"Did you hear about the new state program to measure effectiveness of dentists with their young patients?" I said.
"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 dentist's rating. Dentists will be rated as Excellent, Good, Average, 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. Poor dentists who don't improve could lose their licenses to practice."
Don't you think we should try to improve children's dental health in this state?"
"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, 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 see me until there is some problem and I don't get to do much preventive 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, 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 you're 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 higher than a lot of other dentists because I chose to work where I am needed most. 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 the DOC," I noted.
"What's the DOC?" he asked.
"It's the Dental Oversight Committee," I said, "a group made up of mostly laypersons to make sure dentistry in this state gets improved."
"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."
"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."