbrand
It is still a testing place for those principlts. And the test these principles must meet is the same test they past; they must demonstrate their power to generate visions; to to lift Americans above mere getting and spending and to kindle the At the greatost moment in the American past, Americans had what free men, working together, could make of human life. The great question that the present generation of Americans the American democratic adventure can be continued and renewed life can be lit by a sense of opportunities to be seized and great
have had to meet in the set programs in motion; hopes of people elsewhere. an image before them of will answer is whether and whether American things to be done.
REFERENCES
1. Mershon, J. V. : Orthodontia and Jts Relation to Dentistry, Dental Cosmos 72: 1292, 1930. 2. Waugh, Leuman: Obituary of John V. Mershon, AM. J. ORTHODONTICS 39: 881, 1953. 3. Gardner, John W.: Self-Renewal: The Individual and the Innovative Society, New York, 1964, Harper & Row. 4. Transactions of American Dental Association, 1963, p. 35. 5. William S. Smith: Personal correspondence. 6. Prospect for America, The Rockefeller Panel Reports, Garden City, N. Y., 1961, Doubleday & Company, Inc.
HILLENRRAKD,
D.TI.R.
Ill.
A LITTLE less than three and one half decades ago, at the annual meeting of the Dental Society of the State of New York, an address on “Orthodontia and Its Relation to Dentistry” was delivered by John V. Mershonl of Philadelphia. In additional proof of the French proverb that “the more the world changes, the more it remains the same,” I now find myself addressing you on an almost identical topic in the sixth John Valentine Mershon Memorial Lecture. This Lecture was established in 1959 by the late Mrs. Harriet Worral Mershon, and I am honored to participate in this renewal of the annual tribute to the distinguished dentist who left such an enduring mark on the practice of orthodontics. Waugh2 says that Dr. Mershon ’ ‘ originated and developed the removable lingual arch, combined with a treatment philosophy and technique, that has continued in use for a greater number of years without basic change than has any orthodontic appliance except the plain labial arch.” Dr. Mershon left a rich heritage to his profession and his specialty of orthodontics, and it is most appropriate that he should be memorialized by the establishment of a forum from which the progress of orthodontics can be annotated, it,s present evaluated, and its future envisioned. It is also appropriate that, in this Memorial Lecture, I should have the topic of “Specialism in a Modern World” for, in a very real sense, Dr. Mershon was one of the pioneers of a dental specialty and gave much thought to the way in which orthodontics could best relate itself to the practice of dentistry and to the society which it would serve. The title of Dr. Mershon’s talk 34 years ago, “Orthodontia in Its Relation to Dentistry, ” indicated his concern that the specialist in orthodontics relate himself to the general practice of dentistry so that he could exercise his skills within the broad framework of his profession. John W. C:ardner,3 in his recent book entitled Self-Renewal, has restated Dr. Mershon’s thesis in an excellent and provocative way : *The John Valentine session of the American
566
Mershon Memorial Association of
Lecture, Orthodontists,
delivered at the Chicago, Ill.,
sixtieth annual May 4, 1964.
I~olwm? ci0 Nuw~ber
8
sp4CiN/iSnl
i-j (i 7
Specialization is a universal feature of biological functioning, observable in the ~+~ll structure of any complex organism, in insect societies, and in human social organization. /II human societies, division of labor is older than recorded history and has flourished whc~~:vr~r urban civilization has existed. Specialization involves selective emphasis on certain functions and the dropping of oih~:r functions. The human organism is capable of an unimaginably hroad range of behavioral v:~vany individual can develop only a small fraction of 111~ ation. Out of this vast range, totill.
. . .
short, specialization is biologically, socially and intellectually necessary. rcac>hes of education will always involve learning one thing in great depth. The or sc4rntist often achieves the heights of performance through intensive cultivation row sector of his potentialities. . . .
‘l’lrcl hi&d grcsxt art 1st of a WI
Tn
With this spirited defense of the specialist and of specialization, Gardner warns, as Mershon did, that the specialist must retain some of the qualities z~rtt\ characteristics of the generalist : Clearly, then, we cannot do away with specialization, nor would we wish to. Rut in III\, modern world it has extended far beyond anything we knew in the past. had, unfort,unat.c~ly. there are many tasks that can be effectively performed only I)y men and women who h:iv~ retained some capacity to function as generalists. . . Sot,e that it is not a question of doing away with the specialist,. Tt is a question of’ I’,’ taining some capacity as a generalist. . . . In human societies there is no reason why the specialist should not retain the capwit> to function as a generalist. Whether he actually does so depends partly on his mot,ivation, partly on the manner in which he was educated and partly on the nature of the organization or society in which his abilities mature.
(iardner also tells us how the delicate balance hctwecn and a generalist may be struck:
being
Education can lay a broad and firm base for a lifetime of learning and individual who begins with such a broad base will always have some capacity as a generalist, no matter how deeply he chooses to specialize. Education at develop the individual’s inner resources to the point where he can learn (and learn) on his own. It will equip him to cope with unforeseen challenges and to vcrsatilc individual in an unpredictable world. Individuals so educated will keep itself flesiblc, adaptive and innovative.
a
sp&alist
growth. ‘rhe t,o fum:tion its best will will want to survive a. a the soc*i~t!
Roth Mershon and Gardner, then, ha\c urged ~-on to be good sptcialists but not to turn away from the larger background against which you must, pr;r~tice and live. You must know deeply both the problems and the objrctivcs 01 orthodontics and of dentistry itself. And it would be of interest, to know ho\\ each member of this audience would assess his knowledge of some of the following issues which confront the specialty and the dental profession today. EDIJCATIOS. As members of the American Associat,ion of Orthodontists, you will he aware of the continuing interest your society has taken in orthodont,ic education. The recently issued brochure entitled Orthodontics: Pritwipks and Yolicics, Educational Bequiremcnts, Orgonixationnl Structure is an c~xc~ell~nt statement and one t,hat should be emulated by- a11 of the other spc<?groups. Orthodontists have shown perception in recognizing sonic of the defeci N ol the prcccptorship program, and this is the first and only group to c~stabiish a mc~chanism for regularizing and improving it,. You have also had the contq~~ to fact up to the reality that, this form of trainin g must, one day be phased out.
thus committing orthodontics, along with other learned specialties and professions, to the recognition of the necessity of formal education. With this development, it is essential that standards be sought for graduate and postgraduate education in dental educational institutions. In 1963 the House of Delegates of the American Dental Association authorized Requirements for the &p-oval of Postgraduate Programs in Dentistry to be administered by the Council on Dental Education. This will be an uncommonly difficult assignment and one which will require the full cooperation of your Council on Orthodontic Education if it is to succeed in the area of your specialty.” There are now only 39 graduate and postgraduate programs in orthodontics in 47 of the dental schools” and this number will need to be increased substantially if orthodontists in sufficient number to meet the increasing demands of a growing national population are to be produced, NUMBER AND DISTRIBUTION OF ORTHODONTISTS. As 1 have indicated, there should be concern with the total number of qualified orthodontists, as there is in the American Dental Association with the total number of dentists. You should also share the profession’s concern about the distribution of orthodontists and dentists so that these services may be available to all persons who need and want them. In this connection, you should be aware of the needlessly high barriers erected by some states, which retard the natural flow of dentists and dental hygienists from one state to another. This flow should be facilitated by the profession before an aroused public demands that corrective measures be initiated by legislative means. The dental profession in the United States should observe, and learn from, the example being given it by the European Common Market. In 1957 the Treaty of Rome bound six countries of Europe together in a Common Market whose principal purpose was to establish unity among the countries in social, economic, and political areas. At present, the treaty countries are France, Germany, Belgium, Netherlands, Italy, and Luxembourg. Many will recall that 2 years ago General de Gaulle, in effect, vetoed the entrance of the United Kingdom, thus negating the membership applications of Norway, Denmark, Sweden, Spain, and Switzerland. The 1957 treaty provides that in 12 years there will be free movement of dental and medical practitioners among the six countries and that there will be mutual recognition of each country’s diplomas and other qualifications for the practice of medicine and dentistry. This means that by the end of 1967 (the deadline has been advanced 2 years), a stomatologist graduating in Italy or France with a degree in medicine and practicing dentistry will have the right to locate and practice dentistry in Germany, where the required degree is comparable to the dental degree in the United States. I believe, with many others, that the arrangements for such six-country reciprocity will be extremely difficult to make; yet their completion is compelled by law under the treaty. If the professions cannot come to a satisfactory agreement, a solution will be imposed by the supreme authority of the European Common Market. I believe that if six countries of Europe-with different languages, different systems of education, and a historic tradition of conflict and rivalry-can effect
l~olu~lre.io Yuntber
8
Spec~i(lli.s,)r T,(i!l
a complete exchange of professional personnel, WC:in this country ought to 11~~ warned to adopt voluntarily some measures which will increase the flow of d(kllt,ists and orthodontists between the st,ates. DENTAL PREPAYMENT PLANS. One of the most significant breakthroughs in dentistry in the past decade has been the development of mechanisms for appl:,ing prepayment principles to the costs of dental care. For many years there wi:q an honest feeling in dentistry and in insurance circles that the very nature of dental diseases and malformations prevented the application of this princ:ip!!c on a sound financial and actuarial basis. This view is IJO longer tenable, since It is contradicted by a growing number of prepayment and insurance program;. In my view, the profession will be compelled to cooperate in the developnltll~t. of these programs to fulfill the growing demands of many groups for drntal health care which they now consider to be an essential part of tot,al health (‘ZIIY and a benefit of the American way of life. At the moment there are at least three mecha,nisms available for the grollp purchase of dental care: (1) the dental serrice corporation established on a not,-for-profit basis by state dental societies ; (2) the commercial insurance C:II.riers; (3) the closed panel in which a group employs dentists to provide WVvices for its members on a salary or commission basis. The American rk?Jli:ll Association believes that it is as yet too early to decide on which basis the ncc~l~ of groups can best be met and encourages further experimentation with tl~~ dental service corporation, the commercial insurance carrier, and, under limii t (1 circumstances, the closed panel. The American Dental Association has pioneered in this area by providing a comprehensive dental health care program for its employees and their ticpendents under a plan underwritten by a commercial insurance carrier. This type of program was selected because the dentists of Illinois have not yet established a dental service corporation. When such a corporation is established, the Association will review its program to determine whether better administraticirr and increased benefits can be made available through the not-for-profit,, profrssionally sponsored dental service corporation. The plan has been in effect for only 2 years, and experience already irrtlicates that some of the safeguards placed in the beginning pr0gra.m can SOC~II 1)~ removed or minimized. The program has won excellent acceptance from tl~e dentists of the Chicago area and from Association employees. The program began with a maximum benefit of $200.00 per individual and $500.00 for the entire family in the first, year. These limits have JJOW 1wt~JJ doubled to $400.00 .for the individual and $l,OOO.OO for the entire fanG1.v 1~” year. During t,he first year the deductible amount, paid by the employee as Winsurance, was $25.00 for the individual and not more than $75.00 for the i%lrlily. The deductible amount decreases in the second pear to $10.00 for thti individual and not more than $30.00 for the entire family. The insurance premium is paid by the American Dental Association and approximates $20,000.00 pl*r vear .I . The plan provides, without a deductible amount, for a semiannual ora.l examination which includes prophylaxis, oral examination, x-rays if ~iecdml.
diagnosis, and preparation of a treatment plan. Other basic bencfits are fillings, crowns and bridges, partial dentures, initial complete dentures, extraction of teeth and other oral surgery, x-rays, and periodontal treatment. The dentist receives his “usual or customary fee” for these services, and, of ctourse, the participant is permitted free choice of dentist. For basic benefits, the program pays for 80 per cent of the cost up to the annual maximum, The orthodontic benefit is an addition t,o the basic benefits and is pa.yable, after satisfaction of the deductible amount, for the reasonable expenses incurred for necessary orthodontic treatment. The treatment must commence within 90 days after the date the treatment plan is submitted. The maximum orthodontic benefit for any one individual is $400.00 during any one period of treatment, and it appears that this amount may be increased on t,he basis of experience. While dental prepayment programs under dental service corporations and commercial carriers are being developed, the cooperation of the participating dentists is most essential if the programs are to be sound and enlarge their coverage and their benefits. Certainly, it is one of the good phenomena of oui times that dental prepayment plans should be working effectively in spite of the dire predictions that were made. Yet every dentist should be aware that a savage attack is being made on dental service corporations by two organizations of dentists-the Association of American Dentists (A.A.D.) and the Council on Dental InformaGon (C.D.I.). Both are right-wing groups, and t,here is evidence that the A.A.D. is the dental arm of the John Birch Society. Neither the membership nor the financial support of either organization has ever been disclosed. Both use vicious propaganda to attack dental service corporations, and they seek to infiltrate dental societies in order to establish programs more suited to their ultraconservative philosophy. It appears to this observer that both groups are using the dental profession as a medium through which to obtain announced and unannounced objectives which are more politically than dentally oriented. As specialists and as generalists, you should be aware of this problem and assist the profession in withstanding this ideologically motivated assault, JOINT COMMISSION ON ACCREDITATION 0~ DENTAL LABORATORIES. The Arncrican Association of Orthodontists has recognized its responsibility as an important segment of the dental profession by taking membership in the Joint Commission for the Accreditation of Dental Laboratories. The Commission is composed of representatives of nine dental organizations, and its program is t,o inspect and accredit commercial dental laboratories on a national and volun tary basis. Such a program for the recognition of the competent, ethical dental laboratory has long been needed and can eventually be of great service to the profession in blunting both the illegal practice of dentistry and the drive of some dental laboratories for recognition through licensure and registration by legislative enactment. Participation in the activities of the .Joint Commission is an assuring rerninder that the American Association of Orthodontists is aware of the continuing obligation it has to the dental profession as a whole. KINGANDERSON BILI,. As generalists, orthodontists must also be aware of
legislative proposals which will affect the entire practice of dentistry. One pcntling proposal is the King-Anderson bill, which would provide hospital and nursing home benefits under the Old Age and Survivors’ Insurance (0.A.S. I). 1.1 provisions of the Social Security Act. The American Dental Associat,ion, tli(? Amcricau Medical Association, and a host of other health-related ng:cXn(JicSs are unalterably opposed to this legislation, and all of you should be in ~o\ic~h with your representatives in the Congress, advising them of your att itucl[,. If this bill is not defeated, it seems to me inevitable that, the Federal Governsmerit will expand health benefits under tht? Social Security Act and that. (:w~It nally dentistry and medicine will be overwhelmed in a federalized progr:m~. To ofkt this possibility, you should advise your representatives in your st:lt 0 legislatures that expansion of the voluntary Kerr-Mills legislat,ion, which pf’l)vidrs hc;~lt,lr benefits for the aging, should be accomplished as soon as possiblts. OTHER ITEMS. There are many other areas in which you, as specialists, should retain contact with and influence on the programs of the generalists n.s w~~I’~‘sented by the American Dental Association. The American Association of Orthodontists is to be congratulated on tile purchase of a building for its headquarters in St. Louis, for this is an achicviamerit of which you should be proud. But you should also be proud of tho 213 stor>T, 1-l million dollar headquarters building which the American Ikntal -ISsociation is erecting in Chicago. Both will have great significance in the? slat1~1~‘ of dentistry as one of the leading health professions. Your interest in the Association’s recruitment, program, its health c&cat icln program, its science fair program, its educational and research programs, alid in it)s public relations programs is eagerly solicited. By participation in ihcisr programs, as individuals and as members of the Xmerican Associat,ion of Orthotlont,istjs, you will give continuing evidence ot’ your interest in the VNIISW 01 the cntirc profession. You will demonstratc~ unequivocally that whil(J yo11 R:‘c orthodoiltisk3 and specialists, you remain l’lill~l~ll~l~~llti~ll~ gPncWrlists :rrttl dt‘!lt.ist,s.
‘l’bis catalog of problems which you ant1 thcl dental profession fact> is it\ no means a complete one, but it will suffice to show that all of us face challengcls and decisions in our specialty and in our profession. A recent statement on tltc* Pomr of the Democratic Idea indicates the faith that WC should have as dctltists and as Americans that solutions for these problems can be found and t.hat when they are they will result in a greater stature for the profession and ii1 a better dental health service for all of the people of this nation”: In the past, Americans have responded well when confronted by immediate emergencies. . The great question is whether a comfortable people can respond to an emergency tl~at is chronic: and to problems that will require a long c+fort and a sust,aincd axewise (11’ t !I(’ will and imttgination. . . . There is no alchrmy which will make the problems of the contemporary world sin~l~lw tImI they arc. . . . For nearly two centuries American tlemocrac*y provide~l the’ rrst of thP wwltl will3 a testing place for democratic principles.
572
Hillenbrand
It is still a testing place for those principlts. And the test these principles must meet is the same test they past; they must demonstrate their power to generate visions; to to lift Americans above mere getting and spending and to kindle the At the greatost moment in the American past, Americans had what free men, working together, could make of human life. The great question that the present generation of Americans the American democratic adventure can be continued and renewed life can be lit by a sense of opportunities to be seized and great
have had to meet in the set programs in motion; hopes of people elsewhere. an image before them of will answer is whether and whether American things to be done.
REFERENCES
1. Mershon, J. V. : Orthodontia and Jts Relation to Dentistry, Dental Cosmos 72: 1292, 1930. 2. Waugh, Leuman: Obituary of John V. Mershon, AM. J. ORTHODONTICS 39: 881, 1953. 3. Gardner, John W.: Self-Renewal: The Individual and the Innovative Society, New York, 1964, Harper & Row. 4. Transactions of American Dental Association, 1963, p. 35. 5. William S. Smith: Personal correspondence. 6. Prospect for America, The Rockefeller Panel Reports, Garden City, N. Y., 1961, Doubleday & Company, Inc.