Messages of Concern

Jack F. Conley, DDS

On Dec. 16, 1997, Northwestern University announced plans to permanently close its 106-year-old dental school, an institution that has enjoyed a storied place in the history of the dental profession. If the initially announced plan is followed, Northwestern would become the seventh dental school to close in the past 10 years. Upon close examination, the reasons for the closure appear more far reaching and complex than the announcement suggested. We believe there are significant implications to the future of dental education.

What was startling to many observers is that the dental school did not appear to have major weaknesses. The number of applicants was reportedly at an all-time high, the school had $19.9 million in endowments and had a high profile in research, being named one of four oral cancer research centers in the nation by the National Institutes of Health in 1996. The school probably had a mix of strengths and weaknesses not unlike those of any other contemporary dental school. Aside from local, inside factors unknown to those of us outside of Northwestern University that would clearly explain the rationale for the closure, we are led to believe that another, more serious threat to the future of the dental profession itself and to other dental learning centers may help to explain the demise of Northwestern University's dental school.

Education today is a VERY big business. For quite some time, we have been hearing comments from dental school administrators that suggest that dentistry does not enjoy the kind of position of prestige or glamour in the minds of university administrators that the disciplines of medicine, law or engineering occupy. At least a small part of this theory may have been operant in the Northwestern story.

It is not difficult to read between the lines of the public statement of Northwestern administrators in arriving at our conclusion. According to the Northwestern president, "We have taken a careful look at all of our educational programs, and we believe that we should focus our resources on those areas that are central to the mission of the university. ... We intend to have a greater emphasis on research, particularly in medicine and life sciences."A news release also added undergraduate education and "the university's other professional schools" to the greater emphasis list. The troubling message here is that dentistry is not in the same company with medicine and other professional schools. How it can be separated from life sciences is even more difficult to understand.

According to the ADA News, Northwestern's vice president of university relations suggested that "the money required to raise the level of dental education would be better spent elsewhere. Northwestern is a good dental school. But good is not where Northwestern wants to be. We want to be superb." To achieve that would require higher standards and "the cost of achieving those higher standards would be so great as to bring into question whether that is really an appropriate use of the university's resources."

The university provost stated, "Most American universities that have very good medical schools have no dental schools." He went on to suggest that the responsibility for training in the disciplines not included at Northwestern (soon to include dentistry) "is largely a part of publicly supported universities."

If the philosophy that apparently prevailed relative to dentistry's suitability as a professional discipline at Northwestern University is adopted by other private universities in response to financial circumstances, what will be dentistry's fate? Would a trend questioning the relevance of dentistry as a professional discipline eventually be embraced by public sector higher education as well? For now, we do not believe that such an attitude toward dentistry will develop or prevail. But we do believe the experience at Northwestern sends some tangible messages that all dentists must be sensitive to.

The messages? First, dental school deans and, collectively, the dental profession must do a better job of educating university administrators and boards about the importance of oral health to the American population and about the vital importance of the dental research supplied by our nation's dental schools. If we do not, we will permit administrators to make decisions based upon financial and market share considerations.

In addition, it hasn't been too many years since many dentists were critical of dental education institutions for contributing to an "oversupply of dental manpower." We know that some colleagues are still of the opinion that even their own schools should be educating fewer new dentists, and that there should be fewer schools. The closure of Northwestern would satisfy those holding this belief. If the profession as a whole continues to send the message that it wishes to see fewer dentists educated, and as dental disease is prevented or controlled creating a perception that fewer dental providers and researchers are needed, administrators at American universities could adopt the philosophy apparently applied in the closure of Northwestern and place their resources in support of other disciplines they believe are more important to their image and marketing position.

The messages are clear. We must be more positive and aggressive in ensuring that dentistry continues to receive support as a university educational discipline and is worthy of its status as a profession. To do otherwise will contribute to a much less valued or respected career in the future.

To lose a dental school with the history and reputation of Northwestern is tragic. The implications that this event has for the future of the dental profession are sobering and provide us an opportunity to reflect on the importance of creating a positive relationship between the profession and the educational communities on which it is dependent for its future vitality. As this is written, there is a small possibility that the Northwestern board of trustees could reverse the December announcement. In our view, a reversal would not reduce the importance of the messages that have already been sent to the dental profession.