> No Dentist Left Behind
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.
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 will 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 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. The plan will also encourage
the less effective dentists to get better," I said. "Poor dentists who
don't improve could lose their licenses to practice."
"That's 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."
"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, and that 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 to see me until there
is some kind of problem, and I don't get to do much preventive work.
Also, 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 can't believe that
you, my dentist, would be so defensive. After all, you do a great job,
and you needn't fear a little accountability."
"I am not being defensive!" 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 than a lot of other dentists because I chose to
work where I am needed most."
"Don't' get touchy," I said.
"Touchy?" he said. His face had turned red, and from the way he was
clenching and unclenching 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. The few educated patients I have who
see these ratings may believe this so-called rating is an actual
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 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, expensive 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 asked.
" If you receive a poor rating, 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 made on a test of children's progress
with no 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 representatives and senators," 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, a teacher, see in the mirror so often lately.
*If you don't understand why educators resent the recent federal NO
CHILD LEFT BEHIND ACT and much of the current rhetoric from Trenton
and DC, this may help. If you do understand, you'll enjoy this
analogy, which was forwarded by John S. Taylor, Superintendent of
Schools for Lancaster County, PA. [and slightly modified to better
reflect NJ].
opcorn: