Viable Solution to Shortage in Dental Care

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I believe the mid-level provider is an essential addition to the health care force in the US. The benefits of legalizing dental therapists cannot be downplayed by greedy dentists looking to make a profit. As dentists our goal is to seek ways to eliminate the diseases that allow our profession to exist. Always remember what you told the interviewer at your dental school interviews when asked "Why Dentistry?" - To help people! For many dentists that equates to being the same as " To make money!" Dental therapists will provide countless people with healthcare never accessible before. Don't let ADA/ASDA be a roadblock to progress. I am a dental student who went to a mid level provider. Their work is top notch and the skill with which they handled my dental issues was carpentry at its finest!

http://www.nytimes.com/2010/11/02/health/02dental.html?_r=3&partner=rss&emc=rss&

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I believe the mid-level provider is an essential addition to the health care force in the US. The benefits of legalizing dental therapists cannot be downplayed by greedy dentists looking to make a profit. As dentists our goal is to seek ways to eliminate the diseases that allow our profession to exist. Always remember what you told the interviewer at your dental school interviews when asked "Why Dentistry?" - To help people! For many dentists that equates to being the same as " To make money!" Dental therapists will provide countless people with healthcare never accessible before. Don't let ADA/ASDA be a roadblock to progress. I am a dental student who went to a mid level provider. Their work is top notch and the skill with which they handled my dental issues was carpentry at its finest!

http://www.nytimes.com/2010/11/02/health/02dental.html?_r=3&partner=rss&emc=rss&


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1) There is no shortage in dentists. There is maldistribution of dentists. The only way to fix it is to offer better incentives for dentists to go to those areas or mandate all new graduates to those areas for guaranteed loan repayment. Mandatory is not a word that goes well in the American society.
2) Why is dental care so expensive? Think of dental supplies, cost of education, assistants, lab fees, and costs (insurances and regulations) to run a practice. A dental therapist alone will not be able to run a viable practice without government assistance. Many states don't even fund basic dental care for their adults. Dental insurance (not to be confused with medical insurance) also does nothing for people that has it besides basic maintenance. Dental insurance companies in many states also dictates the amount a dentist can charge based on the cheaper alternative treatment option to you, not what is best for your needs. I am not going to trust a high school student with a few years of specialized education (dental therapist) to make that decision for me either. Dentists are doctors, not technicians.
 
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OP:
False premise + ad hominem = your argument.
 
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Carpentry at its finest? Um, I'm not paying 50k+ to be a carpenter? Nor has wood been used for dentures in a long time.
 
You can go to the dental therapist as many times as you want - it is a free country. You are also free to work for free. The question is how you will be paying off you student debt.
I have never been to dental therapist, but seen a nurse practitioner and other lower level health providers - they only know basic. If I did not have education in medicine, I would have ended up in a lot of trouble, even dead.
You may argue, that a person have 32 teeth - plenty to spare. Personally I do not want to risk my teeth or life on some half baked "specialists"
The solution is to introduce incentives to redistribute the care. Remember even you would not want to live in a bad place and work hard for nothing for a very long time.
 
that a person have 32 teeth - plenty to spare. Personally I do not want to risk my teeth or life on some half baked "specialists"
JuZojV
 
I agree that mid-level practitioners can help provide dental care to the under-served population of patients in this country. I think that most people in rural, under-served communities would appreciate ANY kind of dental care. Many dentists come from well-to do families and don't know the dental issues facing most of America, therefore, they are less likely to go to the areas and set up a dental clinic where they are truly needed. That and they have to be able to pay off the 300k+ debt they racked up getting their education.
 
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I agree that mid-level practitioners can help provide dental care to the under-served population of patients in this country. I think that most people in rural, under-served communities would appreciate ANY kind of dental care. Many dentists come from well-to do families and don't know the dental issues facing most of America, therefore, they are less likely to go to the areas and set up a dental clinic where they are truly needed. That and they have to be able to pay off the 300k+ debt they racked up getting their education. A mid-level practitioner might be better able to work with under-served populations because A) They don't have an enormous debt to pay off, B) They could help a dentist already working in an under-served area to expand their workload by seeing the simple cases, C) They might have a better understanding of the issues facing the communities they work in because they are more likely to come from those communities.
I think, you will change your mind in a few years
 
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I agree that mid-level practitioners can help provide dental care to the under-served population of patients in this country. I think that most people in rural, under-served communities would appreciate ANY kind of dental care. Many dentists come from well-to do families and don't know the dental issues facing most of America, therefore, they are less likely to go to the areas and set up a dental clinic where they are truly needed. That and they have to be able to pay off the 300k+ debt they racked up getting their education.
cool and if the midlevels get federal loans for their training, we can have you pay for it with your tax dollars. If it requires 100% of your income then so be it.
I however do not want a penny of my taxes going to people who have graduated high school and have only 2 years of training doing the same work as those of us who went for 4 years of undergrad and 4 yrs of dental school
 
I think the problem is in the mindset of people with so called low income. They think, that dental care is expensive and refuse to even try. If everyone cared for their teeth on a regular basis - it would not be so expensive
 
I've said it countless times over on this topic. How can a mid level provider render care LESS expensively than a dentist? Since for most of the mentioned "underserved" population cost is the issue?

Is the dental chair a mid level would use less expensive than the chair a dentist uses?
Are the restorative materials a mid level uses less expensive than a dentist uses?
Does the assistant the mid level would use work for less per hour than the assistant a dentist uses?
Is the electricity going to the mid levels operatory less expensive that the electricity going to a dentists operatory?


The answer is no to all of the above, so the overhead for a midlevel, which very often is a key determinant in what the fees we charge are, isn't any lower for a midlevel than for a dentist. Additionally, if that midlevel is seeing a number of patients on "medicaid" type insurance, then the fees that they reimburse in many instances are at best going to allow a practitioner to cover their overhead and often operate at a loss, which means that speed and volume become paramount to stay in business with a heavy medicaid volume practice, and while in overall quality a midlevel when properly trained can do work on par with what a dentist can do, the speed of a midlevel isn't equal to that of a dentist. If you then try and have the gov't subsidize a midlevel practice, there's only a finite pool of money to go around and then the pool of dental monies allocated by the government is having more of it go to keeping midlevels in business rather than for actual patient care, in essence decreasing total overall care to the "underserved"
 
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I think people advocating for the idea expect those practitioners to be independent and charge much less for the same services. Utopic idea. Limited education means, that they would have to be under the dentist's supervision. I see only one way of using them - preventive, but there are hygienists and DA's already
 
I think it's great for states to experiment, and I'm looking forward to seeing how things change. On the surface it seems like a no-brainer: quality of care isn't the issue; no care is the issue -- so let's get more people out there with less expensive training.

But . . . (and here begins the musings of a pre-dental neophyte . . .)

While I think it will find *some* traction, I agree with DrJeff that they still face the same issues, same overhead, same market forces, and same paths to increasing profitability. Will they be able to afford their own practices? Doesn't seem like it. But maybe I'm wrong; maybe they'll find a middle ground that keeps them afloat and still convinces people to skip the DDS, but that seems like an awfully fine line.

Another path for dental therapists: they're just going to be a new kind of employee for the dentists. Yeah, let's have the gov't subsidize a new class of employees whose potential employers are not currently training for themselves. Sounds like a recipe for success.

So, it's going to be difficult for them to own practices (unless they have an exceptional value-add personality), and it's going to be difficult for them to be employed by dentists and make anymore than they would as a hygienist or assistant. Again, they may find some success in those areas, but they aren't silver bullets.

Another route is for dental therapists to be the providers that interface more with managed care because they have less debt-righteousness and less negotiating power. But if that becomes their lifeline they will inevitably gain reputations as dental mills (negating their value-add personality in the process).

I think the best prospect for dental therapists is like the situation they've grown out of in Alaska: rural settings. It will be less expensive for the gov't to convince them to go rural compared to a DDS. And if the training for DT's is state-funded and controlled, they can conscript the students into longer obligations in certain areas. That would still create potential headaches and waste depending on how much the state controlled things, though.

The gov't, for better or for worse, could force some changes that may satisfy some pockets of people (like the Comprehensive Dental Reform Act) -- but I don't see the political climate for that happening anytime soon. ObamaCare is going to be politically toxic for a while. China will surpass the US in GDP in the next several years, spending is up, revenues are down, we're stuck in the Middle East, we keep putting off more permanent budget agreements . . . if by some miracle people calm down enough from those things, Social Security and Medicare insolvency will be on the table as 2030 approaches. Politicians aren't going to risk their political capital on dentistry any more than they'll start brushing and flossing every night. But maybe I'm wrong again.

For the time being, I think corporate dental mills, for profit or not for profit, will be the only good market force from the perspective of underserved populations. Maybe the federal gov't will pass some small incentives for their business models. Not much of a solution, but it's the only thing I really see on the horizon besides a handful of dental therapists in rural settings. There's not going to be a "solution" to the dental crisis, whether you want to call it a shortage, blame a lack of affordable care, or blame people for not brushing and flossing. Care is always going to be finite compared to the demand, and some people will always be able to afford better care than someone else. Dental therapists can fill a gap in the cost/quality continuum, but that only goes so far. The only place dental therapists can really keep practices afloat, in my opinion, will be the places the DDS folks won't go for whatever reason. And the therapists won't want to work there for the same reasons the DDS won't.
 
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