Dental therapist = dentist

[Mascota]

http://www.startribune.com/my-job-kathlyn-leiviska-dental-therapist/299549701/

7th paragraph down -

"Leiviska said students in dental therapy “are taught side by side with dental students, we take the same exams and patient boards. We’re trained to the same level.” The only difference, she said, is that dentists have a wider scope of practice. “It’s much less expensive to hire me to do the exact same thing.”"

Read this today, way to cheapen a 4 year intensive doctoral program with your ignorance and inexperience. That's quite the hubris.

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[Cold Front]

http://www.startribune.com/my-job-kathlyn-leiviska-dental-therapist/299549701/

7th paragraph down -

"Leiviska said students in dental therapy “are taught side by side with dental students, we take the same exams and patient boards. We’re trained to the same level.” The only difference, she said, is that dentists have a wider scope of practice. “It’s much less expensive to hire me to do the exact same thing.”"

Read this today, way to cheapen a 4 year intensive doctoral program with your ignorance and inexperience. That's quite the hubris.

Anyone know how much dental therapists make?

I can see dental therapists association starting in states they already practice in and then lobby to have their own practices in the future. They always make a case to work in rural areas, just to end up in big cities and compete with other dentists. MN is a big example.

 

[suarez 7]

The AGD recently published a study on the therapists in Minnesota (on their journal online). They concluded that they haven't bridged access to dental care for underserved rural areas, nor have they reduced costs of dental services, and nor have they reduced the incidence of ER visits due to dental pain. Granted, there is not a whole lot of therapists running about to make a grand conclusion but the results don't look promising. They also mention the difficulty of new grads with large student loans finding jobs, citing that the dentist owners haven't caught on the idea of hiring a therapist to do these procedures.

The whole concept looks like a huge fiasco and a waste of funding.

 

[CanaDMD]

http://www.startribune.com/my-job-kathlyn-leiviska-dental-therapist/299549701/

7th paragraph down -

"Leiviska said students in dental therapy “are taught side by side with dental students, we take the same exams and patient boards. We’re trained to the same level.” The only difference, she said, is that dentists have a wider scope of practice. “It’s much less expensive to hire me to do the exact same thing.”"

Read this today, way to cheapen a 4 year intensive doctoral program with your ignorance and inexperience. That's quite the hubris.

LOL

 

[ncide]

The ADA is firmly opposed to the encroachment of mid-level providers in our field. Lobbyists are working to preserve our field and not let it go the way of medicine.

 

[CanaDMD]

The ADA is firmly opposed to the encroachment of mid-level providers in our field. Lobbyists are working to preserve our field and not let it go the way of medicine.

once again, LOL

 

[Cold Front]

There is a bill that is waiting for the Governor of Vermont's signature, to allow dental therapists to practice in that state.

I can see the access issue, but creating therapists who will have the freedom to roam and practice anywhere within the state, including where dental access is very high, is the real issue. There should be a way to close that loop, or put an end to the therapist idea all together and find another way to address the access issue.

 

[CanaDMD]

There is a bill that is waiting for the Governor of Vermont's signature, to allow dental therapists to practice in that state.

I can see the access issue, but creating therapists who will have the freedom to roam and practice anywhere within the state, including where dental access is very high, is the real issue. There should be a way to close that loop, or put an end to the therapist idea all together and find another way to address the access issue.

Can you imagine what would happen if the law makers had your logic?

 

[dyesht]

This is like saying physician assistants are taking over the physicians jobs. They lighten the work load of the physician, and so will the dent therapist for the dentist.

 

[DoctaFauci]

There is a bill that is waiting for the Governor of Vermont's signature, to allow dental therapists to practice in that state.

I can see the access issue, but creating therapists who will have the freedom to roam and practice anywhere within the state, including where dental access is very high, is the real issue. There should be a way to close that loop, or put an end to the therapist idea all together and find another way to address the access issue.

Dental therapists must practice under the direct or indirect supervision of a licensed dentist, just like a public health hygienist. Of course the AGD and ADA have a vested interest in the perceived encroachment on the scope of dental practice, and any study done by the AGD has to be taken with a grain of salt in this case. The PEW trusts have done some research that show therapists actually increase dental revenue and access to care. However, as long as dentists keep shouting that dental therapists are "bad" without actually demonstrating WHY, then it's just like the North Carolina tooth-whitening legal battle all over again. Dental students are indoctrinated by established dentists that mid-levels are bad for the profession, when in fact the model has existed internationally for decades and the research shows that it is viable.

As long as dental schools keep pumping out and matriculating students who are not willing to relocate to and work in underserved HPSAs, the dental therapist conversation will only gain steam. If dentists were willing to augment practice models around Medicaid/sliding-fee scales and operate in less saturated markets, we wouldn't be having this conversation.

I personally think it's a great idea as long as they continue to act under the indirect supervision of a dentist. I can pay him/her a hygienists salary to do basic operative (treat almost ALL of the Medicaid patients) while I focus on high end restorative/fixed/endo, etc. Why is this a bad thing?

 

[Sublimazing]

This is like saying physician assistants are taking over the physicians jobs. They lighten the work load of the physician, and so will the dent therapist for the dentist.

The problem is that midlevels quickly become uncontrolled. With strict supervision, enforcement of placement in underserved areas, and regulation on the number of licenses then therapists would be a great boon. But there exists a near certain propensity for more and more therapists to be trained, and when there is a surplus they will not only move towards areas of high population, but will also push for more independence. And our law-makers have proven with midlevels in medicine that they cannot see beyond cheaper providers and supeficial studies showing the "safety" of independent practice in their litigious decisions.

There are more than enough dentists and specialists around...if they wanted to address a problem they would simply make it more lucrative for dentists to provide underserved areas and increase reimbursement for patients using government aid.

The bottom line is that no matter how good of an idea a mid-level may seem in theory, CRNAs and NPs have given us ABSOLUTE proof that midlevels hurt the doctoral providers and ultimately the patient. I see no overwhelming evidence that midlevels are a true threat right now, but they certainly could become one in the future.

 

[Cold Front]

Some interesting numbers on dental therapists...

1. Their billing fees are exactly the same billing fees as general dentist. If that 1 surface filling fee is (let's say) $100 for a general dentist, if a therapist does the same filling, then insurances will reimburse them $100 too.

2. Malpractice insurance for therapists is about $80-90 for the entire year, about 1/20th of what most dentists pay. Yes, dentists do more advanced procedures, but there are a lot of dentists that just do bread and butter (drill and fill) dentistry that still pay $1,500 a year. What are these actuaries thinking?

3. They are required to work upto 1,000 hours of under supervision. After that, the scope of dentistry is minimal without a dentist is present, but I bet this scope is not going to be enforced very well with all those therapists moving around.

 

[CanaDMD]

Some interesting numbers on dental therapists...

1. Their billing fees are exactly the same billing fees as general dentist. If that 1 surface filling fee is (let's say) $100 for a general dentist, if a therapist does the same filling, then insurances will reimburse them $100 too.

2. Malpractice insurance for therapists is about $80-90 for the entire year, about 1/20th of what most dentists pay. Yes, dentists do more advanced procedures, but there are a lot of dentists that just do bread and butter (drill and fill) dentistry that still pay $1,500 a year. What are these actuaries thinking?

3. They are required to work upto 1,000 hours of under supervision. After that, the scope of dentistry is minimal without a dentist is present, but I bet this scope is not going to be enforced very well with all those therapists moving around.

Just to add, I believe #1 is the case because the dentist puts his licence on the line for the therapists' work.

 

[dmdluffy]

Dental therapists must practice under the direct or indirect supervision of a licensed dentist, just like a public health hygienist. Of course the AGD and ADA have a vested interest in the perceived encroachment on the scope of dental practice, and any study done by the AGD has to be taken with a grain of salt in this case. The PEW trusts have done some research that show therapists actually increase dental revenue and access to care. However, as long as dentists keep shouting that dental therapists are "bad" without actually demonstrating WHY, then it's just like the North Carolina tooth-whitening legal battle all over again. Dental students are indoctrinated by established dentists that mid-levels are bad for the profession, when in fact the model has existed internationally for decades and the research shows that it is viable.

As long as dental schools keep pumping out and matriculating students who are not willing to relocate to and work in underserved HPSAs, the dental therapist conversation will only gain steam. If dentists were willing to augment practice models around Medicaid/sliding-fee scales and operate in less saturated markets, we wouldn't be having this conversation.

I personally think it's a great idea as long as they continue to act under the indirect supervision of a dentist. I can pay him/her a hygienists salary to do basic operative (treat almost ALL of the Medicaid patients) while I focus on high end restorative/fixed/endo, etc. Why is this a bad thing?

So you question any study put out by the AGD but don't question PEW studies?

 

[DrJeff]

Once again, this is the "emotion" vs "logic" discussion here.

Emotionally, you hear of all of the "underserved" people out that and how magically some feel that if you suddenly brought in a dental therapist/mid level provider that all "problems" would be solved. One then needs to ask, and far too many people DON'T ask this when talking with a legislator, most of whom have a dental IQ not too far above hearing "you should floss more and we'll see you in 6 months" twice a year during their cleanings, is what is the cause of the "underserved" issue? Is it not enough providers? (that often isn't the case) Or is it that many in the "underserved" population don't want to pay for their dental care? (often the case) - If the answer is "B", then how exactly would a dental therapist/mid level provider be able to provide less expensive care?? Is their overhead on supplies any less than for that of the general dentist? Is the electricity they use in their operatory less than that in the dentists operatory? Is the chair that the mid level/therapist uses for their patients any less than that chair the dentist uses for her/his patients? Are the fees the mid level/therapist would charge any less than the dentist? Can the midlevel/therapist finish the work any faster or better than the dentist could? The answer for all of those questions is "No" - that is logically looking at the issue.

Fact is, you'd be adding a person who given the likely debt load they'd be facing for their training, would be expecting annual compensation likely around 100,000, and could do the work, no better, quicker, or for less overhead than a dentist could, on a patient population who's main issue is they often just want "free" care.

The debate shouldn't be about competence, since the overwhelming data out there shows that a midlevel/therapist CAN do competent work. The debate should be about the economics of how they can deliver the work, and is it actually a less expensive way?

We as dentists are trained to use critical thinking and not get caught up in the emotion of a situation. We are "loosing" this battle in that emotion is often the start of the conversation which puts us on defense from the start, and that's not a good place to be

 

[Daurang]

Some interesting numbers on dental therapists...

1. Their billing fees are exactly the same billing fees as general dentist. If that 1 surface filling fee is (let's say) $100 for a general dentist, if a therapist does the same filling, then insurances will reimburse them $100 too.

2. Malpractice insurance for therapists is about $80-90 for the entire year, about 1/20th of what most dentists pay. Yes, dentists do more advanced procedures, but there are a lot of dentists that just do bread and butter (drill and fill) dentistry that still pay $1,500 a year. What are these actuaries thinking?

3. They are required to work upto 1,000 hours of under supervision. After that, the scope of dentistry is minimal without a dentist is present, but I bet this scope is not going to be enforced very well with all those therapists moving around.

I only do drill and fill dentistry. How do I downgrade/swap my DMD for a dental therapist license so I can reduce my malpractice insurance?

 

[Cold Front]

I only do drill and fill dentistry. How do I downgrade/swap my DMD for a dental therapist license so I can reduce my malpractice insurance?

It's probably due to % of malpractice cases against dentists v therapists, it's similar to female v male auto insurance coverage. The fact that women tend to drive less than men, accident and DUI statistics consistently reflect that male drivers, on the whole, take more driving risks than their female counterparts. So your drill and fill will always be more risky than therapists, in the eyes of actuaries.

 

[Queen Beach]

No more dental reforms! No more dental reforms! No more dental reforms!

Recently, I read that dental therapist will decrease dentist's salary by 16%. All dentist, from the Harvard to the lecom student, went to school for an additional 8 yrs of school after high school. We have to stick together and not let this spread to other states.

No more dental reforms or else it will be like medicine.

 

[480640]

.

 

[Queen Beach]

The Washington Post

Source?

 

[Soleus715]

Source?

The Washington Post

https://www.washingtonpost.com/news/wonk/wp/2015/07/29/why-dentists-are-so-darn-rich/

The article is talking about hygienists in reference to the 16% decrease in income if DH's were allowed to operate independently.
I have no idea about the validity of the study they linked though, besides that fact that they couldn't even check the margins in the first page of the research paper.

I am in complete agreement though, that dental reforms that bring about unethical changes need to be stopped at all costs.
People with 2-3 years of post-secondary education should not be able to perform anything irreversible on patients, especially since the barrier to entry is so LOW for these programs.

 

[Qatarra5]

It's probably due to % of malpractice cases against dentists v therapists, it's similar to female v male auto insurance coverage. The fact that women tend to drive less than men, accident and DUI statistics consistently reflect that male drivers, on the whole, take more driving risks than their female counterparts. So your drill and fill will always be more risky than therapists, in the eyes of actuaries.

selection effect baby

 

[zenrookie]

looking at 350-400k in student loan debt, this is frightening...

 

[Cold Front]

The New York Times is throwing it's hat in the ring on this discussion. Everyone in the dental profession will hear and talk about this by the end of the year.

http://mobile.nytimes.com/2016/06/02/opinion/a-need-for-dental-therapists.html?mabReward=A6&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine&_r=

Here is the official letter from the Federal Trade Commision to the Dental Accreditation.

https://www.ftc.gov/system/files/do...tation-standards-dental/141201codacomment.pdf

 

[Daurang]

The New York Times is throwing it's hat in the ring on this discussion. Everyone in the dental profession will hear and talk about this by the end of the year.

http://mobile.nytimes.com/2016/06/02/opinion/a-need-for-dental-therapists.html?mabReward=A6&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine&_r=

Article said dental therapist will to lead more competition, better access, and lower pricing. They forgot to add that 'if you like your doctor you can keep your doctor, and save $2500 per year.' SURE.

In Massachusetts there are lots of mobile dentistry trucks, lots of middle school hygienists, lots of stand alone public health hygienist practices, lots of dental schools, on top of saturation with lots of dentists. But of course that's not enough access; so starting this year the state will start training lots of dental therapists. These trucks, hygenists, mid-providers take turn stopping by all the underprivileged schools to make quick money to due unsuspecting foreign parents, under the guise of public health. Typically they do exam, prophy, seal for the super easy money; however they leave all the decays for the next guy cause restorations are too time consuming and not as lucrative. The next guy comes around and does the same thing and so on. Some kids get referred out but many already have a regular dentist; now the kid and parent think they're all set with these mid-providers and don't go to their regular dentist until they need root canal. Of course the idiots in government will pat themselves on the back for great public health policy intention but decays is still prevalent.

 

[yappy]

Some interesting numbers on dental therapists...

1. Their billing fees are exactly the same billing fees as general dentist. If that 1 surface filling fee is (let's say) $100 for a general dentist, if a therapist does the same filling, then insurances will reimburse them $100 too.

There is a precedence set that mid-levels will not perform services for a lower price than physicians. It undermines their access-to-care premise for existing.

"With the passage of HB 2902, Oregon becomes the first state in the nation to require insurance companies to follow ‘equal pay for equal work’ rules on insurance reimbursements for Nurse Practitioners, Physician Assistants and Physicians in primary care and mental health."

http://www.oregonrn.org/?page=670

I would respect midlevels more if they were more forthcoming by stating that their goals are to increase their income relative to their current career; and, increase their practice autonomy without the traditional education and training. Instead, they demagogue politicians and the public with false goals of lowering costs and increasing access.

 

[CanaDMD]

There is a precedence set that mid-levels will not perform services for a lower price than physicians. It undermines their access-to-care premise for existing.


http://www.oregonrn.org/?page=670

I would respect midlevels more if they were more forthcoming by stating that their goals are to increase their income relative to their current career; and, increase their practice autonomy without the traditional education and training. Instead, they demagogue politicians and the public with false goals of lowering costs and increasing access.

So happy some people can see how stupid this is lol

 

[DMDWANNABEE]

At this point it might be wise to simply start trying to influence the legislation regarding the implementation of our new auxiliaries. That wouldn't save your income stream if that's what you were worried about, but it would save the patients.

I don't see why a dental therapist couldn't work under the general supervision of a dentist. The dentists could review the health history and prescribe medications. They could also do more advanced procedures that are within their range of abilities.

The auxiliaries would drill and fill under the dentist's license. It'd be nice if they could do cleanings as well.

I felt strongly against this in the past, but as long as there is a dentist somewhere nearby I don't see why dental therapists couldn't be a thing. The time dental therapists' relative lack of knowledge in pathology, pharmacology, and more advanced procedural work would cause a problem is during autonomous practice. They just have to be supervised.

I'll also go ahead and make myself some internet enemies by saying that I do think they would lower the cost of care. Competition will do that in an industry with 30% profit margins. I'm not saying that they will necessarily do a filling for a lower fee. I'm saying that those procedures rarely fully covered by insurance will now have a much larger pool of dentists with idle time to compete for their completion.

Would it be better to just train more dentists in response to a perceived shortage? Probably.
Will that stop dental therapists from existing? Probably not.

 

[Cold Front]

What's going to happen to EFDA's (Expanded Function Dental Assistants) after Dental Therapists become the preferred employee for dentists? EFDA's will become obsolete as Dental Therapists are introduced to more and more states. There are thousands of EFDA's out there, who are hoping the therapist idea withers and dies. Essentially, legislators are throwing an entire segment of the dental workforce (EFDA's) to the wolves.

I can also foresee corporate dentistry trimming their dentist payroll to make room for therapists, to improve their bottom line. Corporate dentistry are hitting a growth ceiling now because of limited dentist workforce, so therapists would be pseudo dentists at a much cheaper labor and payroll taxes for them. Which is a big recipe for disaster, on top of everything else is wrong with corporate dentistry. We could see 1 dentist with 4 therapists corporate offices, the ultimate conveyor belt to treat patients.

There are more downs than ups in therapists being added to the dental profession. The public will start calling them "dentists" eventually, which will just boost their ego and lead to them fighting for more autonomy. Crazier things has happened in Medicine, it won't surprise me.

 

[CanaDMD]

At this point it might be wise to simply start trying to influence the legislation regarding the implementation of our new auxiliaries. That wouldn't save your income stream if that's what you were worried about, but it would save the patients.

I don't see why a dental therapist couldn't work under the general supervision of a dentist. The dentists could review the health history and prescribe medications. They could also do more advanced procedures that are within their range of abilities.

The auxiliaries would drill and fill under the dentist's license. It'd be nice if they could do cleanings as well.

I felt strongly against this in the past, but as long as there is a dentist somewhere nearby I don't see why dental therapists couldn't be a thing. The time dental therapists' relative lack of knowledge in pathology, pharmacology, and more advanced procedural work would cause a problem is during autonomous practice. They just have to be supervised.

I'll also go ahead and make myself some internet enemies by saying that I do think they would lower the cost of care. Competition will do that in an industry with 30% profit margins. I'm not saying that they will necessarily do a filling for a lower fee. I'm saying that those procedures rarely fully covered by insurance will now have a much larger pool of dentists with idle time to compete for their completion.

Would it be better to just train more dentists in response to a perceived shortage? Probably.
Will that stop dental therapists from existing? Probably not.

You haven't made an enemy, but I'd like to point out a few flaws to your argument.

1) How exactly shall we monitor what is appropriate supervision?
2) 30% profit margins? Sure, if you think dentists don't deserve a salary. If you pay the dentist an appropriate salary, the actual "profit" margin creeps back to 10% lol

 

[beannaithe]

The auxiliaries would drill and fill under the dentist's license. It'd be nice if they could do cleanings as well.

This describes 95% of associate jobs. Basically, a dental therapist would be doing the job that most people get straight out of school.

 

[DMDWANNABEE]

You haven't made an enemy, but I'd like to point out a few flaws to your argument.

1) How exactly shall we monitor what is appropriate supervision?
2) 30% profit margins? Sure, if you think dentists don't deserve a salary. If you pay the dentist an appropriate salary, the actual "profit" margin creeps back to 10% lol

I don't know if I understand your question. I think you might be asking how you could monitor if tasks are being delegated properly? If so, I imagine you would regulate them the same way that other auxiliaries are regulated. I'm sure there are hygienists that are inappropriately supervised, but I don't know that it's enough of a problem to be a major concern.

Yeah, it is kinda odd how this industry calculates profit margin before the highest earners on the payroll are paid rather than after. It still works out the same though. The tightened profit margin that I was alluding to would probably come heavily out of the dentist's income.

Edit:

This describes 95% of associate jobs. Basically, a dental therapist would be doing the job that most people get straight out of school.

Yeah. It sucks.

 

[DrJeff]

At this point it might be wise to simply start trying to influence the legislation regarding the implementation of our new auxiliaries. That wouldn't save your income stream if that's what you were worried about, but it would save the patients.

I don't see why a dental therapist couldn't work under the general supervision of a dentist. The dentists could review the health history and prescribe medications. They could also do more advanced procedures that are within their range of abilities.

The auxiliaries would drill and fill under the dentist's license. It'd be nice if they could do cleanings as well.

I felt strongly against this in the past, but as long as there is a dentist somewhere nearby I don't see why dental therapists couldn't be a thing. The time dental therapists' relative lack of knowledge in pathology, pharmacology, and more advanced procedural work would cause a problem is during autonomous practice. They just have to be supervised.

I'll also go ahead and make myself some internet enemies by saying that I do think they would lower the cost of care. Competition will do that in an industry with 30% profit margins. I'm not saying that they will necessarily do a filling for a lower fee. I'm saying that those procedures rarely fully covered by insurance will now have a much larger pool of dentists with idle time to compete for their completion.

Would it be better to just train more dentists in response to a perceived shortage? Probably.
Will that stop dental therapists from existing? Probably not.

Please, please, please enlighten me as to how you think that an actual therapist can lower the cost of care?

If I was to bring one into my office right now, that therapist would be using the exact same materials that I use which cost the exact same amount. That therapist would be using one of my office assistants, and they'd be working for their going hourly wage just as my own assistant does. They'd be using the exact same electricity that I would, be in my building with no change in the taxes that I pay on it. They'd be treating at the exact same fee schedule that I use, not a lower one because there isn't a lower one. They'd likely also be doing the work a bit slower than I can. On top of that they'd want to get paid I presume, so if their basic overhead for an actual procedure is the same as mine for that same procedure AND then I have to pay that therapist, the reality is at the end of it all, it's going to cost my office at best the same, if not more in actual overhead to get that procedure completed on that patient. If it's not costing my office less, then my fees certainly aren't going down.

No ifs and's or buts about it, a properly trained therapist can do quality work. However the actual reality is they CAN'T do the work less expensively, unless you've got a corporate scenario going where the corporate chain reduces their overhead by using more therapists paid at a lower wage that an associate dentist and then increase the profit for the owner.

The reality is, anyone in the dental profession DESERVES to get paid for what we do

 

[OhioDMD]

Please, please, please enlighten me as to how you think that an actual therapist can lower the cost of care?

Not lower the cost, but in the right situation increase access to dental care and probably the income of the employing dentist. Much like each of my two hygienists net me (hygiene procedures billed - salary and benefits)
$75,000 each I'll assume employing a DT could be at least as profitable and certainly more profitable than employing an associate.

 

[DMDWANNABEE]

Please, please, please enlighten me as to how you think that an actual therapist can lower the cost of care?

If I was to bring one into my office right now, that therapist would be using the exact same materials that I use which cost the exact same amount. That therapist would be using one of my office assistants, and they'd be working for their going hourly wage just as my own assistant does. They'd be using the exact same electricity that I would, be in my building with no change in the taxes that I pay on it. They'd be treating at the exact same fee schedule that I use, not a lower one because there isn't a lower one. They'd likely also be doing the work a bit slower than I can. On top of that they'd want to get paid I presume, so if their basic overhead for an actual procedure is the same as mine for that same procedure AND then I have to pay that therapist, the reality is at the end of it all, it's going to cost my office at best the same, if not more in actual overhead to get that procedure completed on that patient. If it's not costing my office less, then my fees certainly aren't going down.

No ifs and's or buts about it, a properly trained therapist can do quality work. However the actual reality is they CAN'T do the work less expensively, unless you've got a corporate scenario going where the corporate chain reduces their overhead by using more therapists paid at a lower wage that an associate dentist and then increase the profit for the owner.

The reality is, anyone in the dental profession DESERVES to get paid for what we do

They would reduce cost by being paid less. And way down the line, if the dentist wants to compete with them, he/she will cost less because that dentist will be paid less.

Edit:
Might as well make this the same post:
I just noticed that my old home state has a DT bill that was introduced yesterday.

Michigan's Senate Bill 1013 was introduced by state Senator Mike Shirkey (R) on 6/7/2016. It allows for the creation of a mid-level provider that does basic restorative and other procedures in line with those proposed by other states that have pushed through similar legislation.

Edit to my edit:

The reality is, anyone in the dental profession DESERVES to get paid for what we do

I just realized my post sounds kind of dismissive. I don't mean to say that dentists don't deserve a wage commiserate with their level of education. I'm just saying that you don't always get what you deserve, and for everyone's sake it makes sense to proceed strategically.

 

[Mascota]

Here's a question for practicing dentists - do hygienists get reimbursed at the same rate the dentist would for doing a cleaning? I don't know the answer to this, but I'd imagine whatever happened with cleaning reimbursement rates when hygiene became a position is what you'd see with DTs.

 

[Daurang]

Here's a question for practicing dentists - do hygienists get reimbursed at the same rate the dentist would for doing a cleaning? I don't know the answer to this, but I'd imagine whatever happened with cleaning reimbursement rates when hygiene became a position is what you'd see with DTs.

The dental office/dentist is the one that gets the money from the insurance company. The hygienist is the employee/contractor of the dentist, not the insurance company. With stand alone dental hygiene practice, I guess their DH association would fight to get same money. With stand alone dental therapist practice, I guess they would fight to get the same money. I wish a simple root canal done by general dentist is reimbursed the same as an endodontist, but we get paid less for the same exact work!

 

[Bernie Sanders]

Surprised to see so many republicans sponsoring that Michigan therapist bill. I would have expected that whole access to care nonsense garbage to come only from Dems. But, I guess the big corporate chains (which are backed by Wall St) have donated heavily to those Repubs.

 

[Cold Front]

My state senate (republican majority) just introduced a bill to create dental therapists profession couple of weeks ago. With 80+ shortage areas within the state, I think this bill will pass without any serious oppositions. I doubt most practicing dentists in the state are aware of this bill either.

 

[DrJeff]

My state senate (republican majority) just introduced a bill to create dental therapists profession couple of weeks ago. With 80+ shortage areas within the state, I think this bill will pass without any serious oppositions. I doubt most practicing dentists in the state are aware of this bill either.

Most of the dentists in MA likely aren't aware of it. A bunch of us dentists just South of you in CT are, as we've been able to successfully prevent Mid Level legislation, through an intensive lobbying effort on the part of multiple members of our State Dental Society to educate and inform our elected reps, especially those on the State Public Health Committee, on the reality of what a Mid Level can do verses what the folks at Pew and Kellogg who have been lobbying for a mid level say that they can do. MA, even though they are in the same ADA District as us in CT, and we have a very amicable working relationship with the leaders in MA, just basically stuck their head in the sand and put very little effort into educating their legislators, and then on top of it, likely for financial gains, the Dean of Harvard Dental School, really went against the what the data shows (kind of a strange thing for one who is trained as an oral surgeon) and put out an opinion piece in favor of mid levels.

Speaking now as someone who's business partner is on the ADA's national Access to Care Task force (so yes I hear PLENTY about this subject while I'm at work), the reality is that the actual "access" issue isn't nearly as bleak as the various folks lobbying for a Mid Level provider make it out to be. What it very often gets down to is its not about the people who claim that they can't find a dentist to see them, it's more often about those people not being able to find a dentist who will treat them for free.

Yes, there are some scenarios where a Mid Level WILL help with access, such as in states with very rural areas like Alaska, parts of the West, and even Northern Maine, but those are the exceptions, not the norm as the lobbying groups want folks to believe.

Again, as I have said before about this, when it boils down to it, if on a procedure basis, a Mid-Level CAN'T do the work any more cost effective than a dentist can, and the midlevel will be getting reimbursed the same rates as a dentist, and the majority of the "access issue" isn't about getting into a dentist but about finding free care, there is no way that widespread implementation of a Mid level provider will help "solve" this perceived problem

 

[DrJeff]

Here's a question for practicing dentists - do hygienists get reimbursed at the same rate the dentist would for doing a cleaning? I don't know the answer to this, but I'd imagine whatever happened with cleaning reimbursement rates when hygiene became a position is what you'd see with DTs.

There is NO DIFFERENCE in the fees for the codes that my hygienists use in my office whether it's them or myself doing the procedure. The insurance companies (if the patient has dental insurance) doesn't reimburse any differently for those procedure codes whether it's myself or one of my hygienists who did the work.

One can presume then that should a Mid Level Provider become part of the dental team that there will be no difference in their fees and reimbursement levels than if a dentist did the same work.

Dental reimbursement and billing/coding is all about what procedure codes where done, not who did the procedure

 

[Cold Front]

Most of the dentists in MA likely aren't aware of it.

I'm actually in Ohio. I finally updated my profile after all these years.

I agree with you on the growing number of people wanting to be treated for FREE. With aging population (more Medicare) and Medicaid expansion (low number of dentists accepting Medicaid), the dental therapy is targeting those markets.

 

[Daurang]

I'm all for midlevel providers if they have to do all the medicaid removeable dentures that most of us dentists don't wanna deal with.

 

[Cold Front]

Vermont is now a dental-therapist state.

http://www.drbicuspid.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=319926

 

[Mascota]

Vermont is now a dental-therapist state.

http://www.drbicuspid.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=319926

And so the dominos start to fall....

 

[Cold Front]

And so the dominos start to fall....

And so the dominos start to fall....

This caught me off guard.

"Shumlin signed S 20 on June 2, which requires current dental hygienists to complete both an additional year of classes and 1,000 clinical training hours before practicing as a dental therapist."

 

[Mascota]

This caught me off guard.

"Shumlin signed S 20 on June 2, which requires current dental hygienists to complete both an additional year of classes and 1,000 clinical training hours before practicing as a dental therapist."

Oh wow, that could create a large influx quickly. Who knows. It'll be interesting to see how the markets react there.

 

[DrJeff]

Oh wow, that could create a large influx quickly. Who knows. It'll be interesting to see how the markets react there.

Doubtful - #1 If you know of VT (and I have a 2nd home there in a fairly rural part of the state), once you get outside of Burlington (meaning about 98.5% of the state) it generally very rural with some occasional small towns and small "cities" that has an economy that is nowadays generally seasonal tourism based. These are the generally "underserved" areas that politicians intend (wish) that the mid levels will practice in. Unless someone likes living in a rural area, this will be a tough lifestyle sell for them

#2 - It's not like VT's mid level program will be turning out thousands of mid level providers a year. The numbers that I've heard floated around are somewhere around 15 - 20. It will take a long time to train and have a significant amount of mid levels potentially begin treating patients in VT, and that assumes that there will be continued interest by potential mid levels for years to come

#3 - As I have said over and over again - economically, a mid level CAN'T provide treatment any more cost effectively than a dentist can - the reimbursement fee schedule is the same, the materials costs are the same, etc. Especially with a medicaid based population, the fees that a dentist or a mid-level work off of are at best just covering our overhead, and often working at a loss. You will not see a mid-level providing cheaper care than a dentist can, unless of course the state or federal gov't chooses to subsidize a mid-level provider, at which point their decreasing the overall pool of medicaid dollars to go around by spending more of it on a smaller subset of people

#4 - the "access problem" very often isn't finding a dentist who will treat them, it's finding a dentist who will treat them for free..... Good luck with that

 

[Mascota]

Doubtful - #1 If you know of VT (and I have a 2nd home there in a fairly rural part of the state), once you get outside of Burlington (meaning about 98.5% of the state) it generally very rural with some occasional small towns and small "cities" that has an economy that is nowadays generally seasonal tourism based. These are the generally "underserved" areas that politicians intend (wish) that the mid levels will practice in. Unless someone likes living in a rural area, this will be a tough lifestyle sell for them

#2 - It's not like VT's mid level program will be turning out thousands of mid level providers a year. The numbers that I've heard floated around are somewhere around 15 - 20. It will take a long time to train and have a significant amount of mid levels potentially begin treating patients in VT, and that assumes that there will be continued interest by potential mid levels for years to come

#3 - As I have said over and over again - economically, a mid level CAN'T provide treatment any more cost effectively than a dentist can - the reimbursement fee schedule is the same, the materials costs are the same, etc. Especially with a medicaid based population, the fees that a dentist or a mid-level work off of are at best just covering our overhead, and often working at a loss. You will not see a mid-level providing cheaper care than a dentist can, unless of course the state or federal gov't chooses to subsidize a mid-level provider, at which point their decreasing the overall pool of medicaid dollars to go around by spending more of it on a smaller subset of people

#4 - the "access problem" very often isn't finding a dentist who will treat them, it's finding a dentist who will treat them for free..... Good luck with that

I think in the legislation it states that you can have a max of two DT for every dental license. This sounds like corporate dentistry's dream scenario - replace 66% of your DDS employees with DTs, pay the DTs a fraction of the salary, continue getting paid the same reimbursement rate, drive competition for the few DDS positions available, pay them a lower salary too, increase corporate net earnings. spread like cancer across the country.

 

[Cold Front]

I think in the legislation it states that you can have a max of two DT for every dental license. This sounds like corporate dentistry's dream scenario - replace 66% of your DDS employees with DTs, pay the DTs a fraction of the salary, continue getting paid the same reimbursement rate, drive competition for the few DDS positions available, pay them a lower salary too, increase corporate net earnings. spread like cancer across the country.

In my state, OH, the DT legislation is proposing 4 DTs per dentist. The bill will pass, thanks to Kellog's Foundation paying for lobbyists to push this through all legislative branches of the state.