appear to be adequate. Therefore, our allowance will be for six periodon­ tal visits rather than the proposed full mouth gingivectom ies.” I ask all my colleagues to put their indignation in writing and take what­ ever personal or collective action they can against any offending insurance carriers. JE FFR E Y L. W E R B L IN , DMD W EST H EM PSTEAD, NY

S ta n d a r d s o f excellen ce

■ Dr. H. J. Van H assel’s editorial in the August j a d a is an example of the excellent philosophy presented by many of our faculty members at den­ tal learning institutions, both gradu­ ate and undergraduate. I heartily concur with Dr. Van H assel’s ideas and only wish that the entire A D A would put up a united effort to implement these ideals. Most often, those men stressing the need for restorative excellence in our profession are those of the “ dental elite” whose principal source of re­ muneration is in the form of institu­ tional salaries, governmental and pri­ vate, and/or guest lecturing. Those colleagues in the US Public Health Service, Veterans Adminis­ tration, armed forces, and faculty members o f learning institutions may see one patient per hour or less. This definitely allows for excellence in the placement of alloy or whatever else is deemed necessary for Che restora­ tive patient. Terms such as “ average Medicaid coverage,” “ standard and customary procedures” and “ bread and butter dentistry” are all terms through which the A D A and govern­ mental agencies by use endorse and condone mediocrity. The private practitioner trying to uphold the ideals o f restorative excel­ lence using those fee schedules pro­ vided by Medicaid cannot survive economically. Still, the A D A advo­ cates Medicaid in dentistry. Today’s well-run private practice shows a 60% to 75% overhead ratio. How many alloy restorations would be required per day, per operator, to allow the operator a $ 100 a day salary? The answer is $400 worth of produc­

tion. Is this possible on Medicaid and/ or institutional fees still maintaining standards of excellence? If this goal seem s selfish, then I might propose full socialism in which all dentists would be educated and sal­ aried by the state; all services per­ formed would be o f the highest stan­ dards of excellence capable o f the operator, whether he sees one patient per day or 20. Perhaps another workable ap­ proach would be to have all o f the recognized craftsmen prepare a time study of all services performed and then, based upon the overhead fac­ tors of private practice, establish a universally acceptable fee schedule which would allow the private practi­ tioner to earn a living commensurate with other professionals of equivalent educational level. Obviously, there are defects and objections to both of these proposals. We recoil from the words “full social­ ism ,” yet the A D A and some political forces recommend increased social services. Is this semantics? When our dental schools graduate dentists who are permitted incorrect conclusions and/or procedures 30% of the time, where is excellence? When insurance company and Med­ icaid tables o f allowable fees are such as to penalize those men of conscience econom ically, then the only recourse is to allow either the institutionally salaried dentists full care of these sub­ sidized patients or accept the fact that those of “ bendable conscience” will take over this realm of our pro­ fession. Is this excellence? D entists can personally solve the problem by professionally practicing to their highest standards but only by creating a fee schedule which allows these standards. Some may call this selfish. Some may call it reality. Most practices do not allow for time wasted, filling out elaborate Medicaid forms or debating with insurance con­ sultants, but rather their time is sched­ uled for treating patients. The realistic solution may come when each of us as professionals prac­ tices to his individual capacity for ex­ cellence and then has the intestinal fortitude to tell those governmental agencies and insurance firms what fees are realistically needed to per­

1066 ■ LETTERS TO THE EDITOR / JADA. Vol. 93, December 1976

form with excellence. There is no doubt that they should vary with the competence of the operator and/or the overhead of the practice. We, as professionals, are not all equal nor average, possessing individ­ ual standards and abilities which must be recognized, or mediocrity will be­ com e the norm rather than the bottom limit of professional idealism. JOHN W . KIRALY, DDS TOMS RIVER, NJ

D o w n g ra d e d b y ‘M a ra th o n M a n ’

m I think that I have just viewed the ultimate in the downgrading o f a pro­ fession. In the motion picture M a r a ­ th o n M a n , Sir Laurence Olivier, as a N azi criminal and a dentist, utilizes his professional skill to attempt to ex­ tract information from a captive. In this day and age, it is almost criminal to see the instruments of the dentist depicted in this manner as an instrument o f torture. It is bad enough that we are just reaching a point in health services where w e are looked upon in a favorable light. Then to have this all torn down in one swoop by the motion picture industry. In view of the fact that continuous dues increases are being asked for by the society, and attempts are still being made to enlighten the public as to the benefits o f good dental care, some effort will have to be made to stop further attempts to depict den­ tistry in this unfavorable light. Among other things, the society should consider a watch-dog commit­ tee over the entertainment industry and the media to prevent any further occurrence as displayed by the pic­ ture M a ra th o n M a n , with Dustin Hoffman as the victim in the torture scene by Laurence Olivier. Incidentally, the acting by all was excellent. ALTON L. W AREHAM . DDS N E W YORK CITY

Standards of excellence.

appear to be adequate. Therefore, our allowance will be for six periodon­ tal visits rather than the proposed full mouth gingivectom ies.” I ask all m...
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