Several states recently have enacted legislation that enables dentists licensed in one state to practice in another without having to retake a clinical entry exam. Forty-three states allow some form licensure-by-credential (also called licensure recognition), according to an article in the January 2003 issue of AGD Impact, the newsmagazine of the Academy of General Dentistry.
Legislation adopted by most of these states is fairly cookie-cutter. Most require applicants to have been licensed for at least five years, to have graduated from an accredited U.S. dental school, and be in good professional standing. But regulations vary from border to border and from region to region. Some states have reciprocal agreements with a limited number of others. Other states open their borders to applicants from around the United States.
So, what qualifies an Iowa dentist to practice in Minnesota or Montana may not be enough for Kentucky or Arkansas. Enough variation exists among states that one state dental board Web site urges dentists not to make life- or career-making decisions before knowing they fulfill the state's licensing requirements.
With 53 dental boards governing an equal number of licensing systems, friction is bound to result-and it has, for more than 150 years. Though the first known practice of dentistry in the New World occurred in 1639, it wasn't until the mid-1800s that licensure took root in the United States. By the turn of the 20th century every state had established licensure rules.
Today dental licensure is regulated by one dental board in each state, as well as one in Puerto Rico, the Virgin Islands, and Washington, D.C. The Academy of General Dentistry supports licensure-by-credential.
Most debate around licensure-by-credential legislation concerns the clinical entry exam. State clinical exams vary in their degree of difficulty. While some states' exams may average a 90 percent pass rate, others average only 60 percent.
"Dentistry has been trying for years to get a definition of quality, but it can't. What we're really talking about is competency," says Myron Bromberg, DDS, chair of the Academy of General Dentistry Council on Dental Care. "Having to take state exams is a bone of contention for some dentists because they feel if a dentist graduates from an accredited school they should be able to practice dentistry."
Though dentists may argue over certain details, some are happy the federal government has not infringed on states' rights to regulate licensure. "Dentists don't ever want to see anything federalized. I want the U.S. government to stay out of state issues. Whenever the federal government gets involved in regulating our profession, dentists have a heavy price to pay," Dr. Bromberg says.
But any confusion resulting from a state's licensure recognition system pales in comparison to its benefits, supporters say. One of the driving forces behind the adoption of licensure-by-credential laws has improved access to dental care. It also gives dentists greater mobility. And pressure from organized dentistry and the public has forced many states to rethink their stance on licensure-by-credential, Dr. Bromberg says.
"I think there's been a lot of activity on the part of dentists who want licensure-by-credential to put pressure on states," he said. A state-by-state list of links to dental boards is available. Click here.
