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Midlevel providers only part of the solution
By Lynn Stedman, RDH, DrBicuspid.com contributing writer

February 7, 2012 -- As SB 6126 enters the Senate chambers of the Washington State Legislature, it seems a shame that it is not roundly supported by both the Washington State Dental Hygienists' Association and the Washington State Dental Association.

SB 6126 and its companion bill in the house, HB 2226, were introduced in early January as revised versions of HB 1310 (defeated a year ago but automatically reintroduced in this legislative session). They would create a dental hygiene practitioner and a dental practitioner, both of whom would be allowed to provide various levels of dental care "pursuant to a written practice plan with a dentist."

Creating more venues for the safe delivery of dental care to all our citizens -- instead of the privileged few who are fortunate to have dental insurance and the financial means to access care -- is a good thing that will result in savings for our entire state.

But the tired arguments of "lack of safety" or "insufficient training" are still bandied about, rather than addressing the real issues: fear of change, and keeping up with technology that is pushing all healthcare professionals to examine how they are practicing.

The cottage industry of dentistry cannot keep up with the demand for basic dental services when most of the practices have only four operatories and set limits on their available hours. The working poor and even the middle class need evenings and weekends to complete their family responsibilities and keep their jobs; many can't find offices that are open past 5 p.m. or on weekends. They also need manageable payment arrangements and time to plan for their needed treatment.

These are the access-to-care roadblocks that we hear about most often in our dental hygiene clinic -- not people seeking unrealistic dental outcomes or free dental care. They want to be free from dental pain and keep their teeth, and they are willing to spend time and money to achieve these goals. Anyone who comes to a dental hygiene program clinic like what we offer at Columbia Basin College has to be patient, and they pay for their care. We are not equipped, however, to continue to be the only dental safety net for our community. A dental practitioner or dental hygiene practitioner could help us meet the restorative needs of these patients in a cost-effective way.

The future of the professions of dentistry and dental hygiene must continue to change and evolve to remain viable and free from government mandates. Midlevel providers are one step in the right direction, but equally important is the development of a collaborative effort between dental and medical professionals to assess and deal with the oral-systemic health link. Now is the time to come together and develop protocols for evaluating and educating patients about diabetes, diet, and cardiovascular disease so that the aging population in our country can become more proactive and accountable for their health.

The more people we can reach with this information, the better chance we have of positively impacting our overloaded and inefficient healthcare system and creating real and lasting change.

Editor's note: On February 6, SB 6126 passed out of a Senate committee with minor changes. Supporters have less than 10 days to get it passed in the Senate and then sent to the House for review.

Lynn Stedman, RDH, is president of the Washington State Dental Hygienists' Association and director of the dental hygiene program at Columbia Basin College.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Wash. lawmakers mull dental therapist bills, February 1, 2012

Wash. dental groups oppose new dental therapist bills, January 27, 2012

Wash. dental therapist bill dies in committee, February 28, 2011

Wash. lawmakers to mull midlevel provider bills, October 27, 2010

Midlevel providers: Is Washington next?, October 28, 2009


Copyright © 2012 DrBicuspid.com

Last Updated kk 2/7/2012 7:13:01 AM

7 comments so far ...
2/7/2012 7:40:08 AM
26DrHusker
I'm sorry but I do not believe that auxilliaries should be coming up with policies for dental care.  If so then lets ask the assistants and maybe also the office cleaning ladies.
 
I have great respect for hygienists.  There is a place for those hygienists who want to further expand their knowledge and impact dentistry.  And they should apply to dental school and go for it.
 
 
2/7/2012 11:38:29 AM
drredpine
What is really the goal of midlevel providers?  Is it really to offer dental services on nights and weekends at a lower cost?
Somebody will have to tell me how the price of dental treatment will go down despite, the cost of doing dentistry remains unchanged.  In my office I charge the same amount whether I clean some one's teeth, or my hygienist does.  How would that model change with mid level providers in a similar role filling teeth?
If there is an access to care issue where the needs of the population aren't being met, why can't a dentist fill the need?  Just because we train people in dentistry doesn't mean they are going to choose nights and weekends as their prefered schedule.
I have not doubt that hygienists and mid level providers, properly trained, can preform excellent dental work.  However, I just don't see the objectives being met.
2/7/2012 12:01:17 PM
drkate
There are no limits on when or where mid-level providers can practice.  They will flock to the large cities and towns just like dentists and will want to keep normal business hours just like dentists.  
2/7/2012 5:23:44 PM
san-diego-bill
The proposal of a "mid-level provider" is a tired, old political gambit that won't work. It has nothing to do with improving the delivery of dental care, and everything to do with self-interested groups gaining more power -- and presumably, more governmental education money.
 
Money and power -- these, as usual, are the true goals of the "mid-level provider" gang. The creation of yet another type of provider requires the creation of more programs, institutions, and government departments, all of which will require new directors and administrators. As with most such programs, the ultimate beneficiaries are those who gain high positions of employment in those new agencies, not the general public.
 
In my state, California, there are plenty of dentists. There are also potential patients who need dental care. What is lacking is NOT another alphabet-soup type of dental provider looking for work. What is needed is sufficient financing to pay for needed dental care.
 
The act of adding another type of "provider" will not lower the cost of providing care by one penny.
Dental prophylaxis costs the same in a dental office whether it is delivered by a dentist or a hygienist. Likewise, dental restorations will cost the same whether delivered by a dentist or any other kind of dental provider.
 
An alternate, better solution to the question of "access to care" would be to place clinics in locations that are truly underserved, and then hire dentists to work in those clinics. There are plenty of unemployed and underemployed young dentists who would leap at the opportunity. Why start an unnecessary program to half-educate a low-level "provider" when there are already plenty of doctors who want to work?
 
As there are already dentists looking for employment, and there are patients who need dental care but who don't have the money to pay for it, the solution would involve getting the two parties together by providing the necessary financing. Wasting even more money by setting up little bureaucratic empires to train and oversee half-educated subsitutes does nothing to provide that financing, and is a short-sighted, ill-conceived proposal that does not address the real problems of access.
2/8/2012 1:01:42 PM
Dr. Larry K
There is a premise that is going without question here, and that is whether there is an "access" problem at all or simply a "not wanting to go" problem. I've practiced for 40 years (sounds old, doesn't it) and even then only 50% of the population availed themselves of dental services - so the government forced more schools to be opened assuming the problem was "lack of dentists"! Guess what - that wasn't the problem and that isn't the problem now - doesn't sound logical, but there are many folks who just won't go! We don't need this type of legislation and it won't correct the "problem" because lack of access ISN'T the problem.
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