Practice of orthodontics health guidance
under public
T
ime was when the newly graduated dentist soon found himself isolated within the four walls of his office. Unlike the young physician, who looked forward to a hospital staff appointment, the dentist regarded the occasionally available hospital dental clinic appointment as offering little more than the practice of tooth extraction and episodic tooth cleaning which was of little avail to the patient as a preventive dental hygiene measure. Today the concern of the dentist, whether specialist or general practitioner, is no longer limited to arrangements between himself and his patient. Not only does the dentist have to satisfy his patient’s needs; he must do so by adhering to the prescribed rules, regulations, and guides specified by the “fourth party”-the official government (federal, state, and local) public health administrators-in addition to rules laid down by the “third party”-the private sector that pays the fee. Of more than academic interest to general dental practitoners and specialists alike is the recently published Report to the President &d Congress on the Status of Health Professional Personnel in the United States by the Department of Health, Education and Welfare (HEW).’ Such a report is required by law under the Health Professions Educational Assistance Act (HPEAA, 1976). The law provides “for the continuation and establishment of programs to support the education and training of qualified personnel to meet the nation’s health care needs.” It provides further that the programs to be established should be directed toward the improvement of primary care availability through the more equitable geographic distribution of health professional personnel. An important goal of the HPEAA is tocontrol the cost of health care. There were approximately 10,828 dentists (10 percent of all private practitioners) in 1976 who limited their practice to one or more of the eight dental specialties recognized by the American Dental Association. Of the foregoing number, 4,499 (63 percent) specialized in orthodontics. During the same year (1976) the American Association of Orthodontists had a membership of 8,321 specialists. In 1976 there were 1,904 students registered in graduate dental educational specialty programs, of whom 758 were preparing to practice orthodontics. Orthodontic specialists were located mostly in large urban centers and their adjacent suburbs and in the vicinity of dental schools. There were four states with fewer than 2 specialists of any type per 100,000 population. The State of Washington averaged 9.3 specialists, and California, New Jersey, Massachusetts, and New York each averaged around 7 specialists per 100,000 population. According to the Report, the immediate manpower problem in dentistry does not lie in the number in practice but in the inadequacy of geographic distribution of manpower. More than 80 percent of the counties in the United States have fewer than 200 dentists which is the average ratio per 100,000 population. 2 There are now two federally funded 0002-9416/79/070103+02$00.20/0
@ 1979 The C. V. Mosby Co.
103
104
Ediroricil
programs intended to correct the manpower maldistribution. New dental graduates are forgiven student loans if they agree to practice in dentally undermanned counties with ratios of 5,000 or more population per dentist.” Dental fees have not undergone the same inflationary rise as some other components ot expenditures for health care. The consumer price index for all health care between 1967 and 1975 was 179. while that for dentistry reached only 161.9. Costs of conducting a dental office increased 100 percent. Decrease in the cost of dental care has failed to show a corresponding increase in demand for service. It was found also that demand for dental care is sensitive to general economic conditions and that dental care is postponed when a downturn in the general economy threatens. In the final analysis, demand for service depends actually on the behavioral attitude of the various strata of the population toward the observance of periodic dental care and their appreciation of “straight teeth.” A strong and direct relationship is believed to exist between the use of “extended function dental auxiliaries” (EFDA) and the number of patient visits per week to the dentist. The number of visits per general practitioner varies from an average of 45 offices without a dental auxiliary to 60, an increase of 15 visits, in 11 offices with one auxiliary. However, the advantage of using extended function dental auxiliaries is selflimiting. The number of dentists required to supervise more than three auxiliaries becomes a factor in the fee scale. As stated in the Report, plans for meeting the health care needs are “work in progress” at present. The problem is as yet far from resolved with respect to not only the professional distribution of manpower but also the behavioral attitude of the public to acceptance of dental care.’ We can deduce from the Report that stress placed by government on dentists advertising directly to the public, the increased use of auxiliary personnel, and the elimination of the cost factor through prepayment programs do not offer an immediate solution to increasing the dental health of the population without a dental health program, especially for children. J. A. Salzmann REFERENCES I. A report to the President and Congress on the status U. S. Department of Health, Education and Welfare 2. &ambler, H. V.: Health manpower for the nation-A Health Rep. 94: 3- 10, 1979. 3. Berman, B. U.: Three-year programs in medical and 85-87, 1979. 4. Salzmann, J. A.: Is prepayment the answer to increased
of health professions personnel in the United (HEW), August, 1978. look ahead at the supply and the requirements, dental
schools;
an appraisal,
dental care? AM. J. ORTHOD.
Public
Health
56: 303-304,
States, Public Rep. 94: 1969.
under public
T
ime was when the newly graduated dentist soon found himself isolated within the four walls of his office. Unlike the young physician, who looked forward to a hospital staff appointment, the dentist regarded the occasionally available hospital dental clinic appointment as offering little more than the practice of tooth extraction and episodic tooth cleaning which was of little avail to the patient as a preventive dental hygiene measure. Today the concern of the dentist, whether specialist or general practitioner, is no longer limited to arrangements between himself and his patient. Not only does the dentist have to satisfy his patient’s needs; he must do so by adhering to the prescribed rules, regulations, and guides specified by the “fourth party”-the official government (federal, state, and local) public health administrators-in addition to rules laid down by the “third party”-the private sector that pays the fee. Of more than academic interest to general dental practitoners and specialists alike is the recently published Report to the President &d Congress on the Status of Health Professional Personnel in the United States by the Department of Health, Education and Welfare (HEW).’ Such a report is required by law under the Health Professions Educational Assistance Act (HPEAA, 1976). The law provides “for the continuation and establishment of programs to support the education and training of qualified personnel to meet the nation’s health care needs.” It provides further that the programs to be established should be directed toward the improvement of primary care availability through the more equitable geographic distribution of health professional personnel. An important goal of the HPEAA is tocontrol the cost of health care. There were approximately 10,828 dentists (10 percent of all private practitioners) in 1976 who limited their practice to one or more of the eight dental specialties recognized by the American Dental Association. Of the foregoing number, 4,499 (63 percent) specialized in orthodontics. During the same year (1976) the American Association of Orthodontists had a membership of 8,321 specialists. In 1976 there were 1,904 students registered in graduate dental educational specialty programs, of whom 758 were preparing to practice orthodontics. Orthodontic specialists were located mostly in large urban centers and their adjacent suburbs and in the vicinity of dental schools. There were four states with fewer than 2 specialists of any type per 100,000 population. The State of Washington averaged 9.3 specialists, and California, New Jersey, Massachusetts, and New York each averaged around 7 specialists per 100,000 population. According to the Report, the immediate manpower problem in dentistry does not lie in the number in practice but in the inadequacy of geographic distribution of manpower. More than 80 percent of the counties in the United States have fewer than 200 dentists which is the average ratio per 100,000 population. 2 There are now two federally funded 0002-9416/79/070103+02$00.20/0
@ 1979 The C. V. Mosby Co.
103
104
Ediroricil
programs intended to correct the manpower maldistribution. New dental graduates are forgiven student loans if they agree to practice in dentally undermanned counties with ratios of 5,000 or more population per dentist.” Dental fees have not undergone the same inflationary rise as some other components ot expenditures for health care. The consumer price index for all health care between 1967 and 1975 was 179. while that for dentistry reached only 161.9. Costs of conducting a dental office increased 100 percent. Decrease in the cost of dental care has failed to show a corresponding increase in demand for service. It was found also that demand for dental care is sensitive to general economic conditions and that dental care is postponed when a downturn in the general economy threatens. In the final analysis, demand for service depends actually on the behavioral attitude of the various strata of the population toward the observance of periodic dental care and their appreciation of “straight teeth.” A strong and direct relationship is believed to exist between the use of “extended function dental auxiliaries” (EFDA) and the number of patient visits per week to the dentist. The number of visits per general practitioner varies from an average of 45 offices without a dental auxiliary to 60, an increase of 15 visits, in 11 offices with one auxiliary. However, the advantage of using extended function dental auxiliaries is selflimiting. The number of dentists required to supervise more than three auxiliaries becomes a factor in the fee scale. As stated in the Report, plans for meeting the health care needs are “work in progress” at present. The problem is as yet far from resolved with respect to not only the professional distribution of manpower but also the behavioral attitude of the public to acceptance of dental care.’ We can deduce from the Report that stress placed by government on dentists advertising directly to the public, the increased use of auxiliary personnel, and the elimination of the cost factor through prepayment programs do not offer an immediate solution to increasing the dental health of the population without a dental health program, especially for children. J. A. Salzmann REFERENCES I. A report to the President and Congress on the status U. S. Department of Health, Education and Welfare 2. &ambler, H. V.: Health manpower for the nation-A Health Rep. 94: 3- 10, 1979. 3. Berman, B. U.: Three-year programs in medical and 85-87, 1979. 4. Salzmann, J. A.: Is prepayment the answer to increased
of health professions personnel in the United (HEW), August, 1978. look ahead at the supply and the requirements, dental
schools;
an appraisal,
dental care? AM. J. ORTHOD.
Public
Health
56: 303-304,
States, Public Rep. 94: 1969.
