President’s Message: Do We Have an Identity Crisis?

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

How many times have you introduced yourself to a patient and been asked, “What exactly is an endodontist?” The question implies that they have come to your office for a complex dental procedure through blind trust in the individual who sent them rather than knowledge of your credentials and expertise. It also is testimony to an identity crisis from which most dental specialties suffer. The reality is that the public at large does not understand the dental specialty process or how a specialist differs from a primary dental care provider. Typically, an identity crisis is defined as a state of confusion in an organization regarding its constitution or direction – our crisis is that our patients and even some of our dental colleagues do not really understand who we are.

But how can this be? Most of the ADA-recognized specialties have been codified for decades. Endodontics was recognized as a specialty in 1963, oral surgery in 1947, orthodontics in 1950 and periodontics in 1949. The truth is that the ADA-recognized specialties are not really recognized by the ADA in a meaningful way. In the ADA’sGuidelines for Practice Success: Specialty Referrals (posted on ADA.org in November 2015), there is no mention of the nine ADA-recognized dental specialties or the resources we provide for patients and dental healthcare providers at large. They simply state, “your patients need to understand that, while you are a highly-educated, trained and skilled dentist, their care can best be delivered by another dentist with more experience in a specific area.” The vague reference to “more experience” fails to differentiate between a formal, specialized residency program and random, unsupervised clinical experience or weekend courses. This is an unfortunate and potentially irresponsible message to all stakeholders. The AAE will be issuing a formal objection to this message in hopes that the ADA will be more specific in their recommendations. We also will be requesting that the ADA form a committee, with all of the dental specialties represented, to establish guidelines for quality of care and outcomes.

Part of our identity crisis is due to our dependence on others to educate and direct the public to specialty dental care. Traditionally, the dental specialist has relied on their referring doctors to serve as their main conduit for patient referrals. Inherent in the referral process is an explanation to the patient as to why they are being referred to a specialist. I often hear from patients that they were referred because I have better equipment – rarely because I have more formal training, have practiced as an endodontic specialist for 30 years or am Board certified. I suspect there are many reasons for this. As a full-time educator for 20 years I have seen that predoctoral dental students have little interaction with the graduate endodontic clinics and limited knowledge of the didactic portion of the endodontic residency training. Most do not appreciate the value of Board certification or even know the difference between Board certification and licensure since there is no equivalent in general dental practice. Furthermore, their exposure to endodontics after graduation is largely through commercial interests. So it is understandable that many of our general dental healthcare providers only see the technical aspect of our work with little perspective on the rigorous formal process and exposures that specialty training entails. They do not know our true identity.

The AAE has recognized this fundamental lack of understanding and has worked to educate the entire dental profession about the advanced training of the endodontic specialist, advancements in care, and the value of consulting with an endodontist in treatment planning. For more than 20 years, the AAE has published theENDODONTICS: Colleagues for Excellence newsletter, a clinical resource on a single endodontic topic, mailed to all AAE members and ADA general dentist and specialist members. Surveys have shown that the vast majority of general dentists read the newsletter and that they find Colleagues to be credible, useful and accurate. In addition, we partner with the ADA to publish a quarterly Specialty Scan e-newsletter on endodontics as well as a periodic specialty update in the Journal of the American Dental Association. Both provide opportunities to educate the profession about the standard of practice in endodontics, but our identity crisis persists and we must do more.

Though we continue to educate our referring dentists, it is worth noting that the paradigm of the general dental care provider serving as the sole conduit for specialty referral is changing. More and more patients are assuming increased responsibility for their own healthcare outcomes, including their providers. While they may take counsel from their primary care dentist, they also research on the internet and consult with friends and colleagues. In Pew Research Center surveys, 87 percent of U.S. adults reported that they use the internet and 72 percent of internet users said they looked online for health information within the past year. The center also reports that information on doctors or other healthcare professionals was among the most-commonly researched topics. One in five internet users have consulted online reviews and rankings of healthcare service providers and treatments. While they still consider their primary healthcare provider an important source of information, today’s patients may very well override their general dentist’s opinion and choose specialty care or a specialist provider on their own.

In recognition of this shift in the way patients access healthcare information, the AAE began implementing a digital communications strategy after wrapping up its formal awareness campaign in 2014. By positioning the AAE and its members at the forefront of the digital community with tactics such as search engine marketing and optimization, proactive social media outreach, enhanced website content and the development of multimedia assets, the AAE is trying to reach patients and dentists with the most authoritative and reliable endodontic information available. For example:

• We have created more robust patient pages on the AAE website. These pages consistently are our most popular content; thousands of visitors use the “Find an Endodontist” search engine each month and thousands more have viewed and shared our high-quality patient education videos.
• We monitor networks like Twitter to contribute to conversations about endodontic treatment and direct patients to AAE resources.
• Our Facebook community is one of the most active of all dental specialties and provides helpful resources that our fans can share to spread positive messages about the specialty.

I encourage all of our members to learn more about our efforts in AAE Digital Outreach by the Numbers.

We are not stopping here. A new communications strategy, developed in concert with the new AAE brand, also will help differentiate endodontic specialists from general dentists. Incorporating input from AAE members and patient focus groups, a new patient-focused website will highlight the endodontist’s superior training, expertise and equipment while building patients’ trust. We will be more aggressive in positioning the endodontist as the only choice for endodontic treatment.

But we know there is more work to do. Arguably one of the most recognized dental specialties among the public is orthodontics. In their patient-focused online content, they tastefully point out that all specialists are dentists but not all dentists are specialists. While this message is obvious to us, to the patient it often is an epiphany. Borrowing from this idea, the AAE’s patient landing page states, “All endodontists are dentists, but less than three percent of dentists are endodontists.” It is important that our patients know that we have two to three years of additional, intensive training that enables us to be uniquely qualified to treat even the most difficult endodontic cases.

Another aspect of the orthodontists’ public awareness campaign is their focus on the results of orthodontic treatment instead of the process. The AAE’s past campaigns often have addressed patients’ fears and misconceptions regarding the pain of root canal treatment rather than emphasizing the end product, saving a natural body part. The orthodontists do not mention the week of pain after each adjustment but instead focus on the beautiful smile a patient will have after treatment. We should consider a similar approach because the real aim of endodontic treatment is to save the natural tooth. Doing so with as little pain as possible is desirable but it is not an outcome.We cannot continue to be defined by a dental procedure that has become synonymous in the popular vernacular with something one should avoid at all costs. We need to be seen by the public as the specialty that saves teeth – that is our true identity.

So how do we overcome our identity crisis? First, we cannot depend on our colleagues or other dental organizations to fashion our persona. That is our responsibility. We must be forthright about who we are and what we have to offer our patients. We must be strategic in our public outreach and convey to our patients that we possess a level of knowledge and training that has been correlated with improved outcomes. We are not just specialists – we are experts. This message also must be conveyed to our teaching institutions, both to our students and our colleagues. Our deans and administrators need to understand that a dentist without formal training in endodontics does not have the knowledge base and skill set to teach predoctoral students at the same level as a trained endodontist. To all of these stakeholders – patients, students and colleagues – we must shape our identity by communicating our value. We have the resources, now we must have the intestinal fortitude.