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MyView: Ethical dilemmas in everyday practice

October 01, 2018
My View
Mert N. Aksu, D.D.S., J.D.
Having graduated from dental school over 30 years ago, and having worked both as a full-time faculty, associate, employee of a large medical group and practice owner, I have seen and heard of many situations that set the stage for ethical dilemmas.

Regardless of the circumstances, most instances are fact specific and have a narrow range of impact. However, one area I have seen with increased frequency is the use of “fellowship” status and the designation of FICD, or FACD in conjunction with earned degrees on many dentists’ letterheads, websites and advertisements. According to advisory opinions on the American Dental Association website, “fellowships that designate association rather than attainment, should be limited to scientific papers and curriculum vitae.”

According to the Bylaws of the International College of Dentists, “Fellows in the College, in good standing, are allowed to use the letters FICD (Fellow of the International College of Dentists), or if applicable, MICD  (Master Fellow), immediately following their name and professional degrees depending on the customs, laws, regulations and professional ethics of their respective Sections and locality.”

The American College of Prosthodontics in a paper entitled “Demystifying Dental Specialty Credentials” writes, “… A fellow of the AGD (FAGD) has completed 500 hours of qualified education and passed a comprehensive written examination. The organization also offers a master’s (MAGD) program. … Credentials such as these are very honorable and indicate a dentists’ dedication, but their use is restricted by the ADA Code Of Ethics to publication and professional curriculum vitae. In general, these credentials can be used among professionals but not displayed or advertised to the general public, as they may be misconstrued as an additional university-based degree.”

Similarly, the American College of Dentists in its “policy and guidelines - code of conduct” writes, “Fellows may use the title “Fellow, American College of Dentists,” or alternatively “Fellow of the American College of Dentists,” on letterhead, business cards, and in biographical summaries, provided this is done in a dignified and professional manner and is consistent with other provisions in the Code of Conduct. The title shall not be used in the direct solicitation of patients or for strictly commercial purposes. Use of Fellow, American College of Dentists or Fellow of the American College of Dentists on the Internet is permitted only in a biographical summary on a dentist’s own website. If the title is used, it must appear on a page within the website that is strictly informational and not commercial in nature.”

In a random internet search using the terms “DDS FACD” and “DDS FAGD” it is easy to see that many dentists use these fellowship credentials for the purposes of commercial advertising and in practice websites. Despite all that has been written and all of the guidance given on the use of these credentials, it is clear that the practicing dental community is confused about the ethical standards with regard to the use of these credentials.

Aside from the ethical responsibility, every licensed dentist faces legal regulation based on the advertising restrictions of their individual state’s dental practice act. Typical state practice act language restricts dentists from advertising in any way that is misleading or false.

Given the statements above, it may be difficult for dentists to defend against false and misleading claims when using any of the fellowship designations. Conversely, as the courts get involved in the legalities of dental advertising, greater freedom to proclaim specialty status of “non ADA” specialties and greater freedom to use the “FAGD” and “FACD” and related designations is predicted to occur in the future.

Looking at this issue and relating this dilemma to the five elements that serve as the foundation of the ADA Code of Ethics (autonomy, non-malfeasance, beneficence, justice, and veracity) it is important to balance the interests of those who wish to proclaim the attainment of fellowship with the interests of patients who will arguably confuse the fellowship designation with the attainment of an earned degree.

Ultimately, in reviewing the hundreds of websites with “FACD”, “FICD” and “FAGD” credentials it is unclear as to whether this issue will really gain the attention of any of the associations and whether the fellowship designation will be limited in the manner intended.

Regardless which way you personally feel about this issue, the regulation of our profession and the ethical standards we set out for ourselves set the standards for what others will expect.

Dr. Aksu is a diplomate with the American Board of Dental Public Health; a fellow of the Academy of General Dentistry; a fellow of the American College of Dentists; and a fellow of the International College of Dentistry.