The future of orthodontics, like the destination of a sailor, is rarely visible to the naked eye. The sailor uses the sextant to get direction as we must use the sextant of past experience to see what lies ahead for us.
There is no question that today's orthodontic students are tomorrow's orthodontic profession, but they will have little control over the educational experiences they encounter. These experiences will be a function of the systems we have put in place. Today's orthodontists, by and large, are professionally happy and successful. The systems worked for us and we would naturally like to see the past as the prologue for the future. Changes have occurred, however, and more changes are inevitable.
The fact that our orthodontic educational system has severe problems is not disputed. Its problems are largely centered around resources in general and finances in specific. The diagnosis is clear and easily agreed upon. It is the treatment plan where judgment comes into play and a diversity of opinions abound.
Some take the laissez faire approach believing that the symptoms probably won't affect them and the systems in place today will ultimately resolve the issue. This avoids all notions of stewardship and has the potential to result in great damage.
The generic solution is to find alternative sources of funding. One action plan is for the orthodontic profession to step up and address the problem through the AAOF or equivalent. This is good stewardship of our profession, but it is hard to visualize this approach totally erasing today's problems given the vast recurring resources required to operate four dozen programs. The organized profession, however, must be a major player in the more complex final solution.
Where is a source of recurring funds that can be made available for orthodontic educational programs? Others have advanced a proposal where the programs themselves would grow their earnings by fee for care approaches and re-channel this revenue to enrich the program. This logic is ostensibly attractive, but the reality is that the orthodontic programs are unable to cope with pragmatic parent dental schools that choose to redistribute most or all orthodontic earnings to other school-wide needs.
Today there is talk of another approach where salaried orthodontists, working for a non-university enterprise outside of the university, would generate patient care revenues for the enterprise. The non-university enterprise would then donate funds to the orthodontic program to produce more orthodontists and the cycle is repeated over and over. The sine qua non of this idea is the need to have a new and special relationship between the private enterprise, the orthodontic program and its students such that the program would continue to supply graduates obligated to work for the non-university enterprise.
Is there a history of non-university support of orthodontic education? Of course there is and we have a long track record of private and corporate support of orthodontic education. No one is concerned when, for example, a giant software company gives large donations to a university computer programming school. The company donates the funds to the university and the university insulates the programs from any undue influence of the private company. The company hopes to benefit by advances in software and more and better software graduates, but it has no guarantees. Universities have a long history of open ended corporate and private support.
If, on the other hand, the software company were to try to dictate curricular content, influence student admissions or otherwise interfere with the program's academic freedom, the university should and would categorically reject the donation. No quality university can or should accept interference in the freedom essential to the academic process. In today's fiscal climate this scenario will be increasingly difficult for a university to resist. Dentistry is the most expensive per student university program and dental deans are under great pressure to develop additional resources outside of traditional sources. However, to place any portion of an orthodontic program or any other university program at the beholding of a private interest is a risk we simply cannot afford. The independence of our university system, from its governing boards to its orthodontic programs, is built on autonomy and total academic freedom from outside political and special interests.
That is not to say that education must be a governmental operation. We have history rich in a mix of private and public universities. The history of training in medicine and dentistry shows private and proprietary beginnings. However, with the Gies Report on Dentistry in 1935 following the earlier Flexner Report on Medicine the problems of freestanding proprietary professional education became apparent and firmly established the role of universities in medical and dental education. This role, like our government, is built on a system of checks and balances to avoid distortions and undue influences on the goals of education. The university must derive its support, be it governmental, corporate or private, free from the influences of the source of the support. This is fundamental to our higher educational system.
The pendulum is swinging to focus on profitability and gain for investment. The university system must be a good steward with public or private revenues and be a source of gain for society, but it must retain its original charge to investigate all ideas free from outside influences. Such freedom is critical to the excellence of both our universities and our orthodontic programs.