I read with interest Dr Turpin's response to "Board certification: 2-tiered system not the answer" in Letters to the editor in the July 2002 issue of the Journal. Although I agree that time alone will not resolve the problem of the American Board of Orthodontics (ABO) representing a minority in our specialty, I was concerned about the final sentence: "They practice just like they did when they graduated 25 years ago." I am not sure to whom he is referring. I experienced what he talks about when I was in my orthodontic residency. Surprisingly, these were ABO-certified orthodontists practicing the same techniques they used when they achieved their board certification and had never progressed after that. Although they were excellent practitioners, I thought that the specialty had evolved from Begg and standard edgewise Tweed appliances. I had the impression that they felt validated in their techniques by becoming board certified and that there was no reason to change.

My back was up against the wall about 2 years ago when my time was running out to take the Phase III examination, and I did much soul searching when deciding whether to prepare for it. Although my reasons, including those above, can only sound like rationalizations for not taking it, I found myself looking at the ABO like I did those practitioners above. The ABO has not progressed to meet the changing environment we practice in. The recent changes introduced by the ABO do not change this fact. We should achieve board-certified status upon successful completion of Phase II, with diplomate status available to those interested in going that extra step. To be called board eligible for 10 years is an insult to all of us who have worked so hard to get to where we are. This approach is consistent with other boarded specialties.

The above-referenced letter talks about "dividing our profession." This is already happening with the National Board of Orthodontics (NBO) in the United States. I took that examination partly out of curiosity and partly out of consternation with the ABO. Although I do not want to be part of a splinter group, with only 2542 board-certified orthodontists in the ABO, I am sure it won't be long before the NBO will have more members than the ABO. The examination I took was clinically based and tested me on a wide range of diagnostic and treatment concepts. I must show proof of continuing education participation to maintain active membership in the NBO; the ABO has never required that of me. If I want to present cases, that option is available to me in the NBO. Today, the public wants to know that they will see a board-certified specialist, not a board-eligible specialist. The ABO has not made changes to meet the needs of most of the AAO's constituents. This must change if the ABO wants to remain the only specialty board recognized by the AAO.

Adam J. Weiss, DMD
King of Prussia, Pa

Certification Levels And Requirements
The National Board Of Orthodontics, US is an independent, nonprofit peer group. A five step ladder of certification will enable you to move upward at your own pace. Levels are logically base on at accredited university training. Post graduates specialization degrees, years of experience in your chosen field, and an objective examination.
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