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The pain of dental licensure

Discussion in 'Dental Residents and Practicing Dentists' started by DrCarabelli, 03.06.12.


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  1. DrCarabelli

    DrCarabelli

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    I will be graduating soon from a dental specialty program and have started the job search process only to realize the lack of decent job openings available in my region. The problem is compounded by the fact that I cannot simply pack up and move to another state due to the inherent difficulties in obtaining a license. It really frustrates me at how others, like our M.D. counterparts, have only to take a computerized exam and submit paper work for their licenses when we have so much more to deal with. How is it, that a graduate of an accredited American dental school and an accredited American post-grad program still has to prove he/she is competent to practice dentistry via regional clinical exam for the vast majority of states? Is 7 years not enough already? I would really like to start a discussion regarding what we as members of the dental profession can do to change the archaic nature of the licensure process. Has there been any more progress in terms of licensure by residency after an initial start in the late 2000s with NY, CT, and MN coming on board? After speaking to many other newly minted dentists, it has become apparent that a desire to avoid the pain of a clinical exam has heavily influenced their decisions on where to work. This has to explain, to some degree, why so many areas of the country cannot attract enough practitioners, while others are over saturated. What can we do?
    Roosevelt likes this.
  2. GTFOOMICT

    GTFOOMICT

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    You are wrong on this part.

    I hope you're just venting. The MDs have it much worse.

    Besides, getting a license isn't hard. It's just annoying and expensive. Seriously, what is so hard about it?
  3. Xigris14

    Xigris14

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    No the MD as I am one, have it much easier to get a license. Getting a dental license is difficult unless you take a exam that covers most states like ADEX. Its all about money and keeping people out of certain states to avoid oversat. This has been a problem and will continue to be a problem until these old dentist retire from the board and we get younger minds that think in this timeframe rather than 30 years ago.
  4. Newgoalsdentdoc

    Newgoalsdentdoc

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    This is an awesome post for discussion. As of today, CA, NY, CT, WA, MN are the only states that a dentist can obtain a license via residency. I know of many colleagues who are headed to these states to avoid the "horrors" of taking a regional board exam. This is a very touchy subject for many in our field and somehow people believe that years of practice and even a residency does not make you competent to receive a license. I have family members who are MD's and have a lot of friends who are MD's. They can't believe the things we have to go through for licensure and they will tell you themselves that, yes, it is easier to obtain licensure in the medical field. I don't see this post as venting and even if it is, it's time for us as practitioners to discuss it fully. I have seen colleagues and good friends of mine go through so much emotional stress regarding licensure and trying to move and be with their spouses and families, even sometimes being separated because they had to stay in a state in order to practice and have a job and support their families. I know of dental practitioners who have not worked for months even years after moving to a new state in order to be with their families as they struggle to pass a board exam after 10, 15 and 20+ years of practicing. This is real and I, too, wonder what changes will take place in future. I am actually in the process of applying for licensure in the states that offer it via residency because I'm just ready to experience some place new and yes, you can believe I am NOT taking another board exam at age 46. Life is too short (smile). I've been stressed out enough. Again, love this post and I am SO glad to see it. What steps can we take to follow through and present suggestions for more changes?
  5. live

    live

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    Sorry but I have to disagree a little. Board exams will never and should never go away. Trust me, having just completed boards I will agree its a VERY stressful event. However, if you go to a STRONG dental school and by that I mean one that trains you well to be a GENERAL DENTIST then boards shouldn't be a problem. Boards are needed. I find it disapppointing and frankly scary for future patients with the number of dental schools graduating dentists who have completed 6-10 crowns or 2 RPD's. I met far to many people on interviews who were going to grad with #'s like this (even your almighty ivy leauge programs... They seemed like they could careless about training general dentists in general). I mean if you are so scared about taking a board exam that you would move to another state just to avoid it (like your friends) do you really think you should be cutting a crown/bridge prep or doing a RCT on a live human being? Seriously ask yourself that. If my neurosurgeon only did 10 aneurysm surgeries and was scared to sit in front on a board from his peers I think I would find someone else. Certain hurdles are needed sometimes in life. Yes they suck, but just do it and quit trying to find the easy way out. Now a nationalized exam or if each state would accept any board, those would be great ideas. Just my .02
  6. Newgoalsdentdoc

    Newgoalsdentdoc

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    First, I think you have taken our posted comments out of context. I can speak for myself that the whole point of my comment was in reference to dentists who have been practicing for a good number of years. I have been out of school for over 20 years. I do believe boards are necessary. On the other hand, I have been out here long enough and have worked with a number of dentists in various settings who PASSED regional board exams and were incompetent. Imagine working with someone or several people who have a license, yet, you are called in a operatory to get a tooth out that they can't remove or you have to finish up a DO amalgam or composite on a maxillary first or second molar that they couldn't reach? Go figure. Yes, there are many who pass boards and think it takes the place of not doing a residency, yet remain incompetent. There is nothing wrong with board exams. I believe the original poster was making a valid point that having a national exam would lower the stress of gaining licensure. It's not a point of going to a state just to avoid taking an exam, it's the point of having practiced for a number of years and circumstances come up that cause one to move, etc. You also brought up a point about completing clinical requirements. That is the issue of a particular dental school and really isn't the issue of licensure as originally posted. The original poster mentioned finishing a specialty program. I believe he's been practicing for while as well. No means to offend, but I believe once you are out of school and you've gotten a taste of the real dental world, practice for a good number of years and then have a circumstance to come your way where you have to relocate or alter something in your career, you'll understand why many feel this way about board exams.
  7. omaralt

    omaralt Senior Member

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    there are a few issues; i dont think anybody is saying to do away with licensure exams. first issue is the confusing state of dental licensure. there are at least 4-5 exams; some states accept one or two, some only accept their own exam, and some require residency. most states grant a license by reciprocity (usually after working 5 yrs) and a few dont (Florida). it's the lack of consistency and uniformity thats upsetting. what needs to be done is the ADA needs to sit down and make a national licensing exam. the same one for every state. force every state to accept this national standard and do away with individual state licensing.

    the second issue is for specialists. i know an oral surgeon who has been practicing many years in PA, but wants to come to FL. well, he has to take the FL licensing exam (which is ADEX now) and yes; he has to prepare a class II amalgam, class III composite, prep a crown, do an RCT, etc. seriously? an oral surgeon with who has been out of school for 10+ yrs has no idea how to do those.. and it's ridiculous to ask a specialist who will never do general dentistry to have to do those to work here... so a specialist licensure exam needs to be developed as well. just my opinion
    hopefullyortho and straightteeth like this.
  8. Newgoalsdentdoc

    Newgoalsdentdoc

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    Omaralt, you made some excellent points. I agree.
  9. caffeinehigh

    caffeinehigh Dentist

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    Another major issue with the current clinical licensure exam violates a general principle of testing in general, standardization. Already there are certain portions of certain exams that are standardized (Prosth and Endo in CRDTS for example).

    The true test of clinical licensure should be three fold, graduation from ADA Accredited Dental School, Successful completion of Standardized Didactic Exams (NDBE 1/2), and a STANDARDIZED clinical exam (Prosth? Endo? Operative? etc....) The use of typodont teeth with caries would solve the issue for operative and put each student on a level playing field.

    Ultimately many people will pass or fail this exam based on patient selection, not wholly on clinical skill.
  10. Pulpoutofhere

    Pulpoutofhere

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    Let's be honest, passing a licensure exam is not difficult--it is more a waste of time and money. Additionally, they are unethical and antiquated. To be thorough, I've listed some of the reasons why I view it this way:
    1. Preparing a class 2 or 3 successfully will rarely give any insight into the ACTUAL capabilities of the candidate taking the test.
    2. Cleaning, shaping and obturating on teeth you've scouted out for months is not very difficult.
    3. Scaling and root planing is not very difficult and something, as a general dentist or anyone else for that matter, you will delegate to your hygienists.
    4. If you fail the restorative section of the WREB are you going to bring that patient back and redo the crappy work? Probably not. So in essence, that patient went home with a restoration that is NOT clinically acceptable and you did nothing about it even after realizing it was not performed to the standard of care.
    5. I can only speak for the WREB when I say this, but these exams in general are more about patient selection than ANY OTHER FACTOR. If you select the right lesion (possibly unethical again if you know about it, don't treat it until the test) you will almost surely pass.

    Unfortunately, it's going to matter very little if you did 19 RPDs, 87 PFMs, 25 complete dentures, because none of this is on most licensure examinations. You need to be able to do 5 things:
    1. Fill a tooth
    2. Scrape some teeth
    3. Plug a root with some orange stuff
    4. Fill out paperwork properly
    5. Have a credit card with a sizeable limit to pay for the exam
  11. Newgoalsdentdoc

    Newgoalsdentdoc

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    Pulpoutahere, well said. It's like you posted what so many of my colleagues have expressed for years. This is a subject in dentisty that is near and dear to my heart because I've been through some things with licensure and other dentists I know before getting a licensed as well. I cannot begin to tell anyone how much money I've invested in exams just to do 4-5 procedures over a period of 2-3 days only to have to keep repeating the exam when I've failed one part that I've done on the manikin but have performed well on live patients on a daily basis. Hmm?
  12. WannaBeDentist

    WannaBeDentist

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    Add a computerized test and that sums it up.

    The idea of a board exam doesn't bother me, but not having a SINGLE unified board exam bothers me. What makes a person who completes the NERB not qualified for states that require the WREB? And vice versa? They test the same thing, just in slightly different ways.

    States that require a residency are a different story.
  13. mike3kgt

    mike3kgt Hopefully scuba diving

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    I'll argue that I'd rather hire an associate that has done 6-10 crowns well rather than one that rushed to get 20 done under his/her belt. Now if you had the opportunity to do 20 of them well (at least from your perspective) then more power to you. RPD doesn't matter anyways, 99% of clinicians don't design them nor care to know. Just get a feel for how to work with CoCr, adjusting clasps and how to manage tissues under distal extensions.

    Regardless of the procedure, it's important to know the enough to measure basic competence rather than sheer numbers.

    Regardless of how much you do in dental school, it's a pittance to what you will do in your first year of practice. The important thing to do is to find a mentor who can take your basic competence and then grow it into something that actually matters.
  14. KinKs

    KinKs

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    There are so many issues wrong with these types of examinations:

    1. It is impossible to standardize
    2. They are absolutely an exploitation of students: $2000 and $990 for a retake - ridiculous
    3. Asking a dentist to pass the NERB before practicing is like telling a lawyer to successfully try a case before he gets a license.
    4. The patient component of these examinations violate the patients and has all sorts of ethical complications.

    We need to start the process of doing away with all regional examinations.
    ghp06c and straightteeth like this.
  15. djeffreyt

    djeffreyt Senior Member

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    Last I heard California was working on its portfolio licensure process. It was something Dr. A. Dugoni always talked to us about as something he felt needed to happen and in my last year at school, the state voted to begin the process to find a way for students to create a portfolio of work done in dental school that would be submitted for acceptance to license...it would only work for california though and I don;t know that any real progress has been made.
  16. yojimbo53

    yojimbo53

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    Which exam did you take? I took the CRDTS, and am allowed to apply for licensure in, I think, 40+ States. It's just a matter of filling out paperwork, and sending a lot of money to some shady government agency who either steals it or wastes it ;)



  17. peg lateral

    peg lateral

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    :thumbup:
  18. KinKs

    KinKs

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    What is the ADA's position on these exams?
    How can we as future dentists agitate for their abandonment?
  19. Newgoalsdentdoc

    Newgoalsdentdoc

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    From several dentists I've talked to over the years, ADA has just told them to contact individual state boards regarding issues, suggestions, or comments regarding licensure. Maybe this needs to be addressed, if possible, at future ADA conferences.
  20. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    You guys are naive. They don't have these licensure exams to test your skill, theyre to prevent dentists from flocking to certain states.

    Do you know what Arizona, Cali, and florida would be like if it were easy to switch your state of licensure? The market would be completely flooded with 60 year old dentists working 2 days a week. These rules keep snow birds out and prevent mass migration.

    Next time you get confused think about money...it dictates almost every policy and law we have in healthcare
  21. Pulpoutofhere

    Pulpoutofhere

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    I get what you're saying, but last time I checked, California and Arizona are some of the easiest states to gain licensure. Places like North Carolina, New York, Wyoming and Florida are tough because they either require a residency, a state board exam or they don't allow reciprocity.
  22. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    So those states may not be trying to keep out retirees (except Florida which def is) they still keep it difficult to limit new dentists coming in.

    And honestly, I don't agree with the whole oral surgeons shouldn't have to take the same dental licensure board...if they can't pass the dental restorative portion they should give back their DDS...now if you want to argue that A LOT of dental school is irrelevant to omfs I'd agree, but a DDS/DMD license entails you can perform at the skill of a general dentist
  23. GTFOOMICT

    GTFOOMICT

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    So what do you think will happen to california saturation?

    I am concerned about this: 140 pacific grads getting near automatic portfolio license in cali only. Lots will take WREB, but not like the past. Those who don't take WREB due to cost and annoyance will have their Cali license and they'll test out the market. They'll have no way out during those first few years. Reciprocity could also work a few years out.

    Granted you get the opportunities you earn, but I bet there will be some folks that get themselves locked in to CA with no WREB to bail them out!
  24. Newgoalsdentdoc

    Newgoalsdentdoc

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    Naive??????????????? I'd hardly say we are naive regarding our comments. That's pretty obvious that states are doing this to keep others out.
    Second, it's easy to get a license in NY, CA, CT, WA, and MN because of licensure by way of residency. Most students graduating from dental school end up in residencies. So, this really opens the door for them to apply to these states.
    I see that some of the posts are clearly off track from what the orignal poster was saying. The original post was expressed by someone who has clearly been practicing for a number of years and then entered a residency to specialize.
    Sorry, but, yes, there is definitely a need for change with licensure.
  25. KinKs

    KinKs

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    The truth is most of these regional exams are money making scams or a means of "keeping others out". I contend that this violates ones fundamental right to move and work where one pleases - uninhibited. Freedom of movement is a fundamental right recognized by the United States Supreme Court.

    So what if I want to move to Florida when I am 60 and work 2 days a week? Who gets to determine or influence where and when and how I work? Are teeth in Florida different from teeth in Arizona or Alaska?

    If dentists would freely move around, it would probably do more good that harm for all parties involved - patients and dentists alike. Its not like if NC would make movement easier every dentist is going to sell his/her practice and immediately set up shop in Charlotte.
    straightteeth likes this.
  26. Sublimazing

    Sublimazing Lingual Nerve Obliterator

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    I wasn't trying to be insulting, but I was, and I apologize. Having said that, I disagree with most of these posts.

    No matter how many years you've been out you should be able to pass those exams. They are basic procedures...if you aren't used to working on a manikin, then practice for two weeks. Even specialists like I said should be able to do this.

    And you can practice wherever you want, but you have to abide by that state's guidelines to do it.

    The tests are expensive, but consider part of the cost of moving your practice.

    And again sorry for coming off rudely before.
  27. Newgoalsdentdoc

    Newgoalsdentdoc

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    No problem. I am sure you didn't mean it. We can all agree that we disagree from time to time. You were not rude at all. Thanks.
  28. Newgoalsdentdoc

    Newgoalsdentdoc

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    Wow, well said. I truly think you summed everything up. I never thought of it that way. But when you think about our profession, we are very confined.
  29. futuredds2011

    futuredds2011

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    Great thread.

    1. A national board exam is definitely needed rather than these regional exams. I have heard that WREB is preparing to join ADEX, which would pretty much make a national board exam. I'm not sure if this is true or not, but it is needed. Also, there should be more means of licensing through a residency. As far as specialties go, we need to figure out a better way than having a 50 year old oral surgeon taking the ADEX in order to practice OS in Florida. A good example for us is Canada. They have on written board over 2 days (I think some sort of practical is involved). That's it. Are Canadian dentists any less competent than us? (Yeah, insert Canada joke here, but in all honesty think about it.) Also, in Canada, I believe specialists are not required to take the national dental board. They're only required to take their specialty exams. WHAT A CONCEPT!!! Who thought of that? Yeah, sad but true, but Canadians are ahead of us.

    2. The issue of live patients on these exams is something I simply don't understand. It is unethical for many reasons. How many of us are saving the "ideal" lesion for a period of time just so we can use it on the board exam? Is it ethical to wait that long? Now, put yourself in your patient's place. Imagine if you knew all the stress the student is under while undergoing these boards. Would you sit for these boards? One more point regarding this: Is it ethical to put on a rubber dam for 2 hours on a patient when it usually takes 30 minutes for a filling and restoration? Someone earlier asked about the ADA's stance on this. I dug up this article for you:
    http://www.jdentaled.org/content/66/5/605.long
    I think we're the only profession that uses live patients to get licensed (maybe some cosmetology licenses need it too, but I don't know).

    3. Now when it comes to the exam itself. It is completely based on case selection and having luck finding the ideal lesions. More importantly having the patient actually show up on that day is the most significant factor. As a result, a good portion of the exam is based on luck. That is not a good way to have an exam. In order to truly have a standardized exam, I believe that this exam should be done on a typodont. Everyone would have the same tooth so it is comparable. I'm not saying get rid of the Endo and Prosth on the typodont for NERB. I think that is fair. So why not do the rest on a typodont?

    Additionally, on the NERB, if you fail either restorative portion (class 2 or class 3), you must retake both the class 2 and class 3. Does failing a class 2 mean you are incompetent in restoring a class 3 you already successfully completed? Same is true vice versa.

    Another problem I have is the retake. Let's say you fail the class 2 (pulp exposure or you get instructions to temporize). You still have 3 hours left on the exam. Why can't you just bring in another patient and do it again? Isn't that the same thing you'll be doing on the retake anyway (trying again on another patient)? Oh yeah, I forgot, they would be losing out on $900 on a retake. If that was me, I'd pay the $900 on the spot and try to retake it the same day. But we all know that option doesn't exist.

    Why is it that if the patient no shows on you, it is your fault? I know someone who not only had his patient no show, but also his back up patient no show. If you didn't submit anything for the exam, why are you being forced to pay another $900 for a retake? Shouldn't the retake be free since you technically didn't take the exam?

    4. I'm sure the state boards are somehow benefiting from these exams. This is probably a large reason why they are still around. When the ADA recommends they should be phased out just like the article above says, and they're still around, it makes you wonder. We all know this is more about money than anything else. This is especially true considering most regional boards are private entities, not associated with the ADA. Basically, dental schools are accredited, but we can't agree that these students can do a Class 2 of Class 3 on a live patient. I really hope that part of this accreditation process is ensuring dental students are able to complete those procedures.

    Sorry this is a long post, but I saw this topic and wanted to jump on.
  30. bikedoc

    bikedoc www.wiggleyourtooth.com

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    I always wondered how ethical it was to find the perfect Perio patient with appropriate pocket depths, detectable calculus, and make him wait a few months to sit for the exam.
  31. panino

    panino

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    What I don't understand is, why my Canadian accredited GPR certificate will not be recognized as the 1 year residency requirement. If there is a reciprocity agreement for DDS/DMD degrees, why is there not one for GPR/AEGDs? So if I want to practice in NY or other states that ask for a 1 yr residency program, I would have to do another GPR??
  32. dcshus

    dcshus

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    Don't forget that a majority of us OMS's graduated at or near the tops of our classes and scored in the 90's on boards.

    For us to advertise as specialists, whether it be OMS, endo, ortho, whatever...The ADA requires us to limit our practice to our specialty.
    From the ADA's PRINCIPLES OF ETHICS AND CODE OF PROFESSIONAL CONDUCT
    SECTION 5.G "The practice carried on by dentists who announce as specialists shall be limited exclusively to the special area(s) of dental practices announced by the dentist."

    It's not reasonable to require an OMS or any other specialist to maintain the skills to pass a licensing board exam. I don't expect general dentists to be able to tell me all the branches of the internal maxillary artery, even though we all learned this in dental school.
  33. armorshell

    armorshell Moderator Emeritus

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    Clean? Shape? Just get teeth with nice big tapered conical canals.

    I just accessed my teeth, extipated the pulp, fit a master cone to length and obturated without any cleaning or shaping. I spent to rest of the time slightly rotating the block to get perfect appearing xrays.
  34. GTFOOMICT

    GTFOOMICT

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    This is what I did.

    You ALL NEED TO DO THIS.

    I blasted 6 shots at a time, slightly rotating it with each exposure.

    Turned a void into homogenous fill.
  35. crax

    crax

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    I shadowed a dentist who was some sort of prominent florida ADA board member, and this notion of dentists coming down to florida when they retire, or for winters, etc... and practicing is the reason they have a really tough licensure exam. Which he then followed up by stating that many bordering states will both share a licensing exam such as GA and FL. I definitely thought this was interesting when he mentioned it to me.
  36. drbrink

    drbrink

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    If I had the opportunity to take the boards for a Fl license, by taking the ADEX in another state, I would. The exams may be the same, but Fl exam in FL is noted for rejecting patients at a very high rate. Take the exam outside of FL
  37. Newgoalsdentdoc

    Newgoalsdentdoc

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    SDN 2+ Year Member
    Excellent point. I have some very close friends who are MD's and yes, their process of licensure is SO much easier than it is for us as dentists. There are places I'd love to practice and it's a true annoyance when you think about taking another board exam especially when you have been practicing for 15+ years. Board exams are so expensive and all the extras that go along with compensation to patients, sitting fees from schools and other expenses.
  38. nuartywayne

    nuartywayne

    Joined:
    12.02.09
    Messages:
    88
    Status:
    Resident [Any Field], Dentist
    SDN 2+ Year Member

    You don't forget how to do a class 2 Comp or Amalgam and Class 3 composite...i'm sorry I don't buy it. My father 30 yrs ortho happened to have patients come in for emergency issues due to the fact very little in area work on saturdays. Instead of palliative care he goes ahead and extract/access/temporize. You don't forget your training. Boards exam are pretty much nationalized. 45 states accept ADEX although it may cost you more for applying by credentials than examination it is what it is. Suck it up and do it. Until older generations get away from the idea that things need to stay the same because that is the way the cards were delt to them in the past then things wont change.

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