I want to congratulate Greg Jorgensen on his future-focusing editorial in the January issue of the Journal (Jorgensen G. Rethinking American Board of Orthodontics certification: a paradigm shift. Am J Orthod Dentofacial Orthop 2017;151:1-2) and applaud Buzz Behrents for his courage to publish it.

When my grandfather entered orthodontic practice in the late 1930s, very few orthodontists were board certified. When my father entered orthodontic practice in the early 1960s, only about 30% of practicing orthodontists were board certified. When I entered orthodontic practice in 2000, only 26% of orthodontists in the United States held board certification.

The American Board of Orthodontics (ABO) Gateway initiative was offered in 2005 to increase board certification among orthodontists. I paid the $1880 fee and received a 5-year time-limited certificate acknowledging me as a diplomate. In the 6 months before expiration of that certificate, I served as chair and program director of an accredited orthodontic program. The Commission on Dental Accreditation (CODA) requires that the orthodontic residency program director maintain board certification. At the time, I found it paradoxical that I could sign 15 orthodontic certificates knowing that the ink in my fountain pen would soon expire. I wondered if this means that the residents I graduated are no longer bona fide orthodontists!

So what percentage of orthodontists in the United States hold board certification 12 years after the start of the Gateway initiative? An evidence-based estimate indicates 30% (calculated by the number of practicing diplomates listed on the ABO’s Web site and divided by the number of practicing orthodontists in the US), not 40% as promoted on the ABO’s Web site. Is a 4% increase in board-certified orthodontists over 12 years a success?

Greg Jorgensen’s editorial clearly describes why it isn’t. So the ABO can either heed the advice offered or continue doing the same thing. Albert Einstein defined insanity as doing something over and over again and expecting a different result. I am sure that our colleagues on the Board would not want to be described as insane.