Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

STATE DENTAL BOARDS AND 

DENTAL DISCIPLINE 

AUGUST 1993 
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services’ (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by three OIG operating components: the Office of Audit Services, the 

Office of Investigations, and the Office of Evaluation and Inspections. The OIG also informs 

the Secretary of HHS of program and management problems and recommends courses to 

correct them. 

OFFICE OF AUDIT SERVICES 

The OIGS Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIG’SOffice of Investigations (01) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions, 

administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 

control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFICE OF EVALUATION AND INSPECI’IONS 

The OIG’SOffice of Evaluation and Inspections (OEI) conducts short-term management and 

program evaluations (called inspections) that focus on issues of concern to the Department, 

the Congress, and the public. The findings and recommendations contained in these inspection 

reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability, 

and effectiveness of departmental programs. 

This report was prepared under the direction of Mark R. Yessian, Ph.D., Regional Inspector 

General, and Martha B. Kvaal, Deputy Regional Inspector General, Boston Region, Office of 

Evaluation and Inspections. Participating in this project were the following people: 

Boston Headquarters 

Barry McCoy, Lead Analyst Alan S. Levine 

Theodore Wall, Program Analyst 

For additional copies of this report, please contact the Boston regional office at 617/565-1050. 
Department of Health and Human Services 

OFFICE OF 

NSPECTOR GENERAL 

STATE DENTAL BOARDS AND 

DENTAL DISCIPLINE 

AUGUST 1993 0EI-01-92-O0821 
EXECUTIVE SUMMARY


PURPOSE 

To examine the capacity of State dental boards to carry out their disciplinary 

responsibilities. 

BACKGROUND 

In a recent inspection, “The Licensure of Out-of-State Dentists (OEI-01-92-00820),” we 

found that many State dental board officials had serious concerns about the capacity 

of the boards to identify and respond to incompetent and/or unprofessional dentists. 

They cited these concerns as a major basis for requiring out-of-State dentists to pass a 

clinical licensure exam before granting them a license. 

In this follow-up report, we identify and review indicators of boards’ capacity to carry 

out their disciplinary responsibilities. We draw on data collected from a survey of the 

boards as part of the above-noted inspection and on data available from published 

sources. 

FINDINGS 

THERE ARE STRONG BASES FOR QUESTIONING THE CAPACITY OF 

STATE DENTAL BOARDS TO CARRY OUT THEIR DISCIPLINARY 

RESPONSIBILITIES. 

They lack comprehensive reporting laws which can help them identi& dentists 

warranting investigation. 

.	 Twenty-nine of 48 reporting boards indicate that their States do not have 

laws mandating other parties to report to the board a dentist who may 

have violated the State dental practice act. In contrast, 47 States have 

mandated reporting laws for physicians. 

.	 Only 14 of the 48 boards indicate that their States require dentists to 

report to the board another dentist who may have violated the State 

practice act. Thirty-one States have such laws applying to physicians. 

They make limited use of disciplirmy action clearinghouses. 

.	 In 1992, only 23 of 48 reporting boards requested information from 

the clearinghouse maintained by the American Association of Dental 

Examiners and only 19 from the one maintained by the National 

Practitioner Data Bank. Failure to obtain such information can 

i 
deprive boards of knowledge about prior actions involving dentists 

under investigation. 

They discipline dentists to widely varying degrees and at a level somewhat less than 

that of State medical boards. 

.	 During the September 1, 1990 to August 31, 1992 period, dental board 

disciplinary actions per 1,000 active dentists ranged from lows of O in 

Connecticut, Delaware, Kentucky, Hawaii, and Wyoming to highs of 23.2 

in Oregon, 15.0 in Alaska, 19.2 in Missouri, 13.5 in Maine, and 12.0 in 

Iowa. 

The median and average rates of disciplinary actions per 1,000 active 

dentists taken by dental boards during this period was 6.41 and 7.0. The 

comparable figures for medical boards were 6.65 and 8.94. Although 

this differential is not extensive, it is important to recognize that dental 

boards may be more vital quality assurance bodies for dentists than 

medical boards are for physicians. This is because dentists are much 

more likely to practice alone and much less likely to be subject to 

oversight by other external bodies, such as hospitals or health 

maintenance organizations. 

They have insufficient resources to devote to investigations, particularly of complex 

cases involving the quality of dental care rendered. 

.	 The American Association of Dental Examiners, the association of State 

dental boards, cites “the lack of sufficient funding as the principle reason 

for enforcement difficulties.” 

.	 Eighteen of 24 boards reporting that they have their own investigators 

indicate that caseloads have increased since 1989, but only 5 state that 

staffing levels have increased during the same period. 

.	 Twenty-three of 48 reporting boards indicate that they do not maintain 

an in-house computerized file incorporating data on prior complaints 

against a dentist. Thirty-one of them state the same in regard to data on 

settled malpractice claims. 

CONCLUSION 

The information presented in this report reinforces the concerns of many State dental 

board officials about the capacity of the boards to carry out their disciplinary 

responsibilities. But the significance of the information goes beyond whether or not 

out-of-State dentists should be licensed by any given board. It suggests that many 

boards may not be providing adequate protection to the consumers of dental services 

ii 
and that they and the State governments of which they are a part would find it 

constructive to focus on ways in which they could improve the capacity of the boards. 

The PHS, through the Agency for Health Care Policy and Research or the Bureau of 

Health Professions, could facilitate State efforts to improve the capacity of their dental 

boards by extending financial support for the development of a self-assessment 

instrument for the boards. The PHS has supported a similar effort for State medical 

boards, with notable success. 

... 

111 
TABLE OF CONTENTS


PAGE


EXECUTIVE SUMMARY


INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1


FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


� Renewal Fee Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


�Consumer Membership on Dental Boards . . . . . . . . . . . . . . . . . . . . . . . . . ...6


�State Mandatory Reporting Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7


�Investigative Staffing Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8


�Computerized Information Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9


�Disciplinary Action Clearinghouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


�Disciplinary Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11


CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12


APPENDIX


k Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..A-l 
INTRODUCTION


PURPOSE 

To examine the capacity of State dental boards to carry out their disciplinary 

responsibilities. 

BACKGROUND 

Prior Reports 

In an August 1988 report, “State Licensure and Discipline of Dentists” (OAI-Ol-88-

00580), we raised concerns about how well State dental boards were carrying out their 

disciplinary responsibilities. In an August 1993 report, ’’The Licensure of Out-of-State 

Dentists” (OEI-01-92-00820), we reported that many board officials themselves were 

raising such concerns and citing them as a major basis for requiring out-of-State 

dentists to pass a clinical examination as a condition of licensure. These board 

officials expressed serious reservations about the capacity and readiness of many 

boards to identify and then respond to incompetent and/or unprofessional dentists. 

Federal Interest 

Given the primacy of the State role in licensing and disciplining dentists, it is 

important to establish the bases for the Federal interest in the-capacity of State dental 

boards. The most direct basis is the Medicaid program, under which the Federal 

government now contributes about $1 billion a year for dental services.l It looks to 

the boards to provide a vital front line of protection for the recipients of those 

semices. It relies upon them to see that dentists meet the minimum necessary 

qualifications to practice dentistry and to take disciplina~ action against them when 

their conduct and/or practice warrant it. 

But the Federal interest in boards also rests on the protection they provide to all 

consumers of dental services, who, from various payment sources, are generating 

annual expenditures of close to $40 billionz for services performed by about 145,00 

dentists.3 To the extent that dental boards carry out their responsibilities effectively, 

they contribute to the capacity of the dental profession to respond effectively to oral 

diseases. The U.S. Public Health Service (PHS) has identified oral diseases as being 

“among the most prominent in the United States”4 and has set forth many specific 

objectives to reduce their incidence by the year 2000.5 These objectives could 

become of even greater concern to the Federal government if some dental coverage is 

included as a core benefit under a reformed national health care system. 

Over the years, the PHS, through the Bureau of Health Professions, has taken a 

number of actions to contribute to the development of dental (and other health care) 

boards. In 1984, it funded the Council on Licensure, Enforcement and Regulation of 

1 
the Council of State Governments to prepare a composite State-by-State information


system on dental and other health care boards. In 1989, it funded the American


Association of Dental Examiners (AADE), the association of State dental boards, to


help it convert its disciplinary action clearinghouse from a manual to a computerized


system. And, just recently, in 1993, it once again funded AADE, this time to facilitate


its efforts to develop criteria and mechanisms that State dental boards can use when


assessing the continued competency of dentists.


Finally, it is also important to recognize that PHS has an ongoing interest in State


dental boards because of its responsibilities for managing the National Practitioner


Data Bank (NPDB) established by the Health Care Quality Improvement Act of 1986.


Intended by Congress to facilitate improved credentialing activities by health care


institutions and licensing bodies, the NPDP serves as a clearinghouse of information


on disciplinary and adverse actions taken against health care practitioners. Among


health care licensing boards, only medical and dental boards are required to report all


their disciplinary actions to the NPDP.


METHODO~GY


In this report, we draw on data collected from our 1992 survey of State dental boards.


That survey was conducted primarily for our inspection on out-of-State dentists and


focused on questions addressing that topic. It included, however, a number of


questions addressing the disciplinary capacities of the State boards. In addition to


these data elements, we draw on data available in many published reports of the


American Association of Dental Examiners (AADE), the American Dental


Association (ADA), The Federation of State Medical Boards (FSMB), the American


Medical Association (AMA), and the National Practitioner Data Bank (NPDB).


We organize the report around seven key indicators of boards’ capacity to carry out


their disciplinary responsibilities. These are not the only such indicators, but they are


ones which we have found pertinent in our work over the past seven yearsG and in


our review of the literature on the licensure and discipline of the health care


occupations.7 They are also indicators for which we can present current and reliable


data. In each case, we present a brief statement indicating why the indicator is


pertinent to a board’s capacity to carry out its disciplinary responsibilities, a figure


revealing the key data, and brief explanatory text. Data was provided for the 50


States and the District of Columbia, hereafter referred to as States.


To facilitate interpretations of the data, we present them, where possible, in a manner


that allows for comparative assessments. We do this primarily by presenting trend


data for recent years. The actual time periods we use vary because of inconsistencies


in the data available.


We also allow for some comparative assessment by presenting parallel data, where


available, for State medical boards. Such boards ha;e the sa;; basic responsibilities


as dental boards. It is important to take into account, however, that dental boards


2 
may well be a more vital quality assurance overseer for dentists than medical boards 

are for physicians. This is because dentists are less likely to be subject to oversight by 

other bodies, such as hospitals, health maintenance organizations, Medicare-funded 

Peer Review Organizations, and insurers.8 

We conducted this study in accordance with the Quality Standards for Inspections 

issued by the President’s Council on Integrity and Efficiency. 

3

� 

FINDINGS


THERE ARE STRONG BASES FOR QUESTIONING THE CAPACITY OF 

STATE DENTAL BOARDS TO CARRY OUT THEIR DISCIPLINARY 

RESPONSIBILITIES. 

There may be individual boards that have adequate capacity to carry out their 

disciplinary responsibilities and that are performing effectively in this regard. But the 

information we present on the following seven indicators raises serious questions about 

the disciplinary capacity of most boards. These data support the reservations that 

many State board officials themselves expressed to us during our inquiry on the 

licensure of out-of-State dentists. 

Renewal Fee Income 

FIGURE 1: ANNUAL LICENSE RENEWAL FEES FOR 

DENTISTS AND PHYSICIANS, 1985 AND 1992 

1985 

MEDIAN


FEE ...’... DENTISTS


AVERAGE


FEE


1992


MEDIAN 

FEE 

AVERAGE 

FEE 

do $25 $40 $75 $1’00 $125 

ANNUAL FEE 

souroes Fordentists- CouncilofStateGovernments,StatsRe@atmn“ Qftileliafdth Qca@Qns and 

&afQ&xw lQ4%8& Maroh1987 andOIG telephonesurvey,April1993. Forphysldans- American 

Madical Association, LB MeslkalLbnaum ~ 1985/19S6 and 1993 editions. N -51 Statsa. 

4

The median renewal fee of dental boards has increased from $40 to $75 between 1985 

and 1992, but it still lags that of medical boards, which increased from $50 to $100 

during the same period (figure 1). In California, the State with the largest number of 

licensed dentists, the 1992 dental board renewal fee was $120, compared with $250 for 

the medical board. In New York, the State with the second largest number of licensed 

dentists, the comparable fees were $70 and $165. 

Aside from the level of the fees, it is important to recognize that the fee income often 

is not reserved exclusively for the use of the dental board. This was the case for 17 of 

the 48 States responding to the relevant question in our survey. 

Thus, it appears quite possible that many boards are left with insufficient resources to 

do their investigatory work. The American Association of Dental Examiners, the 

association of State dental boards, acknowledged that such a deficiency does, in fact, 

exist when in response to our prior report on out-of-State dentists, it commented that 

“the lack of sufficient funding is the principle reason for enforcement difficulties.” 

5

Consumer Membership on Dental Boards�

FIGURE 2: PUBLIC MEMBERSHIP OF STATE DENTAL


AND MEDICAL BOARDS, 1988 AND 1991


1988 

DENTAL 

BOARDS 

MEDICAL 

BOARDS 

1991 

DENTAL 

BOARDS 

MEDICAL 

BOARDS 

A


Z 10% OR LESS 

� 11-20% 

� MORETHAN20% 

10 20 30 & 50 

NUMBER OF DENTAtJMEDICAL BOARDS 

Sourcw For dentists- AmericanAssociationof Dental Examiners,CompQMQ,1989 and 1992 

adiions. For physicians- Federationof State MedicalBoards,Fxchange, 1989-1990 and 

1992-1993 editions. N -51 States. Note -we include only public members with full 

voting privileges. 

In 1989, a broadly based task force of The Federation of State Medical Boards issued 

an important report entitled “Elements of a Modern State Medical Board: A 

Proposal.” Although it focuses on medical boards, it offers many suggestions 

concerning board membership, structure, and operation that can also be highly 

instructive to dental boards. One of those suggestions is that public or consumer 

members should constitute 25 percent of a board’s membership.9 

Even this modest benchmark is one which most medical and dental boards fall short 

of meeting (figure 2). In fact, 15 dental boards have 10 percent or fewer consumer 

members and 38 have 20 percent or fewer; the comparable numbers for medical 

boards are 8 and 32. 

6

State Mandatoy Repo&g Luws�

o 10 20 30 4) 5b 

NUMBER OF STATES 

Sources For dentists- OIG mail survey, Fall 1992. For physicians- l%e Federationof State 

Medioal Boards, ExckngQ,1992 -1993 sdition. N =43 States. 

Among 48 States for which we have comparative information, 47 have mandated 

reporting laws for physicians, but only 19 have them for dentists (figure 3). Only 14 of 

these States require individual dentists to report to the board other dentists who they 

believe may be acting in an unprofessional manner or delivering substandard dental 

care. Even fewer States require hospitals (13) or professional associations (7) to 

report. 

Given the relative lack of reporting laws and the fact that the great majority of 

dentists practice alone, it can be quite difficult for State dental boards to identify 

dentists responsible for poor practice or some wrongdoing. More so than State 

medical boards, they are dependent on referrals made by individual consumers. 
Investigative Sta~g Levei?s�

FIGURE 4: CHANGES IN INVESTIGATIVE CASELOADS 

AND INVESTIGATOR STAFFING LEVELS AT STATE 

DENTAL BOARDS, FROM 1989 TO 1992 

w 

LOWER II CASELOADS 

a 

z 

< STAFFING x 

u 

,, L 6 

0 

a 

5 

HIGHER 

I , 0 5 10 15 20 25 

NUMBEROFBOARDS 

Source: OIGmail survey, Fall 1992. N-24Statedental boardsrepotting theyhaveinvestigatm 

on their own staffs. 

In response to our survey of the State dental boards, 24 reported that they have their 

own investigators to follow up on complaints or referrals received by the board 

(figure 4). Among these 24, 18 indicated that their caseload increased during the prior 

three years, but only 5 stated that their investigative staffing level had also increased. 

Such a disparity contributes to higher caseloads per investigator and more constricted 

investigatory efforts. 

Whether the boards that rely on investigators in a parent department are experiencing 

a similar strain in staffing support is not clear from our survey. It is more difficult to 

assess investigative staffing trends for these boards because the investigators often 

serve boards besides the dental board. 

8

Computerized Information Systems�

FIGURE 5: TYPES OF COMPUTERIZED INFORMATION 

MAINTAINED BY STATE DENTAL BOARDS OR THEIR 

PARENTIDEPARTMENTS ON LICENSED DENTISTS, 1992 

j PRIOR 131SCIPLINARYACTIC)NS \34 

PRIOR COMPLAINTS 25 

i 

MALPRACTICE CUdMS ,7 

{ SEITLED 

ACTIONS Y 7 1=OTHER ST TES

I 

o	 10 20 30 40 

NUMBER OF BOARDS/PARENT DEPARTMENTS 

Sourcxx OIG mail survey, Fall 1992. N -44 States report having computerized informationon licensed 

dentiat~ 43 States responded to the survey question. 

Most dental boards (34 of 48 reporting) can turn to a computerized file that they or 

their parent department maintains to determine if they have taken prior disciplinary 

action against that dentist (figure 5), But for other types of information pertinent to 

an investigation, fewer boards are likely to have this opportunity. Twenty-five of the 

48 can look to an in-house computerized file to determine if any prior complaints have 

been lodged against the dentist, 17 to learn if there have been settled malpractice 

claims involving the dentist, and only 7 to find out if any other State has taken 

disciplinary action against the dentist. 

With some effort, such information can almost always be obtained by the inquiring 

board. But its lack of ready availability adds to the cost and time of an investigation 

and ultimately impedes the effectiveness of a board. 

9 
FIGURE 6: STATE DENTAL BOARDS’ USE OF DISCIPLINARY 

ACTION CLEARINGHOUSES, 1992 

REVIEWED THE MONTHLY AADE DISCIPUNARY REPORTS FOR 

37 

DENTISTS UCENSED IN STATE 

REQUESTED INFORMATION FROM AADE 

23 

FOR NAMED DENTISTS 

I 

REQUESTED INFORMATION FROM 

19 NPDB FOR NAMED DENTISTS 

t 

10 20 30 40 

NUMBER OF BOARDS 

Sourw OIG mailsurvey,Fall 1992. N -43 States. (Eachstate didnotrespondto eachofthe three 

questionsposed.) AADE- AmericanAssociation01DentalExaminers. NPDB - NationalPrac$itloner 

Data Bank. 

Nearly all of the dental boards that addressed the pertinent question in our survey 

(37 of 41), reported that they reviewed the monthly reports that the AADE sends 

them on dentists licensed in their States (figure 6). But during the past year, only 23 

indicated that they made any name requests of the AADE and only 19 of the NPDP. 

The $6 ($10 for paper queries) accessing fee charged by the NPDP may have some 

effect in limiting the boards’ readiness to make name requests of it. Why they may 

also be disinclined to make such inquiry of the AADE clearinghouse, which is 

available free of cost for the first 100 queries in a year, is less clear. 

10 
Dkciplinq Actions�

FIGURE 7: RATE OF DISCIPLINARY ACTIONS BY STATE 

DENTAL AND MEDICAL BOARDS, 9/1/90 - 8/31/92 

b lb 20 4) 4) 

NUMBER OF ACTIONS PER 1000 ACTIVE PRACTITIONERS 

Scurces For denflsts - National Practltkner Datn Bank Ilcenaum acilons reported by Sfata dental 

boards for 9/1/90 - 3/31/92 and lhe American Dental AsaodaUon, IWl, 1992 RktdbWm 9f Ran!&la 

imihaL!niied Si@eshy E@c)naod S!ata. Forpt@Asms-NaUona lPracWonerDataBank,Bce nawe

acdons mportad by Stefe medkai boards for9/1/90. 6/31/92 and The Federatbn of S@ta Medbl 

Boards, ~ 1992-1993 adltlon. N - SOStataa. 

The number of disciplinary actions taken by dental boards during the September 1, 

1990 to August 31, 1992 period varied greatly; at one extreme five boards took no 

such actions and at the other 5 took 12 or more.10 Overall, the median was 6.41 and 

the average 7.0. This compares with 6.65 and 8.94 for medical boards (figure 7). 

Thus dentists were somewhat less likely to be disciplined by licensure boards than 

were physicians, even though, as we noted earlier, dental boards may be a more 

important front line of protection for consumers than are medical boards. 

It would be inappropriate to suggest that there is any proper number of disciplinary 

actions for a board or to overemphasize their importance as an indicator of a board’s 

capacity or effectiveness. Yet it would also be inappropriate to ignore this factor. In 

this context, it is well to note that in a report on medical boards, the American 

Association of Retired Persons advised that the simplest way to determine how well a 

board is performing is to determine how many disciplinary actions it is taking.ll 

11�
CONCLUSION�

The stimulus for this report was our prior finding that State dental board officials were 

often reluctant to license out-of-State dentists because of concerns about the capacity 

and readiness of many of their counterpart boards to carry out their disciplinary 

responsibilities. The information presented in this report supports their concerns, but 

its significance goes beyond the licensure of out-of-State dentists to the more basic 

issue of providing adequate protection to the consumers of dental services in all the 

States. 

Given that the licensure and discipline of dentists is essentially a State responsibility, it 

is the State boards and the State governments of which they are a part that must take 

the lead if the limitations identified in this report are to be addressed. Those 

limitations affect the boards’ capacity to identify dentists warranting investigation, to 

conduct thorough investigations that will facilitate responsible decision making about 

how a board should proceed with a case, and, when, necessary to take disciplinary and 

corrective action that will protect the public and be fair to the dentist involved. 

The Federal government, as indicated at the outset of this report, has a considerable 

interest in how the States address the limitations of their dental boards. In this 

context, one important way in which the Public Health Service (PHS) might help the 

State boards, but still respect the primacy of their role, is to extend some financial 

support for the development of a self-assessment instrument for the boards. Such an 

instrument, if developed by representatives of dental boards, could serve as an 

important stimulus for boards to develop consensus on key indicators of their 

performance, to collect data in accord those indicators, and then to compare the 

results over time and even across States. 

The PHS, through the Agency for Health Care Policy and Research (AHCPR), has 

funded The Federation of State Medical Boards to develop a self assessment 

instrument for State medical boards, with notable success. *2 Similar support whether 

through AHCPR or the Bureau of Health Professions, oriented to dental boards, the 

only other State licensing boards mandated to report their disciplinary actions to the 

National Practitioner Data Bank, could build upon the prior project and have similar 

benefits. 

12

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

APPENDIX A 

NOTES 

Suzanne W. Letsch, Helen C. Lazenby, Katherine R. Levit, and Cathy 

A. Cowan, “National Health Expenditures, 1991,” Health Care Financing 

Review 14 (Winter 1992): 29. Federal Medicare expenditures for dental 

services are only a few million dollars a year as they are limited to 

surgery related to the jaw or facial bone. 

See Letsch, et al., p. 29. 

U.S. Department of Commerce, Bureau of the Census, Stat&ical 

Abstract of the United States, 1992, Table 160, p. 109. Based on data 

supplied by the American Dental Association, Bureau of Economic and 

Behavioral Research. 

U.S. Department of Health and Human Services, Public Health Service, 

Healthy People: National Health l+omotion and Disease Prevention 

Objectives, DHHS Publication No. (PHS) 91-50212, 1991, p. 350. 

Ibid., pp. 352-61.


In particular, see “State Medical Boards and Quality-of-Care Cases: Promising


Approaches,” OEI-01-92-00050, February 1993; “Performance Indicators,


Annual Reports, and State Medical Discipline: A State-by-State Review,” OEI-


01-89-00563, July 1991; “State Licensure and Discipline of Dentists,” 0AI-Ol-88-


00580, August 1988; and “Medical Licensure and Discipline: An Overview,”


P-01-86-00064, June 1986.


See, for examples, American Medical Association, Physician Competence: Whose�

Responsibility: Conference Proceedings, April 7-9, 1988; U.S. Department of


Health and Human Services, Public Health Service, Agency for Health Care


Policy and Research, issues in Medical Liability: A Working Conference, Mary L.


Grady and Randie A. Siegel, eds., 1991; and U.S. Congress, Office of


Technology Assessment, The Quality of Medical Care: Information for�

Consumers, OTA-H-386 (Washington, DC: U.S. Government Printing Office,


June 1988).


See EH O’Neil, Health Professions Education for the Future: Schools in Service�

to the Nation (San Francisco: Pew Health Professions Commission, 1993), 51. A


major reason for dentists being subject to lesser oversight is that about 69


percent of them conduct solo practices. See American Dental Association, me


A-1

1991 Survey of Dental Practice: General Characteristics of Dentists, April 1992, p. 

2. 

9.	 See Federation of State Medical Boards, Elements of a Modem State Medical 

Board: A Proposal, 1989, p. 3. 

10.	 In a recent article, Damiano et al. also reported significant variations 

among the States in disciplinary actions and among State professional 

associations in peer review actions. Such variations, they concluded 

“suggest the need for modifications to improve the licensure and 

disciplinary process to ensure performance in accord with accepted 

professional standards.” See Peter C. Damiano, Daniel A. Shugass, and 

James R. Freed, “Assessing Quality in Dentistry: Dental Boards, peer 

Review Vary on Disciplinary Actions, Journal of the American Dental 

Association 124 (May 1993): 130. 

11.	 See American Association of Retired Persons, E&ective Physician Overnight: 

Prescription for Medical Licensing Board Reform, 1987. 

12.	 A task force of the Federation of State Medical Boards developed a 

lengthy self-assessment instrument which it sent to all State medical 

boards for comment and then, upon revision, for their own use. Many 

State boards have completed the assessment instrument and have sent in 

their results to the Federation. The Federation, upon the receipt of 

such results, enters the data into a common data base incorporating the 

information submitted by all boards. It then returns information back to 

the State boards in a manner which allows them to compare their results 

with those of other States. At the annual meeting of the Federation, 

held in April 1993, many board representatives reported that the selfassessment instrument and process associated with completing it were 

helping in identifying ways of improving their boards’ capacity. 

A-2