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Modernizing the initial dental licensure process

New coalition calls for changes in portability, clinical examination

October 01, 2018

By Kimber Solana

Photo of Drs. MacNeil and Crowley signing the agreement
Signing: From left, Dr. R.L. Monty MacNeil, chair of the American Dental Education Association Board of Directors; Roopali Kulkarni, American Student Dental Association president; and Dr. Joseph P. Crowley, ADA president sign an agreement Oct. 1 at ADA Headquarters to become founding members of the Coalition for Modernizing Dental Licensure, which calls for the modernization of the initial dental licensure process.
Calling for the modernization of the dental licensure process, the ADA, the American Dental Education Association and American Student Dental Association have teamed up to become the founding members of the Coalition for Modernizing Dental Licensure.
    
The Coalition, officially founded Oct. 1, has set two key goals: Replacing the single encounter, procedure-based patient exams with clinical assessments that have stronger validity and reliability evidence; and increasing the portability of dental licensure among all states for the benefit of both the public and the profession.
    
The formation of the Coalition follows the findings and recommendations of the Task Force on Assessment of Readiness for Practice report, which was the culmination of over two years of research, discussion and collaboration among the three organizations.

"Ensuring patient safety and that each dentist meets professional standards for practice are the critical underpinnings of the dental licensure process," said Dr. Joseph P. Crowley, ADA president. "This report and the coalition's ongoing efforts call upon state dental boards to amend and modernize their licensure requirements."
    
As founding members of the Coalition, the three organizations have agreed to "work to advance the vision, goals, objectives and strategies that will be determined by the Coalition, consistent with the policies of each member organization," according to an agreement signed by each organization's respective chief leader at ADA Headquarters.
    
"The Parties will work cooperatively to establish the governance, membership, structure, operations and financing of the Coalition for Modernizing Dental Licensure," the agreement says.
    
Image of combined ADA ADEA ASDA logoLicensure is a process all dentists must go through at least once in their professional life in order to practice dentistry. In the U.S., licensure requirements vary from state to state, and all applicants must meet three basic requirements: graduation from an accredited dental education program; a passing grade on the National Board Dental Examinations; and a passing grade on a clinical examination.

In regard to the third requirement, members of the Task Force on Assessment of Readiness for Practice went on record opposing single encounter, procedure-based examinations on patients currently utilized by all states, except New York, which requires completion of a post-graduate year of advanced dental education (PGY-1) in lieu of a single encounter clinical exam, to fulfill the clinical examination requirement, according to the report released in September.
    
The Task Force, according to the report, was concerned that treating a single patient just one time is not an accurate reflection of the broad set of skills and knowledge expected of a dentist and poses ethical challenges for test-takers, dental schools and the profession. Additionally, the single encounter may not be in the best interest of patients who participate in the process.
    
"There is a critical need to modernize the dental licensure process that reflects current practices in pedagogy, assessment and licensure and that includes opportunities for third-party review and assurance throughout the process," the report said.
    
The Task Force proposed a modernized process for initial licensure to replace the single encounter, procedure-based patient exams with alternative assessments and examinations. These alternatives include the Objective Structured Clinical Examination; graduation from CODA-accredited PGY-1 program; or completion of a standardized compilation of clinical competency assessments designed to demonstrate psychomotor skills and practice relevant patient care knowledge, skills and abilities, such as the California hybrid portfolio or a compendium of [Clinical] competency.
    
"There are much better ways to handle licensure, and we have only to look to every other health profession to demonstrate that," said Dr. R.L. Monty MacNeil, chair of the ADEA Board of Directors. "Dentistry is also an outlier in the lengths dentists have to go to if they want to move across state lines and provide care. It's just time we fix this."

As part of the modernization process, the Task Force report also called for enhancing the professional mobility of nearly 200,000 active licensed dentists in the U.S. by two primary means: increased portability of licensure; and by enabling new graduates to use any of the available examination modalities to obtain a license.
    
According to a November 2017 study by the Health Policy Institute, more than 10,000 dentists moved across state lines from 2011 to 2016. To continue practicing dentistry, each must obtain a new state license, which includes significant financial resources and time submitting extensive documentation required for licensure by credentials, according to the Task Force. Some dentists are required to retake a procedure-based patient clinical exam.
    
Based on the Task Force's findings, the Coalition calls on state dental boards to allow for increased licensure portability and to work at the national level to establish a common core of dentist credentials for licensure that can serve as a basis for licensure compacts among states.
    
"Restrictions on licensure portability present undue challenges and significant costs for thousands of licensed dentists who move across state lines each year, including military spouses, academics and participants in volunteer outreach efforts to increase access to care," according to the Coalition agreement.
    
"As future dental professionals, students hold themselves to the highest ethical standards," said ASDA President Roopali Kulkarni. "We are committed to working together and with the dental boards to modernize the process of dental licensure in order to protect our patients and profession."
    
To view the Report of the Task Force on Assessment of Readiness for Practice, visit ADA.org/en/education-careers/licensure.