Licensing Laws Are Shutting Young People Out Of The Job Market

[jafs]

Who would do the private certifications and how would we know whether or not we could trust them?

It's tricky, isn't it?

If they're getting paid by the providers they certify, then there's a built-in conflict of interest and incentive to certify as many as possible.  If not, who pays them?

Customers could pay, I suppose, but that assumes they have enough money to make it a worthwhile business, and we still have the question of how to evaluate the certifiers.

It just sort of moves the issue from evaluating doctors to evaluating doctor certification organizations.

[Pointedstick]

Who would do the private certifications and how would we know whether or not we could trust them?

It's tricky, isn't it?

It is, as evidenced by the fact that we have the same problem with the government! Because right now, we already live in your nightmare scenario of not being able to trust the license/certification provider. I have no idea if the license that my dentist holds means anything. My previous dentist was a quack, but a licensed quack. I'm sure we all have similar experiences with licensed contractors. What this connote to us as consumers about the value of these licenses? What you fear is already here.

[jafs]

What was your problem with the dentist?

I'm curious, and also have my own experiences with dentists I'm glad to share.

[Pointedstick]

She drilled and filled lots of things that weren't actually cavities, or were so small as to not be worth filling, and the fillings were poorly placed (they were falling out and deteriorating) and had to be replaced by my current dentist, who has a much lighter touch and seems more competent.

[jafs]

Drag.

I've had a number of questionable experiences with dentists, many of whom seem to want to do massive amounts of work that aren't actually necessary, or even advisable.

When I contacted the board in our state that oversees them, it turns out that dentists themselves define the "standard of care" for dentists.  This makes some sense, in that they'd know better than laypeople about it, but it also allows them to define those standards so as to allow them a lot of latitude or promote things that make money, even if they're not needed.

I don't really have a solution for this problem (and it exists in other professions, like attorneys, of course).

I'm glad you found a good dentist - I've also found one that I'm pretty happy with, but it took a while.

[Pointedstick]

He went over the X-rays with me and showed me the actual left-over area of decay under the filling. I gather that you're supposed to drill out all the decay and then replace the removed material with composite. For most of these fillings, only an extremely minute amount of tooth was actually removed, close to nothing at all. So the fillings were all small and shallow. Some didn't adhere well and were actually coming off. Some had gaps around the composite and the real tooth enamel, forming an imperfect bond that stuff could (and did) get trapped in. And in many cases there was a tiny amount of decay left underneath the filling anyway, because I gather the area wasn't drilled or cleaned properly.

In no way do I wish to impugn dentists in general. I like my current dentist. But you're right, MangoMan, there are unscrupulous people in every profession, licenses or no. That was the point I was trying to make: that licensing these professions doesn't actually solve the problem some believe it is supposed to solve.

[jafs]

In my experience, the vast majority of dentists in the town I live in wanted to do a lot of expensive and apparently unnecessary work.

It's understandable, of course, especially if they have a lot of school loans to pay off, and high overhead, but it's not in the best interests of patients.

One that we liked a lot told us of an experiment in which a number of dentists were given an x-ray of the same tooth, and they had very different views of it, and what should be done.  That doesn't create a lot of confidence for me.

The question for me is whether or not it's better with licensing than without - nothing's perfect.  And, there are probably ways to improve how we license/regulate things as well, rather than throwing the baby out with the bath water.

You're a dentist, pug?

[jafs]

He went over the X-rays with me and showed me the actual left-over area of decay under the filling. I gather that you're supposed to drill out all the decay and then replace the removed material with composite. For most of these fillings, only an extremely minute amount of tooth was actually removed, close to nothing at all. So the fillings were all small and shallow. Some didn't adhere well and were actually coming off. Some had gaps around the composite and the real tooth enamel, forming an imperfect bond that stuff could (and did) get trapped in. And in many cases there was a tiny amount of decay left underneath the filling anyway, because I gather the area wasn't drilled or cleaned properly.

So that sounds like a skill issue. How does he know there wasn't decay before they were filled the first time? He told you they didn't need to be done, but then showed you radiographic decay that was not removed during the process. That is contradictory.

Either way, shouldn't the dentist have removed all of the decay before replacing the filling?

[Pointedstick]

Not being a dentist myself, I'm only passing on his opinion. What he told me was that most of the fillings were really small and shallow, and in his opinion it in general it doesn't make sense to fill such small and shallow cavities, because sometimes they can resolve themselves naturally. In the few cases where there was decay left under a filling, he said those were maybe necessary, maybe not, but definitely improperly drilled or cleaned.

[Cortopassi]

Dentist appt in 45 minutes.  Wish me luck.  I hate the dentist (sorry Pug).

[Cortopassi]

I have had only 1 filling come out in 40+ years.

Went to a dentist when we first moved to the area.  Good guy.  2 years later he got into a much nicer office.  Next visit he said, seriously, I had 14 cavities.

We went to another dentist.  He said none were cavities, only stains.

He retired 2 years ago, I went to him for over 30 years.  The lady who replaced him seems reputable, but I still hate it.

[MachineGhost]

To use an experience from my own life, having ben burned by a bad dentist, I was driven to learn more about oral care and dentistry and now I have a better grasp of what my current dentist is doing and feel that I am able to make better decisions along with him, rather than just trusting everything he says.

But that is what separates us from the Great Unwashed.  Creative destruction to ferret out substandard quality only works on the mass mob principle, not the minor self-hacking elitism of the intellectual.  Oh sure, I'm sure a lot of liberal urbanites think they're "intellectuals" and act accordingly, but as you've proven many times before, they're really just ideological groupthinkers on autopilot.  Let's bring in a broader perspetive here...  do all the poor, colored, impoverished millions of the Deep South contribute effectively to the capitalist process of creative destruction?  Think carefully, now!

[MachineGhost]

And, licensing professions, although imperfect, seems better to me than letting anybody practice medicine or dentistry.

How about we let the competitive free market determine appropriate certification, education and licensing rather than incompetent and corrupt government bureuacrats (or cartel competitors)?

[Pointedstick]

Not being a dentist myself, I'm only passing on his opinion. What he told me was that most of the fillings were really small and shallow, and in his opinion it in general it doesn't make sense to fill such small and shallow cavities, because sometimes they can resolve themselves naturally. In the few cases where there was decay left under a filling, he said those were maybe necessary, maybe not, but definitely improperly drilled or cleaned.

In spite of what MG may say or lead you to believe, cavities do not resolve themselves naturally.

That's what he told me, not MG. Also, I believe I have had cavities resolve themselves. My dentist way back when I was a teenager used to "watch" what he called "micro-cavities" and most of them seemed to go away. None ever required filling. My first fillings were with this quack I've been talking about, in fact.

[MachineGhost]

Do we have better doctors now than when they weren't required to be licensed?

Dentists?

Etc.?

We don't with doctors.  They're virtually all automatons that treat lab values instead of the patient's clinical symptoms and are highly restricted by peers, bureaucracy and regulations from committing any career risk outside "standard of care" that may or may not have the level of scientific evidence that is actually non-corruptible.  Every day more and more of the foundations of "modern medicine" that held the profession in such high esteem since the 1950's continues to crumble as more and more fraud, corruption and abuse is revealed.  Don't get me wrong -- it's mostly a Big Pharma patent medicine problem.

Dentists, I think are probably somewhat better, but toxic flouridation in water, toxic mercury-amalgam fillings and toxic root canals are still being performed as "standard of care".

So I think the Pareto Principle applies here.  80% of medicial professionals will be run of the mill inside the box thinkers that don't venture beyond the etucasion dogma overwhelmingly financed by medical and drug business interests, whereas 20% actually treat their career as a rabid passion and treat continuing education as a virture.  A very small vanguard minority of the latter group go on to write books about their discoveries for the layperson and also train and educate other like-minded physicians.

Now, shouldn't we have a licensing system that encourages more of the creative vanguard and less of the money-grubbing automatons?  That's heresy to capitalists.

[Pointedstick]

MG has stated such in other threads, and it was a gross oversimplification of reality. What your dentist is referring to as a 'watch' is when there is no penetration of decay from the enamel into the dentin. Once there is decay in the dentin, game over; it needs to be filled. You can't watch frank decay.

Ah OK, thanks for the info!

[MachineGhost]

Most dentists are honest and skilled. Part of the problem with dentists in particular is --wait for it-- government. There is a huge expense and time commitment to get through school. Huge debt upon graduation. Huge expense to build out and open an office. Extremely high overhead to run a practice. And then the government decides, in its infinite wisdom, that the solution to access to care in underserved areas is to graduate more dentists. And add mid-level providers. So more schools open, and existing schools increase their class size. But guess what? All of the graduates still want to practice in the nice suburbs or the trendy neighborhoods in the city. No one goes to practice in the ghettos or the rural areas that need dentists. So the underserved areas stay underserved. And the 'served' areas now have a glut of dentists with high expenses and no patients. So the unscrupulous ones start finding work that doesn't exist. It makes me sick, but there is zero we as a profession can do about it.

Are you actually saying government intervention literally causes a rise in unscrupulous dentists???  Thought provoking.

[jafs]

So that sounds like a skill issue. How does he know there wasn't decay before they were filled the first time? He told you they didn't need to be done, but then showed you radiographic decay that was not removed during the process. That is contradictory.

Either way, shouldn't the dentist have removed all of the decay before replacing the filling?

Yes, I am a dentist. And I am very scrupulous and skilled if I do say so myself. 

Yes, all of the decay should have been removed, and the fillings shouldn't have been falling apart after a short period of time. But if there was decay present at the first dentist, then the fillings were necessary, which contradicts what the second dentist said.

It's hard for laypeople/patients to make sense of different views/recommendations from different experts.

Especially if they appear to contradict each other.

[jafs]

And, licensing professions, although imperfect, seems better to me than letting anybody practice medicine or dentistry.

How about we let the competitive free market determine appropriate certification, education and licensing rather than incompetent and corrupt government bureuacrats (or cartel competitors)?

Why would we want to leave something like that to average folks, who have little/no knowledge/expertise by which to evaluate professionals of all kinds?

[MachineGhost]

So that sounds like a skill issue. How does he know there wasn't decay before they were filled the first time? He told you they didn't need to be done, but then showed you radiographic decay that was not removed during the process. That is contradictory.

I've read horror stories of unscrupulous dentists just randomly drilling and putting in fillings just to make a nice chunk of insurance income complete with the full spiel bullshit enchilada all the way through the process.  Whether or not there was actually any decay in the first place (it gets even more nightmarish when the more evil ones unnecessarily start extracting teeth for expensive dentures, implants, etc.).  I don't know how "profesionals" like that live with themselves.

[jafs]

Do we have better doctors now than when they weren't required to be licensed?

Dentists?

Etc.?

We don't with doctors.  They're virtually all automatons that treat lab values instead of the patient's clinical symptoms and are highly restricted by peers, bureaucracy and regulations from committing any career risk outside "standard of care" that may or may not have the level of scientific evidence that is actually non-corruptible.  Every day more and more of the foundations of "modern medicine" that held the profession in such high esteem since the 1950's continues to crumble as more and more fraud, corruption and abuse is revealed.  Don't get me wrong -- it's mostly a Big Pharma patent medicine problem.

Dentists, I think are probably somewhat better, but toxic flouridation in water, toxic mercury-amalgam fillings and toxic root canals are still being performed as "standard of care".

So I think the Pareto Principle applies here.  80% of medicial professionals will be run of the mill inside the box thinkers that don't venture beyond the etucasion dogma overwhelmingly financed by medical and drug business interests, whereas 20% actually treat their career as a rabid passion and treat continuing education as a virture.  A very small vanguard minority of the latter group go on to write books about their discoveries for the layperson and also train and educate other like-minded physicians.

Now, shouldn't we have a licensing system that encourages more of the creative vanguard and less of the money-grubbing automatons?  That's heresy to capitalists.

I don't believe it.

I'm virtually certain that before consistent licensing, there was a huge variety in the competence/skill level of doctors, and that now we stand a much better chance that a random doctor will be at least basically qualified.

It may also be true that the system doesn't encourage creativity, but that's a different angle.

[jafs]

It's hard for laypeople/patients to make sense of different views/recommendations from different experts.

Especially if they appear to contradict each other.

Sadly, all you have to go on is often personality/bedside manor. And perhaps recommendations from other patients; but then again, what do they know that you don't? 

Yep.

It's a drag, for sure.

[MachineGhost]

MG has stated such in other threads, and it was a gross oversimplification of reality. What your dentist is referring to as a 'watch' is when there is no penetration of decay from the enamel into the dentin. Once there is decay in the dentin, game over; it needs to be filled. You can't watch frank decay.

Are we going to argue what "natural" really is because "natural" for the OOFA lifestyle eating a SAD diet is extremely "unnatural".  No cavity is going to remineralize "naturally" under such biotoxic conditions.  But cavities will remineralize themselves IF all the ducks are in a row, but there's a point of no return that will vary depending on the "wholistic biological quality" of the individual.  I've read of decayed teeth repairing themselves and even complete regrowing of a tooth, but we're talking about rare one-off events occuring as a result of therapeutic detoxification or extreme raw foodism.  Hardly the typical presentation and hardly something practical to shoot for.  Stick to The Permanent Oral Care Regime.

[MachineGhost]

Why would we want to leave something like that to average folks, who have little/no knowledge/expertise by which to evaluate professionals of all kinds?

Because a true free market of consumer driven demand will raise IQ's and become superior to government control over licensing?  The latter has obviously failed.  What are we going to try next?  We cannot keep going as it is; the corruption is spreading throughout society like a plaque.

[MachineGhost]

I'm virtually certain that before consistent licensing, there was a huge variety in the competence/skill level of doctors, and that now we stand a much better chance that a random doctor will be at least basically qualified.

I think you're conflating licensing with certification?  We had quacks galore, both orthodoxy and alternative, and cartel licensing brought some standardization to the process by eliminating "unruly" competition, but it wasn't necessary to do it by government coercion (and all the unintended or intended consequences that implies).  That's just how shit floats to the top through the dumbest common denominator political process (like, say, AGW -- just had to throw that in there!).