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5 — Principle: Veracity ("truthfulness")
The dentist has a
duty to communicate truthfully.
Report of the ADA Council on Ethics, Bylaws and
Judicial Affairs on Advisory Opinion 5.I.1. General Practitioner
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 advertising,
which is permitted, and that which is not. The rationale for
the 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 harms 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 General Dentist: The ADA’s
specialty recognition system has been responsible for assuring
the American public that an individual
who truthfully
holds himself or herself out as a member
of an ADA-recognized specialty meets
high standards of education and training.
These standards are the same for all the recognized
specialties. Their foundation is
the successful completion of an educational
program accredited by the Commission on Dental
Accreditation of two or more years in
length.
To help patients distinguish between practitioners
who have completed an accredited
program beyond the dental degree and those who
have not, Section
5.H. of the Code states
that only dentists who meet the ADA’s General Standards
for Announcement of Specialization
and Limitation of Practice are qualified
to announce as specialists. The nine specialties currently recognized by the ADA 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.
Announcement of credentials by general dentists
raises ethical concerns because there
is no standardized, nationally accepted
program for recognizing achievement in
non-specialty interest areas. Educational qualifications for
these credentials range from nonexistent to a basic weekend continuing
education course to two years of formal,
full-time education.
Experience, training and examination
may or may not be required to earn the credential. The varying
levels of attainment this
represents are understandably confusing.
Announcement of credentials by general dentists
also raises ethical concerns as an
implied claim of superiority. The Council believes
that dental patients are likely to understand
statements like, "certified," "diplomate," or "fellow" to
mean that the general dentist who possesses these credentials
is better qualified than the general dentist who does not. An
implied claim of superiority may be unethical if it is not subject
to reasonable substantiation. Advisory
Opinion 5.F.2. Examples of "False or Misleading" of the Code states in part:
The following
examples are set forth to provide
insight into the meaning
of the term "false or misleading in a material respect." These
examples are not meant to be
all-inclusive. Rather, by restating the concept
in alternative language and giving
general examples, it is hoped
that the membership will gain a better understanding
of
the term. With this in mind,
statements shall be avoided which
would: . . . d) contain a material,
objective representation, whether
express or implied, that the advertised services
are superior in quality to those
of other dentists, if that representation
is not subject to reasonable
substantiation.
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Need for the Advisory Opinion: The Councill has noted over the years the growth of organizations
that issue credentials to dentists in non-specialty interest
areas. The Council recently identified eighteen organizations
that issue one or more credentials in non-specialty interest
areas, and their number appears to be growing.
The ability of the dental profession to
deal with unethical advertising by
its members has been affected by the Federal Trade Commission
(FTC) investigation of the ADA’s advertising rules. Concern
about legal ramifications has chilled
the enforcement of those rules by constituent
and component dental societies. Similarly,
some state dental boards, under threat
of constitutional challenge to their
advertising rules, have hesitated to engage in rigorous
enforcement.
The Council does not believe that this situation
serves the best interests of the
public or the profession. Public esteem for
the dental profession is based in part
on trust in the profession’s
veracity as reflected in the advertising of its members. Dentists
who make claims which mislead the public about the dentist’s
qualifications or which cannot be substantiated
undermine not only the relationship between
dentists and their patients, but
also the relationship between the profession
and society.
The Council is sensitive to the legitimate
desire of ADA members to build and
maintain their dental practices in today’s
challenging marketplace through advertising. The Council’s
goal in adopting Advisory
Opinion 5.I.1 is to respond to these members while
at the same time protecting the public from false
and misleading advertising by adopting
ethical standards for the announcement
of credentials by general dentists.
Return to Top Text of Advisory Opinion: Advisory
Opinion 5.I.1. General Practitioner Announcement of Credentials to the Code reads as follows:
A general dentist 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;
- The dentist discloses that he or
she is a general dentist; 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.
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
question on appeal. As expressions
of the Council’s
position, advisory opinions take
effect when they are adopted by the Council.
However, because of the importance of this issue to the
profession, the Council took the
unusual step of delaying
implementation of Advisory
Opinion 5.I.1 in order to give the Board
of Trustees and the House of Delegates
the opportunity to comment. Both the Board and the House supported the
Council’s decision
to adopt the Advisory Opinion effective as of the date it was
accepted by the FTC to close its investigation of the ADA’s
specialty advertising rules (Resolution
96H-1997). The FTC notified the ADA in
December 1997 that it had closed its investigation,
and Advisory
Opinion 5.I.1 is now in
effect.
As debate in the House over Resolution 96H-1997 and subsequent
discussion have made clear, the profession has a number of questions
about the meaning of the Advisory Opinion and its implementation.
This report seeks to answer those questions.
Return to Top Interpretation of Advisory Opinion 5.I.1:
What credentials are covered by the Advisory
Opinion? The Advisory Opinion applies to any credential in a non-specialty
interest area announced by a general
dentist, including "certified," "accredited," "diplomate," "fellow" or "master." It
does not apply to a statement of 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.
Does the Advisory Opinion apply to specialists? Advisory
Opinion 5.I.1 applies to general dentists, not members of the ADA-recognized
specialties. The Council believes that announcement of additional
credentials by specialists in non-specialty interest areas can
best be addressed in a separate advisory opinion, which the Council
is in the process of developing.
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 dentist 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 Advisory Opinion does not require the
Council or any agency to credential educational programs in non-specialty
interest areas. Decisions about whether a dentist meets the requirements
set forth in Advisory
Opinion 5.I.1 for announcement of credentials
will be determined on a case-by-case basis when a complaint is
filed for an alleged violation of the Advisory Opinion.
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 disciplinary process. CEBJA will consult with the appropriate
agencies of the ADA as necessary in making these determinations.
Will general dentists who announced their
credentials before the Advisory Opinion
5.I.1 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.I.1.
How prominent must the two disclaimers
required by the Advisory Opinion be? The disclaimers 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.I.1 and to base its
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.
Nothing in Advisory Opinion 5.I.1 prohibits
a general dentist from truthfully
informing the public that the dentist limits
services to an area of dentistry not
recognized as a specialty by the
American Dental Association. However, members are advised
to consult their state’s dental practice acts and the rules
and regulations of their dental boards
concerning any legal restrictions in
this or any other area of advertising.
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 June 1998
revised August 1998, June 1999 and April
2000
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