Note: This blog draws in part on my experiences and observations interviewing political figures, writers, and analysts for "The Campbell Conversations" on WRVO. To hear past interviews I refer to in these posts, please go to the show's website. The views expressed here are solely my own, and do not represent Syracuse University, the Campbell Institute, or the WRVO Stations.

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Tuesday, November 30, 2010

Fatal Extraction

(Apologies to Mark Rom for the post title)

After reading James Mulder's account today of the trail of negligently poor treatment left by a Manlius dentist, I was stunned to also read that she had been fined a whole thousand dollars and suspended from practice......until she completes a "retraining."  Are you kidding me?  A thousand dollars is less than one root canal.  And one wonders what it would take for a permanent suspension.

I want to connect this to two broader problems.  The first was suggested by a recent New York University study of regulation in the State, which concluded that the problem with regulations here is not simply that there are too many of them, but that they are not well crafted, and in particular do not consider appropriate cost/benefit analyses.  Based on the article, it's hard to imagine in this case that the benefit to the local community of having one additional dentist practicing would outweigh the cost of having this particular dentist practicing.

Second, to the degree that these regulations from the State Board of Dentistry reflect the influence of the profession--that they are, despite occurring under the umbrella of the state, in effect internal policing--it illustrates a general problem with the way in which and the degree to which the medical professions monitor themselves.  Part of the unwritten social contract for the sky-high salaries many medical practitioners receive is that in return the quality of care we get will be consistent, and high.  We have expensive health care, but we have excellent health care, so the story goes.  A growing body of research on health care shows that this is often not the case.  Here's one small but jaw-breaking example of that.


Anonymous said...

To whom is the state board of dentistry answerable, if anyone? Are there opportunities for concerned citizens to work with legislators or the governor to amend these regulatory practices?

Grant Reeher said...

Excellent questions. It's part of the Office of Professions, which is in turn part of the Education Department--and therefore public accountability comes in via the Regents Board, which oversees the department. Public accountability also takes place indirectly through the governor's office and the Legislature. So a concerned citizen could try to contact the Regents, or his or her political representatives to get involved or urge a particular action. But at the "point of service" so to speak, there is a strong presumption in favor of self-policing (fellow practitioners keep tabs on practitioners), and I do not believe that this practice has always served us well. A great book that traces out the history and the politics related to this is Paul Starr's The Social Transformation of American Medicine.

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