THE EDITOR'S CORNER

Sooner or later, we are going to have to come to grips with the questions of whether a difference exists between the abilities of general practitioners and specialists in specialty areas and whether there should be a fee differential between them for the treatment of similar problems.

Although this is the context within which the GP vs Specialist controversy has been drawn, it seems obvious that the controversy is misconceived. The test should be competence. The public must be protected to the extent that any dentist who undertakes to perform specialized services must be qualified to do so. There cannot be two levels of orthodontic qualification--one on the basis of training and proven clinical ability and the other on something less than that.

This has been a position that orthodontists have avoided. Possibly it might have seemed self-serving, and possibly it might have tended to exacerbate a simmering GP vs Specialist antipathy. But, in avoiding the issue, we have given tacit and sometimes explicit approval to the position at the one extreme, that the DDS or DMD degree entitles one to perform all treatment in dentistry.

Recently (May 1972) the Dental Society of the State of New York added two items to its Manual of Prepayment Procedures and Policies as follows:

"Item 19: It shall be the policy of the DSSNY that dental insurance plans and other third party programs which maintain differentials in reimbursement fee schedules and tables of allowances for identical procedures by general practitioners or recognized specialist be deemed unacceptable."

"Item 20: Dental care programs which assume the prerogative of designating dentists as specialists shall be deemed unacceptable."

This is the policy of the Dental Society of the State of New York. What is the policy of your state dental society?

With a policy such as DSSNY has adopted, a third party plan which asks for better-trained specialists or differentiates in any way can be termed unacceptable to the state dental society. The fact that there is a growing significance to this aspect of the question as third party programs grow, in no way changes the judgment that the policy is wrong, plans or no plans.

First, as regards a difference in ability. This should not be a matter of dispute. The criterion of who should be permitted to perform a service should depend on the possession of the skill and knowledge required to do so. With such a criterion, one could not practice on private patients until one had demonstrated this skill and knowledge. It would be necessary to have performed orthodontic treatment in a university program, or in a teaching hospital program or in a preceptorship program. There must be this demonstration of skill and there must be an examination for knowledge. That is how one should be qualified to perform orthodontic treatment not only in prepayment programs, but in the entire practice of dentistry.

Once practitioners qualified to practice specialty treatment are identifiable by the public, the side issue of whether limitation of practice to a specialty results in better treatment can be left to the judgment of the public.

Under a logical policy of equal pay for equal work, the question of fee differentials is quickly resolved. If one is qualified to perform the service, then one should be paid the fee. There should be no two levels of qualification, no two levels of treatment, and no two levels of fee.

If we in dentistry show no inclination to protect the public interest, it should not surprise us to find that we are not consulted in decision-making on dental health care legislation, nor that precedents that we have not tried to change turn up as the policy of a universal dental health care plan.