California Dental Association
Continued Competency Programme

An article by Russell Anders, D.D.S.

January 1996

Your views, comments and opinions are welcome.

We are all familiar with CE. An overwhelming majority of us have embraced it as an effective way to keep abreast of the ever-changing treatment techniques that so benefit our patients. Admittedly, there are abuses of the CE program, but, overall, it has been beneficial to us and our patients. Market forces dictate that success comes to those dentists practicing with the newest proven techniques and equipment. Dentists, through individual training and experience, filter out those ideas with which they are uncomfortable and adopt those that can be incorporated into their unique practices.

Continued competency will be a mandated series of classes or tests that must be passed in order to renew a dental license. Several years ago the plan envisioned would have forced every dentist in California to attend classes at a dental school for 1 week every 2-3 years and successfully pass a didactic examination on a subject chosen by the Board of Dental Examiners (BDE).

The need for CC is based upon 2 premises.
First, CDA and the BDE wish to become "pro-active" in the area of dental malpractice. That is, they wish to try to prevent malpractice before it occurs by teaching and testing academic subjects.
Secondly, some form of reciprocity may be accepted and a means of establishing competency among those dentists seeking California licenses from other states needs to be instituted without apparent discrimination from those dentists traditionally licensed.

It is my feeling that both premises are flawed.
Furthermore, the push for CC is being backed by other forces with an entirely different goal in mind.

Attempting to be "pro-active" with CC testing or classes does not make sense. None of us were taught to do substandard dentistry. All of us know the proper techniques for diagnosing and treating the myriad of problems our patients present. If a dentist feels that the patients' needs require a more expert practitioner , there are marvelously talented specialists to whom the patient can be referred.

Continuing education classes are readily available to help in those areas dentists feel less qualified.

What is it that is lacking within some dentists that leads them to such gross behavior and lapses in judgement resulting in disciplinary actions and the production of shoddy dentistry? I contend that the answer is a lack of ethics and morality. Faced with the pressures and stresses of practice, some dentists, although knowing better will compromise quality and judgement. Although it has been attempted throughout history, except for family and perhaps religious traditions, there is no satisfactory or successful method of teaching ethics.

Have CE classes failed to help maintain competence among those dentists that have been practicing for many years? Demographic studies of the BDE disciplinary actions indicate there is no relationship between years of practice and ethical, moral, or clinical competence. In other words, those dentists most recently exposed to dental school curriculum are just as likely to commit egregious errors as those dentists graduation many years ago. This validates the idea that is ethics and morals more than clinical competence that produce poor clinical performance and judgement leading to malpractice claims and disciplinary actions.

The second premise upon which the need for CC is based is reciprocity and its supposedly inherent open-door policy to incompetent practitioners. The State of Washington has had a form of reciprocity in place for many years. Not only do they not have CC testing classes, but they have found no need for CE as a requirement for license renewal. The Washington State Dental Association, which comprises approximately 90% of the dentists in Washington, does require its' members to take CE classes. This is not the same, however, as an onerous requirement for license renewal. Why must California re-invent the wheel (so to speak) when our colleagues to the north have a functioning model in place?

The last time CC was discussed at the BDE the real powers behind its acceptance and implementation were the dental schools in California. They, then and now, would like nothing better than to require the dentists to take classes during those times of the year that the dental schools have vacant classrooms. Dental schools are always seeking methods of raising funds. Unfortunately, this is a continuing crisis in dental education. From the dental school's perspective CC testing will aid significantly to help solve this problem.

It is painfully obvious that this burdensome requirement would be costly to the practitioners both in real out of pocket expenses and time out of the office. Who gains by this oppressive idea? Certainly not the dentists or their patients. Only the dental schools and educators profit by taking another bite out of our time and resources.

If it is the desire of the BDE and the CDA to improve the quality of the entire group of dentists, let them remove those practitioners that obviously do not have the requisite ethical standards. Perhaps CE could be altered in such a way as to eliminate any abuses. A system of directed CE can be established which would require certain fields of dentistry be emphasized during a given period of time. A CC requirement only tends to paint all dentists with the same brush of incapability with no proven benefit. More years of schooling will not produce a clinically competent dentist if that dentists' ethics are compromised. We all object to more and more regulation intruding upon our lives and practices. Do we really want to impose the burden and over regulation of CC upon ourselves?