[Offtopic] Merit pay for dentists

Roland Gesthuizen rgesthuizen at gmail.com
Sun Apr 22 12:22:01 EST 2007

Apologies if you have already seen this. I still have no idea who penned the
original source although from the language I suspect it sources the States
where the debate about performance pay is currently raging. I did search
about the traps and notice it has already done the rounds of the QSITE and
Edulist English mailing lists.

Here it is (* toothless grin *)

Regards Roland

Merit Pay For Dentists

My dentist is great! He sends me reminders so I don't forget checkups. He
uses the latest techniques based on research. He never hurts me, and I've
got all my teeth.

When I ran into him the other day, I was eager to see if he'd heard about
the Federal Government's latest program for improving the dental health of
our children by introducing merit pay for dentists.

"Did you hear about the new federal program to measure effectiveness of
dentists with their young patients?" I asked.

"No," he said. He didn't seem too thrilled. "How will they do that?"

"It's quite simple," I answered. "They will just count the number of
cavities each patient has at Grades 3, 5, 7, 9, and average that to
determine a dentist's rating. Dentists will be rated as excellent, good,
average, below average, and unsatisfactory. That way parents will know which
are the best dentists. The plan will also encourage the less effective
dentists to get better," I said. "Poor dentists who don't improve could lose
their licenses to practice."

"That's terrible," he replied.

"What? That's not a good attitude," I said. "Don't you think we should try
to improve children's dental health in this country?"

"Sure I do, but that's not a fair way to determine who is practising good

"Why not?" I asked. "It makes perfect sense to me."

"Well, it's so obvious," he said. "Don't you see that dentists don't all
work with the same clientele, and that much depends on things we can't
control? For example, I work in a rural area with a high percentage of
patients from deprived homes, while some of my colleagues work in upper
middle-class neighborhoods. Many of the parents I work with don't bring
their children to see me until there is some kind of problem, and I don't
get to do much preventive work. Also, many of the parents I serve let their
kids eat way too much sweet food from an early age, unlike more educated
parents who understand the relationship between sugar and decay. To top it
all off, so many of my clients have tank water which is untreated and has no
fluoride in it. Do you have any idea how much difference early use of
fluoride can make?"

"It sounds like you're making excuses. I can't believe that you would be so
defensive. After all, you do a great job, and you needn't fear a little

"I am not being defensive!" he said. "My best patients are as good as
anyone's, my work is as good as anyone's, but my average cavity count is
going to be higher than a lot of other dentists' because I chose to work
where I am needed most."

"Don't' get touchy," I said.

"Touchy?" he said. His face had turned red, and from the way he was
clenching and unclenching his jaws, I was afraid he was going to damage his
teeth. "Try furious! In a system like this, I will end up being rated
average, below average, or worse. The few educated patients I have who see
these ratings may believe this so-called rating is an actual measure of my
ability and proficiency as a dentist. They may leave me, and I'll be left
with only the most needy patients. And my cavity average score will get even
worse. On top of that, how will I attract good dental hygienists and other
excellent dentists to my practice if it is labeled below average?"

"I think you are overreacting," I said. "'Complaining, excuse-making and
stonewalling won't improve dental health'... I am quoting from a leading
member of the DOC," I noted.

"What's the DOC?" he asked.

"It's the Dental Oversight Committee, a group made up of mostly lay persons
to make sure dentistry in this state gets improved."

"Spare me! I can't believe this. Reasonable people won't buy it," he said

The program sounded reasonable to me, so I asked, "How else would you
measure good dentistry?"

"Come watch me work," he said. "Observe my processes."

"That's too complicated, expensive and time-consuming," I said. "Cavities
are the bottom line, and you can't argue with the bottom line. It's an
absolute measure."

"That's what I'm afraid my parents and prospective patients will think. This
can't be happening," he said despairingly.

"Now, now," I said, "don't despair. The Federal government will help you

"How?" he asked.

³If you receive a poor rating, they'll send a dentist who is rated excellent
to help straighten you out," I said brightly.

"You mean," he said, "they'll send a dentist with a wealthy clientele to
show me how to work on severe juvenile dental problems with which I have
probably had much more experience? BIG HELP!"

"There you go again," I said. "You aren't acting professionally at all."

"You don't get it," he said. "Doing this would be like grading schools and
teachers on an average score made on a test of children's progress with no
regard to influences outside the school, the home, the community served and
stuff like that. Why would they do something so unfair to dentists? No one
would ever think of doing that to schools."

I just shook my head sadly, but he had brightened.

"I'm going to write my representatives and senators," he said. "I'll use the
school analogy. Surely they will see the point."

Roland Gesthuizen - ICT Coordinator - Westall Secondary College

"Never doubt that a small group of thoughtful, committed citizens can change
the world; indeed it is the only thing that ever has." --Margaret Mead
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