dentalWorks

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I am against the dental therapists 100%. That is like a physical therapist vs a orthopedic surgeon. I just don't know what it would do to GP's. They would probably be considered specialists eventually. Kellogs should use its 16 million dollars to provide incentives to dentists to serve the underserved population. If dental school weren't so expensive, I would love to go to an underserved population like Kansas.
 

cybermech

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The issue of dental therapist and mid-level providers is always going to be a debate in the dental world. Mid-level providers are the politicians' answer to underserved populations. It's almost a moot point as to whether or not they persist because it seems that they most certainly will.

My thoughts are that the best way to attack the issue is by being proactive in organized dentistry to ensure that mid-level providers are meeting the clinical and educations outcomes that we should expect from someone doing irreversible dental procedures.

This was definitely a hot topic at the latest ADEA meeting and will most likely come up again at the national conference next year. I believe some sort of policy statement may eventually come out from ADEA to specify the requirements of DT programs.
 

Daurang

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Can someone list the 5 states? The website needs a login id.
 
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dentalWorks

dentalWorks

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Can someone list the 5 states? The website needs a login id.
Here is the first link:

More states moving forward with midlevel providers

November 17, 2010 -- The W.K. Kellogg Foundation has announced a $16 million initiative to help coalitions in five U.S. states develop dental therapist programs similar to a controversial midlevel provider model now being used in Alaskan tribal communities.



The Dental Therapist Project would support community-based drives in Kansas, New Mexico, Ohio, Vermont, and Washington geared toward adding therapists to dental teams providing care in underserved areas. The push is being described as part of a larger effort to address severe shortages of care in thousands of communities nationwide.
"It is time now for more states and tribal nations to seriously consider new and proven approaches -- such as the dental therapist model -- as a way to bring critically needed oral healthcare services to vulnerable children and families," said Sterling Speirn, president and CEO of the W.K. Kellogg Foundation. "Oral health is essential to overall health, yet good, regular oral healthcare is out of reach for far too many people in this country."
With support from Kellogg, groups in each state will work to develop therapist programs tailored to meet local needs, said Dental Therapist Project Director David Jordan of Community Catalyst, a national nonprofit advocacy organization that is the project's lead grantee.
"Too many communities cannot get care because they cannot afford it and there are no providers in their community," Jordan said. "To meet the nation's unmet oral health needs, we need to extend the reach of dental care to underserved communities by adding new members to the dental team."
Addressing a critical need
The dental therapist model first began in the 1920s in New Zealand and is now well-established in many developed countries, including the U.K., Australia, and the Netherlands.
In the U.S., dental therapists receive two years of intensive technical training and provide a range of services, including preventive and restorative procedures and simple extractions. They work under the general supervision of an offsite dentist, who preapproves the care they provide and reviews their work by telephone, fax, and Internet.
.pullQuoteCredit { text-align: right; font-family: arial,sans-serif; font-size: 11px; line-height: 16px; font-style: normal; padding-top: 2px; }

Pam Blackwell, oral health access advocacy project director at Health Action New Mexico, is convinced dental therapists would be a welcome addition to larger dental teams in New Mexico, where 2,000 people recently waited in line and camped out in hopes of getting free care at a two-day Mission of Mercy dental clinic.
"The rural and tribal communities are eager for this kind of provider," she said, noting that a dental therapist program would offer local people the chance to learn new skills and provide their rural communities with culturally competent care. "The dental therapist is really an extension of the dentist, extending the dentist's reach to the wider community."
At least 49 million people are currently living in more than 4,000 areas across the U.S. that lack adequate oral healthcare providers, according to the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA). It would take nearly 10,000 additional dental practitioners to meet the need for care in these dental health provider shortage areas, according to HRSA's calculations, which are based upon a population-to-practitioner ratio of 3,000:1. The shortage of oral healthcare providers disproportionately affects people living in poor and rural communities, according to health officials. Millions more Americans lack dental insurance or other means of paying for care.
In Kansas, "we have 14 counties with no dentists and 91 dental health provider shortage areas," said Shannon Cotsoradis, president of Kansas Action for Children, a group that is working to get a dental therapist program started in that state.
"Kansas doesn't have a dental school," she added, and in an era of financial difficulty, the prospects for getting one seem dim. She acknowledges work lies ahead. Legislation must be crafted, and some in the state's dental establishment must be won over. Yet Cotsoradis believes action must be taken. "It's time to think about different solutions," she said.
ADA, AGD opposition
The ADA, joined by several other specialty dental groups, has long worked to prevent states from implementing dental therapist programs, asserting that the therapists are not qualified to perform procedures considered irreversible or "surgical," such as drilling or extracting teeth.
“The ADA welcomes the Kellogg Foundation to the fight to improve the oral health of the millions who suffer from its lack," said ADA President Raymond Gist, DDS, in a statement issued by the ADA today. "Unfortunately, the foundation’s recent efforts to address this complex issue focus exclusively on expanding a single provider model, the controversial Alaska DHAT. The limited research evaluation conducted by Kellogg did not provide the robust examination or projectable metrics on which to base such important policy and public health decisions.
“No matter where you stand on the issue of non-dentists performing dental surgery -- and we stand firmly against it -- limiting the approach to overcoming the many access barriers to promoting this one workforce model ignores numerous, and we believe much greater, barriers to care. Frankly, these energies and resources would be better directed toward improving existing programs."
The Academy of General Dentistry (AGD) is also opposed to the DHAT model as a singular solution.
“Supporters of independent mid-level providers often claim that this is a turf war, but in reality, we dentists are obligated to ensure the health, safety, and welfare of our patients and all those we serve,” said AGD President Fares Elias, DDS, JD, in a statement released today also.
A mid-level provider only a few years removed from high school does not have the education and experience to deal with complications and emergencies that may or could arise while a patient is being treated, he added.
The AGD sees the creation of independent mid-level providers ultimately leading to the establishment of a two-tiered oral health care system. “It is unconscionable that a respected organization like Kellogg would be advocating that the poor -- especially the minority poor -- and the geographically disadvantaged would be subjected to second-class care from non-dentists,” said Dr. Elias.
Others remain convinced that dental therapists are worth a try. Such providers could help get care for 850,000 people living in underserved areas of Ohio, said David Maywhoor, project director of Dental Access Now at the Columbus-based Universal Health Care Action Network.
"It's a matter of making sure that access to care is provided to people in the remote areas of the state, in places where the traditional dentist is not going to open up a shop," Maywhoor said.
In Alaska, the first dental health aide therapists (DHATs) began providing care in 2005 as part of the longstanding federally authorized Community Health Aide Program that trains residents of Alaska Native tribal villages to provide primary medical care to their neighbors. From the start, the ADA vehemently opposed the DHAT program and sued to stop its implementation in Alaska, arguing that it violated state laws that govern the licensing of dental professionals.
The therapists, however, practice under the authority of the Indian Health Care Improvement Act, and in 2007, an Alaska Superior Court found that the federal law had precedence over state licensing regulations. In 2009, Minnesota enacted a law authorizing dental therapists to practice and students are now in training. The model is also being explored in other states, including California, Connecticut, New Hampshire, and Maine.
Support growing
While the ADA has attacked the therapist model, other dental organizations have spoken out in support, saying that therapists should be considered in light of public health needs. Currently, more than a dozen DHATs are working in Alaska Native communities, four more are completing 400-hour preceptorships under the direct supervision of dentists, and another 13 are in training.
In October, the first major independent evaluation of the Alaskan DHATs found the midlevel providers were offering safe and competent care. The two-year evaluation, conducted by RTI International, a nonprofit research institute, assessed the work of therapists in five Alaskan communities. The study was funded by the W.K. Kellogg Foundation, the Rasmuson Foundation, and the Bethel Community Services Foundation.
The evaluation's findings were dismissed by the ADA but applauded by the American Dental Hygienists' Association (ADHA), which said the research offered evidence that restorative services can be successfully administered by nondentist providers. The ADHA, which had no immediate comment on the announcement of the Kellogg Foundation's Dental Therapist Project, has been promoting ways to expand the practice capacity of the nation's 150,000 dental hygienists.
Meanwhile, the ADA has offered its own new dental auxiliary model, a community dental health coordinator who would provide a limited range of preventive services, such as screenings and fluoride treatments, and help patients navigate the health system.
In Vermont, expanded-function dental assistants who can place restorations and "Tooth Tutors" who specialize in locating dental homes for children are already helping to expand care, said Peter Taylor, executive director of the Vermont State Dental Society, which has not taken a position on the Dental Therapist Project.
But Carlen Finn, executive director of Voices for Vermont's Children, said that many residents are still in need of care that therapists could provide.
"Despite several Vermont programs targeting access to dental care, too many in Vermont lack access to care because they cannot afford the cost of care or they have limited access to dentists," she said. "In 2009, more than 62,000 Vermonters -- both insured and uninsured -- reported not getting dental care because they could not afford it. By adding a dental therapist to the dental team, Vermont will be taking a key step toward its goal of greatly improving access to dental care."
Copyright © 2010 DrBicuspid.com






and, here is the 2nd link:


Kan. groups split on solutions to oral care crisis

November 23, 2010 -- Advocacy groups in Kansas that are working to address what they say is a dire shortage of dental professionals in rural and underserved communities are urging officials to allow midlevel providers to practice in the state.




But the Kansas Dental Association (KDA) is opposed to any solution that would allow nondentists to perform surgical or diagnostic procedures.
The debate is heating up following last week's announcement by the W.K. Kellogg Foundation that it would provide $16 million to fund the study and development of dental health therapist programs in five U.S. states, including Kansas.
The shortage of dentists in Kansas has reached a critical level, according to three nonprofit organizations that recently formed the Kansas Dental Project. The project -- spearheaded by the Kansas Action for Children (KAC), the Kansas Association for the Medically Underserved (KAMU), and the Kansas Health Consumer Coalition (KHCC) -- is focused on addressing the shortage of dental professionals and increasing access to dental care for Kansans living in underserved communities.
.pullQuoteCredit { text-align: right; font-family: arial,sans-serif; font-size: 11px; line-height: 16px; font-style: normal; padding-top: 2px; } Dental care is out of reach for far too many Kansans.
— Anna Lambertson, Kansas Health
Consumer Coalition
"Ninety-one Kansas counties do not have enough dentists to serve their residents," said KAC President Shannon Cotsoradis in a press release. "And, 14 of those counties have no dentists at all."
Dental care is out of reach for far too many Kansans, added Anna Lambertson, executive director of the KHCC. "We're talking about farmers, small business owners, families that have lost their jobs in this economy being unable to find a dentist. We know that the unavailability of dental care affects our children in school. It affects adults in our workforce. And, it affects overall health and healthcare costs for all of us."
As more residents move to urban areas, rural communities struggle to keep local businesses, including dentists, in town. But Kansas Dental Project members say other factors are worsening the dental shortage in Kansas:

  • The dental workforce in Kansas is aging, and, despite incentive programs, not enough new dentists are interested in practicing in underserved areas to replace retiring dentists. "Once the dentists we have now begin to retire, it will further exacerbate the shortage we're facing right now," said Cathy Harding, executive director of KAMU.
  • Only 25% of Kansas dentists accept patients insured through Medicaid, which leaves hundreds of thousands of low-income adults and children without access to a dentist. Comparatively, almost 90% of medical doctors accept Medicaid patients in Kansas.
The Kansas Dental Project is looking at a dentist therapist model that would allow a midlevel provider, known as a dental therapist, to practice in Kansas.
"We use midlevel providers extensively on the medical side," Harding said. "Kansans all over the state receive their care from midlevel professionals, like nurse practitioners and physician's assistants. Dental therapists care for patients in the same way on the dental side."
Dental therapists have been utilized in other countries for decades, and more recently have been helping address the dentist shortage problem in Alaska. Earlier this month, the Kellogg Foundation released a two-year evaluation of the Alaska program, concluding that the midlevel providers are offering safe and competent care to residents of remote and underserved native communities.
But several dental groups -- including the ADA, Academy of General Dentistry, and the American Academy of Pediatric Dentistry -- have expressed strong opposition to the midlevel provider model.
"No matter where you stand on the issue of nondentists performing dental surgery -- and we stand firmly against it -- limiting the approach to overcoming the many access barriers to promoting this one workforce model ignores numerous, and we believe much greater, barriers to care," said ADA President Raymond Gist, DDS, in a statement issued November 17. "Frankly, these energies and resources would be better directed toward improving existing programs."
Likewise, the KDA does not support the midlevel provider model, Kevin Robertson, director of the association, told DrBicuspid.com. The KDA would rather create a new level of dental hygienists that could provide palliative, emergency care but would not be allowed to perform surgical or diagnostic treatments, Robertson said.
"We do not believe that it's appropriate training for the types of surgical services they would provide," he said.
Many Kansans are within driving distance to dental care facilities, Robertson added. He believes a better use of the Kellogg Foundation's funding would be to support projects like the Kansas Mission of Mercy, which runs free dental clinics.
In a recent ADA News story, Dave Hamel, DDS, president of the KDA, suggested giving dentists incentives to open practices in rural areas to address any potential maldistribution problem. The KDA has approached the state Legislature about providing such incentives and is finalizing an oral health package to present in the next legislative session, he added.
In addition to Kansas, the Dental Therapist Project is supporting efforts in New Mexico, Ohio, Vermont, and Washington to add therapists to dental teams providing care in underserved areas.
Copyright © 2010 DrBicuspid.com
 

SeattleRDH

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Hmmmm.... last I heard the DHAT program in Alaska has NOT allowed independent investigators to evaluate their clinics. The "independent evaluation" mentioned in the article was funded by the Kellogg Foundation (conflict of interest perhaps?).

Also, these programs are in communities that someone in the lower 48 might think of as remote but Bethel and Kotzebue are actually quite sizeable for Alaskan cities and they already have dentists practicing in town. The people in the bush still have to travel to these larger towns to access care.

Here's another thing that they don't often mention about DHATs. They are not trained in dental hygiene procedures! They pretty much just drill, fill, and extract. What, so periodontal disease is not a problem in rural Alaska? HA! Why fill a tooth with moderate bone loss that's covered in calculus? If you don't remove that calculus and get the patient in a stable perio condition they're going to lose that tooth anyway! Ugh! A solution could be adding dental hygienists to these teams BUT hygienists can't practice independently in Alaska, nor is it any easier to complete (or get into) a dental hygiene program than a DHAT program.

The bottom line: A dentist can do all of the above mentioned and more! THAT'S who should be out there!
 

DrJeff

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Is there something that we can do about this?
It's really quite simple. As one is talking to a legislator about this, all one has to do is ask the legislator what is more important, spending millions of dollars now to fund a study that *might* end up with some new form of a dental provider, who *might* actually start treating a few patients 7 to 10 years from now (gotta remember that in most states, in order for a mid-level to be able to work, they need to change the states dental practice act(usually a multi-year process in its own right), develop and then get approved a curriculum and licensing standards, locate and/or approve a training site, and then advertise the program, and then finally matriculate a class, and then train them. All that before they can practice). Or putting those same dollars directly into the existing programs in place currently where those limited dollars can provide care RIGHT NOW to the underserved???
 
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dentalWorks

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Is there something that we can do about this?
well, there is. As a dentist, you can choose to NOT hire mid-level providers. They are not allowed to practice without the supervision of a dentist DIRECTLY in the building.

of course, if majority of dentists take a stand against them, thats when you'll run into new trouble. New legislation will try to pass to allow mid-level providers to practice in "close proximity" to a dentist.

Data has shown that approx. 1/3 of the USA population is considered to be undeserved (AKA hard physical access to oral health provider ~ dentist). So how do you resolve this? Mid-level providers MIGHT make a dent, but it ain't gonna resolve this issue. I really don't know the answer, this is a very complicated issue. There are a lot of incentives that might drive dentists (especially newly graduates) to go after these undeserved areas but... I don't think this is enough.

Maybe this explains why dental school tuition has sky-rocketed over the past 10-15 years. They want newly graduates to be in sooo much debt so they can take advantage of those special incentives that have them work in underserved areas..... Its a wicked and mean plan lol but I guess it does serve a purpose..... Its just my theory
 

7 Iron

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There are a lot of incentives that might drive dentists (especially newly graduates) to go after these undeserved areas but... I don't think this is enough.

Maybe this explains why dental school tuition has sky-rocketed over the past 10-15 years. They want newly graduates to be in sooo much debt so they can take advantage of those special incentives that have them work in underserved areas..... Its a wicked and mean plan lol but I guess it does serve a purpose..... Its just my theory
Haha.. I see it the opposite way. If it didn't cost an arm and a leg to attend dental school, some graduates might move to underserved areas and practice, with the knowledge they might not make quite as much as a dentist in the 'burbs, but who also knows their student loans aren't killing them. If ds tuition was lower, then less loans to pay off, and the idealist pre-dents who don't care about money could go and serve the under-served :D

I do agree though that mid-levels won't do very much and unfortunately if the debate is run exclusively by politicians (who never really know what they're talking about) then I can only see mid-levels expanding :(
 

DrJeff

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I do agree though that mid-levels won't do very much and unfortunately if the debate is run exclusively by politicians (who never really know what they're talking about) then I can only see mid-levels expanding :(
This is why on this debate, right now, you can't think like a dentist, but you have to lower your intelligence a substantial amount ;) and think like a politician. And the #1 language that politicians can relate to is the language of "dollars vs. immediate results" If we as a profession can present the arguement in that manor, let alone that we have the financial evidence to show that while a midlevel can provide clinically acceptable treatment, they can't do it as cost effectively as a dentist can, then the message resonates to most politicians, especially in this era of widespread governmental budget crisis
 

SeattleRDH

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Another problem with the system as it relates to mid-level providers is that insurance gets billed the same amount no matter who performs the procedure. When I work a restorative day every procedure gets billed the same whether I fill the prep or the dentist fills the prep but I get paid less than half of what the dentist gets paid. How does this lower health care costs? I'm fairly certain that the managed care facility I used to work for made A LOT of money off me.

For those who are worried about the financial impingement on their profession by mid-level providers know this: You too can make a lot of money off of us. You just have to have 4 chairs with a full simple restorative schedule, 2 assistants, 1 restorative hygienist (or mid-level), and one dentist. Just keep em' turning and burning. Oh wait, what do they call that? A CHOP SHOP!

(Geez, I think I've turned the corner from thinking like a hygienist to thinking like a dentist)
 
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dentalWorks

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Haha.. I see it the opposite way. If it didn't cost an arm and a leg to attend dental school, some graduates might move to underserved areas and practice, with the knowledge they might not make quite as much as a dentist in the 'burbs, but who also knows their student loans aren't killing them. If ds tuition was lower, then less loans to pay off, and the idealist pre-dents who don't care about money could go and serve the under-served :D

I do agree though that mid-levels won't do very much and unfortunately if the debate is run exclusively by politicians (who never really know what they're talking about) then I can only see mid-levels expanding :(
I really don't see it this way. Lets be honest with each other here.... 99.9% of pre-dents (even the humanitarian ones) see the sparkling "$$$$$$" in their eyes when they heard about dentistry.... If you remove the heavy tuition from the mixture, those 99.9% I speak of, will just move into the big cities and make that heavy income.... and the undeserved problem will continue to grow

On the other hand, if you increase the tuition high enough, I mean REALLY higher, so high that working as an associate making 120k a year is no longer enough to cover repayment plan in an acceptable timely manner.... then you'll see more young graduates going into undeserved areas and spending at least 6 years (thats the magic number, 6 years = 100% tuition forgiveness) in there.

There is one thing I don't see people talk about, undeserved / rural areas, just from the dentists I speak with, say there is money to be made. Its not as dead as people make it seem to be. If you pick a good rural location, you might be able to make a killing. The only issue is, most people (whom are married with children) don't like to move to the rural side....

Anyways, I like I said before, this is a HUGE issue.... I can't even think of a possible solution.
 
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dentalWorks

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Another problem with the system as it relates to mid-level providers is that insurance gets billed the same amount no matter who performs the procedure. When I work a restorative day every procedure gets billed the same whether I fill the prep or the dentist fills the prep but I get paid less than half of what the dentist gets paid. How does this lower health care costs? I'm fairly certain that the managed care facility I used to work for made A LOT of money off me.

For those who are worried about the financial impingement on their profession by mid-level providers know this: You too can make a lot of money off of us. You just have to have 4 chairs with a full simple restorative schedule, 2 assistants, 1 restorative hygienist (or mid-level), and one dentist. Just keep em' turning and burning. Oh wait, what do they call that? A CHOP SHOP!

(Geez, I think I've turned the corner from thinking like a hygienist to thinking like a dentist)
ahhh the natural tendency of dentists to being entrepreneurs... man I can see some dentists right now thinking of making some serious cash flow with this idea :idea:
 

DrJeff

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ahhh the natural tendency of dentists to being entrepreneurs... man I can see some dentists right now thinking of making some serious cash flow with this idea :idea:
There is absolutely nothing wrong with earning a decent living from the dental profession, especially given how many years one spends in their education. And that doesn't even get into the issues that many people will think that you're making too much (when in reality you won't be buying that private jet that your patients think you can), insurance companies will think that you charge too much (when we actually think that THEY charge too much and don't provide enough in return), etc
 
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dentalWorks

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There is absolutely nothing wrong with earning a decent living from the dental profession, especially given how many years one spends in their education. And that doesn't even get into the issues that many people will think that you're making too much (when in reality you won't be buying that private jet that your patients think you can), insurance companies will think that you charge too much (when we actually think that THEY charge too much and don't provide enough in return), etc
DrJeff, I was not implying anything negative. Just saying dentists are natural entrepreneurs. thats all :)
 

DrJeff

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DrJeff, I was not implying anything negative. Just saying dentists are natural entrepreneurs. thats all :)
believe me, I didn't take your comment as negative. Suprisingly enough though there are some people both entering and in this profession that have a bit of guilt about the fees they charge and potentially the income they make. It's those folks that I was addressing. Let the entrepreneurs rule!