Advanced dental hygiene practitioner

[futuredds08]

Are you aware that there is already talk from some HMOs (metro dental, healthpartners) that they would require pts to go to ADHPs first and then via a referall to a DDS. Not be prejudice, a DDS doesnt mind seing "those people" as u call them. They are entitled to respect as any other patient. compensation isnt great with MA, but that is not the patients problem, that is the states informed decision to ignore dental access.

I have not done a lot of research on this subject, although now I definitely will be. So far, however, I have noticed that a lot of arguments have centered upon the hope that most patients will choose to go to a DDS over an ADHP if they have the choice (i.e. metro areas and non-underserved areas). Not only that, but the RDH's and ADHP proponents have been arguing on here that ADHP's will logically choose lower compensation as they are not as highly trained as dentists.

BUT, what happens when PPO/DHMO plans find out that an ADHP is charging lower fees than what they are allowing their DDS preferred providers charge? I can't predict the future, but I am pretty sure I understand the innate nature of insurance companies and they could lower their fee schedules OR just not raise the fee schedules until inflation allows the ADHP fees to catch up to their fee schedules. Granted, the DDS has two choices: take the hit on the fees to get insured patients through the doors, or quit accepting the insurance plan.

Obviously, we have already pointed out that DDS's will most likely have a HUGE disadvantage in terms of loan repayments after school. At this point, what do you do? We all know that a lot of times patients choose not only their provider but will change treatment plans based on what insurance dictates. Who is to say that an ADHD doesn't become a preferred provider and with less loans to pay off can accept the lower fee schedules and therefore the DDS's previous patients?

I know that I will get knocked for suggesting this, but I do want to point out that I am all for public service. I do not believe money=happiness, but I do want to be able to put food on the table, pay my bills, and live a semi-comfortable life after spending 8+ years after high school studying my rear end off. I also know that this is an exaggerated example of what could happen, but I just wanted to point out where insurance companies may start to jeopardize the situation even more.

---

Members don't see this ad.

 

[futuredds08]

Whoa! Cool down there- my quotation marks were simply that- Quotation marks to denote a quote from the bill as one one of the delegated procedures- "simple extractions"- perhaps I should have cited it. I can assure you that my attitude is anything but cavalier, and as I've stated before, I have no interest in performing any type of procedure that I do not feel confident, properly trained, and comfortable doing. That would be silly and selfish and put my license, liability insurance, and credibility at risk! I'm glad you mentioned ego, because I keep forgetting to, and that is one major component of this entire situation. Who exactly do you presume will be education these ADHP's? I would certainly hope that a properly trained dentist might have the foresight to educate the students on all of the risks associated with simple extractions and the strategies for managing any problems occuring during said procedure-

That's just it- a DDS/DMD spends 4 very intense years learning the intricacies of this craft. I am not saying that an RDH/ADHP has less intelligence than a dentist, but that dentists are simply more highly trained. Speaking of ego, are you suggesting that it will only take a master's program for an ADHP to learn all of the intricacies that a dentist took 4 years in a doctoral program to learn?

 

[red88m]

I have not done a lot of research on this subject, although now I definitely will be. So far, however, I have noticed that a lot of arguments have centered upon the hope that most patients will choose to go to a DDS over an ADHP if they have the choice (i.e. metro areas and non-underserved areas). Not only that, but the RDH's and ADHP proponents have been arguing on here that ADHP's will logically choose lower compensation as they are not as highly trained as dentists.

BUT, what happens when PPO/DHMO plans find out that an ADHP is charging lower fees than what they are allowing their DDS preferred providers charge? I can't predict the future, but I am pretty sure I understand the innate nature of insurance companies and they could lower their fee schedules OR just not raise the fee schedules until inflation allows the ADHP fees to catch up to their fee schedules. Granted, the DDS has two choices: take the hit on the fees to get insured patients through the doors, or quit accepting the insurance plan.

Obviously, we have already pointed out that DDS's will most likely have a HUGE disadvantage in terms of loan repayments after school. At this point, what do you do? We all know that a lot of times patients choose not only their provider but will change treatment plans based on what insurance dictates. Who is to say that an ADHD doesn't become a preferred provider and with less loans to pay off can accept the lower fee schedules and therefore the DDS's previous patients?

I know that I will get knocked for suggesting this, but I do want to point out that I am all for public service. I do not believe money=happiness, but I do want to be able to put food on the table, pay my bills, and live a semi-comfortable life after spending 8+ years after high school studying my rear end off. I also know that this is an exaggerated example of what could happen, but I just wanted to point out where insurance companies may start to jeopardize the situation even more.

And that's where national healthcare comes into play. Take the power away from the insurance companies and give people (somehow) their basic human right to affordable health care and dental care.

OK- conservative majority on SDN- let's hear it:

 

[bodiddely]

And that's where national healthcare comes into play. Take the power away from the insurance companies and give people (somehow) their basic human right to affordable health care and dental care.

OK- conservative majority on SDN- let's hear it:

First, could you provide a rational argument (as opposed to the shameless utilization of emotional rhetoric employed by politicians) as to why healthcare is a "basic human right?"

 

[gyzeus]

Well, if anyone has taken the time to research the ADHP concept, instead of regurgitating the misinformation and fear from their faculty and fellow students, they would realize that they've got it all wrong- First of all, how sensible would it be to take someone out of community college and have them play dentist? Doesn't sound so intelligent to me- Those pursuing a degree in advanced dental hygiene practice have to first complete an undergrad and then a 2.5 yr master's program- And as much as you would all love to believe that we would be enjoying supreme dental power, forget about it- An ADHP is required to have a collabortaive agreement with a DDS, and is limited on the services they can provide- And no, that does not make the signing DDS liable for any services rendered by the ADHP (no matter how completely unsafe they may be) Also, I've read several items regarding the safety of these "wanna-be" dentists- Really, I can promise you that after all of the education is completed for the ADHP, they graduate with much more clinical experience than the vast majority of graduating dentists- Even for something as simple as giving anesthetic, or placing SSC's, I, as an RDH, have performed it many more times than the graduating dentist- My point is, that in order to prove I am capable of and provide safety during the same procedures, I am asked to perform it many times more than you-Quite honestly, it sounds as though the pervasive attitude here is that only those who have applied for and been granted admission to dental school have the - capacity to apply knowledge and skill- Who do you think will be teaching the ADHP students? Dentists. Are these dentists not capable of imparting knowledge, or are we as hygienists just not capable of learning it? It's quite insulting, the whole superiority attitude. All of this nonsense being spouted here comes down to fear, misinformation, and money- Don't worry- You'll all still get paid, you'll all still have jobs- Nobody's taking anything away from you- Why don't I just go to dental school?- Simply, time- I'm in my 30's and have family and work commitments, and the ADHP model is the best way for me to make a difference at this point- I am fully understanding of the fact that I will not make nearly as much money as a DDS or have the scope of practice a DDS does-And strangely, that's okay-

Scared? No, I just think it's hilarious.

"Only" a time and family issue is what prevents you from going into dental school? Then you must know very well what a huge amount of devotion and sacrifice is required in becoming a dentist, in addition to an excellent accademic background.

You say, that by the time you graduate from your 2 year ADHP program your skills in certain procedures will excel those of DDS/DMD who have to attend classes and clinicals 8am-5pm for 4 years? Then that obviously shows that there must be a whole lot in addition to just tech work that should be learned to effectively diagnose and treat a patient, since even 4 years wasn't enough.


And before telling anybody else to read the bill, why don't you stop altering it. Yes, under the requirements section it does state that ADHP would be a mater's program, but in nowhere does it mention that a BS/BA degree is required. And you don't necessarily need an undergraduate degree to enroll in a master's. So there is no rule that non degree holders or CC grads can't be masters.

 

[quackdentist77]

That's just it- a DDS/DMD spends 4 very intense years learning the intricacies of this craft. I am not saying that an RDH/ADHP has less intelligence than a dentist, but that dentists are simply more highly trained. Speaking of ego, are you suggesting that it will only take a master's program for an ADHP to learn all of the intricacies that a dentist took 4 years in a doctoral program to learn?

Nope- re:ego, I am only saying that much (not all) of the disagreement over the entire ADHP concept is based on (some)dentists ego- And that would be absurb to suggest that 4 intensive years spent in dental school could be replicated in 2 yrs of ADHP- Assuming that you've been following the bill proposal and discussion board, you would know that ADHP are not asking for the same scope of practice of a dentist-

 

[red88m]

Yes, under the requirements section it does state that ADHP would be a mater's program, but in nowhere does it mention that a BS/BA degree is required. And you don't necessarily need an undergraduate degree to enroll in a master's. So there is no rule that non degree holders or CC grads can't be masters.

Which masters programs don't require a bachelors first? I've never heard of any- can you show us these?

 

[quackdentist77]

Scared? No, I just think it's hilarious.

"Only" a time and family issue is what prevents you from going into dental school? Then you must know very well what a huge amount of devotion and sacrifice is required in becoming a dentist, in addition to an excellent accademic background.

You say, that by the time you graduate from your 2 year ADHP program your skills in certain procedures will excel those of DDS/DMD who have to attend classes and clinicals 8am-5pm for 4 years? Then that obviously shows that there must be a whole lot in addition to just tech work that should be learned to effectively diagnose and treat a patient, since even 4 years wasn't enough.


And before telling anybody else to read the bill, why don't you stop altering it. Yes, under the requirements section it does state that ADHP would be a mater's program, but in nowhere does it mention that a BS/BA degree is required. And you don't necessarily need an undergraduate degree to enroll in a master's. So there is no rule that non degree holders or CC grads can't be masters.

Well, first of all I'm not sure why I'm even dignifying this with an answer- That being said, I have no interest in spending 4 more years of my life in school- 2.5 is plenty- Secondly, at Metro State, which as far as I know, is the only program in MN currently set to deliver the ADHP curriculum, a BS/BA is required. And never did I state that my skills would excel a DDS, only that the curriculum I would be adhering to requires more application and practice of many skills than is required of a graduating DDS- So please don't try to twist my words to suit your needs. You speak of the dental school scedule as though it's some superhuman feat, and act as though I'm ordering an ADHP degree out of a mail order catalog.

 

[red88m]

First, could you provide a rational argument (as opposed to the shameless utilization of emotional rhetoric employed by politicians) as to why healthcare is a "basic human right?"

Let's define "basic human right". Could we say life, liberty and the pursuit of happiness? Maybe, but that sounds cheezy and american.
Or more simply, could we just say LIFE? If so, and if you agree that "life" is a right of humans, healthcare to potentiate life would be a basic human right.

 

[futuredds08]

Nope- re:ego, I am only saying that much (not all) of the disagreement over the entire ADHP concept is based on (some)dentists ego- And that would be absurb to suggest that 4 intensive years spent in dental school could be replicated in 2 yrs of ADHP- Assuming that you've been following the bill proposal and discussion board, you would know that ADHP are not asking for the same scope of practice of a dentist-

Maybe this is true right now, but it has been pointed out by other posters that CRNA's also only wanted limited duties, but later lobbied and now can do just about everything that a physician anesthesist can do. Really this entire thread is about trying to predict some of the consequences that will result from this "minor" (although I don't see it this way) change in the law concerning what hygienists can and cannot do without being DIRECTLY supervised by a licensed dentist.

 

[EnamelTuft]

You keep saying that the scope of pratice of a ADHP is different than a general dentist, but come on, lets really look at what they both legally can do. The only difference I see is that the ADHP's can't do crowns, bridges, root canals, and dentures. Beyond that they can essentially do everything else. If this bill passes through, the next agenda for you and your ignorant ADHP's is to ask for rights to perform crowns and RCTs. I mean lets face it, cutting preps is a irreversible procedure and so what makes you guys think that you guys will end it there. Of course it only makes sense that you guys start cutting crown preps. You and your phonies will start telling politicians that the need of crown preps is essential to restore some patients oral health, and then the list goes on and on.

Dentist should be the ONLY ones that should provide IRReversible procedures.

And tell me why you guys won't take the same boards and state licensing exams we do? I can't believe you think that you can learn how to cut preps and diagnose all in two years. Do you even know what Diagnosing entails?

 

[Taurus]

Wow! Seriously? Gas technicians? aren't we proud of ourselves- You haven't even graduated med school yet! Why is it that you want to discount every other profession with only slightly fewer years of education? I'm taking notes from their playbook as we speak- Which year is it that all of the arrogance begins? Or is it after you receive your acceptance letter?

Yes, I'm just another med student who has no clue about these issues. Maybe you should look through my posts. I'm quite knowledgeable about midlevels and their tactics and I am a prolific poster on this topic.

 

[quackdentist77]

You keep saying that the scope of pratice of a ADHP is different than a general dentist, but come on, lets really look at what they both legally can do. The only difference I see is that the ADHP's can't do crowns, bridges, root canals, and dentures. Beyond that they can essentially do everything else. If this bill passes through, the next agenda for you and your ignorant ADHP's is to ask for rights to perform crowns and RCTs. I mean lets face it, cutting preps is a irreversible procedure and so what makes you guys think that you guys will end it there. Of course it only makes sense that you guys start cutting crown preps. You and your phonies will start telling politicians that the need of crown preps is essential to restore some patients oral health, and then the list goes on and on.

Dentist should be the ONLY ones that should provide IRReversible procedures.

And tell me why you guys won't take the same boards and state licensing exams we do? I can't believe you think that you can learn how to cut preps and diagnose all in two years. Do you even know what Diagnosing entails?

Yes, let's please be insulting- phonies, ignorant, yada,yada,yada- How much of your actual time in dental school do you think you spend learning to prep cavities and diagnose? Pardon me, but it's not rocket science- based on your discussion board postings, it's quite obvious to me that you are insecure, bitter, and scared, and on a really big ego trip! You can't wait till you have Dr. in front of your name because that's where all of your identity lies- Get over yourself! Do I even know what diagnosing entails? I've been practicing clinically longer than you've been in dental school dear!

 

[gyzeus]

Which masters programs don't require a bachelors first? I've never heard of any- can you show us these?

Don't you know that there are quite a few health professional schools that accept students without a BA/BS degree?

Pharmacy school for example, and dental school although it is very uncommon. There is no rule or law that prohibits these schools from accepting students without a degree.

But the difference with these professional schools and a ADHP is that any student with any academic background and major can apply to dental or pharmacy school, making it highly competitive and securing the high academic qualities of the entering class.
Whereas for the ADHP, 'only' DH in which the majority of them don't have great stats, don't have a BS/BA degree can apply for this program.
But in this case the BA/BS exemption would be the opposite case for dental applicants, as those accepted to dental schools are being previliged for their extraordinary stats even compared to the other dental applicants with great stats.

So I guess ADHP would be kind of like a specialty program to practice dentistry 'within' this group of low admission stats, CC grads.

 

[red88m]

Do you even know what Diagnosing entails?

I know you were addressing another poster, EnamelTuft.
You'll see when you get out in practice that the diagnosing aspect is acquired by your hygienist (and some of it is also taught in hygiene school) through years of practice and observing your technique.
The ADHP scope of practice is supposed to be approved by a sponsoring dentist. So the dentist could decide whether or not the ADHP could do crown preps.

Why's everyone being so nasty on this thread?

 

[red88m]

Don't you know that there are quite a few health professional schools that accept students without a BA/BS degree?

Oh yeah. Forgot about that. But that rarely happens anymore.

 

[gyzeus]

Oh yeah. Forgot about that. But that rarely happens anymore.

It actually still does in pharmacy. And as I've mentioned, when it happens in dental schools, it happens for the opposite reason for DH programs.

 

[quackdentist77]

Don't you know that there are quite a few health professional schools that accept students without a BA/BS degree?

Pharmacy school for example, and dental school although it is very uncommon. There is no rule or law that prohibits these schools from accepting students without a degree.

But the difference with these professional schools and a ADHP is that any student with any academic background and major can apply to dental or pharmacy school, making it highly competitive and securing the high academic qualities of the entering class.
Whereas for the ADHP, 'only' DH in which the majority of them don't have great stats, don't have a BS/BA degree can apply for this program.
But in this case the BA/BS exemption would be the opposite case for dental applicants, as those accepted to dental schools are being previliged for their extraordinary stats even compared to the other dental applicants with great stats.

So I guess ADHP would be kind of like a specialty program to practice dentistry 'within' this group of low admission stats, CC grads.

You are arrogant and ridiculous- How dare you even begin to think that you can predict the "stats" of other students based on their range of study? You are completely disgusting and just another random example of some nobody student that thinks they are someone with the prospect of putting DR. in front of their name- It's soo pathetic- FIY- Although, there are Associate level hygiene programs, there are also BS level as well- And ALL are very competitive and require great "stats" to get in- Please explain to me how letting everyone apply to a certain program of study ensures high academic qualities? Just keep telling yourself whatever you need to to feel good! You can take MY extraordinary stats and shove em-

 

[gryffindor]

The 2.5 year argument for school is VERY weak, considering that the University of Pacific Dental School has a 3 YEAR DDS curriculum that gives you a DDS, the real deal, for only 0.5 years more training. Pacific is the only 3 year dental program in US, and they go to school year round to fit everything into their curriculum that the 4 year schools have.

This ADHP program in MN will require a BA/BS before entering, and it is a 2.5 year Master's level program. Assume that all students entering have done a 4 year BS/BA. Why bother with a 2.5 year program? That's only 1.5 years short of fully attending dental school. Having attended dental school, I would say that 1.5 years of it is pretty much basic science and diagnosis lectures, and 2.5 is clinical procedures - a combination of live patients in 3rd and 4th years and mannequin heads/plastic teeth in 1st and 2nd.

In fact, there is no need to create this ADHP degree under the disguise of "training takes less time." If 8 years of school is too much, well the University of Pacific also offers a 5 year and a 6 year fast-track DDS program. Students accepted into this program are stellar high school students who spend either 2 or 3 years in undergrad, and then 3 years in dental school.

 

[Taurus]

If dental access is truly a major problem, then just increase class sizes or open up new schools. Increase the number of dentists, not create a new group of providers with lower qualifications and requirements who will later lobby to be your competitors. Doesn't that make more sense?

Recall that back in the late 80's that dental schools such as Northwestern closed because of surplus of dentists. If you allow a dental midlevel group to flourish, then those days of surpluses will come back and all those gains you have made financially will disappear. Dentists need to unite and decide as a group to not simply hire these individuals. If there is no demand, then there won't be many job opportunities for them and fewer people will go ito this field.

You guys need to study how NP's and CRNA's have adversely affected primary care and anesthesiology. Why do dentists on average now make more than a primary care physician? Widespread use of midlevels such as NP's. If there were no midlevels in medicine, the average salary of primary care physicians would be much higher than it is today. What's worse is that NP's and CRNA's claim to be just as good as their physician counterparts and they lobby hard for equal privileges and reimbursements even though they go to school for just 2 years.

Any dentist who doesn't see the parallel between ADHP's and NP's and CRNA's is extremely naive. All of these midlevel groups use the increased access arguments even though they are as likely to work in a rural setting as a regular dentist or physician. Any dentist who hires an ADHP is selling out his/her profession and should be ostracized.

 

[EnamelTuft]

Yes, let's please be insulting- phonies, ignorant, yada,yada,yada- How much of your actual time in dental school do you think you spend learning to prep cavities and diagnose? Pardon me, but it's not rocket science- based on your discussion board postings, it's quite obvious to me that you are insecure, bitter, and scared, and on a really big ego trip! You can't wait till you have Dr. in front of your name because that's where all of your identity lies- Get over yourself! Do I even know what diagnosing entails? I've been practicing clinically longer than you've been in dental school dear!

If you really want to know, we as dental students take several semesters on diagnosing and treatment planning. We spend some 2 years training our hands on cavity preps and crown/bridge preps in Sim labs. All these even before we enter our 2 years of clinical experiences. I can't imagine a 2 year program that combines clinical experience/didactic/high speed hand skills/diagnoses. With all those things combined within 2 years is absurd. There's obviously big short cuts the ADHP's are making and bottom line is that those things will ultimately hurt patients vs treating them. And just because you have more teeth scraping years than me, don't make you a better clinician by any means. You can't diagnose crap if you don't know and understand the etiologies of what your treating. You might combat that statement by saying that you do know what causes caries but what's next? Oral pathology on your list of to do's. I don't know about you but I wouldn't allow any technician to be treating me without thorough understanding of what local and systemic effects a procedure can do to one's body. Essentially what you're trying to say is that just because you spent several years scraping teeth, you are justified to do what a dentsit does. You are just like those old pharmacy technicians who complain about their wages compared to pharmacists. Just because you work as a pharm tech for 30 years doesn't make you equivalent to a pharmacist and same goes for a "advanced" hygienist.

You still haven't answered my question about the boards and licensing exams. Why can't you guys be held to the same standards of care if all what separates our roles is a couple of procedures? And FYI, i'm by no means insecure because even if this proposal goes through, it will take decades for you guys to establish public trust and by then i'd be close to retirement. And by the way, are you jealous about the Dr. thing, because you know, you can get one too. Oh wait you have a family to take care of, you have time restraints.....Come on, don't we all have responsibilities!!!

 

[EnamelTuft]

In addition to dental school, most dental students have a bs/ba degree. The pre-dental requirements include gen chem, o-chem, gen bio, gen physics, etc. Even prior to entering dental school, our analytical and scientific background is much higher than a techy. Go and take the two semesters of Organic chemistry and you discover why you're not in our league.

 

[gyzeus]

You are arrogant and ridiculous- How dare you even begin to think that you can predict the "stats" of other students based on their range of study? You are completely disgusting and just another random example of some nobody student that thinks they are someone with the prospect of putting DR. in front of their name- It's soo pathetic- FIY- Although, there are Associate level hygiene programs, there are also BS level as well- And ALL are very competitive and require great "stats" to get in- Please explain to me how letting everyone apply to a certain program of study ensures high academic qualities? Just keep telling yourself whatever you need to to feel good! You can take MY extraordinary stats and shove em-

Yes I am some "nobody" student that took the DAT, have a 4.0 gpa with a BS in biology and minor in mathmatics that will be attending dental school from this fall, go through 4 years of schooling, take the boards and state exams to practice as a dentist. And I actually find no reason to be arrogant as I will only be an average student in my class in dental school.

I have full respect toward DH as DH. I just don't have any for almost dentists. ADH or however you call it, I just see it as almost dentist when I read the bill.

I have not made any predictions, I just read the numbers.

 

[EnamelTuft]

Why do some people feel that just because they can technically perform a procedure at the same level as someone else, they should be compensated for that. It just doesn't make sense in the health care arena. Does it make sense to start setting up schools to train people for individual surgery procedures? The whole philosophy of these ADHP's are wired in the technical mode. They feel like just because they can do it makes them right. I guarantee that if a kid came right out of middle school, and if I sat there and trained the kid how to cut a class II cavity prep for several of weeks and tell him how to fill it, he can probably practice that for several of months and get better at that one procedure than most dental students. But now, does that quality of work justify him being allowed to treat patients?

Another thing is that pretty soon the insurance companies will jump along and will start to set the fees at a much lower price to satisfy these ADHP's. Everyone knows that all insurance companies care about is the bottom line and that bottom line is lower cost. And ultimately patient's oral health will not be at the standard that they are today. I bet these ADHP's don't even know about occlusion and lateral excursions and how those affect treatment. Man I will soon feel sorry for patients who pay for an amalgam that doesn't allow them to easily go into a right lateral excursion. Oh! I smell tmj problems. What's next, ADPH's are needed in that arena as well?

 

[quackdentist77]

In addition to dental school, most dental students have a bs/ba degree. The pre-dental requirements include gen chem, o-chem, gen bio, gen physics, etc. Even prior to entering dental school, our analytical and scientific background is much higher than a techy. Go and take the two semesters of Organic chemistry and you discover why you're not in our league.

Yer right- I wished I wouldnta spent so much time studien for that GED jus' to git inter hygiene school- Guess what freak? I took all those classes too (at university even), and guess what, my GPA stands at 4.0, so what? Fortunately, my academic standing does set me apart from most, including most of your dental school peers, but alas, my attitude does not put me in your league(so sad)- Why do you think your educational standards are so much higher than everyone elses? And I would love to take your boards, assuming that they only included the curriculum included in my education, and not the areas only covered in DDS, which you seem so keen to think everyone wants to be- You must think all NP's want to be MD's too, right? They probably just couldn't cut it-I'm quite certain that there will be a board exam for ADHP, as well-Thanks though!

 

[gyzeus]

If dental access is truly a major problem, then just increase class sizes or open up new schools. Increase the number of dentists, not create a new group of providers with lower qualifications and requirements who will later lobby to be your competitors. Doesn't that make more sense?

Recall that back in the late 80's that dental schools such as Northwestern closed because of surplus of dentists. If you allow a dental midlevel group to flourish, then those days of surpluses will come back and all those gains you have made financially will disappear. Dentists need to unite and decide as a group to not simply hire these individuals. If there is no demand, then there won't be many job opportunities for them and fewer people will go ito this field.

You guys need to study how NP's and CRNA's have adversely affected primary care and anesthesiology. Why do dentists on average now make more than a primary care physician? Widespread use of midlevels such as NP's. If there were no midlevels in medicine, the average salary of primary care physicians would be much higher than it is today. What's worse is that NP's and CRNA's claim to be just as good as their physician counterparts and they lobby hard for equal privileges and reimbursements even though they go to school for just 2 years.

Any dentist who doesn't see the parallel between ADHP's and NP's and CRNA's is extremely naive. All of these midlevel groups use the increased access arguments even though they are as likely to work in a rural setting as a regular dentist or physician. Any dentist who hires an ADHP is selling out his/her profession and should be ostracized.

Couldn't agree any less.

A friend of mine who is in the nurse practitioner program for ansesthesiology in Columbia University thinks physicians are fools for going through all that hustle to do what she can do in simply 2 years. She says it's definitely a time and cost effective path.

ADH are just the same human as NPs. DH are doing way better than they used to and are now ready to expand through the ADHP. Once they accumulate more power they would start their next lobby for autonomy, again, as usual, "to serve the undesrved and poor".

If the ADHP bills goes through, we should push for an Advanced Dental Assisant program. ADAP.. sounds nice and professional.
And as Taurus had mentioned, we should stick together and hire our fellow dental associates instead of ADHs even though it would result in a higher overhead. Hiring ADHs would be like stabbing our own back.

If the DH makes an invasion and does not respect our profession, why should we respect theirs? If it isn't an attempt of invasion into dentistry through a fast track DDS/DMD program, why not voluntarily and clearly state to the legislature to specify the limits to rural, undeserved areas?

 

[aphistis]

How much of your actual time in dental school do you think you spend learning to prep cavities and diagnose?

Four full years of dental school, and a year of residency...and I still learn something new every day.

Pardon me, but it's not rocket science- based on your discussion board. postings, it's quite obvious to me that you are insecure, bitter, and scared, and on a really big ego trip!

1. With such impeccable professionalism, it's hard to believe anyone would disagree with your argument.

2. Once again, you're betraying your own ignorance. That's twice in this post alone you've suggested diagnosis is some sort of no-brain activity. Looking for dark spots on bitewings is simple enough, yes, but that's the beginning of comprehensive diagnosis, not the endpoint.

You can't wait till you have Dr. in front of your name because that's where all of your identity lies- Get over yourself!

1. I *do* have Dr. in front of my name, and I agree with him.

2. Did I mentioned how impressed I with your professionalism?

Do I even know what diagnosing entails? I've been practicing clinically longer than you've been in dental school dear!

I think it's a fair question. That's three times you've implied dental diagnosis is as easy as falling off a log, and it tells me you don't know jack about it. Stick to hygiene, and leave dentistry to dentists. Everybody--dentists, hygienists, and most importantly, patients--is better off that way.

 

[EnamelTuft]

Yer right- I wished I wouldnta spent so much time studien for that GED jus' to git inter hygiene school- Guess what freak? I took all those classes too (at university even), and guess what, my GPA stands at 4.0, so what? Fortunately, my academic standing does set me apart from most, including most of your dental school peers, but alas, my attitude does not put me in your league(so sad)- Why do you think your educational standards are so much higher than everyone elses? And I would love to take your boards, assuming that they only included the curriculum included in my education, and not the areas only covered in DDS, which you seem so keen to think everyone wants to be- You must think all NP's want to be MD's too, right? They probably just couldn't cut it-I'm quite certain that there will be a board exam for ADHP, as well-Thanks though!

Guess what you are a very small minority within your field with that GPA. You must want a pad on the back for that. I can guartantee you that if we posted up all the academic statistics of dental students compared with hygiene students, there will be no questions asked. Most of my curriculum is geared towards general dentistry which is exactly what you and your phonies want to do. I can bet that you wouldn't come close to passing our boards minus questions regarding endo and fixed/removable prosths. That just goes to show that you and your ADHP's aren't qualified.

Answer my questions:

1. Are ADHP's allowed to diagnose and treat caries (minus endo, fixed and removable prosth)?

2. Are you certain you will past our boards (minus questions regarding endo, fixed and removable prosth)?

3. What do you mean you don't want to become a DDS, then why the blink are you trying to diagnose and treat caries? The last time I checked, those are the jobs of a DDS. (Hygiene = cleanings, GET THAT!!!) (Advanced Hygiene = efficient/smart cleanings)

 

[KOM]

naaa, I'd rather palpate an oral cavity not the anal cavity.

Dude, I can go to my physician and he can tell me I need a CT scan, and I say, no doc, I'd rather want an MRI (a $hitload more expensive) and hell say, umm sure ( I HAVE SEEN THAT HAPPEN IN FRONT OF ME, I'VE WORKED IN HEALTHCARE). In dentistry patients have it worse. It wasnt too long ago that health insurances admitted to themselves that indeed, the mouth is connected to the body and it should be covered in someway under the insurance. Nowadays, if a patient wants a cavity fixed, the insurance tell them, to pay half of it. In case u dont know, it is considered surgery. They (Insurance compaines dare to argue with dentists and patients over less than $200, yet its a flip of the coin between an MRI and a CT. Dental access is indeed a concern that needs a group effort to solve it. As long as we can afford to say open and pay our loas, patients come first.

It's because insurance companies have a very hard time turning a profit on dental procedures. They can do the whole medical treatment deal based on the premise that of 10 people they insure, maybe 1-2 will get sick and have have significant health care costs. The high premiums of everyone else will easily cover those costs. It's bull****. Insurance companies end up protecting10% of the population and turn a profit on the other 90%.

Personally I believe the high healthcare cost are fricking insane. A crown for a grand...gimme a break. However, we have high mofo interest rates on loans now that easily break 250 G. How the F*** are we supposed to pay for that with our MORTGAGE loan and our PRACTICE loan? If you change the high costs associated with our education then you'll change the costs of our services.

Second...MN can implement the program if they want to. I guarantee you'll see all dentists leave the state. I grew up in a rural area and have plans to practice in a rural area and I think the U of MN did a great job looking for applicants that may satisfy this need. I wont stick around under this program and nor will many other classmates I've spoken to. To have our education undermined in such a way is absolutely ridiculous and will only exacerbate the problem.

 

[KOM]

I do enjoy hearing all points of view. Quackdentist is taking a stand that most here will disagree with...but, it's important to listen to her nonethless. We do have an access to care problem and we must figure out a solution. I grew up in AK. People would suffer out in the bush because there simply wasnt care available to them. This is a real life problem...it brings up the age old Q...is adequate healthcare a right. I believe this idea came about because of our inalienable right to pursue happiness. It's very difficult to pursue happiness without having one's own health. How many times has everyone here been very sick, in pain, hungover...just praying for the time when they'll feel "themselves" again. There are very few things worse than feeling very ill.

Quack...I would hope to think that many who look at this bill may easily perceive it as being just way too vague. It doesn't address the problem at hand...providing access to care because it doesn't state that these therapists would be obligated to practice where they are needed most. Having said that, I realize the innate problem with trying to define exactly what an "underserved area" is. Personally, I believe, as has been stated before, BEFORE any program like this is implemented they should simply increase dental school class sizes. Some may argue that results will only be seen then in >4 years while people are suffering now. However, we as dental professionals are qualified under very specific standards to address the dental needs of the public. If the ADA wishes to revise those standards then you will be in a position to take on more of those needs. Hell, in many countries, dentistry is learned simply as an apprenticeship. Is 4 years of training absolutely necessary? As Aphistis and others have commented...they are still learning much to this day. I'm a first year and I feel I have only scratched the surface...

 

[quackdentist77]

Four full years of dental school, and a year of residency...and I still learn something new every day.


1. With such impeccable professionalism, it's hard to believe anyone would disagree with your argument.

2. Once again, you're betraying your own ignorance. That's twice in this post alone you've suggested diagnosis is some sort of no-brain activity. Looking for dark spots on bitewings is simple enough, yes, but that's the beginning of comprehensive diagnosis, not the endpoint.

1. I *do* have Dr. in front of my name, and I agree with him.

2. Did I mentioned how impressed I with your professionalism?

I think it's a fair question. That's three times you've implied dental diagnosis is as easy as falling off a log, and it tells me you don't know jack about it. Stick to hygiene, and leave dentistry to dentists. Everybody--dentists, hygienists, and most importantly, patients--is better off that way.

Dear God! Is anyone REALLY listening? If I thought diagnosing was a "no-brain" activity, I might just suggest I could shadow a DDS for a couple of months and take it from there- Are you kidding me, or just trying to be a jerk? As far as professionalism goes, check in with some of your future colleagues- Do you expect me to just sit back and listen to their/your unfounded attacks? Please... My entire agenda in this discussion group was to listen to justified concerns, provide correction to any misinformation, and hopefully open up a dialogue between two groups of people that I had hoped have similar interests. (that would be patients, not money, in case there was any confusion) Instead, I'm finding a very hostile us vs. them environment. Basically just a "turf" war-I feel like I am forced to defend myself and my position, and it's really quite sad. I see a group of people that only want to discuss GPA's, and play the "I'm better than you" game, and why I let myself be sucked into that I do not know- So much for the dental TEAM, eh?

 

[NileBDS]

What is wrong with this thread ? Chill out guys ...

 

[aphistis]

What is wrong with this thread ? Chill out guys ...

Nothing wrong, just some spirited debate. That's what SDN is here for, right?

 

[gryffindor]

My entire agenda in this discussion group was to listen to justified concerns, provide correction to any misinformation, and hopefully open up a dialogue between two groups of people that I had hoped have similar interests. (that would be patients, not money, in case there was any confusion) Instead, I'm finding a very hostile us vs. them environment. Basically just a "turf" war-I feel like I am forced to defend myself and my position, and it's really quite sad. I see a group of people that only want to discuss GPA's, and play the "I'm better than you" game, and why I let myself be sucked into that I do not know- So much for the dental TEAM, eh?

Dental TEAM means the dentist does the irreversible procedures and handles all of the emergencies and negative consequences, the hygienist does the mostly reversible procedures in periodontics under the dentist's malpractice and supervision, the assistant, the receptionist, the treatment coordinator, the records/radiology tech, etc. Your definition of TEAM according to this bill is encroaching on the "irreversible procedures" part and yes, that does turn this into a turf war. The biggest fault of this bill which others have stated is that it does not specifically send the second-tier dental care providers to the areas of true need and thus it is being viewed as creeping onto our turf without any real benefit to the patient.

I thought the only turf war I was going to deal with in my career was GPs doing ortho vs Orthodontists. Now this.

 

[bodiddely]

Let's define "basic human right". Could we say life, liberty and the pursuit of happiness? Maybe, but that sounds cheezy and american.
Or more simply, could we just say LIFE? If so, and if you agree that "life" is a right of humans, healthcare to potentiate life would be a basic human right.

That's probably the most syllogistic argument in favor of universal health care I've ever heard. Props

But, I would argue that the writers of the declaration (which, btw, is not part of the Constitution) meant it as more of a negative right, meaning that governments should not take away life, liberty, or one's ability to pursue happiness without due process, not that other people should be forced to pay for whatever you require to continue living that you cannot afford on your own (for that matter, even if you can afford it, why should it cost you? It's a "right!" After all, persons who could plausibly hire a private attorney are still provided with the option of having a public defender)

Why's everyone being so nasty on this thread?

My apologies if anything I have said in this thread was interpreted as being meant in an unkind spirit. It's good to debate these things and I have enjoyed reading and reflecting upon your opinions.

 

[gyzeus]

the sad thing is that our school is getting devided. Hygenist, not all but I've seen it, are acting imature. I've seen them try to "grill" a dental student for signing a petition against the bill and calling him stupid. Most importantly, they (hygiene students) are getting misinformed by some hygiene faculty whom are by the way drafters of the bill.

I am sick of all of this... let them try it out.....in the mean time while the lawsuits hit the roof, we can make a new bill for dental assistants to do an advanced degree (6 months long) and they can do everything a hygenist can do.

I don't see anything wrong with having a debate, especially when it comes to protecting our own profession. I'm sure we all agree that we should be a dental TEAM but the difference in our opinions lies in who we should include in this team.

DH may say that dentist who are against this bill lack respect toward their profession, and I know it's just so much easier to see it in this way.. but actually it's the other way around. Think of who started this invasion into the other profession. And think of who is undermining the other profession by advocating that it's ok for people with half the amount of professional education of your own to go on doing the same or similar kind of work that you can do.. as long as they possibly "might" serve those in need.

Quack, the reason why DH can serve in their profession and do the work they are doing, is because the other professions respect your profession and the law protects it. If it wasn't for this respect and protection of your profession, just about anybody can jump in and start doing your work after getting just the amount of training to start the work.
But it's not only about who can do what in what amount of time. If that is what it's all about, why need any kind of professions at all? Just as much as you would like your profession to be protected, our profession hopes for the same.

 

[gyzeus]

Why do some people feel that just because they can technically perform a procedure at the same level as someone else, they should be compensated for that. It just doesn't make sense in the health care arena. Does it make sense to start setting up schools to train people for individual surgery procedures? The whole philosophy of these ADHP's are wired in the technical mode. They feel like just because they can do it makes them right. I guarantee that if a kid came right out of middle school, and if I sat there and trained the kid how to cut a class II cavity prep for several of weeks and tell him how to fill it, he can probably practice that for several of months and get better at that one procedure than most dental students. But now, does that quality of work justify him being allowed to treat patients?

I totally agree with you on this.
To add in another example, one of my math professors in undergrad simply sucked and the TA was always hinting indirectly that he could do way better than him. I'm sure most of the class would have actually agreed with him, but does that mean that the TA could now take the podium?
There is a huge shortage in math instuctors, so does this justify a TA opening his own class along with the professors? Even if a TA is good enough to teach a undergrad class without a Ph.D, it doesn't mean he could just skip through Ph.D and become a professor at a 4 year university.
There are rules and procedures in this society to reach a certain profession and to do the work within these professions.

 

[red88m]

I do enjoy hearing all points of view. Quackdentist is taking a stand that most here will disagree with...but, it's important to listen to her nonethless. We do have an access to care problem and we must figure out a solution. I grew up in AK. People would suffer out in the bush because there simply wasnt care available to them. This is a real life problem...it brings up the age old Q...is adequate healthcare a right. I believe this idea came about because of our inalienable right to pursue happiness. It's very difficult to pursue happiness without having one's own health. How many times has everyone here been very sick, in pain, hungover...just praying for the time when they'll feel "themselves" again. There are very few things worse than feeling very ill.

Quack...I would hope to think that many who look at this bill may easily perceive it as being just way too vague. It doesn't address the problem at hand...providing access to care because it doesn't state that these therapists would be obligated to practice where they are needed most. Having said that, I realize the innate problem with trying to define exactly what an "underserved area" is. Personally, I believe, as has been stated before, BEFORE any program like this is implemented they should simply increase dental school class sizes. Some may argue that results will only be seen then in >4 years while people are suffering now. However, we as dental professionals are qualified under very specific standards to address the dental needs of the public. If the ADA wishes to revise those standards then you will be in a position to take on more of those needs. Hell, in many countries, dentistry is learned simply as an apprenticeship. Is 4 years of training absolutely necessary? As Aphistis and others have commented...they are still learning much to this day. I'm a first year and I feel I have only scratched the surface...

Thank you for pointing this out, KOM. As I have said earlier, there are other developed countries who don't have as many educational "hoops" to go through as we do here in the US.
And I think it would be great to somehow increase the class sizes, increase the number of instructors and DECREASE the astronomically high tuition for dental school. Maybe then the graduating classes would be more likely to serve the underserved and not worry so much about paying off their $400K in loans.
The cost of dental school is the single most deterring factor for me, and it's a shame b/c I'm one of those people who would love to take all the medicare patients.

 

[red88m]

That's probably the most syllogistic argument in favor of universal health care I've ever heard. Props

But, I would argue that the writers of the declaration (which, btw, is not part of the Constitution) meant it as more of a negative right, meaning that governments should not take away life, liberty, or one's ability to pursue happiness without due process, not that other people should be forced to pay for whatever you require to continue living that you cannot afford on your own (for that matter, even if you can afford it, why should it cost you? It's a "right!" After all, persons who could plausibly hire a private attorney are still provided with the option of having a public defender)

As I've said before, it's all about money and greed. We Americans are trained to want more and more of everything. Bigger better faster. It's really silly- we're all human and are just going to die anyway. We should be able to relax and enjoy life without worrying about where our next buck is coming from to pay for our 5 cars and million dollar mcmansions.

My apologies if anything I have said in this thread was interpreted as being meant in an unkind spirit. It's good to debate these things and I have enjoyed reading and reflecting upon your opinions.

I'm generally referring to all the kindergarten name calling flying around here. If I was talking like these people to my sibling, my parents would have stopped the car and smacked me long ago.

 

[gyzeus]

As I've said before, it's all about money and greed. We Americans are trained to want more and more of everything. Bigger better faster. It's really silly- we're all human and are just going to die anyway. We should be able to relax and enjoy life without worrying about where our next buck is coming from to pay for our 5 cars and million dollar mcmansions.

Yes, money is very important especially in a capitalist society where the goverment is not going to pay for your high costing tuition and mortgage payments.
But it's not 'only' about the money, it's also hugely about the professionalism. That's why many people here including myself are suggesting GPR.

 

[red88m]

Why do some people feel that just because they can technically perform a procedure at the same level as someone else, they should be compensated for that. It just doesn't make sense in the health care arena. Does it make sense to start setting up schools to train people for individual surgery procedures? The whole philosophy of these ADHP's are wired in the technical mode. They feel like just because they can do it makes them right.

There already are schools set up to teach individual surgery procedures. Endo, perio, oral surgery, etc.

I guarantee that if a kid came right out of middle school, and if I sat there and trained the kid how to cut a class II cavity prep for several of weeks and tell him how to fill it, he can probably practice that for several of months and get better at that one procedure than most dental students. But now, does that quality of work justify him being allowed to treat patients?

Another thing is that pretty soon the insurance companies will jump along and will start to set the fees at a much lower price to satisfy these ADHP's. Everyone knows that all insurance companies care about is the bottom line and that bottom line is lower cost. And ultimately patient's oral health will not be at the standard that they are today.

I see what point you're trying to make, but in other countries people graduate high school and go straight into dental school or medical school courses. Then they treat patients.

I bet these ADHP's don't even know about occlusion and lateral excursions and how those affect treatment. Man I will soon feel sorry for patients who pay for an amalgam that doesn't allow them to easily go into a right lateral excursion. Oh! I smell tmj problems. What's next, ADPH's are needed in that arena as well?

True, I was taught very little about occlusion in hygiene school. But I know lots about it now. Most of what I know now about it was acquired from working for a good dentist (there are plenty of dentists out there who completely ignore the jaw joint).
This will have to be part of the ADHP curriculum- and I'm sure there will be board exams.

Hopefully they won't put biochem on the ADHP boards. There are some classes that you never use in dentistry and are just another hoop to jump through. How many times have you practicing dentists actually used your organic chem and biochem?

 

[airwolfrocks999]

Four full years of dental school, and a year of residency...and I still learn something new every day.

Well, I also did 4 yrs of dental school but dropped out of a residency program after halfway completion.

Don't get me wrong; I'm on the same side as dentists, as I am technically one myself.

But really, what more knowledge do you need to perform dental procedures?

Dentistry is 90% hand/eye coordination. The other 10% is diagnosis, in which most pathology are very repetitive and become second-hand nature.

 

[blissdental]

I see what point you're trying to make, but in other countries people graduate high school and go straight into dental school or medical school courses. Then they treat patients.

Not a good example to defend your profession from EnamelTufts middle school example.

I'm actually from two of those countries where high school grads go straight to med and dental schools. (Japan and South Korea)
But do you know what kind of students get accepted to those dental and medical schools?
Everybody takes the same college entrance exams once a year on a set date, and only the students that score in the top 1% with top gpa get in.
If this was in the US it would be like only the best students in harvard and ivy league with the best SAT scores and gpa getting in.
I've heard it's no different in other countries such as Canada, Germany, Africa and etc.

Both dental and medical schools consists of a 6 year program: 2 years of predent and premed courses, 4 years of dental and med courses.
And no they don't go straight into seeing patients after that. All med students have to do 1 year of internship and 4 year of residency unless they are going into general practice. For dental just as in the US, residency is optional if you want to specialize.

High school grads go straight to dental and med schools in these countries but these students are in school from 8am-10pm learning and taking all the prerequsite courses during high school.
Even this doesn't seem to be enough that the dental and med school in these countries are now changing to the same system as the US; 4 years of undergad+4years in professional school (+residency to specialize)

So there really is no easy way into becoming a dentist or doctor in a society where these professionals are highly respected.

 

[blissdental]

Hopefully they won't put biochem on the ADHP boards. There are some classes that you never use in dentistry and are just another hoop to jump through. How many times have you practicing dentists actually used your organic chem and biochem?

Then how many hoops have we been jumping through?
Well, why learn math, physics or chemistry or all of that junk in middle and high school that we won't be using? You would need to change the entire enducation system for that.

 

[red88m]

Not a good example to defend your profession from EnamelTufts middle school example.

I'm actually from two of those countries where high school grads go straight to med and dental schools. (Japan and South Korea)
But do you know what kind of students get accepted to those dental and medical schools?
Everybody takes the same college entrance exams once a year on a set date, and only the students that score in the top 1% with top gpa get in.
If this was in the US it would be like only the best students in harvard and ivy league with the best SAT scores and gpa getting in.
I've heard it's no different in other countries such as Canada, Germany, Africa and etc.

Both dental and medical schools consists of a 6 year program: 2 years of predent and premed courses, 4 years of dental and med courses.
And no they don't go straight into seeing patients after that. All med students have to do 1 year of internship and 4 year of residency unless they are going into general practice. For dental just as in the US, residency is optional if you want to specialize.

High school grads go straight to dental and med schools in these countries but these students are in school from 8am-10pm learning and taking all the prerequsite courses during high school.
Even this doesn't seem to be enough that the dental and med school in these countries are now changing to the same system as the US; 4 years of undergad+4years in professional school (+residency to specialize)

So there really is no easy way into becoming a dentist or doctor in a society where these professionals are highly respected.

Thanks for giving us the details. It's nice to hear from someone who has first hand experience in this kind of educational system.

 

[Cold Front]

Looks like New Hampshire and Maine legistlatures will vote on a similar bill that will allow hygienists to open-up their own practices this week.

I wonder how this will effect new associates coming out of school! (especially those coming out with $200k+ debt).

 

[r_u_cool2]

one of the main reason why the ADHP bill has not passed to the senate floor in MN yet is because during the commitee hearing, about 75-100 dental students packed the hearing room to show our opposition to the bill. To protect the integrity of our profession, students and dentists should do the same in Maine and New Hampshire. For the safety of our patients, don't let the DH win so easily.

 

[bodiddely]

As I've said before, it's all about money and greed. We Americans are trained to want more and more of everything. Bigger better faster. It's really silly- we're all human and are just going to die anyway. We should be able to relax and enjoy life without worrying about where our next buck is coming from to pay for our 5 cars and million dollar mcmansions.

That's all well and good to point the finger and call people against universal health care greedy and selfish, but I think your position would be better served by responding to the substance of my argument.

 

[primadonna22274]

You guys have been busy. I kinda stepped away from this debate after I opened the midlevel can of worms, but here's something that perplexes me: why would there be any desire/need for a dental hygienist to have a master's degree? Because my school (Pacific U. in Oregon) has recently opened a dental hygiene program (B.S.) but they're also gearing up for a master's program for those hygienists who want a master's degree. I know next to nothing about this program but since it's housed in the new College of Health Professions along with the pharmacy and PA program my assumption is there will be some kind of a clinical bent (e.g. advance practice hygienist), but that's just my guess.

 

[geometric-pain]

This has been a great thread to watch. If this bill passes and the everything gets set in motion, who will teach these students? Dental schools are all ready having a hard time filling faculty spots. Why would a dentist who wanted to teach go to a Hygiene Masters program when there is a severe shortage of dental educators? Nearly all of my instructors are either retired dentists who work at the school part time, foreign trained dentists, or those who have retired do to health reasons. Does that sound like an endless supply of dental instructors? 2 of the 3 actually reduce the number of practicing dentist and compound the problem of access to care. Another point I would like to make is about occlusion. Quite possibly one of the most important concepts dentists learn and I highly doubt you can duplicate that part of education simply by working with a dentist for a few years. Unless he / she is sitting down with you, with the articulator, waxing up, and giving you lectures on head and neck anatomy with a little neuroanatomy.