Me, a Pseudospecialist?

Michael A. Siegel, DDS, MS, FDS RCSEd

I have been active in organized dentistry for almost 30 years and have tried to contribute to the profession via patient care, teaching, research, and service activities. I am a past president of the American Academy of Oral Medicine (AAOM), an organization that has successfully worked with the Commission on Dental Accreditation (CODA) to gain approval for our graduate level programs. I must admit that I am a bit perplexed when I read an editorial that refers to me as a pseudospecialist.¹ One of the professional issues that continues to confound me is related to a misunderstanding many of our colleagues apparently have regarding the process for accreditation of advanced dental education programs by CODA versus the process for specialty recognition by the American Dental Association (ADA). It is my intent to attempt to shed some light on each of these processes to ameliorate some of the confusion that currently exists. From the outset, by way of disclaimer, I am currently professor and chair of the Department of Diagnostic Sciences in the College of Dental Medicine as well as a professor of Internal Medicine in the College of Osteopathic Medicine at Nova Southeastern University. I was recently selected by CODA to serve on their review committee for Postdoctoral General Dentistry Education. I am a past president of the American Board of Oral Medicine (ABOM), and also a past chair of the ADA Council on Scientific Affairs. It must be clearly understood that the following column represents my opinion only and in no way reflects the opinion or policies of Nova Southeastern University, the AAOM, CODA, the ABOM, and/or the ADA.

The US Dept of Education has granted authority to CODA to “serve the public by establishing, maintaining, and applying standards that ensure the quality and continuous improvement of dental and dental-related education and reflect the evolving practice of dentistry. The scope of the Commission on Dental Accreditation encompasses dental, advanced dental, and allied dental education programs.”² CODA has a set of rigorous accreditation standards that have to be fulfilled before agreeing to site-visit and approve general dental (Advanced Education in General Dentistry, General Practice Residency) or specialty education programs. Three well-recognized disciplines of dentistry—oral medicine, anesthesiology, and facial pain—that have represented general dentistry for a combined total of more than 100 years have gained approval, through CODA, to train residents in their respective disciplines and ensure that the programs comply with educational standards, thereby ensuring the public’s safety and welfare, as well as to serve their healthcare needs.

To reiterate, CODA has absolutely nothing to do with dental specialty recognition. This task falls to the ADA through their Council on Dental Education and Licensure (CDEL). A sponsoring organization, such as the AAOM, has to comply with a very strictly defined application process and meet all six of the following requirements as outlined by CDEL³:

In order for an area to be recognized as a specialty, it must be represented by a sponsoring organization: (a) whose membership is reflective of the special area of dental practice; and (b) that demonstrates the ability to establish a certifying board.
A specialty must be a distinct and well-defined field, which requires unique knowledge and skills beyond those commonly possessed by dental school graduates as defined by the predoctoral accreditation standards.
The scope of the specialty requires advanced knowledge and skills that: (a) are separate and distinct from any recognized dental specialty or combination of recognized dental specialties; and (b) cannot be accommodated through minimal modification of a recognized dental specialty or combination of recognized dental specialties.
The specialty must document scientifically, by valid and reliable statistical evidence/studies, that it: (a) actively contributes to new knowledge in the field; (b) actively contributes to professional education; (c) actively contributes to research needs of the profession; and (d) provides oral health services for the public; all of which are currently not being met by general practitioners or dental specialists.
A specialty must directly benefit some aspect of clinical patient care.
Formal advanced education programs of at least two years beyond the predoctoral dental curriculum as defined by the Commission on Dental Accreditation’s Standards for Advanced Specialty Education Programs must exist to provide the special knowledge and skills required for practice of the specialty.

After the CDEL requirements are fulfilled, the council’s recommendation is forwarded to the ADA House of Delegates for their action. Ultimately, it is the members of our profession, our ADA delegates, who decide on whether or not a specialty should exist within our profession. Now, back to the term “pseudospecialty.” I am certain that practitioners of oral medicine in Canada, Europe, Australia, New Zealand, Israel, and other countries worldwide would be offended by this terminology because they are recognized as specialists in their respective countries. In 1933, only four specialties were recognized in the field of medicine (ophthalmology, otolaryngology, obstetrics and gynecology, dermatology). The American Medical Association (AMA) was so intransigent about creating new specialties that a number of medical “pseudospecialties” held a conference and created the Advisory Board of Medical Specialties. Its successor, the American Board of Medical Specialties, is completely outside the auspices of the AMA and today is responsible for granting specialty recognition in the field of medicine. Medicine now has a diverse group of 24 specialties that has allowed for growth and diversity within the profession. However, presently, only approximately 30% of American physicians belong to the AMA, possibly because they can attain specialty status outside of the AMA. Is this what we want to happen to the greater than 70% market share of dentist memberships that the ADA currently enjoys?

To quote George Santayana (1863-1952): “Those who cannot remember the past are condemned to repeat it.” I am hopeful that we can learn from the lessons taught us by our medical colleagues so that we can build a diverse, thriving profession that is organized under the umbrella of the ADA. This diversity must begin with mutual trust and understanding between all practitioners, whether generalist or specialist. It will also entail an accurate understanding of our professional issues and the facts surrounding them. Ultimately, this will better serve the public whose care is entrusted to us.

References

1. Low SB. Will botoxodontics be a new dental specialty? Today’s FDA. 2005; 17(6):7-8.

2. American Dental Association Commission on Dental Accreditation. Introduction. Revised: January 2001. Available at: https://www.ada.org/117.aspx. Accessed Aug 25, 2008.

3. American Dental Association Council on Dental Education and Licensure. Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists. October 2001. Available at: https://www.ada.org/sections/educationAndCareers/pdfs/requirements.pdf. Accessed Aug 25, 2008.

About the Author

Michael A. Siegel, DDS, MS, FDS RCSEd
Professor and Chairman
Department of Diagnostic Sciences
College of Dental Medicine

Professor
Department of Internal Medicine
Division of Dermatology
College of Osteopathic Medicine
Nova Southeastern University
Fort Lauderdale, Florida