Advanced dental hygiene practitioner

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I just want to say that I am discussed by the dogmatic, illogical, half @ss arguments that are being made by the ADHP proponents here on this forum. You are AVOIDING addressing the main issues that the bill was based on. I have a great relationship with DH at my school and I am able to carry out discussions with them in a decent manner. Many of you have resorted to personal attacks and are avoiding the issues. I must say that your lack of professionalism puts into question whether you are indeed RDHs in practice or not. Is seams as if attaining this new position is “THE goal”, rather than a means of elevating the situation of the underprivileged. There are pressing questions that many here are asking and this discussion has been far from constructive and at times uncivil.

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From reading your posts, I don't think you appreciate the threat the ADHP's are.

You seem to want to justify and rationalize their existence.

Don't make excuses for them.

If you don't have enough dentists, then make more of them. Increase class sizes or open more schools. Don't create a new group who has lower qualifications and less training and yet will lobby for the same rights that dentists have.

The trajectory of the ADHP's is very predictable. Once created, they will lobby for autonomy. After autonomy, they lobby for expanded scope. 20 years from now, an ADHP and a dentist may offer nearly identical services.


I do recognize the threat. But you have to realize that there is a large number of DH students that support this bill and what is in their mind IS different than that of the bill drafters. The level of ignorance in this matter is pretty high from the DH group as well as the politicians. I sat with a state rep last week who supports the bill and his grand comeback to many pressing questions was “well I trust my hygienist, she is just such a nice person.” As you can see, the level of ignorance is at an all time high. I agree with your trajectory and I appreciate the fact that you (coming from the medical area) are making your voice heard on this issue. Putting the patient FIRST, makes it obligatory for all educated citizens (MDs, DDSs, RDHs, other etc.) to take a firm stand against this bill.
 
This is just a trickle down from the ADA's pathetic excuse for a professional response to the issue at hand. The dental students read the ADA newletter and just scream no fair but if we don't address the issue in an acceptable manor as determined by the politicians they're just going to do what they think is right, regardless if it's worse for EVERYONE... including the patients. Offer solutions, not whiny little excuses!

Read my previous post if you haven't already because you were too busy pouting.
 
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This is just a trickle down from the ADA's pathetic excuse for a professional response to the issue at hand. The dental students read the ADA newletter and just scream no fair but if we don't address the issue in an acceptable manor as determined by the politicians they're just going to do what they think is right, regardless if it's worse for EVERYONE... including the patients. Offer solutions, not whiny little excuses!

Read my previous post if you haven't already because you were too busy pouting.


I've already emailed the ADA to suggest GPR as an alternative to ADHP but recieved no resposne yet. I, myself and many D0s around me are for GPR. We don't mind sacrificing some of our time if that's what is takes to protect our profession. I'm sure ADA had already thought of this option but why aren't they suggesting that to the legislatures in place of the ADHP?
Is there really something going on behind all this?

If this bill goes through, I couldn't agree any less to what Taurus had mentioned. If dentists start hiring the ADH, that not only funds them to pay back their loans and set up a practice, but that is actually showing the public that we give them credit to do equal work as dentists. As mentioned above, add in a few PhD hygienists with the assistants calling them Dr. and I'm sure that would be enough for the general public to get confused between the DDS/DMD and ADH. I also agree that we need to empower the dental assistants so that they could balance out the hygienists before our profession gets balalnced out. By doing this we could easily show the public that we have these number of different groups that are not equal to the DDS/DMD but are below our profession.
 
I do recognize the threat. But you have to realize that there is a large number of DH students that support this bill and what is in their mind IS different than that of the bill drafters. The level of ignorance in this matter is pretty high from the DH group as well as the politicians. I sat with a state rep last week who supports the bill and his grand comeback to many pressing questions was "well I trust my hygienist, she is just such a nice person." As you can see, the level of ignorance is at an all time high. I agree with your trajectory and I appreciate the fact that you (coming from the medical area) are making your voice heard on this issue. Putting the patient FIRST, makes it obligatory for all educated citizens (MDs, DDSs, RDHs, other etc.) to take a firm stand against this bill.

I'm sure you mean well, but you are quite naive about how the way things work. You think that by playing nice and pacifying them that everything will work out. The anesthesiologists tried that for a long time with the CRNA's but everytime the CRNA's come back and stab them in the back. Keep in mind that midlevels are intent on autonomy and equal scope and no matter how nice you are to them or how nice they appear to be that's their goal. If history is any guide by the NP's and CRNA's, once their numbers grow, they'll put out propaganda. They'll make statements like "My doctor is an NP" and they'll put out crap studies showing that there is no difference in the care between a ADHP and a dentist. Read the NP propaganda piece that I have linked in my signature by the dean of the nursing school at Columbia University. At least with the NP's, we have PA's who act as effective counterweights to them. The CRNA propaganda is even worse because they're more powerful than the NP's because the anesthesiologists were too late in creating the AA's to counterbalance the CRNA's. These groups will then use propaganda to convince the politicians to agree to their goals.

Like I said, if you need more dentists, expand classes, open more schools, make GPR mandatory. Do whatever it takes. Do not create a brand new group with lower standards and less training. It's inevitable that they want your job. They don't care if their training is inferior to yours or that they have lower admission standards. They want to produce as many ADHP's as possible so that they can achieve critical mass to gain political power.

If you create a new group, you can't control how many are produced every year and it's likely that the total grads coming out of dental and ADHP schools will overshoot demand. Just think for a moment what would happen if suddenly dentists and autonomous ADHP's offered nearly identical services, even the cosmetic ones. Using supply and demand logic, dentist salaries will tumble. Remember, that 10 years ago, the average dentist was making $78k. Don't be surprised if you go back to those numbers.

I'm just glad that nearly everyone on this thread understands the issue much better than you.
 
The GPR idea not only helps the needy but I think it's necessaryto complete the training for a good, well-rounded dentist. Dentists should be comfortable doing extractions and I see way too many young dentists that are not. They all sure know or think they know they can do a veneer prep though! Ask youself if we as a profession are truly helping people with our the state's subsidized dental schools by knowing how to prep a crown/veneer but not being comfortable taking a tooth out. I would actually support ADH's working under indirect supervision. Dentist's could set up satelite offices where they come in once a week or every few weeks and help the ADH's with any difficult cases, give them someone to call if questions, and also maintain a standard level of care. After doing a GPR, I can tell you that many of these people whom the politicians want to help are very medically compromised. There is no way an ADH can get the training they need in 2 years to understand everything a dentist does from a medical standpoint. Yes, I believe we can train them to do the mechanical portion but there's more to it than that. When you look at the numbers between graduation rates and dentists retiring, we are loosing about 1000 dentists a year in this country. Compound that with 40% of the classes being female who in general work less hours and take time off over their careers, the general population is continuing to grow, and you have some massive issues with access to care on the horizon. Something has got to give and we need to look at alternatives as a profession. Even if we opened more dental schools, I'm not sure if that would get to the heart of the matter when you look at the fact that it costs between 300-400K to train a dentist and that doesn't even take into account their lost income. Delegating responsibilities of the dentist is going to have to be the manor in which we deliver care at least for the lower income populations in my opinion. So let's figure out how we can do it on our terms or the politicians are going to do it on their terms. Be proactive and not reactive.
 
Read the NP propaganda piece that I have linked in my signature by the dean of the nursing school at Columbia University. At least with the NP's, we have PA's who act as effective counterweights to them. The CRNA propaganda is even worse because they're more powerful than the NP's because the anesthesiologists were too late in creating the AA's to counterbalance the CRNA's. These groups will then use propaganda to convince the politicians to agree to their goals.

I checked out the article and saw this:

lol.jpg


Epic lulz.
 
Interesting that so many now propose setting up larger class sizes now that this perceived threat is there when before, most would advocate against it. This bill is designed to do make the dental profession rethink their current stance. They've seen how protective a lot of dentists and the ADA are towards this profession and correlate it with greed. They've seen many of the procedures we've done day in and day out and think they should have the right to do it just because they can. All they want is a piece of the profit and they want to call it access to care when it's just their own greed.

I received a response from a senator acknowledging that quality of care may be compromised, but is having a "difficult time" deciding if quality trumps no care whatsoever. I just don't understand why people think that by adding this program all of a sudden those people who absolutely couldn't get care before due to whatever restriction will now be able to receive it. It's ridiculous.

I think DrJeff had it right when he said that politicians understand tax dollars and that funding should be our primary argument when sending off letters. They could care less about our professional code of ethics, level of education, etc. They've already been brainwashed into believing that the reason we're so up in arms about this is because of our greed. They think we would rather sacrifice care for more money. Nevermind, the ethical argument that our #1 duty is to do no harm to a patient and we feel patients will be compromised under this program.
 
Haha, nice find armorshell. :thumbup:
 
I don't understand why no one is seeing the possible benefits of this program. Dentists could potentially employ 2-3 advanced hygienists who would set up satellitte clinics in various rural/urban areas, complete the small production items (aka drill and fills) and then refer all the large production items to the dentist, ultimately increasing their financial gain. If dentists are worried about the financial losses, then I believe they are looking at this the wrong way. Medicine has been using this system of MD, RNP, PA, RN all working together for years, and it seems to be working. As for education, these hygiene students would have already completed hygiene school and then would continue on to complete a masters program. Not every hygiene student is going to choose this path, and therefore the advanced hygienists will be dedicated and extremely driven professionals. Why are people willing to let assistants, who have no education take over some of these responsibilities and yet they are fearful to give highly educated hygienists the opportunity?
 
I don't understand why no one is seeing the possible benefits of this program. Why are people willing to let assistants, who have no education take over some of these responsibilities and yet they are fearful to give highly educated hygienists the opportunity?

2 words - slippery slope.
 
I don't understand why no one is seeing the possible benefits of this program. Dentists could potentially employ 2-3 advanced hygienists who would set up satellitte clinics in various rural/urban areas, complete the small production items (aka drill and fills) and then refer all the large production items to the dentist, ultimately increasing their financial gain. If dentists are worried about the financial losses, then I believe they are looking at this the wrong way. Medicine has been using this system of MD, RNP, PA, RN all working together for years, and it seems to be working. As for education, these hygiene students would have already completed hygiene school and then would continue on to complete a masters program. Not every hygiene student is going to choose this path, and therefore the advanced hygienists will be dedicated and extremely driven professionals. Why are people willing to let assistants, who have no education take over some of these responsibilities and yet they are fearful to give highly educated hygienists the opportunity?


It would benifit us for the first few years but look at the NPs, CRNAs.
As many had mentioned before an ADH is more like a NP than a PA. They don't need supervision and the only case they would want to work for a dentist would be the first couple of years after graduation so that they could pay back loans. After they get their money and the clinical experience, I doubt they would stick around longer.
I also agree on the salary part with what Taurus said. I have a friend that's a dental student in New Zealand who couldn't make it into dental school in the US. He told me he plans to come and practice in the US after he graduates because the salary of dentists is not that high when compared to the overall average income of New Zealand. He said the cost of dental procedures are very high even in NZ but the dental therapists play a big role in lowering their salary.
 
I don't understand why no one is seeing the possible benefits of this program. Dentists could potentially employ 2-3 advanced hygienists who would set up satellitte clinics in various rural/urban areas, complete the small production items (aka drill and fills) and then refer all the large production items to the dentist, ultimately increasing their financial gain.

We already have people who do this, especially in urban areas. They are called associate dentists - newbies who have just graduated dental school and get hired by an owner dentist/corporation to do the less lucrative procedures in a practice.
 
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In the future if the Dental Anesthesiology become a recognized specialty, they would want to come out with a profession called Certified Dental Anesthetist just like the nurses did with CRNA.
 
In the future if the Dental Anesthesiology become a recognized specialty, they would want to come out with a profession called Certified Dental Anesthetist just like the nurses did with CRNA.


And what not with other specialties??

http://www.npcentral.net/press/independentpractice.shtml
The NPs are even asking the regular RNs to stick with them as nurses instead of the physicians. They want to be called DR. NPs, do every single thing that a physician does but when it comes time to get cheap labor they called themselves nurses.
 
I don't understand why no one is seeing the possible benefits of this program. Dentists could potentially employ 2-3 advanced hygienists who would set up satellitte clinics in various rural/urban areas, complete the small production items (aka drill and fills) and then refer all the large production items to the dentist, ultimately increasing their financial gain. If dentists are worried about the financial losses, then I believe they are looking at this the wrong way. Medicine has been using this system of MD, RNP, PA, RN all working together for years, and it seems to be working. As for education, these hygiene students would have already completed hygiene school and then would continue on to complete a masters program. Not every hygiene student is going to choose this path, and therefore the advanced hygienists will be dedicated and extremely driven professionals. Why are people willing to let assistants, who have no education take over some of these responsibilities and yet they are fearful to give highly educated hygienists the opportunity?

Unfortunately, this will be a common view. Greed and the human desire for more income will lead dentists to hire ADHP's. If one dentist in a community hires a few ADHP's and starts to make more income, other dentists in the community will hire them too to sort of "keep up with the Jones'". In the back of their minds, they know that hiring ADHP's will hurt the dentistry profession, but they rationalize their actions by telling themselves that it won't happen for a while. Will the dentists who have 10 years before retirement care what happens to the next generation? Don't count on it. They're more worried about their retirement accounts. Once there is a critical mass of ADHP's, the political ball starts to move and you guys are screwed. The key is to never put this temptation in front of dentists at all.
 
Will the dentists who have 10 years before retirement care what happens to the next generation? Don't count on it. They're more worried about their retirement accounts. Once there is a critical mass of ADHP's, the political ball starts to move and you guys are screwed. The key is to never put this temptation in front of dentists at all.

MN will soon learn that fewer dentists will stick around once this program kicks off. Unfortunately, this will cause even less access to care allowing the ADHP's to fill in the gaps and MN to do their studies showing that THEIR program is working. Then other states will consider implementing it. MN loves setting standards for dental care!!

As far as the above post is concernced, I also have that worry though I'm not sure how valid it is. I've always thought that as the older generation dentists begin retiring (and aging), they're going to begin looking out for their own welfare more...for ex, once conservatives, beginning to feel much less apprehensive about socialized medicine, etc and caring less about the future of dentistry. In our society that is very individualistic/independent vs. many other cultures where family means much more, one would come to expect people here in the US to look out more for their own immediate pressing needs. "They already got their's so to speak."

But I think conservatives have very fundamental beliefs that seem to be resistant to change and I don't think we should expect older dentists to turn their backs on us.
 
We already have people who do this, especially in urban areas. They are called associate dentists - newbies who have just graduated dental school and get hired by an owner dentist/corporation to do the less lucrative procedures in a practice.


Its a shame this is how you see your associates. Im surprised you can employ them.
 
I don't understand why no one is seeing the possible benefits of this program. Dentists could potentially employ 2-3 advanced hygienists who would set up satellitte clinics in various rural/urban areas, complete the small production items (aka drill and fills) and then refer all the large production items to the dentist, ultimately increasing their financial gain.


Money is important to keep our clinics open and its a huge factor but allow me help u understand why money does not dictate the profession's opinion on this matter.

It is because....

-Patient care comes first not our pockets, and if u disagree, consider taking an ethics class to understand why. (that is for you predents too, u are not immune from ignorance)

-When u want to talk about dental access, KEEP IT REAL..look at the bill, dare to ask yourself why U think its written the way it is. Be a critical thinker.

-With every tx performed by a clinician there is risk of $hit goin wrong. Ethically, it is wrong to expose a patient to an unnecessary elevated level of risk. And don't try the "is half @ss care better or no care." Look up the code of ethics all healthcare providers must abide by and it says "do no harm". Meaning, it what u do can F%&$ up pt even more, u shouldn't do it.

I apologize for the 4 letter words because its unprofessional but I am sick of ADHP proponents going down the route of dental access with the politicians and trying to talk about financial incentives. Bottom line is Insurances companies will save money and the patient will pick up the cost by accepting substandard care.
 
Its a shame this is how you see your associates. Im surprised you can employ them.
If I may presume to speak for her, I think this is gryffindor's perception from being at the associate end of that relationship before she went back to specialize. She's never been a practice owner.
 
MN will soon learn that fewer dentists will stick around once this program kicks off. Unfortunately, this will cause even less access to care allowing the ADHP's to fill in the gaps and MN to do their studies showing that THEIR program is working. Then other states will consider implementing it. MN loves setting standards for dental care!!

This is exactly what I was thinking. With huge number of associates leaving MN to other states, dental office will be more willing to hire the ADH in place of the associates because of their abundance and cheap labor. And after the older dentists start to retire, the ADH will be taking their places and they will thrive on from then.
 
Its a shame this is how you see your associates. Im surprised you can employ them.

Go on Dentaltown and you'll find plenty of "The owner doc is screwing me" posts from associates. As aphitis pointed out, I've posted my experiences as an associate on here many times as well. I think unfortunately that the presence of these ADHP is going to lead to the road Taurus posted - the more established docs who stand to make more off employing an ADHP over a newbie associate will gladly hire the ADHP and not care if it ruins the profession as long as his take home is bigger.
 
MN will soon learn that fewer dentists will stick around once this program kicks off. Unfortunately, this will cause even less access to care allowing the ADHP's to fill in the gaps and MN to do their studies showing that THEIR program is working. Then other states will consider implementing it. MN loves setting standards for dental care!!


You're right.. MN does seem to love setting the standards of dental care.

I've read in an article that ADPH bills have failed to pass already and are not being further considered in 2 other states. So not every state agrees on this nonsense and it's not national, yet.
And it's not too late yet to come up with a solution.

I say we learn from this MN case and start paying close attention to our state DH associations before things get serious like MN. We should get more involved and start suggesting alternative solutions to this access problem to our state dental associations and the senators "before" the DH associations make a head start.
I've read in some article that the DH association in TX and NEW MEXICO are showing support for the MN ADHP bill and are already meeting senators possibly to slowly start suggesting the ADHP. (I'm not sure on this but it wouldn't hurt to be precautious at this point, knowing that the MDHA had been lobbying and preparing for this bill since 2004)

We all know that before the MN bill states that those ADH would be limited to underserved areas, the access problem is never going to be solved. And dentists, or ADH or whoever the caregiver may be, we all know that dental prices can go down only so far. So all it takes is just one state to show that GPR or some other solution that the dental profession can come up with would be a better option to ADHP.

Let's all please, please get involved and start contacting our state dental associations to be aware of this nationwide ADHP trend going on before it really get's too late.
 
MN will soon learn that fewer dentists will stick around once this program kicks off. Unfortunately, this will cause even less access to care allowing the ADHP's to fill in the gaps and MN to do their studies showing that THEIR program is working. Then other states will consider implementing it. MN loves setting standards for dental care!!


You're right.. MN does seem to love setting the standards of dental care.

I've read in an article that ADPH bills have failed to pass already and are not being further considered in 2 other states. So not every state agrees on this nonsense and it's not national, yet.
And it's not too late yet to come up with a solution.

I say we learn from this MN case and start paying close attention to our state DH associations before things get serious like MN. We should get more involved and start suggesting alternative solutions to this access problem to our state dental associations and the senators "before" the DH associations make a head start.
I've read in some article that the DH association in TX and NEW MEXICO are showing support for the MN ADHP bill and are already meeting senators possibly to slowly start suggesting the ADHP. (I'm not sure on this but it wouldn't hurt to be precautious at this point, knowing that the MDHA had been lobbying and preparing for this bill since 2004)

We all know that before the MN bill states that those ADH would be limited to underserved areas, the access problem is never going to be solved. And dentists, or ADH or whoever the caregiver may be, we all know that dental prices can go down only so far. So all it takes is just one state to show that GPR or some other solution that the dental profession can come up with would be a better option to ADHP.

Let's all please, please get involved and start contacting our state dental associations to be aware of this nationwide ADHP trend going on before it really get's too late.
 
I can't wait to refer my patients to the ADHP's for difficult extractions.
 
So basically they can perform cavity preps, provide diagnosis, pulpotmony on primary teeth, pulp capping, prescribe meds, perform extractions, supervise dental assistants, place sutures, etc, as long as a licensed dentist is present..... if I am reading this correctly (correct me if I am wrong pls)....wow so we get to twiddle our thumbs... this will allow us to make more cheese by cutting our work out and delegating it to others... which works for me... however why wouldn’t this dental hygienist with an advanced masters degree just go to dental school and be able to dictate their own life... it seems like logic that if this passes it won't be too long before the hygienist will be able to run a practice....

I pray i read this wrong

In some states hygienists can already run there own practice CO and AZ are examples. We stillhave to refer to an actual DDS/DMD for exams and the like.
 
In some states hygienists can already run there own practice CO and AZ are examples. We stillhave to refer to an actual DDS/DMD for exams and the like.

As someone pointed out earlier, something like 70% of a dental practice's income is based on cleaning. If hygienists can open their own practices and refer to dentists when they find a cavity or pathology, then dentistry as we know it is in big trouble.
 
As someone pointed out earlier, something like 70% of a dental practice's income is based on cleaning. If hygienists can open their own practices and refer to dentists when they find a cavity or pathology, then dentistry as we know it is in big trouble.

I believe that the advantage of a hygienist opening a "cleaning shop" is a double edged sword. Yes it benefits the public by providing much needed access to care yet takes money out of the dentists pockets (in theory).

A lot of people inthis forum seem to think that hygienists that eventually become an ADHP will want to be on there own. That is unfounded to say the least. Hygienists are still regulated by the dentist they work for regardless of there educational level or functional role. The ADHP was designed to fill a need in the underseerved/underpriviledged arena.

As someone said earlier why would you not want someon that can do the mundane things in restorative dentistry and leave the crown, bridge, onlay/inlay, implants and removeable prostho to those that have the expertise and training?

The proposed ADHP curriculum would require those entering into it to have a bachelors in dental hygiene. Then an additional two years of intensive training.

Below are two links with information on the ADHP. I am currently looking for a file small enough with the proposed curriculum.


View attachment fetch.pdf

View attachment fetch2.pdf
 
A lot of people inthis forum seem to think that hygienists that eventually become an ADHP will want to be on there own. That is unfounded to say the least.

As someone said earlier why would you not want someon that can do the mundane things in restorative dentistry and leave the crown, bridge, onlay/inlay, implants and removeable prostho to those that have the expertise and training?

The assertion once their numbers reach a critical point that ADHP's will lobby for autonomy and eventually scope expansion is hardly unfounded. Practically every midlevel group has done this or has tried to, e.g., NP's, CRNA's, optometrists, etc, etc, etc. The motivation lies in the basic human desire to work for oneself and make more money.

Like I pointed out before, if you allow a midlevel group to do your "mundane" work, you're getting on a slippery slope where they eventually will say to themselves, "If I can do this by myself, why do I need you to supervise me?" If the midlevel can bill independently, then they don't need to split the fee with any supervising dentists. They can keep it all to themselves.

It amazes me that some folks still have trouble conceptualizing the midlevel threat, especially when there are plenty of examples to go around. Once the genie is out of the bottle, you can't put it back, as the anesthesiologists have painfully learned with the CRNA's.

I also realize that once ADHP's are made available the dentist with 10 years before retirement and whose retirement accounts have been depleted by the stock market correction will be tempted to use them. Too many dentists like rdhdds1 will downplay the threat and go ahead maximize their income to the future detriment of the profession. It's unfortunate.
 
As someone pointed out earlier, something like 70% of a dental practice's income is based on cleaning. If hygienists can open their own practices and refer to dentists when they find a cavity or pathology, then dentistry as we know it is in big trouble.


What??????? Where did this number come from.
 
True.. So what do you all think is a good option that we could suggest to them? And what are some major points that should be strongly indicated in these emails?

For myself, I plan to cover in my email the points that:

-As many have mentioned above, I think we should inform them with the option of starting a new GPR system and sending the dental grads out to rural areas where populations are below a certain number.

I've lived in a country with a similar system where army is mandatory and physicians and dentists are obligated to serve within bases or public hospitals in rural areas after graduation or residency. I've seen that this doesn't completely solve the shortage problem but it does help greatly in resolving this problem.

-As advanced hygenists will be previliged to practice a similar range of procedures to dentists without any supervision, it would only be reasonable that they recieve the same or similar amount of education as dentists. A minimun of 4 years should be required for this program for the enhancement of the scientific background of these professionals as the majority of them do not hold a BS or BA degree but in avearge have only completed 2 years of college work at a community college.

-Setting an absolute designation of where these hygenist can practice (determined not by a fixed boundry line but through a population census, as there could always be a fluctuation of population growth or reduction within a certain region)

Anything else to add?

The educational requirement is a bachelors in dental hygiene prior to starting the masters degreed course work to become an ADHP. Why there are some of those out there that think any insitution would grant a masters to someone with only an AA is beyond me.
 
I also realize that once ADHP's are made available the dentist with 10 years before retirement and whose retirement accounts have been depleted by the stock market correction will be tempted to use them. Too many dentists like rdhdds1 will downplay the threat and go ahead maximize their income to the future detriment of the profession. It's unfortunate.


Do you not think that doctors went through the same heartache/heartburn when PAs and nurse practitioners came about? Or in your case CRNAs? I spoke to an anesthesiologist today who says that about 95% of the CRNAs that he has worked with are exceptionally capable but there are those 5% that you are like whoa. This can be said of any profession.

Instead of looking at each other and pointing fingers why not look at the big picture. In respect wot CRNAs, PAs and the like. Why would a practice higher two or three MDs when they can higher twice as many PAs or nurse practitioners to do the same job and pay them less? It makes good business sense. See more patients make more money. Simple economics.

Better planning will help weather any storm.

And personal attack are not appreciated in any of the forums. Making assumptions of one is like making assumptions of the many.
 
stop it with the "wanting to serve the underserve crap"....there are some who really do want to serve those areas, but those are just the minority. This fast track pseudoDDS thing is getting out of hand. All this talk about serving the underserved but no where in the bill is the mention of serving these areas. That idea is just the fantasy of the politicians who are proponents of the bill. They're too ignorant to see through the true intentions of these phonies!!
 
What??????? Where did this number come from.

The figure was posted in a previous post on this thread. Whatever the true figure is, cleaning is a major part of a dental practice, not only because of the income but also because it a major driver for the rest of the dental practice. Not only does cleaning drive the need to do fillings but other services like whitening. How would a dental practice look like if a lot of the cleaning business went to ADHP's and they referred their patients to you for fillings and whatnot? How much business would be lost for a typical dental practice?
 
70% with the hyg, that's complete BS! In a well run practice, hyg with run 30-40% of total production and hygienists have managed to control the number of graduates they pump out a year so well that they get paid 30-45 an hour. because of this most dentists only profit about 10-25% from their hyg dept. If they participate with a number of insurances and practice good standard of care dentistry(1 hour cleanings, perio exams) there's a good chance their profit is negligable and all their profit is on referals for restorative work done in the practice. It's the referal base that is so critical for dentists. When you look at the business component of dentistry and factor in overhead for equiping two chairs with x-ray and the like to do hygiene you're looking at an investment of at least 150K to own a hygiene-only office. Then there's staff and other business expenses as well. It's just a bad business model compared to working for a dentist at a guaranteed salary. Hygienist make much more than a beautician(yet, almost the same amount of training) so you can't compare apples and oranges.

Those who wish to discuss numbers of a dental office need to know what they're talking about as the number being shown here are totally false.
 
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Stats show that cleaning and exams take up 76% of all dental services and are estimated to grow even higher in the future. Plus, the fake dentists are not limited only to these procedures.
Taurus had made a good point. We should learn from the NP case and not hire nor take any referrals from the cleaning clinics of these midlevels if that nonsense bill goes through.

Let's say not to bite the hand that feeds you. If the "cleanings clinics" are referring to you then that means more business for you.

Why do you call them (RDH, ADHP) fake dentists? I am unclear as to what that statement is intended to provoke. Nobody has said that the ADHP was a dentist. Just like nobody has said the PA is a doctor.

SO.............going with your mindset. All PAs and NPs are fake doctors as well and they can't be trusted either.

The bill pased a while ago in MN and the first program for the ADHP is set to open in the Spring 2009.
 
Let's say not to bite the hand that feeds you. If the "cleanings clinics" are referring to you then that means more business for you.

Why do you call them (RDH, ADHP) fake dentists? I am unclear as to what that statement is intended to provoke. Nobody has said that the ADHP was a dentist. Just like nobody has said the PA is a doctor.

SO.............going with your mindset. All PAs and NPs are fake doctors as well and they can't be trusted either.

The bill pased a while ago in MN and the first program for the ADHP is set to open in the Spring 2009.


Not all PAs and NPs are fake doctors. Only the ones that overestimate themselves, asking to do the same kind of work as physicians and independent practice are fake doctors. Not that many people including myself are against independent practice of hygienists for teeth cleaning, we only have a problem with them doing surgical, dental work.

Why are you so offended by people calling this midlevel as fake dentists??
They aren't dentists, but they want to do dental work. So tell me what better way I could describe this group as other than fake dentists.

Once the ADHs start opening up their dental shops, you're going to see how dentists will start pushing for another midlevel group. Just like how the physicians are starting to support AAs instead of CRNAs. So it would be their benifit to stay cooperative if they don't want to be outcompeted by another midlevel that would be strongly supported by the dentists.
 
As usual, agree with Taurus. Few additional thoughts:

1) I've heard a few people state that "its only one state." What you dont understand is that the first state is always the biggest, most protracted battle. Subsequent battles move along much faster and the number of skirmishes increases rapidly. State lawmakers are lawyers at heart, and they are big on the concept of precedent. What happens in one state is a threat to EVERY state.

2) You need to get rid of the leeches in your profession NOW. It will start in private dental clinics, and gradually invade dental schools. Call out the sellout dental faculty who agree to set up ADHP programs as part of dental schools. Before you know it, your dental faculty with be putting ADHP students in your dental clinic rotations, and they'll even delegate patients to them just like a regular dental student.
 
Not all PAs and NPs are fake doctors. Only the ones that overestimate themselves, asking to do the same kind of work as physicians and independent practice are fake doctors. Not that many people including myself are against independent practice of hygienists for teeth cleaning, we only have a problem with them doing surgical, dental work.

You dont get it. EVERY SINGLE MIDLEVEL ORGANIZATION has pushed for independent practice. Not just some of them, EVERY SINGLE FREAKING ONE OF THEM.

Its a matter of WHEN, not IF.

In terms of scope of practice, its the same deal. EVERY SINGLE MIDLEVEL organization has fought for and gotten increased scope of practice that overlaps with physicians.

Explain to me why dentistry will be different. Explain to me why the ADHPs will be content to play in their sandbox without eventually expanding scope into dentists' turf. Explain to me why the ADHPs will be the single isolated exception to trends going back over 40 years involving over a dozen allied health and midlevel organizations/groups?

Once the ADHs start opening up their dental shops, you're going to see how dentists will start pushing for another midlevel group. Just like how the physicians are starting to support AAs instead of CRNAs. So it would be their benifit to stay cooperative if they don't want to be outcompeted by another midlevel that would be strongly supported by the dentists.

By then, its too late and the ADHPs will have enough political power to kill any opposition. CRNAs have successfully killed bills in many states that license AAs.
 
You dont get it. EVERY SINGLE MIDLEVEL ORGANIZATION has pushed for independent practice. Not just some of them, EVERY SINGLE FREAKING ONE OF THEM.

Its a matter of WHEN, not IF.

In terms of scope of practice, its the same deal. EVERY SINGLE MIDLEVEL organization has fought for and gotten increased scope of practice that overlaps with physicians.

Explain to me why dentistry will be different. Explain to me why the ADHPs will be content to play in their sandbox without eventually expanding scope into dentists' turf. Explain to me why the ADHPs will be the single isolated exception to trends going back over 40 years involving over a dozen allied health and midlevel organizations/groups?



By then, its too late and the ADHPs will have enough political power to kill any opposition. CRNAs have successfully killed bills in many states that license AAs.


Actually, I totally agree with you in that ADH would be no exception to the other midlevels. As a matter of fact, it's not even in some future after they gain polotical power, the ADH are already asking for autonomy from this very beginning.
Hopefully the dentists have seen how the NPs have invaded into the profession of physicans, and start pushing for another midlevel group before things get out of hand.
 
Let's say not to bite the hand that feeds you. If the "cleanings clinics" are referring to you then that means more business for you.

A naive person would believe this statement. The volume from ADHP referrals would not offset the significant lost income from cleaning and the extra services it drives to a dental practice.

Does anyone believe that ADHP's will be happy with just cleaning? Cleaning is how they justify legislating themselves into existence with lawmakers. Just like dentists, ADHP's will eventually offer add-on non-surgical services like teeth whitening and other cosmetic services.
 
Do you not think that doctors went through the same heartache/heartburn when PAs and nurse practitioners came about.

Why would a practice higher two or three MDs when they can higher twice as many PAs or nurse practitioners to do the same job and pay them less?

Dentists can definitely learn a lot from what happened to the midlevel groups in medicine and apply it to dentistry.

When doctors first created the NP's, they never envisioned that someday that the NP's would organize and lobby for autonomy and scope expansion. That's exactly what has happened. In 11 states, NP's have full prescriptive rights and treat patients exactly as would a doctor (although not as skillfully obviously). In most other states, they have various levels of autonomy and scope expansion. When the NP's started to lobby for autonomy, the medical organizations counteracted by promoting the PA's. PA's fall under the board of medicine and physicians sit on the boards that overseer them whereas NP's and CRNA's fall under the boards of nursing. The nursing leaders and groups are determined to make nurses equal with the physicians in every way possible. The physicians used the PA's to counterbalance the influence of NP's through the marketplace. PA schools went from 40 in the early 90's to more than 100 today. There are currently about an equal number of NP's and PA's in this country, ~40k each. Because PA's and NP's are interchangeable in their roles, doctors can typically hire either one. As a result, the average salary of a NP is ~70k, not much more than what a floor nurse makes. Many NP's have difficulty finding the jobs that they want because there is an oversupply of them. Many NP's have to go back to floor nursing because they can't find a decent job.

Constrast the NP's with the CRNA's. The CRNA's are the most successful and powerful "advanced practice" nursing group today because they have a monopoly on midlevel anesthesia providers. Their lobbying group in Washington, DC is in the top 10 of healthcare-related PAC's. The CRNA's got this powerful because the anesthesiologists were slow to realize that they needed to counterbalance the CRNA's with a midlevel anesthesia group that falls under the board of medicine. The anesthesiologists are trying to promote the anesthesiology assistants (AA's), but the CRNA's have put up a strong defense to keep AA's out. There are only 5 AA schools compared to more than 100 CRNA schools. There are only 600 AA's in the country compared to 40k CRNA's. Only 11 states have passed legislation to allow AA's to work in their states whereas all 50 states license CRNA's. In other states, the CRNA's have successfully defeated bills for AA's, with Texas the latest example. The average salary of a CRNA is 150k because the demand is greater than the supply. CRNA's force every CRNA student to become a paying member of the parent organization. CRNA's and their parent organization have the gall to openly state that CRNA's are just as good as anesthesiologists.

The lesson from the medical midlevels is to not depend on any one group. Play them off each other. The NP's are not as successful as the CRNA's because of the PA's. Furthermore, you should have oversight over one of the groups so that you can have degree of control of the midlevels through manipulation of the marketplace. If ADHP's become a reality, then dentists need to push for the dental assistants. If dentists do not do this, then the ADHP's will end up resembling more like the CRNA's than the NP's in how successful and powerful they become.

Furthermore, ADHP's are more analogous to the CRNA's than the NP's. This is because like the CRNA's the ADHP's are basically doing the technical aspects of the job and do not need to accumulate a huge knowledge base to do their job. You can train a monkey to get good at doing something, even though he doesn't understand why he's doing it. NP's will never be able to compete at the same level of an internists because the internist job is more cognitive and requires lots of experience. I call CRNA's gas technicians because they just know how to deliver gas and not much else. CRNA's don't know how to diagnose and treat medical conditions. Similarly, ADHP's will be teeth technicians and won't know much teeth pathology, but they don't need to. ADHP's are a much bigger threat to dentistry than some of you realize.
 
ADHP, NP, CRNA..

Same old game, new midlevel.

Listen, these guys don't know what they don't know. Sure, ADHP's just see a rich dentist scrapeing some teeth: They have no idea what it means to be a dentist: the training, the thought processes, the techniques.

Same for CRNA's (especially). Same for NP's. Somehow, the PA's rarely fall into this category. Sure, there are some, but it's predominately the nursing wing of the midlevel party.

At the end of the day, we have less qualified people who for whatever reason (inability, lack of desire, etc) couldn't get into medical/dental school, trying to use the legislative process to elevate themselves in a way their skills and education cannot. Finally, they use the "we love poor people" argument. Dentists, fight this. Arm up with doctors. We are much farther down the creek than you are....We gotta stick together. You guys are ALOT more vulnerable because a general dentist doesn't need a residency: only 4 years will suffice. If the ADHP's add a 2.5 year masters, it will get real difficult to convince brainless politicians that you are "superior" in training, even though you obviously are.

At least we Anesthesiologists have 8-10 years of training after college as compared with the 2 years of training after nursing school which CRNA's have.

This is all great until the ADHP's then lobby for autonomy. Dude, this has already been played out by the NP's and CRNA's. It's the same arguments, same pattern. Anesthesiologists made mad money supervising 4 CRNA's and billing for them. It was all great until the CRNA's lobbied for autonomy and got it.

If dentists fail to see ADHP's for the threat they are to their profession, then dentistry will follow in the footsteps of primary care and anesthesiology. Then, maybe you guys would have wished you went to medical school and became dermatologists instead. :)
 
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?

Uh, they are technicians who, while highly trained, are not trained in diagnoses and treatment of medical conditions, neither are they trained in the medical model of evaluation and decision-making.

And, I hope all the dentists caught this: " I'm taking notes from their playbook as we speak ", them being the CRNA's. Fight this guys, fight it hard!
 
A lot of people in this forum seem to think that hygienists that eventually become an ADHP will want to be on there own.
Although it may not be your desire to practice on your own, those who drafted the bill got PISSED when an amendment was made that they had to work under a Minnesota dentist with a limit of 4 ADHPs per DDS.

The ADHP was designed to fill a need in the underseerved/underpriviledged arena.
Read the bill, be honest, be a critical thinker, and it will be obvious to you that this bill was LABELED a dental access bill BUT it does not contain the necessary clauses that would require an ADHP to work in those much needed areas.

As someone said earlier why would you not want someon that can do the mundane things in restorative dentistry and leave the crown, bridge, onlay/inlay, implants and removeable prostho to those that have the expertise and training?.
Restorative work is irreversible removale of tooth structure. Agian, With every tx performed by a clinician there is risk of things going wrong. Ethically, it is unacceptable to expose a patient to an unnecessary elevated level of risk. And don’t try the "is half @ss care better or no care." Look up the code of ethics all healthcare providers must abide by and it says "do no harm".

The proposed ADHP curriculum would require those entering into it to have a bachelors in dental hygiene. Then an additional two years of intensive training.
How do you know they will be intensive? the ciriculum has not even been made. And with the way the ADHA is trying to keep a distance from the ADA, and MDA (Minnesota Dental Association), how involved are DDSs going to be in designing the ciriculum? Dentistry is a team effort. Keeping the ADHP bill on the down low (yes you si toa and HMO buddies) and then submitting it to the state without involving dentists is playing dirty and implies a lack of cinfidence in the bill design to start with.
 
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?


Here is what happens: They lower compensation.

Guys, guys....flee. I'm telling you. Fight this. Dentists have been very very smart compared with physicians. Take it from us: Keep it in the fold, keep the market strong, and stay away from any inroad by militant mid-levels, which will inevitably lead to decreased reimbursement, increased scope of practice by the mids, and an open door for less autonomy by dentists as a profession.
 
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.

Yes, they think they are as good as we are at the things we do. Anesthesiologists are peri-operative physicians, trained not only in OR anesthesia (which is critical care medicine, census of one), but critical care medicine (ICU), pain management, a boatload of interventional procedures...

The point remains: CRNAs push for things they think they are qualified to do, yet they aren't. You guys will have the same problem with the ADHP, and when they put their 2.5 year master's up against a 4 year DMD, the argument will be ALOT tougher for dentists when it comes to showing superiority. Trust me...
 
Uh, they are technicians who, while highly trained, are not trained in diagnoses and treatment of medical conditions, neither are they trained in the medical model of evaluation and decision-making.

And, I hope all the dentists caught this: " I'm taking notes from their playbook as we speak ", them being the CRNA's. Fight this guys, fight it hard!

IF this ADHP goes through, DDSs need to put patient care above all and in order to do that DDSs should not involve or register ADHPs under thier practices. They are a legal liability to DDSs and a health liabilty to the patients. They remind me of the brand name FUBU (For Us By Us). They did not involve DDSs in the design of this postion and thus out of principle, DDSs should not involve them in thier practices.
 
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