Parallax View is an editorial series presented for educational and discussion purposes only.
The opinions expressed are those of the authors only, and by no means is any anti-trust action implied or to be inferred.
A Look at Organized Dentistry
Let’s go straight to the question: does the American Independent Dentist’s Association represent a "slam" on Organized Dentistry?
Unequivocally not.
In fact, many active and respected leaders in dentistry are involved, and more are becoming so every month. AIDA’s leadership understands that, when discusses organizational effectiveness in dentistry and points out weaknesses therein, there may be some in Organized Dentistry that feel offended. AIDA feels sure that anyone who is in Organized Dentistry for the right reasons will be thrilled at the emergence of AIDA, and thrilled to find a Beacon for Choice in dentistry. Let us assure ourselves that this is the case.
Let’s look at Organized Dentistry (the tripartite ADA, the AGD, and specialty organizations). What are their responsibilities and functions? Organized Dentistry is charged with the vision and leadership of a $40 billion industry, with stakeholders including dentists and patients, auxiliaries and office staff, related industries, some hospitals, and the government. Its responsibilities are (1) to protect the vital interests of each of those stakeholders, and (2) to prioritize well when those interests may be in conflict with or among each other.
The most direct stakeholders are dentists and patients. Let’s look first at patients. As the leadership of a profession, Organized Dentistry is charged with the paternalistic care of patients of all ranges of dental knowledge and appreciation, all ranges of ethnicity, all ranges of wellness or pathology, in all types of locations, under all manners of healthcare access, and with a plethora of acquired attitudes toward dentistry and dental health.
The tripartite ADA (local, state, national), assumes broadest responsibility, and also represents the widest diversity of interests among dentists. By definition, the ADA must represent generalists and specialists, male dentists and female dentists, HMO dentists and cash-practice dentists, good dentists and bad dentists, foreign trained dentists and US trained dentists, young dentists and old dentists, dentists with commitment and dentists with apathy, dentists with the highest ethical standards and dentists with none. The AGD eliminates only one of these "Diversity Constraints". Despite whatever organizational opinions and consensus the ADA (in its three parts) might have through its leadership, it must and should responsibly represent the diversity of its membership, from the local dental society to the presidency.
From a corporate standpoint, this diversity of representation is a muzzle on the potential power and effectiveness of Organized Dentistry. To over-represent the interests of one group would obviously risk offending the another group. To this point, Faulkner and Gray’s Medicine and Health reports that the American Medical Association has toned down its opposition to [pro] managed care legislation over the last two years because so many of its members belong to managed care groups. (Over forty percent of physicians in this country are now employees, and at least sixty five percent of the insured population is covered by some type of managed medical care.)
In a system without competition, such as the US government, broad and oppositional diversity is a benefit- it is a built in check and balance that achieves slow, sometimes plodding evolution but rarely allows for reactive errors on the part of its leadership. A democratic, competitorless civil government is a desirable and successful entity for our society as a whole. In the historical incidents in which there has been a direct competitor to our civil government, the outcome is a simple but ominous premise: war or the threat thereof.
How, then, is "dental government" different from civil government? There are two basic differences. First of all, each member of Organized Dentistry is a competitor to all others. This is true in an actual and a legal sense, as is promulgated by the Federal Trade Commission. Thus, each member of Organized Dentistry is his or her own special interest group (SIG), with inherent conflicts between altruistic goals and financial motivation. How those internal conflicts are handled speaks deeply to the character of the leader. This premise may be arguable, but only to the very naïve is it deniable.
The second major difference is that one group of primary stakeholders in Organized Dentistry, with numbers thousands of times greater than dentists, has no representation and almost no political input into the progress of the dental profession. This group is the patients, our external market. Denied organizational input into their own outcomes, patients are thus self-empowered to find other means of expressing and gaining voice for their concerns and any means for achieving their health care goals. Recent history speaks to this premise quite clearly.
Do these differences between civil government and "dental government" necessarily lead to ineffectiveness in Organized Dentistry? Is this the full etiology of today’s challenges? Up until the past five to eight years, no. The same factors have always been present, yet dentistry to that point truly was "Health Care That Works". History and common sense dictate that a "guild" of small competitors, or cottage industries, can be successful and move a profession forward. In small industries with direct and focused consumer contact, customer service and fraternalistic sharing of knowledge and resources between small scale competitors are economically adaptive traits, and have contributed to the previous success of dentistry. Organized Dentistry performed well in a situation where everyone had a vested interest in "getting along".
Remember that in our model of civil government, fundamental competition leads to war or the threat thereof. A significant, but predictable new entity has entered the health care arena, and has lead to visible ineffectiveness in Organized Health Care, to the point where Organized Medicine has surrendered its autonomy. Organized Dentistry, like its medical colleagues, despite the best intentions and arduous work of its leadership, has been rendered visibly ineffective by the introduction of huge, centralized, shareholder driven competition.
This, then, is a unique moment in history. Fundamental assumptions regarding the rights of patients are being challenged. Health care is being, quite literally, rationed. Access to health care providers is being rationed. Medicine, as we knew it, is already gone. It has, and will continue to undergo fundamental change. As once again evidenced by today’s issues, dentistry has traditionally been five to eight years behind medicine in political, legal, and reimbursement issues. We are mortals in an open field, having just witnessed Goliath slaying the vast numbers of medicine. We are few, and we need a David. Perhaps not to slay the giant, but to establish new rules for how and where he might go about his business. We can be our own David, but not if we continue our reactive posture. We need to understand the competitor and his strengths, and challenge him on his weaknesses. Organized Dentistry cannot do that effectively as it now stands, because of the multiplicity of its special interests.
The beauty of Organized Dentistry’s leadership is that those who care, can serve. It is not hard to attain positions of responsibility, leadership, and input within our system. Unfortunately, many bright and worthy dentists have traditionally stayed away from direct participation or even belonging to Organized Dentistry for a variety of reasons. Some of the reasons we have heard (without passing any judgment on their validity) have been:
distaste for a "good old boy network"
The sad part about these assumptions is that, despite their validity or the lack thereof, the person who spoke them cared enough to notice, cared enough to speak, but did not have the courage to participate and become a change agent.
The American Independent Dentist’s Association desires to be the Beacon of Choice in dentistry. We aspire to find ways to bring the disenfranchised of dentistry, those who have given up hope, those who presume that their new ideas will fall on deaf ears, those who care enough to speak out, to the front of the room in dentistry. We aspire to represent fee-for-service dentistry in the same manner that a power plant injects energy into a community, to literally brighten the lives and add possibility to the existences of all. AIDA intends to be the partner of Organized Dentistry.
AIDA’s vision is that dentistry should be a learning organization; aligned with its consumers; responsive and responsible to its internal and external marketplace, the government, and science. The term "learning organization" comes from the corporate management literature, its maven being author Peter Senge. A learning organization is a self aligning, self healing, introspective, intelligence gathering organization that is prescient to its marketplace. A learning organization constantly challenges itself as to its mission, vision, and strategic view. A learning organization goes through no motions. Effectiveness is its only goal.
Very few of us are able to live on such a plane in our own lives, and the thought of evolving a large representative organization along those lines is a daunting job. But it is not an impossible job. Fee-for-service dentistry has many weapons available to it so that it may thrive, not just survive, throughout this era of change and upheaval. But this is a job for a courageous and dedicated group. AIDA is not this group. AIDA is the wake up call. You are the group.
Rededicate yourselves to dentistry. Come out of your offices, take one or two nights a month away from your family. Spend a little money. Make the organizational aspects of dentistry benefit you as a fee-for-service dentist. That’s OK, just don’t expect someone else to do it for you. They won’t. Educate yourself and bring a corporate mindset to a world of corporate competition. And don’t pay too much attention to the gurus who are selling advice on how to survive today’s health care challenges. Their knowledge is valuable but their premise is wrong. We can’t all be in the "top 10%". Don’t be fooled. You can’t go it alone. There is strength in numbers, there is strength in knowledge.
Let AIDA help, let AIDA motivate.
But stand up and step forward,
or sit down and sign that contract.
K. Randall Groh, DDS
Acting Chair
The American Independent Dentist’s Association
336 Alhambra Circle
Coral Gables, FL 33134
E-Mail feeforserv@aol.com
June 14, 1997© K. Randall Groh, 1997
Please use the
"BACK" button on your browser, or select 
to return to the Navigation Page.
