Apologies if you have already seen this. I still have no idea who penned the original source although from the
language I suspect it sources the States where the debate about performance pay is currently raging. I did search about the traps
and notice it has already done the rounds of the QSITE and Edulist
English mailing lists.<br><br>Here it is (* toothless grin *)<br><br>Regards Roland<br><br><div style="margin-left: 40px;"><span style="font-weight: bold;">Merit Pay For Dentists</span><br><br>My dentist is great! He sends me reminders so I don't forget checkups. He
<br>uses the latest techniques based on research. He never hurts me, and I've<br>got all my teeth.<br><br>When I ran into him the other day, I was eager to see if he'd heard about<br>the Federal Government's latest program for improving the dental health of
<br>our children by introducing merit pay for dentists.<br><br>"Did you hear about the new federal program to measure effectiveness of<br>dentists with their young patients?" I asked.<br><br>"No," he said. He didn't seem too thrilled. "How will they do that?"
<br><br>"It's quite simple," I answered. "They will just count the number of<br>cavities each patient has at Grades 3, 5, 7, 9, and average that to<br>determine a dentist's rating. Dentists will be rated as excellent, good,
<br>average, below average, and unsatisfactory. That way parents will know which<br>are the best dentists. The plan will also encourage the less effective<br>dentists to get better," I said. "Poor dentists who don't improve could lose
<br>their licenses to practice."<br><br>"That's terrible," he replied.<br><br>"What? That's not a good attitude," I said. "Don't you think we should try<br>to improve children's dental health in this country?"
<br><br>"Sure I do, but that's not a fair way to determine who is practising good<br>dentistry."<br><br>"Why not?" I asked. "It makes perfect sense to me."<br><br>"Well, it's so obvious," he said. "Don't you see that dentists don't all
<br>work with the same clientele, and that much depends on things we can't<br>control? For example, I work in a rural area with a high percentage of<br>patients from deprived homes, while some of my colleagues work in upper
<br>middle-class neighborhoods. Many of the parents I work with don't bring<br>their children to see me until there is some kind of problem, and I don't<br>get to do much preventive work. Also, many of the parents I serve let their
<br>kids eat way too much sweet food from an early age, unlike more educated<br>parents who understand the relationship between sugar and decay. To top it<br>all off, so many of my clients have tank water which is untreated and has no
<br>fluoride in it. Do you have any idea how much difference early use of<br>fluoride can make?"<br><br>"It sounds like you're making excuses. I can't believe that you would be so<br>defensive. After all, you do a great job, and you needn't fear a little
<br>accountability."<br><br>"I am not being defensive!" he said. "My best patients are as good as<br>anyone's, my work is as good as anyone's, but my average cavity count is<br>going to be higher than a lot of other dentists' because I chose to work
<br>where I am needed most."<br><br>"Don't' get touchy," I said.<br><br>"Touchy?" he said. His face had turned red, and from the way he was<br>clenching and unclenching his jaws, I was afraid he was going to damage his
<br>teeth. "Try furious! In a system like this, I will end up being rated<br>average, below average, or worse. The few educated patients I have who see<br>these ratings may believe this so-called rating is an actual measure of my
<br>ability and proficiency as a dentist. They may leave me, and I'll be left<br>with only the most needy patients. And my cavity average score will get even<br>worse. On top of that, how will I attract good dental hygienists and other
<br>excellent dentists to my practice if it is labeled below average?"<br><br>"I think you are overreacting," I said. "'Complaining, excuse-making and<br>stonewalling won't improve dental health'... I am quoting from a leading
<br>member of the DOC," I noted.<br><br>"What's the DOC?" he asked.<br><br>"It's the Dental Oversight Committee, a group made up of mostly lay persons<br>to make sure dentistry in this state gets improved."
<br><br>"Spare me! I can't believe this. Reasonable people won't buy it," he said<br>hopefully.<br><br>The program sounded reasonable to me, so I asked, "How else would you<br>measure good dentistry?"
<br><br>"Come watch me work," he said. "Observe my processes."<br><br>"That's too complicated, expensive and time-consuming," I said. "Cavities<br>are the bottom line, and you can't argue with the bottom line. It's an
<br>absolute measure."<br><br>"That's what I'm afraid my parents and prospective patients will think. This<br>can't be happening," he said despairingly.<br><br>"Now, now," I said, "don't despair. The Federal government will help you
<br>some."<br><br>"How?" he asked.<br><br>ģIf you receive a poor rating, they'll send a dentist who is rated excellent<br>to help straighten you out," I said brightly.<br><br>"You mean," he said, "they'll send a dentist with a wealthy clientele to
<br>show me how to work on severe juvenile dental problems with which I have<br>probably had much more experience? BIG HELP!"<br><br>"There you go again," I said. "You aren't acting professionally at all."
<br><br>"You don't get it," he said. "Doing this would be like grading schools and<br>teachers on an average score made on a test of children's progress with no<br>regard to influences outside the school, the home, the community served and
<br>stuff like that. Why would they do something so unfair to dentists? No one<br>would ever think of doing that to schools."<br><br>I just shook my head sadly, but he had brightened.<br><br>"I'm going to write my representatives and senators," he said. "I'll use the
<br>school analogy. Surely they will see the point."<br clear="all"></div><br><br>-- <br>Roland Gesthuizen - ICT Coordinator - Westall Secondary College<br><a href="http://www.westallsc.vic.edu.au">http://www.westallsc.vic.edu.au
</a><br><br>"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has." --Margaret Mead