Let’s Assess All Professionals with Tests! 

My dentist is great!  He sends me reminders so I don't forget checkups.  He
uses the latest techniques based on research.  He never hurts me and I've
got all my teeth.  So when I ran into him the other day, I was eager to see
if he'd heard about the new state program.  I knew he'd think it was great.

 "Did you hear about the new state program to measure effectiveness of
dentists with their young patients?"  I said.

 "No," he said.  He didn't seem too thrilled.  "How do they do that?"

"It's quite simple," I said.  They will just count the number of
cavities each patient has at age 10, 14 and 18 and average that to determine
a dentists rating.  Dentists will be rated as excellent, Good Average and
Below Average and Unsatisfactory...    That way parents will know which are
the best dentists.  It will also encourage the less effective dentists to
get better," I said.  "Poor dentists who don't improve could lose their
licenses to practice."

"Thats terrible," he said.

"What? That's not a good attitude," I said.  "Don't you think we
should try to improve children's dental health in this state?"

"Sure I do," he said," but that’s not a fair way to determine who is
practicing good dentistry in this state."

"Why not," I said. “It makes perfect sense to me.

"Well, it's so obvious," he said.  "Don't you see that dentists don't
all work with the same clientele; so much depends on things we can't
control?  For example, he said, "I work in a rural area with a high
percentage of patients from deprived homes, while some of my colleagues work
in upper middle class neighborhoods.  Many of the parents I work with don't
bring their children to see me until there is some kind of problem and I
don't get to do much preventative work.  Also, he said, many of the parents
I serve let their kids eat way too much candy from an early age, unlike
more educated parents who understand the relationship between sugar and
decay.  To top it all off," he added, "So many of my clients have well water
which is untreated and has no fluoride in it.  Do you have any idea how much
difference early use of fluoride can make?"

" It sounds like your making excuses," I said.  I couldn't believe my
dentist would be so defensive.  He does a great job!

 "I am not!" he said.  "My best patients are as good as anyone's, my
work is as good as anyone's but my average cavity count is going to be
higher that a lot of other dentists because I chose to work where I am
needed the most."

"Don't get touchy!" I said.

"Touchy?" he said.  His face has turned red and from the way he was
clenching his jaws, I was afraid he was going to damage his teeth. 

"Try furious.  In a system like this, I will end up being rated average, below
average or worse.  My more educated patients who see these ratings may
believe this so-called rating actually is a measure of my ability and
proficiency as a dentist.  They may leave me and I'll be left with only the
most needy patients.  And my cavity average score will get even worse.  On
top of that, how will I attract good dental hygienists and other excellent
dentists to my practice if it is labeled below average?"

"I think you are overreacting," I said.  "Complaining, excuse making
and stonewalling won't improve dental health...I am quoting from a leading
member of DOC," I noted.

"What's DOC," he asked. "It's the Dental Oversight Committee," I said, " a group made up of mostly lay persons to make sure dentistry in this state gets improved."

"Spare me," he said.  "I can't believe this.  Reasonable people won't
buy it," he said hopefully.

The program sounded reasonable to me, so I asked, "How else would you
measure good dentistry?"

"Come watch me work," he said.  "Observe my processes."

"That's too complicated and time consuming," I said.  "Cavities are the
bottom line, and you can't argue with the bottom line.  It's an absolute
measure."

"That's what I'm afraid my parents and prospective patients will think.
This can't be happening," he said despairingly.

"Now, now," I said," don't despair.  The state will help you some."

"How?" he said.

"If you’re rated poorly, they'll send a dentist who is rated excellent to
help straighten you out," I said brightly.

"You mean," he said, "they'll send a dentist with a wealthy clientele
to show me how to work on severe juvenile dental problems with which I have
probably had much more experience?  Big Help"

"There you go again."  I said.  "You aren't acting professionally at
all."

"You don't get it," he said.  "Doing this would be like grading schools
and teachers on an average score on a test of children's  progress without
regard to influences  outside the school, the home, the community served and
stuff like that.  Why would they do something so unfair to dentists?  No one
would ever think of doing that to schools!"

 I just shook my head sadly, but he had brightened. "I'm going to write my representative and senator," he said.  "I'll use the school analogy--surely they will see the point."

He walked off with that look of hope mixed with fear and suppressed
anger that I see in the mirror so often lately.


John S. Taylor
Superintendent of Schools for the Lancaster County School District
Lancaster, PA

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