THE EDITOR'S CORNER
The article in this issue comparing fees of orthodontists with those of GP's and pedodontists for categories of orthodontic treatment procedures should be an eye-opener to orthodontists and everyone else. The article shows pedodontists fees to be 40% higher than GPs' fees and 20% higher than orthodontists' fees for the categories of service to which pedodontists responded; and orthodontists' fees to be only 10% higher than GPs' fees for fixed appliance therapy and 7½% higher for removable appliance therapy. Beyond the 75th percentile, GPs' fees were much higher than orthodontists' for fixed appliance therapy. GPs' fees for fixed and removable retainers were 27-32% higher than orthodontists' fees.
When these statistics were presented to a sampling of lay persons, several interesting questions were asked. The most frequent were:
Are pedodontists charging too much?
Are GP's charging too much?
Are orthodontists charging too little?
Should orthodontists fees be higher than those of GP's and pedodontists for comparable services?
Are the services comparable?
The strongest initial reaction was that pedodontists are charging too much. The next strongest was that orthodontists, with superior training, could be expected to do a better job and deserve a higher fee.
I do not think that we should get into the kind of game in which we insist that orthodontists' fees should be higher than pedodontists' or GPs'. Orthodontists may be performing more efficiently and with greater productivity. If so, that should be public knowledge. Nor do I think that we should make a judgment that the fees of pedodontists and GP's are too high. Give the public the facts and let them decide if that is true or not.
I do not think we should get into the kind of game in which orthodontists attempt to denigrate the work of GP's and pedodontists and in which GP's and pedodontists respond in kind. You will find the best and the worst in both camps and the middle to contain the majority. The real question is at what level the majority are performing and it defies belief that very many can perform adequately in so complicated a field as orthodontics has become without at least a full graduate university course in orthodontics, or its equivalent. So, I don't think we need to make the judgment of whether the services of orthodontic specialists, GP's and pedodontists are comparable. I think that the public deserves to be informed about the complexities of orthodontic diagnosis and treatment, particularly about the complexities of the stage of growth and development; and about the education that is required to understand and manage those complexities.
In spite of the fact that I believe that specialization in orthodontics provides a more efficient, more productive, better service, I do not believe that the question of competency should rest on specialization versus non-specialization. It should rest on competency itself. The fact that I would favor a change in state dental practice acts to identify competency on the basis of full university graduate training or its equivalent, and/or on the basis of examination, and that I would favor requiring continuing postgraduate education in orthodontics, does not prevent us from informing the public at this time as to what competency means today. It is an error of judgment if we tacitly approve the present arrangement in which any dentist may perform any procedure.
Until state dental practice acts are changed to set forth high standards of qualification necessary to perform orthodontic treatment, I would merely insist that there not be two levels of orthodontics either for performance or fee. The crux of the matter then becomes disclosure about qualifications, services, and fees.
Unfortunately, orthodontists must "go public". No mechanism appears to exist in the general dental organizations that will recognize the concept that every dentist should not be permitted to perform every dental procedure, regardless of his training and educational qualifications. I do not advocate or even believe that it is necessary for orthodontics to divorce itself from dentistry. This would be a mistake. Orthodontics is a significant part of dentistry and will probably become an even more significant part of dentistry. I believe that orthodontists should press the advocacy, among dentists as well as elsewhere, of full qualifications with the best educational background as prerequisite to performing orthodontic treatment. This is not a general question of specialist versus non-specialist. This is simply full training in orthodontics versus less than full training in orthodontics.
Public information programs should be organized on a state basis, because of the differences that exist from state to state and because the ultimate influence will be within each state to change state dental practice acts. However, the contributions must be made at all levels--national, state and local--to assure a maximum effort. These contributions must be substantial. If orthodontic societies have been saving for a rainy day, well brother, it's raining now.
