Ethics: Schools should prepare residents for real-world experience

I am in entire agreement with the underlying philosophy espoused in the November 2011 Ethics column (Greco PM. When the tail wags the dog. Am J Orthod Dentofacial Orthop 2011;140:603), but I am concerned with the implications. The indictment should not reside with companies that are marketing a product. To chastise them for doing so in the venue where debate among professionals is often generated (restaurants, golf courses, ball games, lunchrooms, and so on) is, in my opinion, not the issue. Gratuities are, for better or for worse, a manner of business in which orthodontists participate far more regularly than do faculty and residents at learning institutions. Around the holidays, orthodontists routinely offer gifts to referring or nonreferring dentists; reciprocity hopefully ensues. Of course, no one would openly admit that such referrals and gifts are quid pro quo and wouldn’t have occurred anyway without the holiday cheer, but the appearance remains the same.

Companies are no different from the gift-giving orthodontist. They wish to ingratiate themselves to those who would generate a benefit. In albeit a less-than-perfect world, these benefits would inure to our patients, the company, and the practitioner. I imagine that this manner of doing business, which has been in place since the beginning of commerce, is plausibly incorrect in the medical and dental arenas, but only through ignorance and abuse does the sinister potential get a foothold. Organized orthodontics clearly and justifiably recognizes the business of orthodontics. To characterize a well-intended and accepted business practice as generally undesirable because it is at times misapplied and subject to abuse by unscrupulous people is, in my opinion, a bit unfair.

Part of the charge given to orthodontic resident educators goes beyond moving teeth, managing occlusions, and caring for patients. Preparing our residents for real-world experiences and navigating the vagaries of commerce would be aspects of orthodontic education in which orthodontic residents are greatly interested and which they appreciate. By way of evidence-based heuristic endeavor, dialogue, and practice management exposure, the new-age resident becomes sufficiently savvy to wade through marketing pitches, advertising, and pay-to-play engagements. It is far more a matter of personal integrity and intelligence than the fault of orthodontic supply purveyors for the outcome of any transaction. That is a matter of orthodontic applicant and admission protocol.

There is a great deal to be learned through the benefits bestowed on programs through orthodontic supply companies. They are an asset to our specialty and should not be maligned for doing what they are supposed to do. How they are received is a matter of introspection.

Too often, credit is withheld from our academic institutions and those who manage them in preparing our professional students to be so well informed and do the right thing. It might be more a matter of “covering one’s rear” policies that restricting access to residents. My experience with residents, let alone faculty, is such that decisions relating to orthodontic appliances or devices would never be made based on gift giving by anyone at anytime. Perhaps there are an unprincipled few who would allow or, worse, embrace these practices, but that minority will not be swayed by restrictive policies in residencies that have more to do with appearance than substance.

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Apr 8, 2017 | Posted by in Orthodontics | Comments Off on Ethics: Schools should prepare residents for real-world experience
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