Embrace Progress: Too Big to Act? by Dr. Daniel Grob

This year I received notification of my lifetime membership for both the American Association of Orthodontists and the American Dental Association. Finally, after more than 30 years in the profession, these organizations think that I either should retire or deserve a financial break!

When I first got my AAO membership, I wasn't considered a full or complete member because I had additional training in prosthodontics, which at the time meant that I couldn't possibly devote all my time to orthodontics. That changed over the years, and so has the AAO.

Like many of you, I'm sure, I pay my dues with apprehension. Does the AAO address all of our needs? Some of the association's changes have been progressive while others—or lack thereof—exist as opportunities for the organization to improve. To answer the question, we must first agree on what the AAO is designed to do. From there, the answers emerge, albeit not in the clear-cut and definite form of a final result. In a profession that strives for treatment perfections, sometimes it's hard to accept anything but perfection from the organization that represents us. So, we must manage our expectations accordingly and accept that needs vary even among specialized peers.

Reflecting on the past few decades, I reflect on what my $100,000 in dues and assessments has returned to me and the profession. The goals of any professional association should include these shared ones:

• Advance the profession.
• Serve those engaged in the profession.
• Serve the public interest.

Are the associations advancing the profession?
Yes and no. I think we would agree that the ADA and AAO have defended the professions, but would we also agree that they sometimes do so from behind? Arguably, campaigns aimed at educating the public have been too little and too late. Realistically, though, how many public campaigns are ever anything but reactionary in nature?

We want this symbiotic relationship with the general dental community, yet we wish to hold ourselves out as "better trained" than those same dentists. This is not the fault of the AAO, though it has become its burden to carry.

I've witnessed the rise of denturists, expanded-function hygienists, and attempts at a new licensed professional that advocates say is like a physician's assistant being promoted by the public. We've seen the arrival of at-home whitening and tooth straightening, and watched as more insurance claims were submitted for orthodontics by non-orthodontists than we submitted ourselves. We can't blame the AAO for these things or the new circumstances they've created, but we might be right to question how proactive the association should be about them.

Thankfully, the American Board of Orthodontics has seen its membership and certification levels increase, which I believe was at the heart of the problem for years. Let's hope the campaign to have the majority of orthodontists board certified will reap rewards down the road, especially in the realm of insurance.

Are they serving those engaged in the profession?
Overall, yes. We have an extraordinary insurance program sponsored by the AAO that makes many forms of professional, liability and business insurance available. Sadly, the health insurance option has been missing for years.

It's funny that the same dentists who look down their nose at others offering discounts or reduced fees feel entitled to special breaks because of their membership in a professional organization. I spent the better part of my tenure as local society president, arguing against granting dentists such discounts. (Keep in mind, we get the group discount benefits from the AAO and the ADA.)

Access to attorneys is a substantial perk—certainly from the AAO. Numerous boilerplate contracts, transition and estate-planning documents are available to help ease the legal hurdles in starting and running a practice, as well as planning for retirement.

The numerous webinars and programs for young and new orthodontists on the technicalities of opening a new office are especially appreciated. It is easy for seasoned doctors to overlook this value, but for many new practitioners it is invaluable help.

Collateral, though, seems overabundant, with attempts to provide patient educational material on just about every topic imaginable. While support for Dental Hygiene Month, Facial Protection Month, etc., is valuable, the generic and wordy brochures don't always adapt to most practices and could be discontinued. Most have marketing and office personnel who adequately emphasize their vision and ideas anyway.

Are they serving the public interest?
Here is where we've fallen short. Without a mission and mandate to ensure that orthodontists perform orthodontics, our group will be in a decline in perception from the public for years to come. The main goal of our association should be supporting board certification and insurance benefits paid to orthodontists.

I recently attended the AAO/American Academy of Pediatric Dentistry meeting in Scottsdale, Arizona, and I sat with an AAO trustee who expressed concern about competing meetings offered by manufacturers and others. This highlights the limitations of our professional society addressing new developments in a timely manner. Manufacturers and other for-profit enterprises get their products and techniques to members in a timely, effective manner. Meanwhile, many topics at national meetings are of historical importance or a rehashing of old information, technologies or procedures that have been mainstream for months, or even years. Granted, the annual session is an all-inclusive event, but perhaps our association should limit the attempts at covering everything to a minimum, or refocus topics to be more relevant and timely so that members can better serve the public interest.

Lastly ...
Let me close by saying that I have valued my membership in both the AAO and the ADA! However, it is incumbent upon us as members to hold the organizations accountable to a strict set of objectives, so that "mission creep" doesn't give us a false sense of security or accomplishment about advancements and successes. Conversely, the tail does not wag the dog, and we cannot overlook the many positives and improvements within these associations in lieu of a few issues that irk us. As our profession changes, so do our expectations, and the AAO has shown its willingness to adapt and evolve to the changing times. There is room for more improvement and there is also something to be said about what a professional bunch of perfectionists should fairly expect beyond the clinical chair.