President’s Message: Board Certification: Debunking the Elitist Myth

By Linda G. Levin, D.D.S., Ph.D.

A hot topic within the dental community has been the process by which the dental specialties are recognized. Some have contended that the existing system is undermined by its inherent political nature and that it lacks the objectivity necessary to fairly evaluate a request for recognition of a new specialty or recertification of the existing specialties-a process that must occur every 10 years per the ADA guidelines. Under the present system, the Commission on Dental Accreditation and the Council on Dental Education and Licensure make recommendations to the ADA for recognition of a specialty based on the information supplied by the candidate discipline. The recommendation is voted on by the ADA House of Delegates. Some argue that this is where the system fails because objectivity gives way to political machinations and conflicts of interest. The recent ruling in AAID v. Parker and the subsequent formation of the American Board of Dental Specialties showed that the legal system found significant flaws in the present system. One component of the present system, however, is the requirement that a dental specialty must have a certifying board. This requirement likely will prevail regardless of how the process changes because the value of an independent testing body to protect the public and promote a minimal level of competency in a defined area is well-established. For the AAE, the percentage of Diplomates is slowly rising, however there still are many who do not appear to see the value in Board certification and who may misunderstand the process.

What does it mean to be Board-certified in an ADA-accredited specialty? Board certification is a fairly common credential in most healthcare professions, yet the minority of specialty practitioners in dentistry has attained it. The reasons for this are varied. The time commitment and personal sacrifices involved in preparing for and engaging in the process can be daunting. Proponents of the theory espoused in Steven Levitt’s Freakonomics, however, would contend that the most likely reason that dental specialists do not pursue Board certification is that they perceive no direct benefit to themselves. Those of us who have achieved Diplomate status know that the benefits are great. The preparation alone orients us to evidence-based practice. So what accounts for the difference in the perceived and actual benefits of Board certification? One explanation would be that many misunderstand the process and what it seeks to achieve. In an effort to gain perspective on the layman’s understanding of Board certification, one can look at Wikipedia. The definition given there is surprisingly accurate and to the point. In fact, it seems that Wikipedia has a better grasp of the objectives of Board certification than many of its critics within the dental profession. Wikipedia states, “Board certification is the process by which a physician or other professional in the United States demonstrates a mastery of basic knowledge and skills through written, practical, or simulator-based testing.”

Notice that the definition does not use adjectives like superior, superlative or exclusive. Instead, it stresses testing to confirm that a candidate has mastered the very basic skill set and knowledge base that we expect an endodontist to possess. The ADA has outlined this skill set and knowledge base for us (and all of the recognized dental specialties) thereby defining our specialty. The American Board of Endodontics is the designated body charged with the task of certifying that a candidate for Board certification is competent in the defined areas of our specialty. In predoctoral dental programs there several levels of evaluation to ensure competency, but all students must pass a standardized National Board Dental Examination to ensure that the dental school graduate possesses the requisite skill set and knowledge base to practice safely and competently.

How do we establish such a standard in endodontics? The only national agency that tests endodontists is the ABE. To become Board-certified, candidates must successfully complete three examinations: a written exam testing endodontic knowledge; a case history exam, evaluating the practitioner’s skill as a clinician; and an oral exam, demonstrating treatment planning and problem-solving skills.

One could argue that if the ADA requires that each specialty have a certifying board that serves as the sole agency for confirming competency in that specialty, then the pursuit of Board certification should be mandatory. This is not the case. In fact, no specialty requires Board certification. All of the pressures to pursue Board certification are extrinsic to the profession or intrinsic to the individual. In the dental specialties, Board certification is required for an individual to become a graduate program director. Likewise, the military ties Board certification to promotion. Aside from these instances, the desire to become a Diplomate is fueled by self-motivation and a belief that the system is valid. Successful completion of Board certification is the final confirmation to the profession and the public that an individual has gleaned from their program the necessary information and skills to declare themselves an endodontist. At AAE17, we will recognize the new Diplomates of the ABE. The challenges and sacrifices for each candidate are most certainly different. Some have families and most have thriving practices that demand their attention. Some will be academicians whose position mandated the credentials to progress in their career path. The candidates will be distinctive in many regards. As a result of having become Board-certified, however, they have will have something very important in common: they have all demonstrated a “mastery of the basic knowledge and skills that define” endodontics. I look forward to congratulating them on their accomplishment. But make no mistake, being Board-certified does not guarantee that one is more qualified or a better clinician-no licensure or certification examination can do that. It does mean that the Diplomate has had their abilities assessed in a systematic and objective manner by an independent group of their peers. We must dispel the misconception that the Diplomates of the ABE represent an elitist group. In contrast we should work to make certification the norm, not the exception. Every graduate of an ADA-accredited program is qualified to pursue Board certification. It is both an important confirmation of their knowledge base and level of skill as well as a crucial outcomes measure for our endodontic training programs. It also fulfills one of the requirements for being a dental specialty, thereby ensuring that endodontics remains a specialty in good standing.

As we look to a new year I wish everyone joy and prosperity. For those of you who aren’t Board-certified, I hope that it will become your new year’s resolution for 2017. It is a gift you give your patients, your specialty, your profession and yourself.