Specialization, Socialization and Freedom
By: Allen Vean, DDS
We all remember our dental education days. Some of us are reminded of hard times, good times and friendships that have lasted our entire professional lives. Moments of learning when your brain finally realized the instructor was giving you a difficult time for a reason. Unfortunately, the school that I attended, Washington University, St. Louis, was a victim of the many private dental schools forced to close for pure economic
reasons. It was the oldest dental school west of the Mississippi River with famous faculty such as G.V. Black and Robert Gorlin.
Many of us also remember faculty who guided and mentored us through challenging procedures and taught us to do the right thing. Dr. John Gilster was one of those for me. Dr. Gilster was a classic pediatric dentist. He was calm, cool, collected and had a personality you could not help but love. However, his true talent was writing. The Gilster Report was included in each issue of the Missouri Dental Association Journal. In it, he would address current issues and dilemmas facing dentistry at that time. He then became the journal’s editor.
Here is his incredible editorial from the Missouri Dental Association Journal, November 1963.
“A lecture on the social and economic aspects of medical care was brought to my attention recently. This discussion was the first of the annual Michael M. Davis Lecture Series at the University of Chicago. And, fittingly enough, it was given by Michael M. Davis, Ph.D. As the standing authority on medical economics, Dr. Davis presented some intriguing thoughts on the present status of medical service and projected some developments we should expect in the future.
Dr. Davis discussed overspecialization in medicine. His analysis of the problem, as well as his suggested solutions, might be applied to dentistry too; therefore, some exposition of the lecture should be appropriate.
Admitting that the complexities of modern practice have made specialization necessary, Dr. Davis expresses regret at the difficulties this presents the patients. Occasionally, an important facet of the patient’s health is completely overlooked because of the separate, sometimes unrelated examinations by specialists. The old-time family doctor didn’t know as much about specific diseases and the separate body systems, but his concern about the individual as a whole helped him bring many a patient through illness or injury. Unfortunately, modern medicine has all too few men who can pull all findings together and treat the whole patient.
Dentistry, too, is becoming more and more specialized. It has become possible for a patient to go to great lengths to preserve teeth when the problem of dental caries has been severe; and then, perhaps find that a periodontal problem seriously threatens these same teeth. Patients may neglect to accept a referral to another specialist and then all may be lost. Although life itself may not often be at stake, good health always is.
What are Dr. Davis’s suggestions to medicine? He states the basic problem: “to organize services and institutions with the objective of the care of persons rather than of diseases.” His solution is for doctors to be members of organized medical groups that have within them all the specialists. One of the group would be responsible for coordinating the work of all. This plan would come closest to replacing the old- fashioned family doctor or personal physician and still afford the advantage of specialists’ training. In other words, he suggests group practice.
Group practice is certainly not a brand-new idea in dentistry, either. The advantages to the patients and to the dentists, as well, seem obvious. Efficiency and the broad experience and skill available from a group of specialists sounds like a winning combination. It should have all the advantages.
Dr. Davis continues his dissertation with some discussion of prepayment plans in medicine, pointing out the ease with which group practices can work within prepayment plans. He admits that governmentally organized and financed medical service would be inadvisable, feels that we should experiment with a combination of voluntary and governmental support for medical care. This seems sensible, for in this day and age we must concern ourselves with providing good health service to more people at fees they can and will pay. Perhaps the above plan is a possible approach. However, the plan is really a closed panel approach to prepayment and to me the closed panel is like the little girl who had a curl in the middle of her forehead (when good, very, very good; when bad, horrid).
Another serious drawback is the possible loss of independence of action. With so few careers left in which a person may enjoy freedom and assert his independence, the growth of group practices may possibly discourage some persons from going into dentistry. Personally, freedom to practice dentistry at my own rate, on my own schedule, in my own manner is very important. I’m afraid I wouldn’t like being squeezed into a pattern set by a group. On the other hand, the patient, too, should be permitted the freedom to choose his own dentist or physician. Group practices, tied in with prepayment plans, would make freedom of choice by the patient difficult, if not impossible. Efficiency, humanitarian principles and high quality of service ring loud and clear. But conformity and machine-like operation of such a highly personal service as dentistry sound unattractive to me. Alas, I’ll need more convincing.”
Fast-forwarding fifty-seven years and reading Dr. Gilster’s words today, I still find his insight fascinating. Some of his thoughts certainly apply to 2020. My deepest thanks to Elisabeth Brander at the Washington University School of Medicine Library who was able to locate many of Dr. Gilster’s writings.
The MDDS team has worked tirelessly over the last months to keep our Society running beautifully in these complex times. The 2021 RMDC Anywhere is no exception. They deserve a standing ovation. We hope you will find our virtual platform a valuable addition to your membership. Thank you all for your support of organized dentistry. Unfortunately, we are not on the other side as of yet. Let’s hope 2021 makes 2020 an enormous aberration.
As always, your contributions and comments are always welcome. Stay safe, test negative.
Dr. Allen Vean is a retired pediatric dentist and co-editor of the MDDS Articulator magazine. Dr. Vean is a long-time member of organized dentistry and owned a private practice for over 30 years in Denver, CO. In addition to volunteering with MDDS, he donates his time to a number of community organizations including Special Olympics Colorado.