The American Perspective - Part II:
Strategies for the survival of the species... cont'd

By Orhan C. Tuncay

Today's orthodontist faces two options. The first option is to do nothing and eventually become a general practitioner dentist, and the other is to be proactive in preserving the specialty. In the face of serious shortage of educators there isn't a third option. It is safe to assume that given a choice no orthodontist would like to relinquish his/her specialty status. What then are the preservation measures?

The answer is simple: academia must be made attractive either for the residents of the United States or for potential immigrants, or both. People are happiest in an environment where they make a comfortable living, achieve the things they think are important and be recognized for those achievements. Who will make all these happen? The dental school? Dental schools have neither a good track record of such deeds, nor any willingness to change that one can recognize. They have their own set of problems. The salvation therefore, must come from within - obviously, in the form of an organization. The American Association of Orthodontists (AAO) along with its Foundation (AAOF) is in a position to make a difference. These two organizations can lobby to change the way an academic earns a living and to have the opportunity to advance the field.

Medical schools faced the faculty shortage problem long ago and were able to quickly institute an effective solution. For all intents and purposes, the medical school clinics today are faculty practices and the attendings earn commensurately per their busyness. At the same time, money for their activities of scholarship comes from those same clinics or from the associated foundations of various specialties. In contrast, the current fiscal model of a dental school is for the administration to claim the money generated in the orthodontic clinic, and in turn give a meager budget or handouts or favors to the department. A perhaps politically correct version of this model in some schools is where the administration has taken away the department's budget entirely, but the department keeps a portion of the clinical income. In either scenario, the sum of money is small, and there are no funds for investment. No funds to pay the faculty satisfactory salaries, for investing in new faculty lines, or for investing in scholarly activities. In many schools alumni contributions have kept the departments afloat, but in some other schools, administration takes even those funds away from the department. Generally speaking, the orthodontic department is the cash cow that supports the inactivity of other departments. Clearly, there would be no attraction for this arrangement in academia for any sane person where the pay is low and the obligation to carry the school's financial burden is high. How can the AAO and AAOF help?

The system must change. Dental schools must be run by administrators with entrepreneurial skills, and the fiscal power decentralized. It would be naïve to expect any existing administration to make this change on its own volition. The change must come from the office of the President of the University and the Board of Trustees. The AAO must put significant effort and money into lobbying these bodies. Perhaps, such lobbying is needed even at the Congressional level. Lobbying is expensive, but no more expensive than not being a specialist. In the short term, AAOF funds are better spent for lobbying activities to preserve the specialty.

During the period while this new order is taking place the orthodontic department could be augmented by imported academic personnel from abroad. Unfortunately, there is no such mechanism. At best in some states, the imported faculty member can teach in the clinic and have an intramural practice one day per week. The State Board of Dentistry must be lobbied to allow these faculty to practice on a daily basis as long as they stay in academia full-time. Additionally, AAOF could provide matching funds for their retirement plans as well as portfolio management advice and services. There is ample expertise among the AAO to provide such support to the young academic, citizen or permanent resident.

Investment of funds in these areas is what will ensure our survival as specialists. Not as a criticism, but rather as a statement of fact, it can be said the AAO has been preoccupied to address the needs of the current membership at the expense of investments for the future of the specialty. The exceptionally well put together "Practice Alternatives" program, for example, is in place really to help the selling of current members' practices. Similarly, the Council on Scientific Affairs while trying to decide whom to award among the candidates oftentimes finds itself trying to choose between advancement of science and practical issues of today. Meanwhile, the Council on Informatics spends more time trying to help the current membership, rather than planning for the future, and there are identical stories told for the Council on Communications or Education, or the rest. Obviously, the needs and interests of the current membership can never and must never be overlooked. Yet at the same time, room must be made for the future of the specialty.

It will behoove all of us to support the AAOF to make these changes happen at the AAO level, Board of Trustees level and at the State Board of Dentistry level. Extinction is not an exciting practice alternative.