An Open Letter to the MIT Faculty

Regarding the Report of the Task Force on
Medical Care for the MIT Community

Edward B. Seldin

I wish to share with you a reaction to the Report of the Task Force on Medical Care for the MIT Community (the Report) from the perspective of a member of MIT’s Dental Service. I have been a Medical staff member and MIT’s oral and maxillofacial surgeon for the past 28 years. (I have also led a Freshman Advising Seminar for 11 years and have participated in pre-professional advising for about 25 years. I have served on numerous committees and have had the honor to represent the Medical staff as its Elected Staff Representative to the Medical Management Board during a recent three-year term of office. I am deeply attached to the MIT Community and very pleased to have played a number of roles over the years.)

The small portion of the Report that deals specifically with the Dental Service (no more than two pages out of 120) is disappointing in its lack of substance and its dismissive treatment of the Service.

I believe it demands a response:

In sharing some written thoughts about the Medical Department with the Task Force in January of this year [2005], I proposed the following goals for an On Campus Medical Department:

• To support MIT’s mission by preventing commonly occurring disease processes from detracting from the productivity and quality of life of the members of the Community.
• To insure seamless continuity of care when referral to outside specialists is called for.
• To participate in the intellectual life of the community and educate it as regards practices and behaviors that enhance long term health maintenance.
• To enable MIT to live up to certain responsibilities ­- acknowledged or otherwise - that fall on Institute shoulders when it attracts to the United States foreign students, fellows, and other individuals with limited means and unmet health-care needs.
• To foster a satisfactory level of productivity while avoiding excesses that can occur when the profit motive is allowed to be a driving force in the delivery of health care.

Back to top

With these general goals in mind, I find it incongruous that, while strongly advocating re-investment in on-campus health care in general, the Task Force does not consider the Dental Service to be “a high priority for the Medical Department.”

The Report reflects a particularly unenlightened attitude towards dental health as a component of health in general – almost as if a different set of rules apply to the prevention and treatment of disease processes of the oral cavity, which diseases are amongst most prevalent afflictions of human beings and disproportionately disruptive for young people.

The Report, almost in a single breath, indicates that students do not make full use of the Dental Service even while noting that MIT does not provide any dental insurance for students. Did the Task Force see a connection between these facts? It’s impossible to tell by reading either the ponderous, on-line, 120-page Report or the 22-page Executive Summary. The Report suggests that there are “convenient alternatives” for the dental care of students. I assume this is a reference to the current stop-gap measure which allows MIT students to get lower-cost care by being treated by undergraduate dental students at one of Boston’s three dental schools. This mechanism is certainly helpful but it is, by report of students themselves, very time-consuming and inconvenient, geographically and in other ways. It also means that a class of individuals within our community with limited resources is singled out for a second tier of care.

I submit to you that, despite the historical accident whereby Medicine and Dentistry became separate realms, the mouth and teeth are legitimate components of the human body and that dental care is inseparable from health care, current insurance practices notwithstanding. I hope you will agree that the goals stated above apply to all aspects of health care – including dental health.

I wish to share with you the belief that not having a (capitated) dental insurance plan is a disservice to the MIT student body and that the lack of such a plan handicaps the Dental Service in its efforts to meet the needs of the very segment of the Institute’s population that should be its principal focus. The superb educational opportunities for which the Institute is famous induce graduate students from around the world to come and study in Cambridge. Many foreign students arrive with top-flight academic credentials sadly conjoined with egregious unmet dental needs and no experience in negotiating care for themselves and family members, some of whom may not speak English upon arrival. Students find themselves in an environment that is, at once, confusing, expensive, and occasionally predatory. For a significant number of foreign and even domestic graduate students, one of the hidden costs of an advanced degree from MIT can be the loss of potentially salvageable teeth for want of convenient, appropriate care at a manageable price. On-campus care delivered by providers who are sensitive to the needs of our students is the best way of addressing this problem.

I believe that MIT has an unmet responsibility to its student population – especially foreign students. I would argue that, even if no other university in the United States had such a plan, the Institute should marshal the resources and take the lead in developing an enlightened capitated plan that provides a base-line level of dental care sufficient to prevent the loss of restorable teeth from being a part of the price of a degree from MIT.

One other point

In the Report, the Dental Service is denigrated as being unprofitable, suggesting, perhaps, that other divisions of the medical service are self-supporting. May I point out that the Service is one of but two “fee-for-service” divisions of the Medical Department (the other is Optometry).

As such, the Dental Service is held to a very different standard of financial performance and accountability than any other division.

All other divisions work under a system of capitated care in which profitability depends upon careful regulation of the flow care delivered. I do not believe that any other clinical division of the Medical Department could duplicate the financial performance of the Dental Service if operated on a fee-for-service basis.

 I hope you will agree that it is fair to ask the larger question, i.e., whether any division of a university health service should be run on a “for profit” basis. I believe that a university health service – especially MIT’s Medical Department – should exercise a patient-focused moderation, contrasting with the national pattern of care that is largely driven by the profit motive. Such moderation does not preclude goals of high productivity and efficiency. The fee schedule of the MIT Dental Service remains modest. It is obliged by MIT to accept Delta Dental fee profiles, a 10% student discount, and it must pay for a very generous Institute-mandated employee benefit package. These requirements would render any outside, for-profit dental practice non-viable. The Dental Service adheres to a mildly permissive, non-punitive approach to resolving conflicts between dental care and academic life. Part of our job, after all, is to educate students how to interact with the health care establishment. I believe that it is unrealistic to expect the Dental Service to do its job properly without a modest subsidy. Such a subsidy could consist of MIT simply continuing the entirely reasonable practice of not charging the Dental Service “rent” for the space it occupies.

MIT has just appointed a capable new Chief of its Dental Service. We currently have a technically skilled, hard working group of providers and support staff, fine-tuned and enthusiastic about working to meet the needs of the MIT Community. I believe that the Dental Service is worthy of the Institute’s full support as an integral and necessary part of the Medical Department.

As was true for the entire Medical Department, over the last several years the Dental Service sustained many curtailments to achieve short-term tactical advantages at the expense of sound, long-term strategic objectives. Our previous Chief, for example, waited in vain for a promised computerized management system for our Dental Service of the sort that is now the rule rather than the exception in well-run dental offices. I hope our new Chief is given this modern management tool of proven efficacy without further delay.

I sincerely hope that, as MIT expresses its confidence and re-invests in Health Care for the MIT Community, it will take an enlightened approach to dental care and allow us to do our part on a level playing field with other divisions of the Medical Department and with other providers of health care.

I plead with you: “Give us the tools and we will finish the job.”

	Back to top
	Send your comments