An Open Letter to the American Board of Orthodontics

by Laurance Jerrold Dds, jd

I am quite dismayed by the recent decision made by the American Board of Orthodontics to grant Diplomate status to those who have merely passed the written examination. I know that the certification is valid only for a fixed time period, the intent being that once orthodontists have their certification, they will not want to let it lapse. While the goal behind this decision is to have a greater percentage of Board-certified practitioners—which I, too, believe needs to be accomplished—in my opinion, the mechanism is flawed.

Those of us who have obtained Board certification worked our butts off to get it. It was a lofty aspiration, one that was worth pursuing because it took something that most doctors are unwilling to do. It required taking a good, hard, critical look at what we do, how we do it, and why we do it. Apparently, 75% of us were not willing to undergo this introspection and face the scrutiny of our peers. Right or wrong, it’s the way it was—until recently.

For years, I’ve always said that we need a better way to get more of us Board-certified; but giving it away is not the answer. It diminishes the stature of all of us who have achieved certification, it diminishes the stature of the Board as our governing body, and it diminishes the stature of the specialty that grants authority to the Board. How is it conceivable that someone who passed an exam 20 years ago, doesn’t keep up with the literature, rarely attends continuing-education courses, and does not maintain an academic affiliation to keep up with what’s happening can now send in just under $2,000 and “buy” a certificate? So what if it expires in 5 years? Arguably, that’s all the more reason that it proves nothing.

To those who say, “What’s the big deal?” consider the following. Now that this individual is Board-certified, someone might say, “By all means, let’s make him or her a program director.” This certainly can’t be good for orthodontic education. How about the orthodontist who has been a plaintiff’s hired gun and now can bolster his credentials by testifying under oath that he is Board-certified? What about the orthodontists whose clinical skills are suspect, borderline, or worse? How will this fact ricochet back against all of us and devalue the meaning that being Board-certified holds? You see, this is a big deal.

Where were the communities of interest on this issue? Was the Board of CDABO polled to see how they felt about this? If they were, was their opinion unbiased? I don’t know, but an organization that stands to have a few thousand extra members might conclude that anything to increase the potential member pool is good thing. Were the educators polled? A lot of academics are not certified, one reason being that they could never develop the required number of cases to show. This was always wrong, but they certainly won’t be opposed to the new method of achieving certification. Was the membership of CDABO polled? After all, the new mechanism allows all of these potential members to ultimately stand side-by-side as equals with current members even though they have not undergone the same scrutiny. I don’t know, it just seems that this was foisted upon all of us with not so much as a “What would you say if we decided to do…?”  

Wholesaling Board certification is not the answer. I cannot believe that, in this day and age, we don’t have the technological expertise to treat cases virtually and have the results analyzed and evaluated within days. I can’t believe that there aren’t enough photographs, models, and radiographs lying around that we can’t truly test someone’s knowledge in the course of an hour or two and discern what they know and don’t know. Ibelieve that we should at least make candidates take the case-presentation part of Phase III; in other words, evaluate them clinically in some form or fashion. I know that the Board has the best of intentions. However, every now and then, organizations make collective mistakes and, in case you haven’t figured it out yet, from where I and many others I know sit, this is one of those times—and it’s a doozy.

I know that there are very good and important reasons for increasing the percentage of Board-certified doctors in the shortest possible time. However, to the ABO I say look at what you represent, and then look all 25% of us who are Board-certified in the eye and tell us that giving certification upon application without having a meaningful clinical component to the examination is the right thing to do. If it is, then this should have been done long ago. If you say that this is merely to make up for errors of the past, then so be it. But it’s the wrong way to do the right thing.

Please, rethink this issue. It really is quite important. I don’t know how to end this letter other than to say that what you, the American Board of Orthodontics, have done emasculates the meaning of what it means to be Board-certified. I recall a phrase my wife said to one of our children after he had done something that was wrong. She gently said, “What you did hurt my heart.” You guys not only hurt my heart but the hearts of many of us—shame on you.

Laurance Jerrold, DDS, JD, is the interim dean and program director of the Advanced Education Program in Orthodontics and Dentofacial Orthopedics at Jacksonville University’s School of Orthodontics in Florida. He can be reached at [email protected].