A Quiet Wind of Change

The issues facing each American Dental Association House of Delegates are usually quite different from those that faced the previous annual session. The attitude of the delegates as they debate the issues has also varied every year, sometimes significantly from the preceding year.

As an example of the latter, during previous House sessions, we have seen the delegates reject a budget resolution or a potential dues increase, sending the Board of Trustees into a special session with a request to modify programs or identify other funding sources for presentation back to the House. Such sessions have been spirited and, often, contentious.

In past House sessions, there has been impassioned or even divisive debate over public awareness programs and proposed dental specialties, to name just a few of the proposals reviewed by ADA delegates in recent years. With an agenda that has been averaging between 100 and 125 resolutions for consideration, there have usually been at least a handful of issues that have stimulated forceful debate before reference committees or on the House floor.

Given that background, the first ADA House of Delegates of the new millennium was decidedly different. Within days after the close of the House proceedings, we find it difficult to pinpoint why this session seemed to have a different mood than any of its predecessors in the past few decades. Nonetheless, we would like to explore some of the factors and characteristics that lead us to this conclusion.

The most divisive issue to face the 2000 House of Delegates was a resolution to create a new single-state trustee district. California, the largest constituency of ADA members, has been one of five single-state trustee districts, each represented by its own member on the ADA Board of Trustees. The other states are combined in accordance with the ADA Bylaws to form 11 multistate districts, each having one trustee representative. Florida Dental Association membership has increased in recent years to a level that qualified Florida under the bylaws for consideration as a single-state district.

In simplified terms, this issue was controversial to the majority of the California delegation and other delegations as well, because the membership total achieved by Florida is only slightly more than one-third of the current membership in California and about one-half of the membership in New York. It was natural that the California delegates should question the obvious imbalance in representation under this formula and would want to consider other mechanisms to ensure that their constituents received equitable representation.

While the opposition of California delegates and a few allies was well-known, in the final analysis, the delegation did not push the issue into a contentious floor debate. Our analysis here is that based on the existing bylaws language, the Florida position was correct and California would have nothing to gain and a great deal to lose in future ADA deliberations if this issue were pursued. Sixty-eight percent of the House approved the new district with a distinct lack of the contentious debate often seen in past House sessions. And while progress was not made on the representation issue, by placing a focus on it, the CDA delegation has helped place this issue on the agenda of the task force on ADA governance structure that will be making a final report to the 2001 ADA House.

Despite officer and candidate presentations that linked membership dues and a continuing decline in the market share of ADA membership, a slight increase in dues for 2001 to balance the budget for programs voted by the House was approved by more than 91 percent of the delegates. This was in addition to a $30 annual assessment for six years to cover renovation costs for the ADA headquarters building that had already been approved by 85 percent of the delegates. The level of agreement and support for these measures was surprising, given discussions that identified cost and value as stumbling blocks to membership, particularly of young dentists.

Even the consideration of specialty recognition for orofacial pain failed to generate much debate. In a non-emotional review of the six requirements for a specialty, more than 76 percent of the delegates voted to deny specialty status to the American Academy of Orofacial Pain.

A review of our notes showed that a significant majority of issues for which a machine vote count was taken were either approved or defeated by 80 percent to more than 95 percent of the delegates. As an example, a resolution initiated by California to create a task force to make recommendations on a position for pursuing antitrust relief for dentists and health care professionals was approved by more than 94 percent of the delegates.

This leads us to wonder why there was a high level of agreement and noticeable lack of debate. The reasons are many and varied. Perhaps because there was only one issue with major financial impact (assessment for headquarters renovation), there was a less emotional environment to stimulate debate. It is also possible that increased levels of communication -- including the Internet -- have helped educate more delegates so that they are "on the same page" in their understanding of the issues. The regional differences that may have been the cause of emotional debate in past ADA sessions may be fewer in number.

Also of note were two important announcements that preceded the deliberations and could have affected the mood of this House. It was announced that Executive Director John Zapp would retire at the end of March 2001 and ADA Editor Lawrence Meskin would be retiring at the end of 2001. These unrelated personnel changes involving visible participants may have signaled a transitional period with an expectation for change that contributed to a quieter, less contentious mood for this House.

The different mood of this ADA House of Delegates seems to be symbolic of a period of change immediately ahead for the American Dental Association. A new leader and a new voice in a year are only part of the equation. What may well be most significant about the mood of the 2000 House is that it seemed to be more agreeable, more respectful, and more understanding of the problems challenging the profession on a national basis. The districts may be working together better with less emphasis on political alliances than has sometimes been the case in the past. If there were any failing, it was the lack of resolutions under consideration that would have directly addressed value-of-membership issues.

All things considered, a quiet wind of change was experienced in the Windy City of Chicago in October during the American Dental Association House of Delegates meeting.