October 12, 2017
by Brian Chapnick
I was perusing the exhibit floor at a major meeting I usually attend yearly and stopped by a booth prompted by an advertisement that caught my attention. A refinement of a long established technique that was supposed to solve all the problems associated with what we all know to be an issue. Learn the technique and it would save me time, make my patients more comfortable and generate thousands of dollars in the process. When I questioned the principal of the company all he was interested in was selling his 4 DVD set that taught what the technique was and of course there was a special price if I bought it at the show. No mention of the technique itself. Sort of like seeing a magic trick and then having to buy the secret to make it work. As soon as I stepped up to the previously empty booth, so did someone else who quickly brought forth a credit card. A shill? Most likely. I walked away. Knowledge in a caring profession shouldn’t have to be bought like that. Equipment, instruments, materials, and how to use these items – sure. We all attend CE programmes to learn of new thoughts, procedures, and gain from the experience of others, but this was distasteful to me.
The experience left me thinking. I’ve spent much of my professional career in organized dentistry, on committees both as a participant and chair. I’ve presided as President for several significant organizations. I’ve helped plan many continuing education programmes both large and small. I’ve dealt with truly wonderful colleagues, experts in their field who give their time and expertise freely for nothing more in return than their expenses. I’ve dealt with clinicians who request and receive huge honorariums, some who have turned down offers in excess of what I in my own practice generate in a month. I’ve dealt with industry leaders, some who are happy to help sponsor programmes with no ties to their company, and others who will only give support to a programme tightly woven to the products they sell.
More often than not, it has been my experience, continuing education, the transfer of knowledge, knowledge that is aimed at helping those we treat, has become nothing more than business, a means of generating income, income for the presenter, income for the sponsor, income for the host, and income for the registrant. It is often nothing to do with making the lives of our patients better, only to do with making the lives of the knowledge holder better.
Recently, there have been a number of editorials in prominent journals, addressing and questioning the quality and expertise of some CE programmes, presenters and journals. It is a minefield out there. It is a concern when we listen to an ‘expert’, and the information presented is a commercial, disguised as a course in continuing education, or the when the ‘expert’ really isn’t one. Many articles we read are no better. It is very difficult to know who or what to believe. Disclosure is often subverted.
All the organizations I have worked with as a volunteer have been ‘not for profit’. Excess funds generated in programming for those groups I have participated in, have helped support the profession and the community we serve. Profit was never a primary motive. Many organizations, struggle to keep solvent, others generate hundreds of thousands of dollars providing avenues for continuing education. We volunteer our services, and never receive financial benefit for the tireless efforts we expend. We do it as a means of giving back and to lay the foundation for those who follow in our path as others have done for us. We make our living generating an income to support our families, from the service and treatment we provide to our patients, not selling what we have learned to the highest bidder. The experience we gain in providing care should be shared for the benefit of all our patients, not sold for unreasonable profit. It used to be an honour to be asked to share ones knowledge. Now organizers often must speak to the ‘experts’ business manager to schedule a presentation and provide large honorariums, first class travel and other incentives.
Dental schools all have departments of continuing education and their mandate is to generate a profit or be shut down. Commercial professional continuing education companies sprout up all over the place, product manufacturers and suppliers sell continuing education. Our licensing bodies even get into the act. In our province our College has developed tiered levels of CE and of course, our providers and presenters clamor to provide the programmes needed to maintain licensing requirements. It is a gift for those who provide and those who present CE. It is also a gift for our regulators, who now have more to regulate and need more staff to do so. It is a gift for government as it makes it appear as they are doing something.
There was a time when we attended CE programmes because we wanted to learn, to grow, develop and improve. It was interesting. We met with our colleagues. It was fun. If we didn’t like what we were hearing we would leave and attend something else. We now more often than not, attend CE to get our points. Because qualifying programmes are rigidly screened to meet stringent requirements, the cost to us increases, as the process is expensive. The programmes end up being more about what we needed to know to become a dentist and less about what we need to know to be a dentist, and are often dull, uninspiring, and academic. But now, good or bad, we stay, get our points and once we have our quota we don’t have to expend any more time, or expense for more until the next cycle.
The competition in CE is fierce. I have known some providers to intentionally run a programme to conflict with another and take away from attendance and profit from others by cutting the pie into smaller pieces for their own benefit.
Many of our friends in medicine are often shocked when they hear of huge honorariums and profiteering we are experiencing. Most in medicine receive very little in return other than the honour that is conferred to share their knowledge.
The quota system does not make outcomes better. There are just as many cases going to complaints and discipline or more than when programmes did not have to be qualified, not less. We have more regulators, more regulations, and as a result it is more difficult and costly for all of us: providers, dentists and patients alike.
Compliance with mandated regulations does not generate proficiency or competence. Compliance is about satisfying a bureaucratic process, not about education.
Is there a solution? I’m sure there is but we haven’t found it yet. One thing
I believe is for sure. It isn’t more regulation we need but more guidance in selection of the right sources of education may be a good place to start.
Dentistry, a caring profession…….caring for whom? OH
Brian Chapnick graduated from the University of Toronto and has been in private practice of general dentistry for 40 years.
I applaud your excellent presentation.
Definitely, there is a huge problem in the works.
It is becoming increasingly difficult for the individual practitioner, especially the general dentist, to navigate in the current environment that you have eloquently described.
It will likely get worse before it gets better, if it ever gets better, and I am of the conviction that it will not.
One just has to look at the example of the amount of dental journals available in the world as well as the amount of articles being published. For an individual general practitioner, how is it possible to review it all and even make any sense of it, let alone the impossibility of being able to pay for the exorbitant cost for access to these publications. Then, is the content of the publication of any value? Journal publication board members need to increase in a very significant way their standards for publishing acceptance of submitted papers. Too often, I find disturbing elements in published material such as spelling errors and mis-labelled tables and figures, an alarming increase in publications claiming to report a “Novel Technique”, when in reality it is merely a variation of an already well established concept, or a combination of very well established techniques, and simply NOTHING NEW. Are aspiring authors trying to get recognition, basically, by trying to “re-invent the wheel”? The list is too long.
Colleagues, perhaps it is time to push the reset button.
Dr Mario Marcone
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