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My View: Turning point in dental licensure modernization is here

October 07, 2019

By Lindsey Yates, D.D.S.

Lindsey Yates, D.D.S.
Whenever and wherever dentists gather, there are few conversational topics that generate more professional unity than the archaic licensure process and fragmented portability landscape, which still, in 2019, significantly restrict dentists’ freedom of movement to live and practice anywhere in the United States. The reality is that these regional exams, centered on single-snapshot-in-time procedures on patients, are inherently not standardized. They lack strong validity and reliability evidence; random error plays a significant role in determining whether an individual will pass or fail the examinations. Further, these testing agencies have not been able to correlate clinical performance in dental school with performance on the examination.
In the past, calls for licensure reform have come separately from practicing dentists, dental educators and dental students. Though the call to action is not new, the unity among these three groups in accomplishing this important goal is new and very exciting.
Licensure has been of interest to me since the late 1980s/early 1990s, when I recall conversations between my grandmother and father — both dentists — about the seemingly insurmountable restrictions they would face if they ever wanted to move to another state and continue practicing dentistry. In the mid-2000s, I found myself caught in a changing licensure landscape when the state of New York announced sweeping licensure reform in response to the numerous challenges created by the patient-based licensure exams, e.g., questionable solicitation and selection of patients, insufficient patient involvement in and consent to treatment decisions, the possibility for unnecessary treatment and lapses in treatment follow-up. I moved to Chicago to complete a general practice residency in order to comply with New York’s new licensure requirement, amid fears that there would not be enough residency positions in my home state to accommodate all of New York’s dental school graduates. While in Chicago, I met my husband and continued to practice dentistry there for eight years. When it became clear that working in public health dentistry was financially incompatible with living and raising a young son in downtown Chicago, my husband and I decided to relocate so I could continue to provide care to underserved communities. The single most important factor in deciding where to relocate was finding a state where I could continue to practice dentistry using my postgraduate year 1, or PGY-1, and existing [North East Regional Board of Dental Examiners] credential and not be a victim of the arbitrary whims of state dental boards, many of which have tight relationships with regional testing agencies — relationships laden with obvious conflict of interest. Dental licensure restraints have literally shaped the course of my life more than once; while I am just one example, there are countless other U.S. dentists whose lives have been unnecessarily restricted in this way.

I have been involved in the licensure reform conversation for more than a decade, and from 2016 through 2018, I had the honor and privilege to serve on the Task Force on Assessment of Readiness for Practice. On Oct. 1, 2018, I was present for the landmark formation of a coalition by the three leading dental organizations that, I believe, is a turning point in the licensure reform and modernization effort. The ADA, American Dental Education Association  and American Student Dental Association signed a charter and became the founding members of the Coalition for Modernizing Dental Licensure. The coalition’s mission is twofold: to provide a valid and reliable alternative to the existing regional patient-based licensure exams through support of a U.S.-developed dental licensure objective structured clinical exam (DLOSCE) and to increase portability of licensure exams, with the ultimate goal of having the DLOSCE be accepted by licensing jurisdictions nationwide.
Creation of the DLOSCE is well underway, with pilots expected in early 2020, and a projected launch in late 2020/early 2021. Colorado, Minnesota, Washington and Canada currently license dentists using the Canadian OSCE. The Canadian OSCE reported a passing rate of 93% in 2018 while testing a much broader scope of dentistry than the current single-snapshot procedure-based exams; thus, use of an OSCE for dental licensure raises the standards for individuals to enter our great profession. When almost every candidate, after multiple attempts, eventually passes the current single-snapshot procedure-based licensure examinations, one can hardly argue that these licensure examinations are truly protecting the public, and not merely a costly formality.

The more challenging part of the coalition’s mission will be achieving nationwide portability; this is where I call on my fellow dentists who have witnessed and/or experienced the injustices and irregularities of the current exam process to step up and get involved. Acceptance of the DLOSCE will take time and must happen on a state-by-state basis. What can you do to be part of the solution? Get involved with your state board of dentistry! State boards need volunteers who are well-informed and free from financial and territorial biases; these conflicts of interest currently exist when examiners who are also board members steer their state board towards certain exams and away from other exams. In the future, when we look back on the history of dental licensure modernization, I believe we will consider this a turning point. I am filled with encouragement that meaningful change is achievable for the first time in decades. Won’t you join me in being part of the solution?

A version of this editorial first appeared on the New Dentist Now blog in June. Dr. Yates practices general dentistry in Aurora, Colorado, and is an assistant professor at the University of Colorado School of Dental Medicine. The views in this editorial represent the author’s personal perspective.