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.