AN INTERVIEW WITH DR. JOE CROWLEY, CHAIR OF THE COALITION FOR MODERNIZING DENTAL LICENSURE
Dr. Joseph Crowley has a long and distinguished career in organized dentistry. Among his many offices, he has served as president of both the Ohio Dental Association (2005-06) and the American Dental Association (2017-18). In 2019, following the end of his term as ADA president, Crowley was appointed chair of the Coalition for Modernizing Dental Licensure. Below is a recent exclusive interview the “ODA Today” staff held with Crowley.
You obviously are keeping busy after your term as ADA president. Tell us about the Coalition for Modernizing Dental Licensure, which you have chaired for the last five years.
The CMDL is a coalition of 130 national and state organizations, institutions and programs representing dentistry, dental education, dental specialties, dental hygiene and nonprofit groups working to improve public access to oral health care.
Since its founding in 2018-19, the Coalition has focused on two essential goals:
- To eliminate single-encounter, procedure-based patient examinations, replacing them with clinical assessments that have stronger validity and reliability evidence, and
- To increase licensure portability to allow for professional mobility and improved access to care.
What is the Coalition doing to reform the dental licensing examination process?
The Coalition builds on the work of the Task Force on Assessment of Readiness for Practice which was a joint task force of the ADA, the American Dental Education Association, and the American Student Dental Association. The Task Force’s report was published in 2018 and raised awareness about the ethical and patient safety issues inherent in the licensure system, particularly surrounding the single-encounter, procedure-based patient examinations. This was before COVID, so live patient exams were the norm.
I was very frustrated by the fact that we were still using live patients for dental licensure exams in 2018, despite widespread awareness of the ethical and patient safety concerns related to these exams. In fact, I remember the ODA lobbying the Ohio State Dental Board to stop using live patient exams back in 2006 while I was ODA president. Unfortunately, the OSDB and most other states remained wedded to the status quo and live patient exams for 14 more years!
Fortunately, in the last few years, we have now made significant headway in getting state dental boards and testing agencies to see the error of their ways. I am not sure it would have happened if not for the COVID pandemic and the challenges of using live patients for testing purposes at that time. The state dental boards had no choice but to use manikin exams, which have now become the norm for dental licensing exams. While we consider this a very big success for our coalition and the profession of dentistry, the real winners are those who now participate in a licensure exam process that is more ethical and promotes patient safety.
There are still some states that allow for the use of live patients for dental licensing exams. In light of the ethical and patient safety concerns, the Coalition will continue to advocate for the elimination of these single encounter patient-based licensing exams.
What is the future of dental licensing exams?
Additional mechanisms for clinical competency assessments continue to emerge in dentistry.
For example, the Objective Structured Clinical Examinations (DLOSCE, Canadian Dental OSCE, etc.) are multi-station assessments designed to measure specific clinical skills, including diagnosis, interpretation and treatment planning. OSCE exams have been the gold standard for testing clinical skills and judgement in medical schools and residencies for 30 years. The development and enhancement of OSCE exams in dentistry has led several states to accept them for initial dental licensure purposes and that number will likely grow.
Another approach is granting licensure by portfolio – where an independent analysis is done on the portfolio of a student’s work while in dental school, including measuring competency in specific areas of providing dental care. Finally, several states, including Ohio, accept the completion of a CODA-accredited post-graduate dental residency program of at least one year (PGY1) for the clinical competency assessment portion of dental licensure.
All of these methods are similar to traditional clinical exams in terms of assessing competency for initial licensure, while avoiding the practical and ethical pitfalls of using live patients in a one shot, high stakes clinical exam. Despite the opposition from some in the licensing and testing community that have a self-interest in maintaining the current system, these alternative clinical competency assessment approaches challenge the status quo and are good for the dental profession and the public. Because of that, the Coalition for Modernizing Dental Licensure will continue to advocate for these alternatives.
Tell the readers about the Coalition’s efforts related to professional practice portability across state lines.
Back in 2021, the U.S. Department of Defense made grant funds available to the Council of State Governments – the nation’s largest nonpartisan organization that serves all three branches of state government – to assist professions in the development of new interstate licensure compacts in order to streamline freedom of movement between states for licensed professionals. The Department is primarily interested in licensure compacts to reduce the burden of obtaining multiple licenses for military spouses.
With support from other stakeholder organizations, including the Coalition for Modernizing Dental Licensure and others, the ADA applied for assistance in forming a Compact for the professions of dentistry and dental hygiene. The Department of Defense then selected the ADA to receive technical assistance from the Council of State Governments to draft the Dentist and Dental Hygienist Compact Model Law along with related tool kits and educational materials for state policymakers. This process included input from both the dental and dental hygiene professions, and representatives from the dental education, licensing and the testing communities among others.
The model legislation was finalized in 2022 and, as of today, 10 states have already passed the dental Compact legislation. I was very proud that Ohio was the 10th state to pass it!
Licensure Compacts exist for many professions, including medicine, nursing, physical therapy, and now dentists and dental hygienists. The dental Compact will allow a dentist who is licensed in Ohio to practice pursuant to a Compact privilege in any other state that has passed the dental Compact law. Alternatively, dentists licensed in other states that have enacted the Compact law will be able to practice in Ohio pursuant to a Compact privilege as well. In all cases, any dentist or dental hygienist who is practicing in a remote state via a Compact privilege is subject to that state’s laws and regulations and is subject to oversight by the remote state’s dental board including the full range of discipline.
The bottom line is that the development of the Dentist and Dental Hygienist Compact is one more positive step for freedom of movement for dental professionals and dental licensure reform. I am proud that my home state of Ohio continues to be a leader on these issues.
For more on the Coalition for Modernizing Dental Licensure visit www.dentallicensure.org.
