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Blog: FCAR
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The Best Dentist
My dentist is great! He sends me reminders so I don't forget checkups. He
uses the latest techniques based on research. He never hurts me, and I've got
all my teeth, so when I ran into him the other day, I was eager to see if he'd
heard about the new program. I knew he'd think it was great.
His reaction was not as I had predicted.
"It's quite simple, " I said. They will just count the number of cavities each
patient has at age 10, 14, and 18 and average that to determine a dentist's
rating. Dentists will be rated as Excellent, Good, Average, Below Average, and
Unsatisfactory. That way, parents will know which are the best dentists. It will
also encourage the less effective dentists to get better," I said. "Poor
dentists who don't improve could lose their licenses to practice."
"That's terrible," replied the dentist.
"What? That's not a good attitude," I said. Don't you think we should try to
improve children's dental health ?"
"Sure I do," the dentist said, "but that's not a fair way to determine who is
practicing good dentistry."
"Why not?" I replied. "It makes perfect sense to me."
"Well, it's so obvious," the dentist said. "Don't you see that dentists don't
all work with the same clientele; so much depends on things we can't control.
For example, I work in a rural area with a high percentage of patients from
deprived homes, while some of my colleagues work in upper middle class
neighborhoods. Many of the parents I work with don't bring their children to see
me until there is some kind of problem and I don't get to do much preventive
work. Also, many of the parents I serve let their kids eat way too much candy
from an early age, unlike more educated parents who understand the relationship
between sugar and decay. To top it all off, so many of my clients have well
water which is untreated and has no fluoride in it. Do you have any idea how
much difference early use of fluoride can make?"
"It sounds like you are making excuses, " I replied. I couldn't believe my
dentist would be so defensive. He does a GREAT job.
"I am not defensive!" the dentist said. "My best patients are as good as
anyone's, my work is as good as anyone's, but my average cavity count is going
to be higher than a lot of other dentists because I chose to work where I am
needed most."
"Don't get touchy, " I said.
"Touchy?" my dentist asked. His face had turned red and from the way he was
clenching and unclenching his jaws, I was afraid he was going to damage his own
teeth. "Try furious!! In a system like this, I will end up being rated average,
below average or worse! My more educated patients who see these ratings may
believe this so-called rating actually is a measure of my ability and
proficiency as a dentist. They may leave me, and I'll be left with only the most
needy patients. And my cavity average score will get even worse. On top of that,
how will I attract good dental hygienists and other excellent dentists to my
practice if it is labeled below average?"
"I think you are over-reacting," I said. "Complaining, excuse making, and
stonewalling won't improve dental health....and I am quoting from a leading
member of the DOC," I noted.
"What's the DOC?" the dentist asked.
"It's the Dental Oversight Committee," I said. "A group made up of mostly lay
persons to make sure dentistry in this state gets improved."
"Spare me," he said. "I can't believe this. Reasonable people won't buy it, " he
said hopefully.
The program sounded reasonable to me, so I asked. "How else would you measure
good dentistry?"
"Come watch me work." he said. "Observe my processes."
"That's too complicated and time consuming," I said. "Cavities are the bottom
line, and you can't argue with the bottom line. It's an absolute measure."
"That's what I'm afraid my parents and prospective patients will think. This
can't be happening, " he said despairingly.
"Now, now," I said. "Don't despair. The state will help you some."
"How?" he said.
"If you are rated poorly, they'll send a dentist who is rated excellent help
straighten you out," I said brightly.
"You mean," he said, "they'll send a dentist with a wealthy client to show me
how to work on severe juvenile dental problems with which I have probably had
much more experience? Big help!"
"There you go again," I said. "You aren't acting professionally at all."
"You don't get it," he said. "Doing this would be like grading schools and
teachers on an average score on a test of children's progress without regard to
influences outside the school, the home, the community served and stuff like
that. Why would they do something so unfair to dentists? No one would ever think
of doing that to schools?"
I just shook my head sadly, but he had brightened. "I'm going to write my
government representative," he said. "I'll use the school analogy--surely they
will see the point."
He walked off with that look of hope mixed with fear and suppressed anger that I
see in the mirror so often lately.
John S. Taylor, Superintendent
Lancaster County School District
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