typical dental school clinic, put simply, is not patient-friendly. The focus is still very much on procedures rather than on patients, and sufficient emphasis has not been placed on efficiency, quality, and accountability for care from the patient's perspective. Problems it these areas are serious in their own right and will become more acute if current trends in health care delivery and financing continue. Academic health centers are having to compete for patients and for participation in managed care plans of various sorts. Whether a dental school clinic adds or subtracts from the overall institution's market position is likely to be an issue in its future. As currently structured, few dental schools—even when they charge lower fees— are attractive to insured patients.

Over the long-term, the committee believes that dental schools have no ethical or practical alternative but to make their programs more patient-centered and more economically viable. This will involve very significant changes in the way many dental educators and practitioners view the roles and operation of dental schools. Such changes will not be achieved painlessly or immediately or without the support of community dentists and dental organizations. Financing will be a major challenge.

To affirm that patient care is a distinct mission, each dental school should support a strategic planning process to

• develop objectives for patient-centered care in areas such as appointment scheduling, completeness and timeliness of treatment, and definition of faculty and student responsibilities;
• identify current deficiencies in patient care processes and outcomes, along with physical, financial, legal, and other barriers to their correction; and
• design specific actions—including demonstration projects or experiments—to improve the quality, efficiency, and attractiveness of its patient services.

To respond to changes in roles and expectations for providers of outpatient health services including dental school clinics, the Commission on Dental Accreditation and the American Association of Dental Schools should

• reexamine processes for assessing patient care activities in dental schools and ensuring the quality of care, and
• begin to evaluate new options such as eventual participation by dental schools in separate accreditation programs for their ambulatory care facilities.

To increase access to care and improve the oral health