Achieving Access without
Licensure Limitations
Date: February 12, 2009
Monday, February 16, 2009

Obstacles to Oral Health
Lack of Public Understanding & Awareness
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People lack transportation to clinics or flexibility in work schedule
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Regional Shortages of Oral Health Providers
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Inadequacy of public dental insurance programs
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Insufficient resources to pay for care
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Care Limited by Physical Disability or Illness
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Absence of Community Programs
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Monday, February 16, 2009

Dental Therapists
97% Participation of Elementary School Students
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Elimination of Permanent Tooth Loss
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Monday, February 16, 2009

Eliminate Dental & Medical
Licensing
Monday, February 16, 2009

The Primary Goal of Licensing is to
Protect the Public...
Monday, February 16, 2009

Reality
Most Patient Protections Unrelated to State Licensing
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Licensing Efforts Redundant
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Works Against Established Public Protections
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Monday, February 16, 2009

Graduation!
Monday, February 16, 2009

Licensing’s Accomplishments
Limitation of Professional Autonomy
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Workforce Restrictions
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Creates an Anti-Competitive Culture
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Shelters Practitioners from Accountability
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Presents Ethical Dilemmas
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Monday, February 16, 2009

Dental Board of CA Disciplinary
Guidelines
“The Board requests that the ALJ (Administrative Law Judge) clearly
✤
state the factual basis for his or her decision. This is especially
important should the ALJ deviate from the recommended guidelines.
The rational for the deviation should be reflected in the decision to
enable the Board to understand the reasons for the deviation and to
evaluate the appropriateness of the decision.”
Monday, February 16, 2009

Ethical Dilemma
45% of Physicians with direct knowledge of an impaired or
✤
incompetent employee did not always report
46% did not report a serious medical error on at least one occasion.
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Those reporting did not necessarily report to the state board
Monday, February 16, 2009

Hearing the People
Licensing institutions do not believe public complaints are good
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indicator of problems with practitioners
2004-2005 survey of licensing institutions
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Monday, February 16, 2009

Boards vs. the Courts
Only 16%of physicians with malpractice payouts above $1 million
✤
dollars had been sanctioned by state medical boards
Only 1/3 of physicians who had made 10 or more payouts between
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1990 and 2005 were disciplined
Monday, February 16, 2009

Zero Continued Competency
Licensing doesn’t guarantee initial competency either
Monday, February 16, 2009

Patients are well protected without
licensing.
Monday, February 16, 2009

Regulation
Reputation of profession & individual practitioners more essential
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Risk Aversion
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Private elective credentialing signals skill set to the public & offers
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continued competency
Workforce regulated by market factors and insurance
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Legal Oversight
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Monday, February 16, 2009

The Benefits of Liberty
Community Programs
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Competition and creation of new markets for care
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Improved ethics & informed consent
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Workforce Flexibility & Mobility
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Improved Patient Care
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Monday, February 16, 2009

Building a Better Tomorrow
Competition & Decentralization Medical Data Portability
✤ ✤
of Professional Power
Full Transparency to the Public
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Elimination of IP System
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Reputation Management
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Insurance Reform
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Private Credentialing Network
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Education & Awareness
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Legal Precedents
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At Home Diagnostics &
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Prevention
Online Consultations
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Monday, February 16, 2009