EDITORIAL

Specialty practice resolutions: A clarification*

C ONFUSIOS and uncertainty still exist over the perplexing resolutions on pre- ceptor training and specialty announcement recently adopted by the HOWW of Delegates of the American Dental Association. This is not surprising because. read separately, the several resolutions do in fact seem to conflict in purpose and content.

The first resolution was adopted in 1959. It is a part of the legislation entitled “Requirements for National Certifying Roards for Special Areas oi Dental Practice.” The pertinent sentence in this resolution relates to one -Form of orthodontic education, preceptor programs in particular. Tt reads as follows :

Until January 1, 1967, candidates entering the preceptorship program operated by tht: American Association of Orthodontists may have the study and training of such prograrnt~ accepted as a substitute for a formal education program.

The second resolution was adopted in 1961. It is concerned chiefly wit11 the professional requirements for announcement to the public of a limited or specialty practice. It reads thus:

Resolved, that after January 1, 1965, all members of this Association who have n01 previously announced limitation of practice and who desire to announce themselves a.~ limiting their practice exclusively to one of the areas approved by the American Dental Association be required to complete two or more academic years of advanced education as specified by the certifying boards, essentially all of which must be in or directly related fn the selected area, or to possess a state license permitting announcement in an area approvptl by the American Dental Association.

These two resolutions were proposed by the Council on Dental Education. This Council was also requested to consult with the Judicial Council in revising &Section 18 of the Princif)Zes of Ethics of the american Dental Association. It resulted in t,he adoption of the following resolution on specialty announcement by the House of Delegates in November, 1962:

SE(!TION 18: ANNOUNCEMENT OF LIMITATION OF PRACTICE. Only a dentist $v]lo limits 11%

prartice exclusively to one of the special areas approved by the American Dental Association

*B. F. Dewel of Evanston, Tll., president of the American Board of Orthodontics, was requested by the Editor to clarify the present situation regnnling spcLci:liiy practice. This editorial was prepared in compliamc with that reqn&.

3 6 Editorial

for limited practice may includr a statement, of his limitat,ion in announcements, cards, letterheads and directory listing,s (consistent with the custom of dentists of the community), provided at the time of the announcement, hc has met the existing educational requirements and stantlardh set Ijy the American 7kntal i\saociation for members wishing to announce limitation of practice or posswsw a state license permitting announwment in an area ap- proved by the American Dental .kwlciation.

In accord with establisimd et11 ical ruling that tlentists should not claim or imply superiority, use of tile phrases “ Spwialist in ---------- ” 01 “Specialist on ----------!’ in announcements, cards, lcttcrheads or tlirwtory listings should be discouraged. The USC of the phrase “Practice limited to -----__-_- ‘! is preferable

What does this all mean to the young man who would like to enter the exclusive practice of orthodontics! Two principles arc involved. One concerns the need for an adequate education before he can ethically announce a limited practice. The other specifies the various means by which he can attain that specialized education.

In orthodontics, this advanced education can be achieved by a minimum of two academic years of graduate or postgraduate training, or by a three-year preceptor program under the supervision of the qualifying committees of the constituent societies of the American Bssoriation of Orthodontist,s, provided that the preceptor program starts before *Jan. 1, 1967. These preceptor programs have been approved by the Bmerican Board of Orthodontics as fulfilling the educational requirements specified in the I965 resolution on limited practice announcement.

This 1965 resolution is based on the premise that adequate educational training must be a prerequisite to specialty announcement. Its purpose is to protect the public from the untrained or the poorly trained “specialist.” Ac- cording to a statement by the Council on Dental Education, this policy “differs from previous requirements for announcement of limitation of practice only in the provision that minimum educational requirements should be completed before such announcement is made.” Its effect in the future will be that of reassurance to the public, for specialty announcement will then mean that it has been preceded by proper training.

Confusion arises because there seems to be a conflict between the 1965 and 1967 deadline dates. It is true that no one can ethically announce a limited practice after Jan. 1, 1965, without first satisfying the stipulated educational requirements. The young dent,ist who wishes to become an orthodontist can meet these requirements in a recognized university graduate or postgraduate department. He can also do it by preceptorship training, provided the pro- gram has been a,pproved by the qualifying committee of a constituent society of the American Association of Orthodontists. The only limiting factor here is that the preceptorship training must be started before ?Jan. 1, 1967.

In either case, he must successfully pass the examinations of his program, whether under the jurisdiction of a university or of a qualifying committee. After he has done this, he is enWed to certain rights and privileges. These in- clude specialty announcement to the public and associate membership in the American Association of Orthodontists. After he has been an active member

for two years, he can apply for examination and certification by the American Hoard of Orthodontics. The Council and the Board also require five years of exclusive practice before the candidate can apply for Board certification. The time spent in his training program can be includcti in this five-year requiremeni.

Despite the confusion that arises between the 1965 and 3.967 dates. thtl 1967 prect>ptorship legislation remains in cffcct, and prW,~ptOI~ programs I'ill!

c3ntinue to bc arranged through qualifying committees of the American Asso- ciation of Orthodontists. Moreover, it is possible that a rtqaest, fey a.n extension of t,he 1967 terminal date will have to be madcb if the schools fail to establish sufTieient graduate programs to fill the public nectl for orthodontists. Ktartrt ltc- less, the critical younger dentist, contemplating a carprr in orthodontic’s will consider srrio-tlsly the advantages of a formal etluc~ntion over a preceptor ~)r’o- lain, for he mill realize that in another quartcl,-(~entm‘~ most of his ~~llt~a~~~c~ * will have had university graduate or postgraduate training.

\Vhat effect do these various resolutions hart on the older dentist who wol~ld like to announce a specialt,y practice prior to the 1965 deadline? Other legis- laGon adopted in 1962 lists the following requirrmt~nts: (1) The specialty arca must hare a recognized certifying board: (2) the dentist must limit his pracaticc esclusivel!- to the indicated arca; and (3) he must cithrr be a board diplornatc or be eligihlc for membership (if not already :I member j in the sp~4alt.~ s0ciet.v officiallp related to the indicated certifying ljoard. In orthodontics. th(xse organizations are the American AssocGtiolr of Orthodontists and th(k American Board of Orthodontics.

How do the Principles of Ethics fit into this picture! Soc.iety has granted to the professions certain privileges and resl)o~lsihilities. The chief responsi- bilitics arc (I) the primary duty of service to the public and (2j faducational qualifications beyond that of the usual level of mankind. Among the privileges are the right of self-government, but this also parries t-he obligation o-f’ s(!lf- discipline. The means bp which this is put into cEect is through a code xvhic~ii has been designated as the Principles of Ethics.

These principles are determined by each individual profession, and thc~ arc all much alike in substance and purpose. Kccluircmcnts are not sy(~l[& 011~ in det,ail; instead, a code of ethics provides a cdoncept in which thcl spirit r;jtllela than the letter of the law is the guiding principle in determining ethicAa1 pro- priety and professional conduct. It is this concept that sets a profession ;lp,nl,t from a craft, trade, business, or commercial venture.

Society expects each profession to establish its principles at U, high levttl and to live up to t,hem. Similar principles of ethics are also a part of evpr~ specialty ol*ganization, and both the public? and the professions expect, cac.h

specialty to maintain an exceptionally high Icvc~l of srrvicar to the public, a con)- prehensiv-e program of advanced education and experience in its particul;l rs specialty area ; and a rigid code of discipline among its members.

B. F. 71.