For today’s blog I want to highlight three studies. The first is about motives to enter the Dental profession; the second about the reasons why Dentists leave the public sector; and the third about what practice setting creates the most job satisfaction for Dentists. All three have, basically, the same conclusion – autonomy!
College students who want autonomy choose Dentistry as a career – they want to make their own decisions. Public Health Dentists quit because of a lack of autonomy. The practice setting that is most satisfying to Dentists is the one that affords the most autonomy – Solo Practice. But consider this question – is autonomy in conflict with standardization?
In the United States, 58% of Dentists are in Solo private practice – an environment where the Dentist can enjoy autonomy in decision making. I can speak about my own small practice experiences – I worked in a 4 Dentist practice and taught at the University 1 afternoon per week before I decided to reverse that commitment in 2008. As a small private practice owner I did little to pursue best practices or evidence based dentistry – I was only interested in what works in my hands.
Monthly, I would read only the coverstory of the Journal of the American Dental Association and I received most of my continuing education from dental supply companies. If my co-workers saw one of my patients and disagreed with something I did – they would keep it to themselves because they would rather keep the peace than confront me. Additionally, I would afford them the same kindness. The result of this is that no one ever gave me feedback to improve.
It can be taken for granted, then, that one Dental Practice may have enormous variability in processes, materials and methods compared to another. Yet, we cannot argue that one is, necessarily, superior to the other because evidence about best practices is exceedingly limited in dental medicine. This is both the strength and risk of the Dental Profession – the variety means every patient can find a practice environment and provider operating style that suites them, however, standardization and true quality gains are near impossible.
Thus, we confront a fundamental issue in our profession – that we value autonomy and seek uniqueness rather than valuing standardization and seeking best practices. This is a culture that may be in conflict with what is best for our patients. Our colleagues in Medicine have a very different perspective. Extensive research in Medicine demonstrates that standardization leads to reduced mortality, better quality and fewer complications. Moreover, checklists have never been broadly implemented in Dentistry even though we know checklists reduce medical error and improve outcomes. Dentistry needs a paradigm shift – rather than doing what works best in our hands we need a culture that pursues best practices and standards of care.