The American Perspective:
ORTHODONTICS - The First Specialty Of Dentistry is at risk to be the first to disappear... cont'd

By Orhan C. Tuncay

Despite the good economic times and impressive advances made over the past twenty years in our field, we may not have orthodontics as a specialty much longer. There are several reasons for this, but the most imminent one is the potential for the disappearance of the orthodontic department.

Why would an orthodontic department disappear? This question has a simple answer: There cannot be a department without faculty. The current lack of full-time faculty is the most significant crisis we had to face since the inception of our specialty. Much of the current full-time orthodontic faculty have gray hair, and some no hair. Once this fifty or sixty something crowd retires they will not be replaced. There are only a handful full-time faculty who have the interest, enthusiasm and skills necessary for a career in academics. Unfortunately, many of this already small group will give up the academic life to put bread on the table and pay their children's school tuition. Whether senior or junior, the income of a typical orthodontic faculty member is many fold less than what a practicing orthodontist can earn. All the studies conducted to understand the core of full-time faculty dissatisfaction, come up with the same conclusion: the full-time faculty salary is not an incentive to do the work. The other and intangible element is that the full-time faculty is not really "accepted." They may even be the subject of ridicule when the young doctors (to borrow a phrase from LE Johnston, Jr.) get together for a quick beer.

Clearly, this is disgraceful. The full time faculty have accepted that they will indeed get paid a little less, and they will put up with the politics of their institution. Not to mention they will put in endless hours of work - but why? It is because they understood the importance of education, advancing the field and giving back. Above all, however, to ensure the sustenance of the specialty. They have chosen to make sacrifices for the greater good, the future of orthodontics. They believe looking after their fellow persons is important. But how big must that sacrifice be? Moreover, are they the chosen ones to pay for the attitude (if not the sins) of the rest?

Unless steps are taken to prevent it, we will lose our specialty. Imagine a scenario in a dental school far away, where time has come for all the orthodontic faculty to retire or to resign. There are no full-time orthodontists to lecture, conduct the precilinical laboratory sessions, assign patients, grade exam papers, report the final grades, etc. at the predoctoral level. In order to stay accredited, the dental school curriculum must contain orthodontic courses. How will the administrators handle this problem? Certainly it will be no sweat off their back to ask the pedodontic department to teach orthodontics. As bizarre as it may sound, this is a trivial event compared to the bigger issue. The bigger issue is that this dental school will no longer have a graduate program in orthodontics either. As this trend spreads to other schools around the nation, the graduate orthodontic program, as we know it will disappear.

The specialty status is granted by the American Dental Association. To be a specialty, the field must be special, have an organization, a board certification process, a journal, and an educational system. In the absence of any one of these elements, the field is not special to be recognized as a specialty. If orthodontics can be taught by pedodontists or other specialists, how can anyone claim it to be special? The orthodontist will no longer be a specialist.

Imagine the orthodontist is not a specialist!

A small group of wise men realized this could happen and founded the AAO Foundation. The purpose of AAOF is to support the orthodontic education. The support is in many forms, but mostly the foundation funds the orthodontic research that would not be funded by other means, and the young faculty with salary support. The money to do all this comes from the interest accrued. But who cares if the orthodontist is recognized as a specialist? only less than 23% of the membership. Sadly, a good number of those sponsors are the current residents. Many of the practitioners who contribute do so at the minimum level.

For example, the regent level sponsorship requires a pledge of $25,000. It can be paid over a ten-year period. Simple arithmetic reveals that this is a $208 a month contribution. Where else do we spend $208 a month? An orthodontist who goes out to eat say, three times a week, will leave more than $208 in tips for the waiter. If the orthodontic community's self-respect in being a specialist is less than the tip left for the waiter, then not much could be said. Obviously, the orthodontist is neither special, nor he/she deserves to a specialist. Perhaps, the non-contributing 76% of our members fall into this category. Chances are they have not given to their departments either. Yet, they preach to others the importance of tithe.

It is hard to imagine there exists an orthodontic practice that does not give away free treatment. For a dentist's kid, a family member, a friend, etc. At the end of the fiscal year, when the income and overhead figures are assessed how can anyone tell that they gave a treatment or two away? Clearly, the few freebies would have no impact. Could those free treatments not be given to the department or to the specialty? and most importantly, to the AAO Foundation in return for self-respect?

There can be no excuses for not supporting one's practice, principles and pride. The issue is the survival of our species. Not to contribute $208 a month is a vote for extinction. Often we hear "someone ought to do something." Who might that someone be? If read carefully, the O of the AAO spells orthodontists. It is the organization of the orthodontist, not orthodontics. The orthodontist is that someone who ought to be doing the something. Dear colleagues, time has come for all orthodontists to put their money where their mouth is. Being a specialist, in particular and orthodontist, is worth more than the tip left on the restaurant table. Don't give away your specialty. Don't let it be the first to disappear.