Dental licensure portability remains a work in progress

Oklahoma City — When Dr. Lajoi Wiggins moved from North Carolina to Oklahoma for a one-year general practice residency program, she was hoping to moonlight at a practice to earn some extra income or, at the very least, volunteer and provide services to those in need.

Dr. Wiggins

Dr. Wiggins

“I genuinely wish things were different,” she said. “Ideally, it would be amazing to start at least making payments on my student loans that I have obtained over the course of undergrad and dental school. It’s just too bad I’m not allowed to make additional income to assist in making payments on my student loans.”

The 2017 graduate of East Carolina University School of Dental Medicine passed her dental licensure exam administered by the Council of Interstate Testing Agencies, Inc. (CITA). Unfortunately, she said, Oklahoma Board of Dentistry only accepts dental licensure examination results administered by the Western Regional Examining Board (WREB) and would only allow her to obtain licensure under a resident permit.

“At the end of the day, I’ve been trained by very highly qualified dentists from the state of North Carolina who would not have allowed me to graduate unless I was prepared to adequately provide comprehensively care to the general public,” Dr. Wiggins said. “I know I’m capable and complete the same procedures every day in my residency program.”

Licensure portability continues to be an issue for many new dentists who decide to move across state lines and pursue professional opportunities after dental school, according to the ADA, which continues to work on encouraging states to advocate for portability in dental licensure.

There are five clinical test administration agencies for dentistry: the Commission on Dental Competency Assessments (CDCA, formerly NERB); Central Regional Dental Testing Service Inc. (CRDTS); CITA; Southern Regional Testing Agency Inc. (SRTA); and WREB. Overall, the exams should be able to identify a “safe beginner” dentist for initial licensure.

The ADA has analyzed the examinations administered by each of the testing agencies — CDCA and CITA administer the American Board of Dental Examiners (ADEX) dental exam, while CRDTS, SRTA and WREB administer their own exams — and found that these examinations “adhere to a common set of core design and content requirements that renders them conceptually comparable.”

For example, each agency:

  • Utilizes the Standards for Educational and Psychological Testing as the guidelines for evaluating the validity for their exams.
  • Produces a technical report that documents and summarizes available validity and reliability evidence concerning the examinations.
  • Utilizes conjunctive scoring, requiring candidates to pass each of a series of tests in order to pass the full examination.

In 2015 and 2016, the ADA and partnering organizations called on state boards to increase licensure portability. Today, only Colorado accepts all initial licensure pathways, while 30 states accept results of all five clinical testing agency examinations.

Earlier this year, the ADA Board of Trustees created a new steering committee tasked with overseeing the development and implementation of an Objective Structured Clinical Examination for dental licensure purposes. The Board had directed that a pilot of the DLOSCE be available in 2019 with an exam deployment in 2020. The ADA Board of Trustees sought the creation of the exam to help address issues of portability.

The development of the DLOSCE also supports current ADA policy calling for the elimination of patients from the dental licensure examination process. It addresses potential ethical concerns stemming from the use of patients in traditional exams.

“Creating a non-patient-based exam and portability were among the many issues we advocated for alongside members of the ADA,” said Dr. Wiggins, who served on the 2015-16 American Student Dental Association Board of Trustees. “I’m glad the ADA continues to work on those same goals and continues to fight for the interest of both of its members and public.”

Although Dr. Wiggins considers herself a native of North Carolina, she was born in Hawaii whose parents both served in the military.

“I’m used to moving and adapting to new environments,” she said. She ultimately her family settled in North Carolina.

Dr. Wiggins said she knew she would be busy with her general practice residency program but says she would be more than willing to find time to work part-time at a dental practice or volunteer for different community projects.

“Right now, in moments that I am not responsible for emergency trauma call or fulfilling my other resident responsibilities, I devote my spare time to activities for personal growth,” she said. These activities include reading novels, taking additional CE courses and exploring the Midwest. “If I can find time to do all of those things, I am certain I can find time to work as well.”

With the cost and time associated with taking a licensure exam, Dr. Wiggins said it wasn’t worth taking the WREB. She plans on moving back to North Carolina after she completes her general practice residency in June 2018.

“I understand states want to make sure they’re producing well-qualified dentists,” she said. “But if everyone just put their own interest aside and consider about what’s best for patients and our colleagues, we can collaborate to find a more opportune solution that works for all parties involved.”

One comment

  • Allen Hindin, DDS, MPH

    Dr. Wiggins experience is no doubt mirrored by many recent grads and thousands who preceded her. Dental licensure remains incomprehensible to those in other American licensed health professions.

    Barriers to mobility have been deep within the DNA of American dentistry, since the 1880s, when licensing examinations were initially created to end the practice of proprietary education. This preceded accreditation of dental schools and national board exams.

    While I applaud the ADA for pursuing a national model, for a non-patient based licensure examination, it has been less than courageous in dealing with barriers to mobility. In today’s economy, spouses and significant others of newly and recently graduated dentists, even among those with years of unblemished experience, the marketplace demands and expects rapid mobility. They cannot wait upon the snail’s pace of dental licensing systems, in place more to limit movement, than to assure quality and patient protection. What data exists, with which to justify accepting one board and not another??? When will state dental boards be required to demonstrate evidence for their behaviors?

    As we can see from declining membership, the organization is seen as less relevant to the needs of young dentists than ever before.

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