Volume zyxwvutsrqp 50, zyxwvutsrq No. zyxwvuts 2, Special Issue 1989 147 Anticipating the Future and Change Dan G. Blazer, 1, MD, PhD Director, Affective Disorders Program Duke University Medical Center Durham, NC zyxwvutsrqp Abstract zyxwvutsr As zyxwvutsrqpo in all of medicine, there are basic assumptions underlying the present system of dental education and delivery. These basic assumptions are facing challenges due in part to the marked reduction in the incidence of caries and the development of more effective therapies. This current period of time is described as an era of true change, rather than the mere modification of existing technology. Changes are going to occur in a number of areas. Themove willbe fromgovernment to private, from small to large, fromgeneralist to specialist. Since change is inevitable, one can learn about and prepare for the stress of change, the changes happening now, and how to adapt to change. Although many changes are beyond the individual’s control, their occurrence may be benefi- cial. Key Words: change, stress, adaptation. Introduction All health care providers share some similar problems that we are going to have to face over the next few years. It is 1988and, like every four years in the past, the media are broadcasting the idea either that we need four more years just like the last four, or we need four years of change, depending on which particular party happens to be in office at the time. It really doesn’t make a lot of difference which political party happens to be elected in 1988, because there will be change in 1989 and 1990. To take a twist on the old saying that the more thingschange, the more they stay the same, many times it seems more like the more they stay the same, the more they actually change. Dentistry has not escaped that issue of change. I came across a statement by Howard Bailit that I would like to share with you. Bailit said, “As the 21st century ap- proaches, the dental profession is again faced with chal- lenges to some of the basic assumptions underlying the present system for educating dentists and delivery of care. The marked reduction in the incidence of canes and the development of more effective therapies are ex- amples of changes that are likely to have a fundamental impact upon dentistry” (1). But is dentistry really all that different? No, it is not. That same statement could have been made by virtually any specialty in medicine and is especially true in psychiatry. Weare inanageof change.Peter Drucker (2)suggested that the next 20 to 25 years are going to be quite different than the last 25 to 30years. He suggested that after World War I1 we entered into a period of rapid growth and development lasting into the mid-1970s. Many of you have witnessed this period of rapid growth and develop ment almost in its entirety, while others have witnessed parts of it. This period has not been marked by dramatic changes in technological innovation, but rather by a worldwide extension of technology. In other words, those changes that fueled the developments after World War I1 had actually occurred before the war. What we have seen is an extension of the discovery of the rocket engine, the computer, and the findings of modern physics. The next 20 to 25 years are going to be different. Drucker said that they are going to be a lot like the years around 1914. That was an era when things changed dramatically and were not just an extension of technol- ogy. It was an era when we went from riding in a horse- drawn carriage to flying an airplane. He said, and others have agreed, that we are entering a time where we’re going to have to grapple with issues like superconduc- tivity and artificial intelligence. It will be a period of true change, rather than a modification of existing technol- z om. These changes are going to occur in a number of areas. First, there is going to be a change in the organizational climate with continued movement from government to private. Many have discussed medicine in terms of privatization of the medical establishment, and the same could be said for dentistry. We‘ve seen the decline of the state hospital. In psychiatric services there has been a development of small public units in primary care hospi- tals where severely ill psychiatric patients are cared for, and that’s been a dramatic change. Analogous changes have been seen in dentistry, as well. We‘re going to see changes from small to large. Donald Trump not- withstanding, the airline industry is demonstrating a consolidation of its resources. Most people say we are going to see somewhere between five and eight megacompanies that will dominate the airline industry in the United States. We are going to see a change from generalist to specialist. People are gradually being pushed into increased specialization. Second, we are seeing change in adaptation to technol- ogy. Remember when you bought your first personal