We wanted to share the news that the live-patient portion of the dental licensure exam has been eliminated in Massachusetts. We also wanted to share what this news means for us as dental students.
Dentistry is a profession, and so you need to be licensed in order to practice dentistry. During 4th year, all dental students need to take and pass a licensure exam in order to practice dentistry after graduation. Dental licenses are controlled at the state level.
The Massachusetts Board of Registration in Dentistry (BORID) is in charge of setting the licensure requirements for Massachusetts. At their meeting on August 5, 2020, they voted to accept a manikin-based exam in place of a live-patient exam.
It is very exciting that the live-patient portion of licensure exams has been eliminated because there were many problems with the live-patient exams. Here is a quick summary of the problems with live patient licensure exams in the words of the Massachusetts Dental Society:
1. It focuses on a limited set of procedures that do not accurately reflect the multifaceted requirements and responsibilities demanded of dentists in everyday clinical practice. Several studies looking at the relationship between performances in dental school compared to results of live patient exams found little or no significant relationship between the two.
2. It can encourage improper patient care. Applicants often must find patients months in advance of their test date, purposely delaying care so that they will have a patient who presents with the qualifying oral health issues. Once in the exam, applicants may need to perform procedures that are unnecessary and potentially harmful while ignoring other pressing issues that require treatment, solely to complete the exam requirements. Using live patients in a way that their overall oral health is a secondary concern behind evaluating the applicant sets a poor example for would-be dentists and contradicts a licensed dentist’s duty to provide quality and timely care to the patient, as described in the American Dental Association’s Principles of Ethics and Code of Professional Conduct.
3. Obtaining a patient to sit for the exam is unduly burdensome on applicants. Finding and vetting patients who will qualify to sit for an applicant’s live exam is exceptionally time-consuming, expensive, and difficult to accomplish. Once an applicant identifies a potential patient who presents with the characteristics that fit the required procedures to be performed, the applicant is completely beholden to them to pass his or her exam. They must pay for the patient’s travel and lodging expenses, and still have no guarantee that they will appear on exam day. Knowing the implications for applicants if their patient does not show up (i.e., failure of the exam), extortion by patients is not unheard of.Patients who show up but are found unqualified by the examiner cause an automatic failing grade for the applicant. This sets applicants back months and causes them to lose hundreds of dollars in exam fees.
For these reasons, we are happy to see the live-patient exam being eliminated.
Depending on where you want to practice after graduation, you might still have to complete a live-patient licensure exam. Students who plan on practicing in Massachusetts after graduation will not need to do a live-patient exam, but students who plan on practicing in other states may still need to. You can use this map from the ADA to see the licensure requirements for all states (note Massachusetts hasn’t been updated yet). Although the elimination of the live-patient licensure exam is a huge win for new dentists in Massachusetts, there is more work to do on reforming licensure requirements in other states.
-HSDM ASDA Advocacy Committee