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5 — Principle: Veracity ("truthfulness")
The dentist has a
duty to communicate truthfully.
Report of the Council on Ethics, Bylaws and Judicial
Affairs on Advisory Opinion 5.H.2. Specialist Announcement of
Credentials in Non-Specialty Interest Areas
Ethical Advertising under ADA Code: The
American Dental Association recognizes
the right of its members to promote their practices
within the ethical standards set forth
in the ADA Principles of Ethics and
Code of Professional Conduct ("Code"). Section
5.F. Advertising of the Code states:
Although any dentist may advertise, no dentist shall advertise
or solicit patients in any form of communication in a manner
that is false or misleading in any material respect.
The standard of "false or misleading in any material respect" is
accepted in ethics and the law to distinguish between permissible
and non-permissible advertising. The rationale for this standard
is the protection of the public. Truthful, nondeceptive advertising
of a dentist’s qualifications, services or facilities can
help patients make informed choices about
practitioners and services. On the other
hand, advertising which is false or misleading can
harm patients by making it more difficult
and costly for them to make informed
choices.
Return to Top Ethical Concerns Raised by Advertising
of Credentials by Specialists: Section
5.H. Announcement of Specialization and Limitation of Practice, of the Code sets forth the General Standards for determining
the education, experience and other appropriate requirements
for announcing specialization and limitation of practice. These
are:
- The special area(s) of dental practice and an appropriate certifying
board must be approved by the American Dental Association.
- Dentists who announce as specialists must
have successfully completed
an educational program accredited by the Commission on Dental
Accreditation, two or more years
in length,
as specified by the Council
on Dental Education and Licensure, or be diplomates of
an American Dental Association
recognized certifying board. The scope of the
individual specialist’s
practice shall be governed
by the educational standards for the specialty in which
the specialist is announcing.
- The practice carried on by dentists who announce as specialists
shall be limited exclusively
to the special area(s) of dental practice announced by the
dentist.
The nine specialties currently approved by the Association are:
dental public health, endodontics, oral and maxillofacial pathology,
oral and maxillofacial radiology, oral and maxillofacial surgery,
orthodontics and dentofacial orthopedics, pediatric dentistry,
periodontics and prosthodontics.
A dentist who meets the General Standards
for announcement of specialization
and limitation of practice may also possess credentials
in non-specialty interest areas, such
as implant dentistry, cosmetic dentistry
or temporomandibular joint disorder. The dentist may
wish to announce these non-specialty
credentials with the dentist’s
specialty credentials. The ethical challenge for this dentist
is how to do so without creating the impression of equivalency
between specialty and non-specialty credentials. For example,
the statement "Specialist in periodontics and implantology" would
be likely to mislead the public into believing that that there
is a specialty known as implantology. The statement "Board
certified in prosthodontics and cosmetic dentistry" raises
the same concern.
Need for the Advisory Opinion: The Council has noted over the
years the growth of organizations that issue credentials to dentists
in non-specialty interest areas. The Council is aware of at least
eighteen organizations that issue one or more credentials in
non-specialty interest areas, and their number seems to be growing.
A recent Council review of sample Yellow Pages advertising from
around the country shows that specialists are as likely to announce
non-specialty credentials as general dentists. In 1998, the Council
adopted Advisory
Opinion 5.I.1. General Practitioner Announcement of Credentials. At that time, the Council indicated its intention
to address the issue of specialist announcement of credentials
in non-specialty interest areas in a separate advisory opinion,
which is Advisory Opinion 5.H.2.
Return to Top
Text of Advisory
Opinion: Advisory
Opinion 5.H.2. reads as follows:
5.H.2. Specialist Announcement of Credentials in Nonspecialty
Interest Areas. A dentist who is qualified to announce specialization under this
section may not announce to the public that he or she is certified
or a diplomate or otherwise similarly credentialed in an area
of dentistry not recognized as a specialty area by the American
Dental Association unless:
- The organization granting the credential
grants certification
or diplomate status based on the following:
a) the dentist’s
successful completion of a formal, full-time advanced education
program (graduate or postgraduate level) of at least 12 months’ duration;
and b) the dentist’s training and experience;
and c) successful completion of an oral and written
examination
based on psychometric principles;
and
- The announcement includes the following language: [Name
of announced area of dental practice] is not recognized
as a specialty area
by the American Dental
Association.
Nothing in this advisory
opinion affects the
right of a properly qualified dentist to announce
specialization
in an ADA-recognized
specialty area(s)
as provided for under Section 5.H of this
Code or the responsibility of such
dentist
to limit his or her
practice exclusively to the special area(s)
of dental
practice announced.
Specialists shall not announce their credentials
in
a manner that implies
specialization in a non-specialty interest
area.
Return to Top Council
Authority to Issue Advisory Opinions: The Council has the authority under
the ADA Bylaws to issue advisory opinions
that give guidance on how the Council
would interpret the ADA Code if faced
with a particular issue on appeal. As expressions
of the Council’s position, advisory opinions generally
take effect as soon as they are adopted
by the Council. However, because of the
importance of this issue to the profession, the
Council decided to circulate the advisory
opinion in draft form to the communities
of interest for comment. Based on the comments
received, the Council made several changes
in the advisory opinion before it was
adopted in final form. This report provides information
on the meaning of key terms and concepts
used in the advisory opinion for the
guidance of the membership and the constituent
and component societies that may be called
upon to enforce it.
Return
to Top Interpretation of Advisory Opinion 5.H.2:
What credentials are covered by the Advisory Opinion? The
Advisory Opinion applies to any credential in a non-specialty
interest area,
including "certified," "accredited," "diplomate," "fellow" or "master." It
does not apply to a statementof membership
in an organization as long as the
statement does not express or imply specialization
or special qualifications which cannot
be substantiated.
What effect will the Advisory Opinion have on the issuance of
credentials by organizations in non-specialty interest areas? None. The Advisory Opinion does not control the granting of credentials.
Its scope is limited solely to the announcement of credentials
by ADA members.
What effect will the Advisory Opinion have on non-ADA members? The ADA Code governs the conduct of ADA members, who agree to
abide by the Code as a condition of membership. Nonmembers have
not made this commitment. However, the Advisory Opinion will
provide guidance to nonmembers and can be of use to state dental
boards as a model advertising rule.
What effect will the Advisory Opinion have on the scope of specialty
practice? None. As stated in the Code, Section 5.H.
Announcement of Specialization and
Limitation of Practice, under General
Standard 2: "The
scope of the individual specialist’s practice shall be
governed by the educational standards for the specialty in which
the specialist is announcing." Nothing in the Advisory Opinion
affects this standard.
Doesn’t the Advisory Opinion conflict
with General Standard 3 on limitation
of practice? No. General Standard 3 states: "The practice carried on by
dentists who announce as specialists shall be limited exclusively
to the special area(s) of dental practice announced by the dentist." Advisory
Opinion 5.H.2 would only permit a specialist to announce credentials
in a non-specialty interest area if the services covered by the
interest area were within the scope of the specialist’s
practice.
Why did the Council adopt a special advisory opinion for specialists? Although most of the issues involved in advertising non-specialty
credentials are the same for specialists and general dentists,
there are differences that warrant a separate advisory opinion.
Advisory Opinion
5.I.1. General Practitioner Announcement of Credentials requires the dentist to disclose that he or she is
a general dentist. Clearly, this requirement is inapplicable
to specialists. Advisory
Opinion 5.H.2. Specialist Announcement of Credentials in Non-Specialty
Interest Areas cautions specialists
against making claims that might confuse the public about the
difference between their specialty and non-specialty credentials.
This caution has no relevance to general dentists.
What constitutes a "formal, full-time
advanced education program of at least
12 months duration?" The Council will be guided
by generally accepted educational standards in
defining these terms. The Council’s intent in adopting
the 12-month requirement was to specify
a program of at least one academic
year in length. The concept of an academic
year is used in the ADA Bylaws to define a
Student Member (Chapter I, Section
20.C). The length of the academic year
is traditionally determined by the sponsoring institution.
At the advanced dental education
level, this is usually 12 months. It
is understood that the program content will be primarily
related to the non-specialty interest
area.
"Formal" is another term that must be defined by reference
to accepted usage in the educational community. The Commission
on Dental Accreditation has taken the position that a "formal" advanced
educational program is one beyond the
predoctoral curriculum offered at the
graduate or postgraduate level by an accredited
institution of higher learning. The Council
sees no reason at this time to use a
different definition for purposes of this
advisory opinion.
Could a specialist fulfill the formal, full-time advanced education
requirement on a part-time basis? Yes, the Council believes that the requirement could be met on
a part-time basis, so long as: 1) the educational experience,
including clinical experiences and responsibilities, is the same
as that required of the full-time program; and 2) there are an
equivalent number of months spent in the program.
Will the ADA evaluate educational programs to ensure that they
meet these standards? The ADA House of Delegates has from time to time considered proposals
for the ADA to recognize credentialing bodies in non-specialty
interest areas but opted not to pursue them. Advisory Opinion
5.H.2 does not rely on the existence of such a recognition program.
Unless and until the House adopts such a program, the Council
believes that decisions about whether a dentist meets the requirements
set forth in Advisory Opinion 5.H.2 for announcement of credentials
can be made on a case-by-case basis when a complaint is filed
for an alleged violation of the Advisory Opinion.
Could a specialist meet the educational requirements of Advisory
Opinion 5.H.2 based on his or her advanced specialty education
program? The advisory opinion states that a credential
may be based on advanced education
at the graduate or post-graduate level.
This requirement might be satisfied by an
advanced specialty education program,
as long as the program included formal,
full-time education of at least 12 months’ duration primarily related to the
announced non-specialty interest area. Ultimately, it will be
up to the body that grants the credential to decide whether a
particular program satisfies the educational standards for the
award of its credential. The Council will look to the credentialing
body’s educational standards to determine whether they
satisfy 5.H.2.
What type of "training and experience" is
required to announce the credential? The Council believes that this decision should be left to the
credentialing body of the non-specialty interest area. As a rule
of thumb, the experience requirements of the recognized specialty
boards are at least equal in time to their educational requirements.
What are "psychometric principles" and
who will decide if a particular examination
is based on these principles? Psychometric principles are standards of test construction and
administration assuring the reliability, validity and reproducibility
of the examination results. These principles are set forth in
Standards for Educational and Psychological Testing published
by the American Educational Research Association, American Psychological
Association and National Council on Measurement in Education.
Whether a particular examination is based
on psychometric principles will be
determined on a case-by-case basis by, in the first instance,
the component or constituent society
that investigates a complaint of
an alleged violation of
the Advisory Opinion and ultimately
by CEBJA sitting as the highest level
of appellate review in the tripartite
system’s disciplinary
process. CEBJA will consult with
the appropriate agencies of the ADA as necessary
in making these determinations.
Will dentists who announced their credentials before the Advisory
Opinion 5.H.2 was adopted be allowed to continue to do so, even
if they do not meet the education, training, experience or testing
requirements called for in the Advisory Opinion?The
Advisory Opinion does not contain a "grandfather" provision
that would waive any of the provisions
of Advisory Opinion 5.H.2.
How prominent must the disclaimer required by the Advisory Opinion
be? The disclaimer must be clear and visible compared to the announcement
of the credential. Whether a particular disclaimer is clear and
visible will be judged in the context of the advertisement as
a whole, but, at minimum, the Council will require the disclaimer
to be in the same font, size, style and color as the credential.
The use of abbreviations to designate credentials shall be avoided
when such use would lead the reasonable person to believe that
the designation represents an academic degree, when such is not
the case.
How will the Advisory Opinion be enforced? It
will be enforced like any other part
of the Code through the tripartite
system’s disciplinary process, which is spelled
out in Chapter XII of the ADA Bylaws.
The Council expects the constituent and
component societies’ hearing
panels to take evidence on whether an
accused member’s
advertisement meets the requirements
of Advisory Opinion 5.H.2 and to base their findings on the
evidence. The constituents and components
are reminded that before a member can
be disciplined, he or she is entitled
to notice and a hearing conducted in
accordance with Chapter XII, Section 20 of
the ADA Bylaws.
How will dentists and other interested parties be informed of
future Council interpretations of the Advisory Opinion? The
Council has the option of adopting a supplemental report, which
would
be communicated to the profession and
the communities of interest in the same manner as the
original report. Interpretations
of Council advisory opinions made in
the context of disciplinary proceedings are routinely published
in
the Council’s annual
report to the House of Delegates.
Adopted August 17, 1998
Revised December 10, 1999
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