Although most states have requirements for continuing education, none, according to the U.S. Department of Health and Human Services, Office of Inspector General (1993, p. 9), requires "any assessment of what a dentist actually learned from a course." Some states examine competency of licensed, out-of-state dentists on a one-time basis by requiring them to be reexamined through a state clinical examination or requiring reexamination if a past examination dates back more than five years. None of these states, however, requires periodic reexamination for in-state dentists.
Those who favor periodic assessment of competency argue that state boards do not satisfactorily monitor continued competency and that required continuing education is inadequate because courses are too variable in content and impact. (Issues related to continuing education are discussed in Chapter 4.) Within dentistry, the American Association of Oral and Maxillofacial Surgery has adopted a recertification process that is scheduled to begin in 1998 (AAOMS, 1993).
In the future, periodic reviews of competency may become increasingly feasible and acceptable with the growth of sophisticated electronic communication and computer-based patient records. Such assessments would have to be relatively unobtrusive and inexpensive as well as valid. (See discussion of the Dental Interactive Simulations Corporation below.) To the extent that assessments are designed to help improve performance rather than punish poor practice, they are more likely to be welcomed.
Clearly, dentists in many parts of the United States view clinical examination requirements for out-of-state dentists as a barrier to mobility. Some also cite the potential adverse effect on access to care (Pew Health Professions Commission, 1993). The Inspector General of the U.S. Department of Health and Human Services reported instances in which state licensure requirements discouraged National Health Service Corps dentists from staying in underserved areas (USDHHS, OIG, 1993). However, the Inspector General's 1993 report stated that "we found no data, nor any studies, to indicate that licensure-by-credentials policies have much overall bearing on the access to dental services in underserved areas" (p. 10). Other factors such as isolation, family preferences, and earnings potential appear more significant.