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GUEST EDITORIAL |
Professor and Academy 100 Eminent Scholar, College of Dentistry, University of Florida, PO Box 100415, Gainesville, FL 32610-0415, USA; imjor{at}dental.ufl.edu
KEY WORDS: clinical doctorate • graduate degree • advanced education
Several dental school faculty positions in the clinical disciplines are vacant or occupied by less than optimally qualified individuals. In North America, it is estimated that there are 400 unfilled positions. The shortage of qualified faculty is usually blamed on the disparity in the income between academic positions and private practice. It is not unusual for graduates leaving dental schools to have an income, within the first year of practice, which exceeds that of their teachers by 50–100%. An increase in the salaries of faculty that will match or even closely approach the income of clinicians in general practice is unlikely in the foreseeable future.
Many factors play a role in the disparity in income between academia and private practice. One reason for the relatively low salary for clinical faculty is the lack of academic activity, apart from teaching, leading to additional qualifications, e.g., the engagement in clinical research.
The dental curriculum typically does not include training either in general research or in clinical research. Clinical conditions inherently vary by nature, and standardization of clinical decisions is rarely given attention in lectures or clinical sessions. Calibration of faculty is not common in most clinical disciplines. Exceptions are found in some clinical specialties. Periodontics is an example where standardization and calibration are part of the academic training program. Furthermore, grant writing is not included in the training of dentists, and funds are not readily available to cover research expenses. Therefore, individuals with a dental degree have a handicap in competing for funding for any research they may want to conduct.
In the large field of restorative dentistry, which constitutes the main activity in general practice, diagnosis and treatment planning are hampered by the lack of well-defined criteria and definitions. This situation, coupled with the use of crude diagnostic methods, renders the teaching and treatment subjective, with great variations in treatment outcomes. The lack of consensus in the methods of and criteria for diagnosing primary and secondary (recurrent) caries, the most common diagnoses in general practice, exemplify the problems encountered.
The foundation for improvement in the quality of the dental care provided by clinicians in general practice must start in dental schools, and it is closely linked to the qualifications of the clinical faculty. Additional qualifications tend to change attitudes, engagements in the teaching, and status in the profession—all of which are important components for the advancement of both the academic programs and the individual teacher personally. Since the salary level is also tied to status, salary increases and academic advancements should be based on the individual’s achievements as a clinician-scientist.
In the US, programs have been funded to encourage individuals with dental qualifications to seek traditional PhD degrees to cover the need for research-oriented clinical faculty. The recruitment and the results from these efforts have been mixed at best. Some of these individuals with double degrees end up in clinical disciplines according to the intentions of the programs. Others continue as basic scientists or engineers, with minimal contact with clinical dentistry, while some end up in private practice. Part of the problem encountered may have been that no requirements for a clinical commitment were part of the selection process for entering the traditional PhD programs. Without the individual’s deep-rooted commitment to clinical dentistry, the additional education, training, and research experience will be of limited value for dentistry.
The requirement of a genuine clinical interest by dentally qualified individuals entering traditional PhD programs with the view to becoming clinician-scientists has been lacking. A selection of clinically committed individuals seeking additional training is already in place, and it should be taken advantage of and extended to include individuals seeking PhD qualifications. Individuals seeking a clinical master’s program or a two- or three-year residency program to comply with specialty boards’ requirements do so because of their genuine interest in clinical dentistry. However, these programs do not focus on research, and there is a general lack of well-qualified mentors for individuals seeking advanced training as clinician-scientists. Many MSD programs have thesis requirements, which represent a start toward a research career, but they are basically professional educational programs. If two years were added to the MSD/residency requirements focusing on research design, statistics, grant writing, clinical research, and electives, totaling a minimum of 24 credit hours at the graduate level, a combined MSD/PhD program in dentistry for clinical faculty could be made widely available.
The most important component in this proposal is to attract students with a true interest in clinical dentistry. Most of the required additional courses for the PhD are available at the graduate schools in universities offering advanced degrees. Thus, minimal infrastructure developments are needed to initiate a PhD program in dentistry. Some funding will be needed for the students, but it should clearly be of interest to agencies, like the NIDCR, to fund programs that will provide the academic community with clinician-scientists for the clinical departments in dental schools. In fact, existing programs are in place that could accommodate the PhD training of clinician-scientists as soon as the programs are made available. This doctoral degree should be referred to as PhD (Dentistry) or PhD (Endodontics), PhD (Prosthodontics), PhD (Operative Dentistry), etc., as appropriate. This proposal is in agreement with the views expressed in a recent Guest Editorial in the Journal of Dental Research (J Dent Res 83:276–277, 2004).
PhD programs or other doctoral degree programs in dentistry with emphasis on research achievements are available in other parts of the world, including Europe. These programs differ in many ways from the conventional PhD programs in North America, in both research and didactic requirements. North American universities need to establish programs to address the lack of adequately trained clinical faculty to be competitive with the rest of the world in teaching and research associated with clinical dentistry.
Accepted July 1, 2004
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