Presidential Address
clinical examination which can be utilized by other regional boards, some of whom have already made inquiries about it. I do not need to point out that this project will eventually influence, for the better, the periodontal awareness of practicing dentists and even the thoroughness with which periodontics is taught at the undergraduate level. The Committee deserves our thanks for a job well done. The past year has seen only the beginning of a project of tremendous importance to each one of us, a Task Force to Define the Future Role of the Periodontist. It is mind-boggling to contemplate the possible limits of change in our immediate future and the forces and currents of ideas which are shaping our future, often against our will. One of the most important things we can do as a academy is to discern the outlines of that future's shape and prepare ourselves for it. The members of both the Long Range Planning Committee and the Task Force have been selected with care to investigate and prognosti cate on our future role in education, practice and third party relationships. A t this beginning point, all I can do as outgoing president is wish them all success from the bottom of my heart, and acknowledge that their job carries strong implications for our future.
by RICHARD
E.
STALLARD,
B.S.,
D.D.S.,
M.S.D., PH.D.* Distinguished colleagues, honored guests, ladies and gentlemen: It is my special privilege to welcome all of you to the Twin Cities of Minneapolis and St. Paul. The event, however, is saddened by the passing of an old friend and colleague, Norman Korn; whose efforts were instrumen tal in the selection of this site. This morning marks the opening of the 61st Annual Session of the American Academy of Periodontology. Presumably it is the 61st occasion on which a President has risen to his feet to address the assembled members and friends of the Academy and I take some comfort that my feelings have probably been shared, at least in part, by all my predecessors. The feeling is compounded of pride, gratitude, some sadness, and even a little relief. It is not difficult to explain the pride I feel at the termination of the year in which I have been privileged to serve as President of this Academy. When I first became a member of A A P I felt proud to belong to an organization with a long and honorable history in which the names of some truly great men and women of dentistry appear prominently, names like Arthur Hast ings Merritt, and Edward and Grace Rogers Spalding. But at that time, it was essentially a fairly small group of people with ideas whose time was only beginning to arrive. The years have seen dramatic changes both within and outside the Academy. I do not need to dwell on our internal changes because you are acutely con scious of how great they have been, and I believe that almost without exception the changes have been for the good of the organization. We are completing a year in which much of what we planned has been accomplished, and I would like to review some of these accomplish ments with you. Few of you may know that for over two years the Academy has been working with the Central Regional Dental Testing Service to construct and evaluate an examination in clinical periodontics to be given to every applicant for licensure in the ten states served by C R D T S . It has been a time-consuming job for the committeemen who have worked on the examination, first to construct it, and then to evaluate its strengths and weaknesses. It has involved not only the time and effort of the committemen but an outlay of Academy funds to support a workshop attended by the committee and members of C R D T S . The net result of their labor is that we have in existence a successful, tested prototype
It seems that it is impossible to address members of the health professions these days without making some reference to the implications of Professional Standards Review Organizations and peer review in general. I shall be no exception. The Committee on Oral Health Care Delivery Systems this year had the difficult—almost impossible—job of formulating and stating criteria for use by P S R O Organizations in evaluating the quality and appropriateness of periodontal therapy. On the subject of difficult-to-impossible tasks, an ad hoc committee was formed this past year to determine an approach to defining the criteria for success in periodon tal therapy, and what clinical research might be neces sary to establish a rationale for the treatment we render our patients. Y o u have seen letters to the editors challenging the very basis of periodontal therapy and questioning its ultimate usefulness in some cases. Per haps the high degree of threat we feel as we read such letters is related in a significant way to the realization on our part that we have not yet defined the criteria for success nor rationalized our treatment to the extent possible with some other disciplines. Again, I can only wish the committee well and feel exceedingly thankful that I have not been asked to serve on it. I could go on for the next hour to describe to you the activities, the problems and the accomplishments of the other 61 committees and subcommittees of the Academy. They work in important areas of acknowl edged interest to each of us—internal organization, education, research, ethics, membership, third party relationships, public and professional relations, and last but not least, this very annual session. I would not for the world slight any of them because they are the very substance of this Academy. We owe all of these dedi-
* Delivered on September 24, 1975 at the Annual Meeting of the American Academy of Periodontology in Minneapolis, Minnesota.
50
Volume 47 Number 1
cated, talented, hard working people a tremendous vote of thanks. I hope you will take the time today to look down the committee list on pages 18 to 23 of your pro gram, and that you will even go out of your way to say a personal "thank you" to these people for the way they have worked on our behalf during the year. This has been a tremendous group, and I would like to ask them all to stand at this time so we can demonstrate our apprecia tion. W i l l all the committee and subcommittee men for the year 1974-1975 kindly stand at this time? (Applause) Thank you, you may be seated. A moment ago I made reference to the necessity for discerning the outlines of our future, first as members of the dental profession and then as periodontists. I cannot tell you very much that you have not already heard from other sources about the growing importance of thirdparty payment systems. I have heard various estimates of how many patients in a given periodontal practice already possess some coverage for periodontal services. They range from negligible proportions to well over half of the patients in the practice. It is fairly safe to say that every one of us in practice has already experienced the joys and frustrations of dealing with the third-party payment world. Our regional and state network of dental health plans advisors testify to the growth of third-party arrangements and concomitant problems over the past several years. A s a segment of the dental profession, I like to think that periodontists are among the most progressive and concerned of dentists where the welfare of patients is concerned, and I have no doubt that this is true. But taken by and large, I am far from convinced that the profession at large, periodontists in general and even I in particular have fully realized the implications and accepted the responsibilities that the future holds. The President receives many letters and requests covering the spectrum of academy activities. Just this past week I received a report of a patient's experience with one of the members of our Academy. Referred by her general dentist to a periodontist, she reported that the initial interview was conducted with what she described as "an excessive zeal for business." She was asked several questions, all related to her ability to pay her bills, and was informed that he "didn't bother with insurance papers, ever." Until that part of the interview had been completed and the fee stated, the member declined to examine the state of her periodontal health. Even in recounting this, it is difficult to conceive of anyone being able to say: "I don't bother with insurance, ever." But like many other remnants of the past, this statement can have no validity in our present world. This is especially true when we consider the monumental efforts made by the Academy in establishing and publish ing the Uniform Reporting Forms, a Relative Values Index for periodontal procedures and the Current Proce dural Terminology. On Friday we are going to honor two individuals instrumental in completion of these activities, Drs. Donald Masters and H a l Meador. Today, according to the Health Insurance Association,
Presidential
Address
51
over twenty five million people carry some form of dental insurance. Although this is far fewer than the number who carry, for example, surgical insurance, it still represents one out of every nine persons. William Blair & Company, one of the large brokers, reports that 32% of the public companies in Fortune's 500 offer dental insurance, and 62% of these contracts have only been in existence since January, 1974. They state that "While dental plans arising out of union negotiations continue to be the single most important factor causing companies to adopt plans, an almost equal number of companies have indicated they have started plans to improve employees health care benefits and encourage routine dental care. A n increasing number of companies are adopting dental plans to maintain a competitive benefits program." The number of persons with dental insurance has gone from about 4 million in 1967, to about 18 million by the end of 1973, to the 25 million now cited by the Health Insurance Association in 1975. This is phenomenal growth, to say the least, and despite the difficulties associated with coverage of periodontal services, the trend in our special area is sharply upward. Although the cries of dissatisfaction and chagrin are still echoing from the lack of periodontal coverage in the A . T . & T. contract, remember that the other large union contracts do contain varying degrees of coverage for periodontics. Even A . T . & T. covers some periodontal services, al though it excludes surgical procedures. The United Auto Workers, the Teamsters, the Steel Workers all have periodontal coverage. A n d at this moment, Delta Dental Plans refuses to write a plan that does not include periodontal services. The young men and women entering the practice of periodontics today do not have memories of "what it was like to treat patients without the formalities of the insurance forms and the frustrating round of correspond ence that is occasionally necessary to assist a patient in collecting benefits." But neither do they have the emo tional and antagonistic attitudes that sometimes encour age us to engage in counterproductive avoidance behav iors. They accept third parties as a fact of life and they strive to equip themselves with the knowledge and available aids to minimize the stress that such relation ships can cause. Blind acceptance, however, can lead to the downfall of our profession. While you can't stand on the side of a mountain and shake your fist at an oncoming avalanche with any effect, a calm scientific approach may alter the pathway of the avalanche. Viewed positively, insurance offers us the only alterna tive that I can see to a far greater evil—a national health insurance plan that depends for its adminstration and financing on a federal bureaucracy. N o less a person than former H E W Secretary Wilbur Cohen has pled vehe mently with our government not to adopt a sweeping, all-inclusive health program such as the one propounded by the Senate Finance Committee—the so-called Ken nedy-Mills plan. If you comb through the plans now proposed by various agencies and under consideration by
52
Presidential
Address
both houses of congress, it seems to me that those based on financing through our insurance industry offer the best prospect for a national health insurance system that will not disrupt, dislocate and possibly even destroy the hard-won quality of our health care in these United States. Federal financing of any program is a two-edged sword as many Deans of Dental Schools are learning. Capita tion programs have led to the situation that the very existence of certain schools is dependent on the flow of federal dollars. Undue pressures can and are being brought by the threatened withdrawal of such funds. While the federal legislation creating the Health Maintenance Organizations ( H M O ) was to create a competitive edge for this alternative to the delivery of health care, federal financing of some such programs has brought the federal government into the area of licensure and actually dictating the scope of care to be delivered. These problems have been addressed squarely by the Long Range Planning Committee, chaired by Charles Finley, and received maximum attention by your Execu tive Council yesterday. One of our prime duties to ourselves and our future ought to be to make the relationship between the members of the dental profession and third-party agen cies as smooth and efficient as possible. A s a first step, I suggest a conscious effort on our part for attitudinal change, from unthinking and unvarying resistance to the insurer's demands for a consideration that he has a right to protect his legitimate interests and derive a profit from his efforts, the same as we have. Maintenance of a free enterprise system is essential. Once we decide to under stand the adversary's problem, we have made a giant step towards solving our own. A s a second step, I suggest that we make a real commitment to acquire and utilize all the information and aids at our disposal. A great deal of trouble could be avoided if we would get in the habit of
J. Periodontol. January, 1976
communicating with the Academy's state dental health plans advisors. The chances are that he has faced or heard about the problem before from another member within the state. If he cannot offer a solution and the problem is a real one, he will communicate with the regional advisor. A n d if it is something that merits and requires the action of the Academy at the national level, that help will be forthcoming. If there are deficiencies in our present methods of coping with third parties, com munication between yourself and your state advisor is the first step in supplying what is needed. I am optimistic that health care in this country has a bright future. Despite the problems and frustrations we all encounter, and despite what sometimes seems a meandering and purposeless course by our legislators, I truly believe that the mounting aspirations of our people, especially the minorities; the wave of consumerism, the swell of third-party payment, and the strong continued striving for excellence by the professions will meld eventually into a system more equitable, more efficient and better able to respond to the needs of our people than any the world has seen so far. It will be our privilege as periodontists, and our responsibility as an Academy to participate fully in everything that the future holds for us. A s I leave office during this Annual Session, I do it with full confidence that my successor, your President-Elect Timothy J . O'Leary, his fellow officers, and the many people who will work with him are capable and anxious to provide you with leadership of high quality and usefulness. I can only thank you, from the depths of my heart, for the support and encouragement you have given to me during all the months since I took office in October, 1974. It has been one of the supreme honors of my life to serve you as your President Thank Y o u .
clinical examination which can be utilized by other regional boards, some of whom have already made inquiries about it. I do not need to point out that this project will eventually influence, for the better, the periodontal awareness of practicing dentists and even the thoroughness with which periodontics is taught at the undergraduate level. The Committee deserves our thanks for a job well done. The past year has seen only the beginning of a project of tremendous importance to each one of us, a Task Force to Define the Future Role of the Periodontist. It is mind-boggling to contemplate the possible limits of change in our immediate future and the forces and currents of ideas which are shaping our future, often against our will. One of the most important things we can do as a academy is to discern the outlines of that future's shape and prepare ourselves for it. The members of both the Long Range Planning Committee and the Task Force have been selected with care to investigate and prognosti cate on our future role in education, practice and third party relationships. A t this beginning point, all I can do as outgoing president is wish them all success from the bottom of my heart, and acknowledge that their job carries strong implications for our future.
by RICHARD
E.
STALLARD,
B.S.,
D.D.S.,
M.S.D., PH.D.* Distinguished colleagues, honored guests, ladies and gentlemen: It is my special privilege to welcome all of you to the Twin Cities of Minneapolis and St. Paul. The event, however, is saddened by the passing of an old friend and colleague, Norman Korn; whose efforts were instrumen tal in the selection of this site. This morning marks the opening of the 61st Annual Session of the American Academy of Periodontology. Presumably it is the 61st occasion on which a President has risen to his feet to address the assembled members and friends of the Academy and I take some comfort that my feelings have probably been shared, at least in part, by all my predecessors. The feeling is compounded of pride, gratitude, some sadness, and even a little relief. It is not difficult to explain the pride I feel at the termination of the year in which I have been privileged to serve as President of this Academy. When I first became a member of A A P I felt proud to belong to an organization with a long and honorable history in which the names of some truly great men and women of dentistry appear prominently, names like Arthur Hast ings Merritt, and Edward and Grace Rogers Spalding. But at that time, it was essentially a fairly small group of people with ideas whose time was only beginning to arrive. The years have seen dramatic changes both within and outside the Academy. I do not need to dwell on our internal changes because you are acutely con scious of how great they have been, and I believe that almost without exception the changes have been for the good of the organization. We are completing a year in which much of what we planned has been accomplished, and I would like to review some of these accomplish ments with you. Few of you may know that for over two years the Academy has been working with the Central Regional Dental Testing Service to construct and evaluate an examination in clinical periodontics to be given to every applicant for licensure in the ten states served by C R D T S . It has been a time-consuming job for the committeemen who have worked on the examination, first to construct it, and then to evaluate its strengths and weaknesses. It has involved not only the time and effort of the committemen but an outlay of Academy funds to support a workshop attended by the committee and members of C R D T S . The net result of their labor is that we have in existence a successful, tested prototype
It seems that it is impossible to address members of the health professions these days without making some reference to the implications of Professional Standards Review Organizations and peer review in general. I shall be no exception. The Committee on Oral Health Care Delivery Systems this year had the difficult—almost impossible—job of formulating and stating criteria for use by P S R O Organizations in evaluating the quality and appropriateness of periodontal therapy. On the subject of difficult-to-impossible tasks, an ad hoc committee was formed this past year to determine an approach to defining the criteria for success in periodon tal therapy, and what clinical research might be neces sary to establish a rationale for the treatment we render our patients. Y o u have seen letters to the editors challenging the very basis of periodontal therapy and questioning its ultimate usefulness in some cases. Per haps the high degree of threat we feel as we read such letters is related in a significant way to the realization on our part that we have not yet defined the criteria for success nor rationalized our treatment to the extent possible with some other disciplines. Again, I can only wish the committee well and feel exceedingly thankful that I have not been asked to serve on it. I could go on for the next hour to describe to you the activities, the problems and the accomplishments of the other 61 committees and subcommittees of the Academy. They work in important areas of acknowl edged interest to each of us—internal organization, education, research, ethics, membership, third party relationships, public and professional relations, and last but not least, this very annual session. I would not for the world slight any of them because they are the very substance of this Academy. We owe all of these dedi-
* Delivered on September 24, 1975 at the Annual Meeting of the American Academy of Periodontology in Minneapolis, Minnesota.
50
Volume 47 Number 1
cated, talented, hard working people a tremendous vote of thanks. I hope you will take the time today to look down the committee list on pages 18 to 23 of your pro gram, and that you will even go out of your way to say a personal "thank you" to these people for the way they have worked on our behalf during the year. This has been a tremendous group, and I would like to ask them all to stand at this time so we can demonstrate our apprecia tion. W i l l all the committee and subcommittee men for the year 1974-1975 kindly stand at this time? (Applause) Thank you, you may be seated. A moment ago I made reference to the necessity for discerning the outlines of our future, first as members of the dental profession and then as periodontists. I cannot tell you very much that you have not already heard from other sources about the growing importance of thirdparty payment systems. I have heard various estimates of how many patients in a given periodontal practice already possess some coverage for periodontal services. They range from negligible proportions to well over half of the patients in the practice. It is fairly safe to say that every one of us in practice has already experienced the joys and frustrations of dealing with the third-party payment world. Our regional and state network of dental health plans advisors testify to the growth of third-party arrangements and concomitant problems over the past several years. A s a segment of the dental profession, I like to think that periodontists are among the most progressive and concerned of dentists where the welfare of patients is concerned, and I have no doubt that this is true. But taken by and large, I am far from convinced that the profession at large, periodontists in general and even I in particular have fully realized the implications and accepted the responsibilities that the future holds. The President receives many letters and requests covering the spectrum of academy activities. Just this past week I received a report of a patient's experience with one of the members of our Academy. Referred by her general dentist to a periodontist, she reported that the initial interview was conducted with what she described as "an excessive zeal for business." She was asked several questions, all related to her ability to pay her bills, and was informed that he "didn't bother with insurance papers, ever." Until that part of the interview had been completed and the fee stated, the member declined to examine the state of her periodontal health. Even in recounting this, it is difficult to conceive of anyone being able to say: "I don't bother with insurance, ever." But like many other remnants of the past, this statement can have no validity in our present world. This is especially true when we consider the monumental efforts made by the Academy in establishing and publish ing the Uniform Reporting Forms, a Relative Values Index for periodontal procedures and the Current Proce dural Terminology. On Friday we are going to honor two individuals instrumental in completion of these activities, Drs. Donald Masters and H a l Meador. Today, according to the Health Insurance Association,
Presidential
Address
51
over twenty five million people carry some form of dental insurance. Although this is far fewer than the number who carry, for example, surgical insurance, it still represents one out of every nine persons. William Blair & Company, one of the large brokers, reports that 32% of the public companies in Fortune's 500 offer dental insurance, and 62% of these contracts have only been in existence since January, 1974. They state that "While dental plans arising out of union negotiations continue to be the single most important factor causing companies to adopt plans, an almost equal number of companies have indicated they have started plans to improve employees health care benefits and encourage routine dental care. A n increasing number of companies are adopting dental plans to maintain a competitive benefits program." The number of persons with dental insurance has gone from about 4 million in 1967, to about 18 million by the end of 1973, to the 25 million now cited by the Health Insurance Association in 1975. This is phenomenal growth, to say the least, and despite the difficulties associated with coverage of periodontal services, the trend in our special area is sharply upward. Although the cries of dissatisfaction and chagrin are still echoing from the lack of periodontal coverage in the A . T . & T. contract, remember that the other large union contracts do contain varying degrees of coverage for periodontics. Even A . T . & T. covers some periodontal services, al though it excludes surgical procedures. The United Auto Workers, the Teamsters, the Steel Workers all have periodontal coverage. A n d at this moment, Delta Dental Plans refuses to write a plan that does not include periodontal services. The young men and women entering the practice of periodontics today do not have memories of "what it was like to treat patients without the formalities of the insurance forms and the frustrating round of correspond ence that is occasionally necessary to assist a patient in collecting benefits." But neither do they have the emo tional and antagonistic attitudes that sometimes encour age us to engage in counterproductive avoidance behav iors. They accept third parties as a fact of life and they strive to equip themselves with the knowledge and available aids to minimize the stress that such relation ships can cause. Blind acceptance, however, can lead to the downfall of our profession. While you can't stand on the side of a mountain and shake your fist at an oncoming avalanche with any effect, a calm scientific approach may alter the pathway of the avalanche. Viewed positively, insurance offers us the only alterna tive that I can see to a far greater evil—a national health insurance plan that depends for its adminstration and financing on a federal bureaucracy. N o less a person than former H E W Secretary Wilbur Cohen has pled vehe mently with our government not to adopt a sweeping, all-inclusive health program such as the one propounded by the Senate Finance Committee—the so-called Ken nedy-Mills plan. If you comb through the plans now proposed by various agencies and under consideration by
52
Presidential
Address
both houses of congress, it seems to me that those based on financing through our insurance industry offer the best prospect for a national health insurance system that will not disrupt, dislocate and possibly even destroy the hard-won quality of our health care in these United States. Federal financing of any program is a two-edged sword as many Deans of Dental Schools are learning. Capita tion programs have led to the situation that the very existence of certain schools is dependent on the flow of federal dollars. Undue pressures can and are being brought by the threatened withdrawal of such funds. While the federal legislation creating the Health Maintenance Organizations ( H M O ) was to create a competitive edge for this alternative to the delivery of health care, federal financing of some such programs has brought the federal government into the area of licensure and actually dictating the scope of care to be delivered. These problems have been addressed squarely by the Long Range Planning Committee, chaired by Charles Finley, and received maximum attention by your Execu tive Council yesterday. One of our prime duties to ourselves and our future ought to be to make the relationship between the members of the dental profession and third-party agen cies as smooth and efficient as possible. A s a first step, I suggest a conscious effort on our part for attitudinal change, from unthinking and unvarying resistance to the insurer's demands for a consideration that he has a right to protect his legitimate interests and derive a profit from his efforts, the same as we have. Maintenance of a free enterprise system is essential. Once we decide to under stand the adversary's problem, we have made a giant step towards solving our own. A s a second step, I suggest that we make a real commitment to acquire and utilize all the information and aids at our disposal. A great deal of trouble could be avoided if we would get in the habit of
J. Periodontol. January, 1976
communicating with the Academy's state dental health plans advisors. The chances are that he has faced or heard about the problem before from another member within the state. If he cannot offer a solution and the problem is a real one, he will communicate with the regional advisor. A n d if it is something that merits and requires the action of the Academy at the national level, that help will be forthcoming. If there are deficiencies in our present methods of coping with third parties, com munication between yourself and your state advisor is the first step in supplying what is needed. I am optimistic that health care in this country has a bright future. Despite the problems and frustrations we all encounter, and despite what sometimes seems a meandering and purposeless course by our legislators, I truly believe that the mounting aspirations of our people, especially the minorities; the wave of consumerism, the swell of third-party payment, and the strong continued striving for excellence by the professions will meld eventually into a system more equitable, more efficient and better able to respond to the needs of our people than any the world has seen so far. It will be our privilege as periodontists, and our responsibility as an Academy to participate fully in everything that the future holds for us. A s I leave office during this Annual Session, I do it with full confidence that my successor, your President-Elect Timothy J . O'Leary, his fellow officers, and the many people who will work with him are capable and anxious to provide you with leadership of high quality and usefulness. I can only thank you, from the depths of my heart, for the support and encouragement you have given to me during all the months since I took office in October, 1974. It has been one of the supreme honors of my life to serve you as your President Thank Y o u .
