Mid Level Provider program at my school.

[haisha ni narou]

So, today was mentioned to us that the Dean will step down and head the development of a few specialty programs at MWU including a Mid Level Provider program.... I can think of a few pros but mostly cons. I can see issues arising including a step in the wrong direction for the patient's best interests. I know it is a hot topic amongst those in the dental field.

I'm not sure I know how to feel about it becuase I haven't looked into it enough to make an objective viewpoint. From my point of view, looks like there could be a lot of implications including unhealthy competition, sub-level clinical restorations etc. It's been said that they can work in your practice similar to PAs working in a physicians office but I thought the whole objective was to get providers out into the rural areas where there are not any dentists. How am I supposed to be comfortable carrying the liability of malpractice, including missing diagnoses, with my MLP working "under" me at a satalite clinic???

Any input?

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[tncekm]

歯医者になろう-さん

You talking about hygienests? Aren't they pretty restricted in their scope of practice? I.e. They give some shots, do lots of cleanings, and that's about it? What states allow restorations?

 

[Oracle DMD]

歯医者になろう-さん

You talking about hygienests? Aren't they pretty restricted in their scope of practice? I.e. They give some shots, do lots of cleanings, and that's about it? What states allow restorations?

not hygienists. MLP's can drill and fill. they do crown n bridge too. minnisota has them already. they've been in canada for 25 years and new zeland for like 100 years. they are like PA's to Physicians.

 

[TJNova2011]

Minnesota is working on them. But remember, some of this students will have ONLY 4 years of training! That's right, at Minnesota there's a Bachelors level and a Masters level! Oracle is right, they can extract, crowns, a lot of the bread and butter procedures. No RCT, perio, etc. The good in the programs is that the 50% of the patients must be under public assistance. The program will be watched after a few years past 2011 as the law states. But nothing will happen if it's doing poorly (useless law that was advertised when I went to an event and heard him speak).

You need to protect our profession and knock those ideas about before it gets carried away like up there in Minnesota.

 

[TJNova2011]

not hygienists. MLP's can drill and fill. they do crown n bridge too. minnisota has them already. they've been in canada for 25 years and new zeland for like 100 years. they are like PA's to Physicians.

I wonder why those programs haven't flown off the charts in Canada? One of the programs has some wacky accreditation with Canada. There are a lot of New Zeland but those are largely for pediatric patients

 

[Ostracized]

In Canada they are called 'dental therapists'. There are only a few hundred of them, mostly in the prairie provinces. They are supposed to work mostly with rural/native communities and children.

I've never heard of any working in my province (Ontario).

 

[goin back]

I know a lot about the NZ, canadian and alaskan mid level provider program. feel free to ask me whatever you want.

 

[tennischamp822]

...

 

[AZ2thDOC]

Haisha: I am curious as to why Midwestern University wants to develop a Mid Level Provider program when there is no legislative authorization in Arizona nor any other states other than Minnesota and Alaska at this time. Does Dr. Simonsen know something that Arizona dentists do not? I know this has been bantered about for the past few years as a method to increase "access to care", but the details are sketchy. Will your school lobby state legislatures to allow the use of Mid Levels so their graduates have somewhere to work?

Here in Arizona there are currently many dental offices closing or merging because of the poor economy. I have several dentist friends who are struggling or who are only working 2.5 - 3 days per week and hoping to ride the recession out. If what you say is true, looking at this from the outside it appears to be a slap in the face to the Arizona dental community, many of whom currently have "busyness" issues.

I also would inquire as to whether or not MWU dental faculty themselves would desire that their personal dental care be delivered by Mid Level's in the future. If they're truly honest, I think I already know what their answer would be.

 

[Oracle DMD]

Haisha: I am curious as to why Midwestern University wants to develop a Mid Level Provider program when there is no legislative authorization in Arizona nor any other states other than Minnesota and Alaska at this time. Does Dr. Simonsen know something that Arizona dentists do not? I know this has been bantered about for the past few years as a method to increase "access to care", but the details are sketchy. Will your school lobby state legislatures to allow the use of Mid Levels so their graduates have somewhere to work?

Here in Arizona there are currently many dental offices closing or merging because of the poor economy. I have several dentist friends who are struggling or who are only working 2.5 - 3 days per week and hoping to ride the recession out. If what you say is true, looking at this from the outside it appears to be a slap in the face to the Arizona dental community, many of whom currently have "busyness" issues.

I also would inquire as to whether or not MWU dental faculty themselves would desire that their personal dental care be delivered by Mid Level's in the future. If they're truly honest, I think I already know what their answer would be.

is the recession the cause of dental practices closing? sure it's a factor, but it seems like a lot of dentists that were overextended got caught with their pants down when buisness slowed down. what i'm saying is, how can we say the recession is causing dental offices to close and not bad buisness is causing buisnesses to close?
i'll ask about the legistive roadblocks for the program, i think that's a great question.
also, regarding dentists letting dental therapistsdo their work, i don't think many veteren dentists would let a recent dental school grad do their dental work either.
I dont know how to feel about the MLP's. if a dentist could hire them for less than a new associate, then why would he hire a recent dental school grad? also, would procedure codes change? i mean, would patients be charged less for work done by MLP's? would insurances pay less?

 

[DrReo]

is the recession the cause of dental practices closing? sure it's a factor, but it seems like a lot of dentists that were overextended got caught with their pants down when buisness slowed down. what i'm saying is, how can we say the recession is causing dental offices to close and not bad buisness is causing buisnesses to close?
i'll ask about the legistive roadblocks for the program, i think that's a great question.
also, regarding dentists letting dental therapistsdo their work, i don't think many veteren dentists would let a recent dental school grad do their dental work either.
I dont know how to feel about the MLP's. if a dentist could hire them for less than a new associate, then why would he hire a recent dental school grad? also, would procedure codes change? i mean, would patients be charged less for work done by MLP's? would insurances pay less?

In Minnesota, the dental therapist is required to see 50% of the patients as underserved/state insurance. The other 50% can be crowns on anyone, extractions, etc taking a toll in any dentist's work. They all can crowd and practice in Minneapolis. They could go near Canada, but why would they go there? Few dentists are they. They have no required location, just the population in Minnesota.

 

[Oracle DMD]

In Minnesota, the dental therapist is required to see 50% of the patients as underserved/state insurance. The other 50% can be crowns on anyone, extractions, etc taking a toll in any dentist's work. They all can crowd and practice in Minneapolis. They could go near Canada, but why would they go there? Few dentists are they. They have no required location, just the population in Minnesota.

how do they bill for services? are they cheaper then dentists? do insurances have codes for a Dental Therapist crown vs a DMD crown?

if the MLP's are providing the standard of care to (at least 50%) underserved then we have to ask ourselves "Is this a good thing for the patients?" and if we say "yes it is", then we have no choice but to support it.

What's the word about it up at the north pole Reo?! haha how does UMin frame the future role of dentists with MLP's in the mix?

 

[Aceofspades]

I wonder about that 50% thing. Is that rule really going to be enforced? How would anyone know if a mid-level provider is actually following the rules? If this becomes like medicine where the MD is supposed to "oversee" midlevels, you will essentially see midlevels working solo while one DDS "oversees" dozens of them from miles away.

 

[DrReo]

I wonder about that 50% thing. Is that rule really going to be enforced? How would anyone know if a mid-level provider is actually following the rules? If this becomes like medicine where the MD is supposed to "oversee" midlevels, you will essentially see midlevels working solo while one DDS "oversees" dozens of them from miles away.

Supposedly it'll be monitored in a similar fashion as those who treat at least 25% of disadvantage/public patients and those dentist receive a certain break, (student loan repayment, etc).

 

[DrReo]

how do they bill for services? are they cheaper then dentists? do insurances have codes for a Dental Therapist crown vs a DMD crown?

if the MLP's are providing the standard of care to (at least 50%) underserved then we have to ask ourselves "Is this a good thing for the patients?" and if we say "yes it is", then we have no choice but to support it.

What's the word about it up at the north pole Reo?! haha how does UMin frame the future role of dentists with MLP's in the mix?

I do not think they have thought this far ahead. As of now, the board exam has not been made. No one knows what malpractice will cost, either.

 

[Aceofspades]

Don't be surprised if malpractice is next to nothing. Why sue the midlevel when you can sue the managing dentist? Also, expect them to charge only slightly lower amounts than dentists. The public probably won't even know or care about the difference.

 

[ucla2134]

i am only predent, but will Mid Level Provider make the quality of oral health care go down???

 

[Oracle DMD]

i am only predent, but will Mid Level Provider make the quality of oral health care go down???

no. hopefully it will greatly expand access to care for everyone, which is a big win for the overall quality of care.

 

[Masseter]

I hope I'm not being ignorant...

but I'm very reluctant to change. You see, by letting this happening it will slowly become like physical therapy / chiropracy / occupational therapy. While these professions are different, it's still grey-ish for most of the people and some don't seem to know which one to choose for treatment.

If we let them do small restorations by now , in 10 years they will want to do more advanced stuff. It's common sense. It's happening right now with denturists some provinces in Canada. They want to set implants.


I know this is selfish of me. But I've worked my *ss to get in Dentistry and I'm still working my *ss to be the best so I can give what the patient deserves.

And as of now, I don't think they deserve to be treated by someone who's training is half-baked.

 

[Oracle DMD]

I hope I'm not being ignorant...

but I'm very reluctant to change. You see, by letting this happening it will slowly become like physical therapy / chiropracy / occupational therapy. While these professions are different, it's still grey-ish for most of the people and some don't seem to know which one to choose for treatment.

If we let them do small restorations by now , in 10 years they will want to do more advanced stuff. It's common sense. It's happening right now with denturists some provinces in Canada. They want to set implants.


I know this is selfish of me. But I've worked my *ss to get in Dentistry and I'm still working my *ss to be the best so I can give what the patient deserves.

And as of now, I don't think they deserve to be treated by someone who's training is half-baked.

i cannot speak for other professions, but it seems like PA's are good for patients and PT's are good for physical therapy, and there are still MD's/ DO's and DPT's doing very well.

I am not sure that you are familiarized with the training of MLP's so to say that their training is half baked is like saying a movie is horrible that you've never seen.

If you have truly worked your @ss off for the PATIENT, then you've done your job and patients will be thankful/ their care will be excellent.

If UOP can bang out quality dentists in 3 years, is it outside the realm of possibility that a quality Dental Therapist can be made in 2 years?

 

[Oracle DMD]

I think it should be OK to say it here, that MLP's are most likely good for patient care which we are in favor of; but at the same time the unknown is a scary thing and a lower cost care option poses obvious implications of competition on some level that our profession needs to deal with in a healthy and patient centered way.

 

[Taurus]

This is simple. Dentistry needs to collectively refuse to train or hire them. If they can't find jobs, fewer people will go into it. This is the start of a slippery slope in dentistry. The proper analogy is not with PA's. The better analogy is with NP's. Soon you'll be reading propaganda from these dental therapists that they are just as good at drilling/filling, crowns, etc and cheaper than dentists!

 

[TJNova2011]

This is simple. Dentistry needs to collectively refuse to train or hire them. If they can't find jobs, fewer people will go into it. This is the start of a slippery slope in dentistry. The proper analogy is not with PA's. The better analogy is with NP's. Soon you'll be reading propaganda from these dental therapists that they are just as good at drilling/filling, crowns, etc and cheaper than dentists!

Exactly. According to Minnesota's website... you can have a bachelors degree and be drilling. You pay for what you get.

As dentists as a hole, one needs to stop this before it gets out of control. The class size is small, I'm sure a few will get job connections through the University, but people need to REFUSE to hire these people who will degrade the profession on procedure/DT BS degree at a time.

 

[Oracle DMD]

This is simple. Dentistry needs to collectively refuse to train or hire them. If they can't find jobs, fewer people will go into it. This is the start of a slippery slope in dentistry. The proper analogy is not with PA's. The better analogy is with NP's. Soon you'll be reading propaganda from these dental therapists that they are just as good at drilling/filling, crowns, etc and cheaper than dentists!

Exactly. According to Minnesota's website... you can have a bachelors degree and be drilling. You pay for what you get.

As dentists as a hole, one needs to stop this before it gets out of control. The class size is small, I'm sure a few will get job connections through the University, but people need to REFUSE to hire these people who will degrade the profession on procedure/DT BS degree at a time.

i have to believe this type of post is done stictly out of fear. fear of competition, fear of job security, fear of the unknown. if they are trained to the standard of care, there is no ethical arguemant to be made about not having them. slippery slope arguements are garbage. they are reactionary and hyperbolic in nature.

 

[Taurus]

i have to believe this type of post is done stictly out of fear. fear of competition, fear of job security, fear of the unknown. if they are trained to the standard of care, there is no ethical arguemant to be made about not having them. slippery slope arguements are garbage. they are reactionary and hyperbolic in nature.

How naive you are. Review and study the methods that the NP's and CRNA's have used against physicians. It won't be long before these dental therapists come out with garbage studies claiming no differences in outcomes between them and dentists. Then they create a PAC. Members happily contribute because they want to see their scope expanded. Then they lobby their state legislatures to change the laws to expand their scope. Voila! Dentistry will be in the same mess that physicians are with NP's.

Spend a few minutes reading through the links in my signature and learn.

Sadly, the genie is out of the bottle and dentistry can't put it back. The best it can do is slow the adoption of dental therapists nationwide. Dentistry can severely hamper the spread by refusing to train or hire them. I don't see dental therapists as a threat to the current generation of dentists because they are so new but I could see them being a serious threat in 20-30 years.

I have a strong interest in dentistry. My fiance is a dentist.

 

[InMyCrossHairs]

i have to believe this type of post is done stictly out of fear. fear of competition, fear of job security, fear of the unknown. if they are trained to the standard of care, there is no ethical arguemant to be made about not having them. slippery slope arguements are garbage. they are reactionary and hyperbolic in nature.

Standard of care? Who is going to determine this? The programs training these people...oh I wonder where there interest will lie. We go to dental school for a reason...to be dentists. There is an old saying, "if you want to be a physician go to medical school." The same can be said for dentistry.

I dont know where you are in your dental education, I would assume just out of your MPH and probably a first year, but there is more to being a dentist than passing some stupid regional board. I gather from your post that you think that by extending "access" to more individuals that you are somehow getting better care. This is not the case. Poor care is worse than no care in many instances. And if you think for one second this has anything to do with care you are grossly mistaken. This is all about MONEY.

I would suggest you more fully understand what it means to be a dentist, and respect the education you are going to get. Trust me, it is far superior to what someone will get from a Bachelors. You can train anyone to cut a prep or take teeth out, but you need more than that to provide care.

As for slippery slope, the term is garbage, but the philosophy is not. Listen to what Taurus is telling you, it is true.

 

[Aceofspades]

How naive you are. Review and study the methods that the NP's and CRNA's have used against physicians. It won't be long before these dental therapists come out with garbage studies claiming no differences in outcomes between them and dentists. Then they create a PAC. Members happily contribute because they want to see their scope expanded. Then they lobby their state legislatures to change the laws to expand their scope. Voila! Dentistry will be in the same mess that physicians are with NP's.

Spend a few minutes reading through the links in my signature and learn.

Sadly, the genie is out of the bottle and dentistry can't put it back. The best it can do is slow the adoption of dental therapists nationwide. Dentistry can severely hamper the spread by refusing to train or hire them. I don't see dental therapists as a threat to the current generation of dentists because they are so new but I could see them being a serious threat in 20-30 years.

I have a strong interest in dentistry. My fiance is a dentist.

You are absolutely correct. Anyone who doesn't see this coming needs to open their eyes. Do you think mid-levels will just say "geez, well let me just stick to my lowly mid-level restricted procedures" or develop the gall to directly challenge dentists and claim that their education is equal or better? If I put you in a mansion and gave you permission to open 90% of the doors, you will be craving to see what's behind the other 10%. People always strive to test the limits. This goes for any field. If you think the ADA will prevent this potential spread, just wait until they get the politicians on their side. Game over at that point. I'm surprised that the ADA even blessed this abomination... well, actually I'm not.

It is not only probable but foreseeable that they (advanced dental hygienists/oral healthcare providers/whatever they are calling themselves these days) will want full autonomy. What makes you think they won't? Really, ask yourself that question. Why wouldn't they push for autonomy? Why not? More recognition, money, and being praised as the savior of dentistry for the underserved are certainly in their best interests. I can already see the mid-level doctoral programs, alphabet soup, and long white coats they will don all under the auspices of the "underserved".

 

[Oracle DMD]

How naive you are. Review and study the methods that the NP's and CRNA's have used against physicians. It won't be long before these dental therapists come out with garbage studies claiming no differences in outcomes between them and dentists. Then they create a PAC. Members happily contribute because they want to see their scope expanded. Then they lobby their state legislatures to change the laws to expand their scope. Voila! Dentistry will be in the same mess that physicians are with NP's.

Spend a few minutes reading through the links in my signature and learn.

Sadly, the genie is out of the bottle and dentistry can't put it back. The best it can do is slow the adoption of dental therapists nationwide. Dentistry can severely hamper the spread by refusing to train or hire them. I don't see dental therapists as a threat to the current generation of dentists because they are so new but I could see them being a serious threat in 20-30 years.

I have a strong interest in dentistry. My fiance is a dentist.

you're right. the genie is out of the bottle. this show is gonna play out regardless. you have discussed the negative impact on physicians but you haven't said anything about it being bad for patients!!!!!! if its better for patients, you can and shut up and get out of the way. sorry to put it so blunt, but if the patients aren't #1 in the conversation, then we don't have much to talk about in the first place.

Standard of care? Who is going to determine this? The programs training these people...oh I wonder where there interest will lie. We go to dental school for a reason...to be dentists. There is an old saying, "if you want to be a physician go to medical school." The same can be said for dentistry.

I dont know where you are in your dental education, I would assume just out of your MPH and probably a first year, but there is more to being a dentist than passing some stupid regional board. I gather from your post that you think that by extending "access" to more individuals that you are somehow getting better care. This is not the case. Poor care is worse than no care in many instances. And if you think for one second this has anything to do with care you are grossly mistaken. This is all about MONEY.

I would suggest you more fully understand what it means to be a dentist, and respect the education you are going to get. Trust me, it is far superior to what someone will get from a Bachelors. You can train anyone to cut a prep or take teeth out, but you need more than that to provide care.

As for slippery slope, the term is garbage, but the philosophy is not. Listen to what Taurus is telling you, it is true.

you act like there isn't a standard of care right now! haha if they they can do it and get it done right, then you have know arguement. its all about money? no its all about care! i suggest you get an education on what a lot of people have to go through to get care in this country. perhaps you forgot about the ethics of dentistry along the way. principle #1 beneficence.
the slippery slope arguement is for fear mongering. example: if we allow gay marraige, then what's next? ...marrying animals?? thats the insane art of the slippery slope arguement

You are absolutely correct. Anyone who doesn't see this coming needs to open their eyes. Do you think mid-levels will just say "geez, well let me just stick to my lowly mid-level restricted procedures" or develop the gall to directly challenge dentists and claim that their education is equal or better? If I put you in a mansion and gave you permission to open 90% of the doors, you will be craving to see what's behind the other 10%. People always strive to test the limits. This goes for any field. If you think the ADA will prevent this potential spread, just wait until they get the politicians on their side. Game over at that point. I'm surprised that the ADA even blessed this abomination... well, actually I'm not.

It is not only probable but foreseeable that they (advanced dental hygienists/oral healthcare providers/whatever they are calling themselves these days) will want full autonomy. What makes you think they won't? Really, ask yourself that question. Why wouldn't they push for autonomy? Why not? More recognition, money, and being praised as the savior of dentistry for the underserved are certainly in their best interests. I can already see the mid-level doctoral programs, alphabet soup, and long white coats they will don all under the auspices of the "underserved".

do you need to be talked off the ledge of a building??!! in your whole statement, you didn't address the primary concern....patient care and access to care.

 

[Taurus]

if the patients aren't #1 in the conversation, then we don't have much to talk about in the first place

This is why I say that dentistry can only slow not stop this. There will always be naive and idealistic people like Oracle who will think there is nothing wrong with training and hiring midlevels like dental therapists.

 

[Guy Smiley]

you're right. the genie is out of the bottle. this show is gonna play out regardless. you have discussed the negative impact on physicians but you haven't said anything about it being bad for patients!!!!!! if its better for patients, you can and shut up and get out of the way. sorry to put it so blunt, but if the patients aren't #1 in the conversation, then we don't have much to talk about in the first place.




you act like there isn't a standard of care right now! haha if they they can do it and get it done right, then you have know arguement. its all about money? no its all about care! i suggest you get an education on what a lot of people have to go through to get care in this country. perhaps you forgot about the ethics of dentistry along the way. principle #1 beneficence.
the slippery slope arguement is for fear mongering. example: if we allow gay marraige, then what's next? ...marrying animals?? thats the insane art of the slippery slope arguement



do you need to be talked off the ledge of a building??!! in your whole statement, you didn't address the primary concern....patient care and access to care.

You wanted someone to say this is bad for patients...I'll say it. I used to work in a public health clinic and one of the MD's complained constantly about having NP's there because they would always ask questions about why the meds they administered didn't work or what should they do with this or that patient. This physcian told me he really felt burdened because they (the NP's) didn't really know what they were doing to really manage their patients' diseases and he still ended up giving advice or seeing many of their patients. I know this is cliched, but those who don't know what they don't know are far more dangerous than someone who knows what he doesn't know...hope that made sense.

 

[Oracle DMD]

You wanted someone to say this is bad for patients...I'll say it. I used to work in a public health clinic and one of the MD's complained constantly about having NP's there because they would always ask questions about why the meds they administered didn't work or what should they do with this or that patient. This physcian told me he really felt burdened because they (the NP's) didn't really know what they were doing to really manage their patients' diseases and he still ended up giving advice or seeing many of their patients. I know this is cliched, but those who don't know what they don't know are far more dangerous than someone who knows what he doesn't know...hope that made sense.

ok. so the first actual arguement about patient care. my understanding is that MLP's can not perscribe meds.( hey reo, can they do it in Minn?? i figure we should use minnesota as our reference. ) i dont think dentists really manage systemic diseases so much as deal with systemic diseases in the context of their dental care. i guess im not sure what MLP's will know/not know.

 

[Andrew324]

I just wanted to throw this out there since this thread is about Midwestern anyway.

Former Dean Simonsen stepped down to help Midwestern start a Midlevel Provider program, I don't know how many people will be in this class (Minnesota has 9 I believe) but if he really wanted to help the community as much as possible, why not open another Dental School and send 100 fully trained dentists out into the world every year.

 

[Oracle DMD]

I just wanted to throw this out there since this thread is about Midwestern anyway.

Former Dean Simonsen stepped down to help Midwestern start a Midlevel Provider program, I don't know how many people will be in this class (Minnesota has 9 I believe) but if he really wanted to help the community as much as possible, why not open another Dental School and send 100 fully trained dentists out into the world every year.

MWU is opening another dental school in 2012 at its Downers Grove location in chicago.

 

[Andrew324]

MWU is opening another dental school in 2012 at its Downers Grove location in chicago.

Nice, so open another one, 3 more, 5 more...

 

[Oracle DMD]

Nice, so open another one, 3 more, 5 more...

more dentists will not meet the needs of the underserved. why? because we're expensive to make, and need to repay back the 200-400k that we owe when we're done.

 

[AZ2thDOC]

Haisha: I am curious as to why Midwestern University wants to develop a Mid Level Provider program when there is no legislative authorization in Arizona nor any other states other than Minnesota and Alaska at this time. Does Dr. Simonsen know something that Arizona dentists do not? I know this has been bantered about for the past few years as a method to increase "access to care", but the details are sketchy. Will your school lobby state legislatures to allow the use of Mid Levels so their graduates have somewhere to work?

Oracle or haisha:

Have you received any answers to the questions mentioned above? I'm still interested as to why Midwestern is planning a dental mid-level provider program.
Thank you in advance.

 

[cjb04]

When Dr. Simonsen announced that he was stepping down as Dean, it was specifically to allow time lobby for legislation as well as develop this program. I'm sure he knows that it will not be popular with many dentists, but he probably feels that the mid-level provider is inevitably going to materialize as a profession, so why not take part in determining just what their role will be? He made sure we understood that he wanted greater oversite over the MLPs than what PAs currently have. He also stated that their role would be restricted to reversible procedures, and any preps would only be done on primary teeth. He said one possible role of the MLP in private practice might be to come behind and place fillings in secondary teeth that the doc has prepped, leaving more time for the doc to focus on more involved (and possibly more profitable) procedures. Obviously this is nothing more than a vision at this point until legislation is in the works, but that should give you an idea of what Dr. Simonsen has in mind.

***Disclaimer: I'm only a D1, and I'm only privy to what we were told when the announcement was made***

 

[Oracle DMD]

Oracle or haisha:

Have you received any answers to the questions mentioned above? I'm still interested as to why Midwestern is planning a dental mid-level provider program.
Thank you in advance.

MWU has a lobby working on it now. The legislation that we're hoping for will specifically (but not exclusively) be written in order to bring care to counties with no dentists or very few dentist. the MLP's will be hired by dentists, and not have their own practices. it will be up to the dental community to decide whether they support the MLP's as part of the dental team. dentists that feel that an MLP would help in their practice or in another county close by, will hire MLP's and those who oppose MLP's will not hire them.
Studies cited by Dean Lloyd at UMinn (from what ive heard about last weekends ASDA meeting) from other counties using MLP's suggest that the communities approved of MLP's when supported by the dentists in that area, and in places that MLP's were not supportes by local dentists, the communites did not approve of them either.

 

[Guy Smiley]

When Dr. Simonsen announced that he was stepping down as Dean, it was specifically to allow time lobby for legislation as well as develop this program. I'm sure he knows that it will not be popular with many dentists, but he probably feels that the mid-level provider is inevitably going to materialize as a profession, so why not take part in determining just what their role will be? He made sure we understood that he wanted greater oversite over the MLPs than what PAs currently have. He also stated that their role would be restricted to reversible procedures, and any preps would only be done on primary teeth. He said one possible role of the MLP in private practice might be to come behind and place fillings in secondary teeth that the doc has prepped, leaving more time for the doc to focus on more involved (and possibly more profitable) procedures. Obviously this is nothing more than a vision at this point until legislation is in the works, but that should give you an idea of what Dr. Simonsen has in mind.

***Disclaimer: I'm only a D1, and I'm only privy to what we were told when the announcement was made***

Why create a new position to do this? EFDA can already do this in several states.

 

[Oracle DMD]

Why create a new position to do this? EFDA can already do this in several states.

EFDA can't drill or ext. There 2 levels of MLPs a with different discriptions of what they can do, but the water is muddy to what the scope of their job is exactly. EFDA is a few weekend courses is some states right?

 

[Lopyswine]

in my opinion the idea of a MLP is ridiculous.

WE ARE NOT TECHNICIANS! We are doctors of the oral cavity!

you can't just hand someone a handpiece and bur block and let them loose on the public! You have to know WHAT to do, HOW to do it, BUT MOST IMPORTANTLY, you must know WHY WHY WHY you are doing it!

the MLP will most likely not be trained to DDS level in anatomy or pathology. The MLP will essentially be following a "play book" for diagnosis and treatment. They'll have some memorized flow chart that will conveniently lead them to a few different diagnosis

It will be horrible for the patients. I guarantee that more crowns and restorations placed by MLP will fail than those placed by dentists. If they don't fail, I guarantee that a large percentage of them won't occlude properly.

I've seen the hygeine program at several schools. They are god awful. Its amazing that they are able to prophy after 2 years. Do we really want MLPs drilling with only 2 years training?


We have to ask ourselves: IS IT BETTER TO GIVE GREAT TREATMENT TO A FEW OR ADEQUATE TREATMENT TO MANY.

my answer is: I wouldn't know how to give "adequate" treatment. I am trained to give ONLY GREAT treatment to my patients. I will continue to give only great treatment to as many patients as I can, but I won't start cookie cutter dentistry that can potentially hurt the patients in the long run.

The answer is more dentists not the MLP and better public aid compensation for dentists. Dentists need better protection from getting sued or audited to death by public aid. The red tape and absurd bureaucracy of public aid needs to be streamlined so that more dentists are prone to accept it in their practice. Then we will start seeing more access to care.

 

[Concepcion10]

After a long descriptive conversation with my brother in law who is finishing his Aneasthesia Residency at the Mayo clininc in Minn about Nurse Aneasthetists, the major concern for these positions is the level of training they CRNA's receive. When the sh@# hits the fan they often don't have the background nor training to confront every situation. It is extremely difficult in these positions for even a MD trained Aneasthesiologist. Likewise, we need to study history of other health professions to be able to determine the future of our own. Allowing these so called "technicians....technologists....eventually a glorified PA" start to perform some of our routine cases, they will want more! Not only that they will have their own form of "specialties" after they alloted 2-4 years of intial training. Dental Therapist in my opinion will promote a very superficial service provided to patients. Regardless if they need total facial reconstruction form an oral surgeon, plastics and ENT or a class 1 filling from our local GP, they patient deserves to be in the hands of someone who is properly and proficienlty trained. Let us focus on becoming experts in our field and get as close to knowing everything about it as possible. This will better suit the needs of our patients then to merely "change the oil in an engine that needs a rebuild...." A little food for thought.

 

[Oracle DMD]

in my opinion the idea of a MLP is ridiculous.

WE ARE NOT TECHNICIANS! We are doctors of the oral cavity!

you can't just hand someone a handpiece and bur block and let them loose on the public! You have to know WHAT to do, HOW to do it, BUT MOST IMPORTANTLY, you must know WHY WHY WHY you are doing it!

the MLP will most likely not be trained to DDS level in anatomy or pathology. The MLP will essentially be following a "play book" for diagnosis and treatment. They'll have some memorized flow chart that will conveniently lead them to a few different diagnosis

It will be horrible for the patients. I guarantee that more crowns and restorations placed by MLP will fail than those placed by dentists. If they don't fail, I guarantee that a large percentage of them won't occlude properly.

I've seen the hygeine program at several schools. They are god awful. Its amazing that they are able to prophy after 2 years. Do we really want MLPs drilling with only 2 years training?


We have to ask ourselves: IS IT BETTER TO GIVE GREAT TREATMENT TO A FEW OR ADEQUATE TREATMENT TO MANY.

my answer is: I wouldn't know how to give "adequate" treatment. I am trained to give ONLY GREAT treatment to my patients. I will continue to give only great treatment to as many patients as I can, but I won't start cookie cutter dentistry that can potentially hurt the patients in the long run.

The answer is more dentists not the MLP and better public aid compensation for dentists. Dentists need better protection from getting sued or audited to death by public aid. The red tape and absurd bureaucracy of public aid needs to be streamlined so that more dentists are prone to accept it in their practice. Then we will start seeing more access to care.

After a long descriptive conversation with my brother in law who is finishing his Aneasthesia Residency at the Mayo clininc in Minn about Nurse Aneasthetists, the major concern for these positions is the level of training they CRNA's receive. When the sh@# hits the fan they often don't have the background nor training to confront every situation. It is extremely difficult in these positions for even a MD trained Aneasthesiologist. Likewise, we need to study history of other health professions to be able to determine the future of our own. Allowing these so called "technicians....technologists....eventually a glorified PA" start to perform some of our routine cases, they will want more! Not only that they will have their own form of "specialties" after they alloted 2-4 years of intial training. Dental Therapist in my opinion will promote a very superficial service provided to patients. Regardless if they need total facial reconstruction form an oral surgeon, plastics and ENT or a class 1 filling from our local GP, they patient deserves to be in the hands of someone who is properly and proficienlty trained. Let us focus on becoming experts in our field and get as close to knowing everything about it as possible. This will better suit the needs of our patients then to merely "change the oil in an engine that needs a rebuild...." A little food for thought.

everyone is speculating a bit about their proficiency, but in the end; they're here. if you dont support them, don't hire them when you become a dentist.

 

[AZ2thDOC]

everyone is speculating a bit about their proficiency, but in the end; they're here. if you dont support them, don't hire them when you become a dentist.

Oracle:

Unless I've been misinformed, the only places I know of where MLP's are currently legal is in Minnesota and parts of Alaska. None of us knows what the future will bring--its simply wrong to say "they're here". THEY'RE NOT.

Its amazing to me how well intentioned politicians and dental academics who never put their hands in patient's mouths have all the solutions to the "access to care" issue.

 

[gryffindor]

EFDA can't drill or ext. There 2 levels of MLPs a with different discriptions of what they can do, but the water is muddy to what the scope of their job is exactly. EFDA is a few weekend courses is some states right?

I used to work in nursing homes in several underserved areas. The procedures I did were limited to exams, gross debridement of calculus bridges, extractions, dentures, and an occasional restoration on a resident who actually had some restorable teeth. Despite the fact that most of these procedures are what the MLPs are trying to push, I would bet money that not a single MLP would touch this patient population base with a ten foot pole.

 

[Oracle DMD]

I used to work in nursing homes in several underserved areas. The procedures I did were limited to exams, gross debridement of calculus bridges, extractions, dentures, and an occasional restoration on a resident who actually had some restorable teeth. Despite the fact that most of these procedures are what the MLPs are trying to push, I would bet money that not a single MLP would touch this patient population base with a ten foot pole.

considering that their job is being created for that purpose, why would you bet that they wont serve that population? you did.

 

[Aceofspades]

considering that their job is being created for that purpose, why would you bet that they wont serve that population? you did.

It is not strictly required, that's why. Why would you think they won't go to desirable locations? The definition of desirable should answer your question. Generally, people would rather do and be in desirable situations than not. Why work in those conditions when you can work in a posh dental office making big bucks? If people were serious about this whole mid-levels serving underserved then their patient pool should be limited to medicaid only. What's up with the supposedly 50% must be "underserved." Does the legislation even give a definition of "underserved?" Also, why only 50%? If the sole purpose is to treat the underserved shouldn't it be 100%? There are certainly enough in underserved communities to occupy a mid-level 100%.

This whole thing stinks. If you want more dentists to treat the underserved open more dental schools, increase medicaid reimbursements and reduce paperwork and hassle, provide incentives and loan repayment for new grads, etc. There are many things you can do to provide quality care for the underserved. What you don't do is create mid-level after mid-level to "solve" the problem with no mandate that ALL their patients must be undeserved (with a strict definition like medicaid).

Legislation often suffers from unintended consequences that people find out later on. The unintended consequences of this legislation are visible to the rational person immediately upon sight! It isn't unintended if the consequence is clearly visible. At that point it just becomes a consequence of incompetent and reckless thinking. To think this is being sanctioned by dentists. I don't know if someone here brought it up, but many of these policies are probably being created by armchair dentists who haven't treated a patient in a decade or more.

 

[Dr.Millisevert]

Generally, people would rather do and be in desirable situations than not. Why work in those conditions when you can work in a posh dental office making big bucks? If people were serious about this whole mid-levels serving underserved then their patient pool should be limited to medicaid only. What's up with the supposedly 50% must be "underserved." Does the legislation even give a definition of "underserved?" Also, why only 50%? If the sole purpose is to treat the underserved shouldn't it be 100%.

Exactly!

 

[gryffindor]

considering that their job is being created for that purpose, why would you bet that they wont serve that population? you did.

Reasons mid-levels won't touch the nursing home population include the fact that they usually have medical histories that are a page and a half long, many of them on coumadin, etc. Will they have the background in medicine to know what the consequences of extracting seemingly simple root tips can be if the INR is borderline? Many have limited mobility of their necks, limited responsiveness (if any responsiveness), limited opening, poor cooperation, etc. Not an easy population to work on, I was often on the floor upside down trying to get out an abscessed tooth. When a patient's relative decided to file a complaint with the state board over an issue during treatment, guess who got to call their malpractice carrier? Is the MLP going to have to carry their own malpractice or is some distant doctor going to be on the hook for the MLP's incompetence?

I did the job for exactly the reason AceofSpades stated. It was a nice paycheck to tide me over until I finished residency and could bail for a more cush job in a more desirable location. However, I enjoyed the work and don't regret it. I think it would be a great job to develop for new dental grads to get experience and encourage loan repayment programs, if our bonehead officials could open up to this possibility and make it attractive.

 

[AZ2thDOC]

This whole thing stinks. If you want more dentists to treat the underserved open more dental schools, increase medicaid reimbursements and reduce
Legislation often suffers from unintended consequences that people find out later on. The unintended consequences of this legislation are visible to the rational person immediately upon sight! It isn't unintended if the consequence is clearly visible. At that point it just becomes a consequence of incompetent and reckless thinking. To think this is being sanctioned by dentists. I don't know if someone here brought it up, but many of these policies are probably being created by armchair dentists who haven't treated a patient in a decade or more.

I'm curious as to when Dr. Simonsen last practiced dentistry; a while back I asked the Dean of Arizona's other dental school when he'd last put his hands in a patients mouth -- his response was "1984".

I guess I was naively brought up with the ideal that real leadership was by done by setting an example. My point is not to put down someone who was made significant contributions to dentistry; but I believe its a fair question to ask. Any Midwestern students know the answer?