Maine Physicians get Dental Training

[Cold Front]

Primary care doctors who do their medical residency in Maine are learning to lance abscesses, pull teeth and perform other basic dental skills.

New York Times article says Maine Dental Association supports the program.

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[Lopyswine]

how much head and neck anatomy and pathology do they do in med school? At my school the med students do minimal h&n.

 

[gryffindor]

Are they taking radiographs? Anyone can physically pull a tooth with training. But if you don't take a radiograph to pick up that little curly q at the apex of a seemingly easy bombed out premolar, then there will be trouble.

 

[achilles2]

My guess is Maine has a shortage of dentists and due to the rural nature is having some MD's try and help out with the current situation.

Again this is an assumption.

 

[NyCzPeter]

If we have to learn all that med stuff totally unrelated to dentistry. Dentistry is a specialty of medicine no matter how you look at it, so I think it would be fair that all md programs have a required dental portion aswell

 

[djeffreyt]

My guess is Maine has a shortage of dentists and due to the rural nature is having some MD's try and help out with the current situation.

Again this is an assumption.

Your guess would be pretty accurate

 

[J-Rad]

From the article:
"Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.

Nationally there is one dentist for every 1,600 people.

Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state's largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state's southernmost town."

Like many states with large rural populations (look at a map particularly in the western and northern regions. The densest populations are located on the southeastern coast) it has long struggled with dental health. It's hard to get dentists to come work in Carabou or Houlton or any number towns with names (or without names in some cases) in places where winters can be grueling. University of New England (UNE) has tinkered with the idea of starting a dental school, but I don't think that's gotten anywhere and you'd still have to have an incentive to keep the grads in state. UNECOM, the only med school in the state, does a great job of getting docs to stay in state, but even that's a struggle.
As for the H&N anatomy question, that's going to be school specific. If the grad went to UNECOM, then their H&N anatomy was quite in depth relative to medical school education (I have no context with which to base a comparision of H&N anatomy taught in dental vs. medical school as I went to med school [UNECOM, specifically])

 

[makushin]

.

 

[Pyriots]

Hmm.....anybody remember the MD/DDS program at Case? I remember consider applying for it. And then I sat down to write the essay and for the life of me, I had a hard time putting down on paper why I would NEED both degrees.

Seems like state boards think everything can be resolved if we just "add one more CE class". I'd feel much better if those couple of CE classes was at minimum turned into some kind of externship. Like if you want to be licensed to perform these procedures, you have to temporarily shut down your office for one day out of the week and spend that day with a regular dental training program (school, residency, externship, etc)

 

[UCSF2012]

Maine, eh? I don't mind working in a dental shortage area, but someone help me out on this one...name one decent city to live in within Maine.

 

[NyCzPeter]

Maine, eh? I don't mind working in a dental shortage area, but someone help me out on this one...name one decent city to live in within Maine.

I don't even know where Maine is on the map...

I'm an immigrant

 

[DrReo]

Maine, eh? I don't mind working in a dental shortage area, but someone help me out on this one...name one decent city to live in within Maine.

York, ME

 

[NileBDS]

I personally find it hypocritical (even irresponsible) of states like North Carolina and Maine to claim shortages of dentists, but do nothing to attract/recruit new dentists. How about accepting different licensure exams (WREB, CITA, ...) like others have done to overcome similar problems (Virginia, Connecticut, California, ...) ?

How about increasing loan repayment programs in underserved areas ? How about actually adding and funding new GPR/AEGD/VA programs or adding dentists to more and more hospitals as staff members ? What radical ideas ...

Stubborn state boards and their poor constituents ...

 

[NileBDS]

Portland, ME. Maine is certainly not for everyone, but if this sort of life style "tickles your fancy" so to speak, it is one hell of a playgorund. Fishing, hunting, skiing, lakes ... and home of the lobster laden road side diners !

 

[Yellow Snow]

I personally find it hypocritical (even irresponsible) of states like North Carolina and Maine to claim shortages of dentists, but do nothing to attract/recruit new dentists. How about accepting different licensure exams (WREB, CITA, ...) like others have done to overcome similar problems (Virginia, Connecticut, California, ...) ?

How about increasing loan repayment programs in underserved areas ? How about actually adding and funding new GPR/AEGD/VA programs or adding dentists to more and more hospitals as staff members ? What radical ideas ...

Stubborn state boards and their poor constituents ...

The Dental Board of Maine paid for a few NYU students to drive up there and stay the night for a few days, meet some local dentists and watch a presentation of loan repayment. The state of ME will repay all of your loans if you will move there and live where they say. I think they do this recruiting every year but I'm not sure.

 

[gryffindor]

The Dental Board of Maine paid for a few NYU students to drive up there and stay the night for a few days, meet some local dentists and watch a presentation of loan repayment. The state of ME will repay all of your loans if you will move there and live where they say. I think they do this recruiting every year but I'm not sure.

Seriously? If I was graduating from a high-debt school, this sounds like a good offer to take for a few years. Better than any associateship you'll get in the east coast cities.

 

[Pyriots]

The Dental Board of Maine paid for a few NYU students to drive up there and stay the night for a few days, meet some local dentists and watch a presentation of loan repayment. The state of ME will repay all of your loans if you will move there and live where they say. I think they do this recruiting every year but I'm not sure.

say WHAT? Never heard of this. Rosenthal is so going to hear from me the next time this is offered.

Outdoors and lobster sounds pretty damn good to me. Better than the nyc jungle and gyro food carts at least.

 

[Pyriots]

say WHAT? Never heard of this. Rosenthal is so going to hear from me the next time this is offered.

Outdoors and lobster sounds pretty damn good to me. Better than the nyc jungle and gyro food carts at least.

Hmmm. maybe not

http://www.mainelegislature.org/legis/statutes/20-A/title20-Asec12302.html

max loan repayment of 20k per year for 4 yrs? you'd have to do the math based on average income for the area they ask you to work in. but for us private schoolers, thats not such a great deal

AND they only take 3 dentists per year....which I realize still costs them a good amount of money annually. But for the money they then spend educating MDs to do these procedures, they could take more.

specially given that those 3 dentists are VERY likely to be in the first class of applicants (maine residents) which is pretty much people who would have stayed in maine for private practice ANYWAY

 

[tkim]

http://www.famemaine.com/education/financialAidPrograms.asp#maineDentalLoanRepayment

 

[djeffreyt]

I personally find it hypocritical (even irresponsible) of states like North Carolina and Maine to claim shortages of dentists, but do nothing to attract/recruit new dentists. How about accepting different licensure exams (WREB, CITA, ...) like others have done to overcome similar problems (Virginia, Connecticut, California, ...) ?

How about increasing loan repayment programs in underserved areas ? How about actually adding and funding new GPR/AEGD/VA programs or adding dentists to more and more hospitals as staff members ? What radical ideas ...

Stubborn state boards and their poor constituents ...

As someone already pointed out, they do have a lot of recruitment. They have loan repayment programs, as mentioned, but there are also some programs in Maine for helping pay for you to build an office and other moving bonuses to bring in more people...these have been in effect for years, but they just can't draw enough.

As for the Carolinas, part of their changes with Pediatricians in the last few years was done more to address the fact that even among dentists who do live there, they cannot get enough to take medicare patients, so they've made some changes in the way pediatricians can treat patients.

 

[gryffindor]

I looked at the link tkim posted and seems like Maine offers $20K per year loan repayment. Sorry, but that is peanuts. It doesn't sound like enough to entice someone who just spent 4 years living in Southern California or NYC coming out with a $350K loan to spend the next few years in the middle of nowhere for a $20K break on their mountain of loans. Back when average dental school debt was $100K, it might have sounded like an ok deal. IMO, if a state sweetened these payback programs to at least $50K loan repayment per year plus a newbie full-time salary of $90K, then maybe they'd get more takers.

 

[DrJeff]

I've said it before and I'll say it again the rural area is a GREAT place to practice and live! I have family that lives in the Portland area and for those that think that Maine is just a bunch of Moose, pine trees and lobsters its far from that(or it could be that if you want too).

One of my best friends is an oral surgeon who is on with a group of 4 other OMFS's across Southeastern Maine. His practice is booming, and he keeps trying to get me to move up there, and if I wasn't very happy in my own little rural corner of CT, I'd STRONGLY consider moving there.

If you practice in a "rural" and I'll also add "under dental served" area, you'll find that you have an ample patient supply that will very often travel from miles around to see you, and you'll also have a lower overhead and a lower cost of living in general. Plus from a living standpoint, it's not necesarily a bad thing to be able to reasonably afford a nice house with a good sized yard for kids to run around in, and NOT have to pay alot of $$ for it.

As for the concept of medical docs in Maine being able to lance and abcess and extract a tooth, once again this is an access issue that I'd bet *if* it happens will be more likely to occur in a primary care walk in clinic far away from the Maine coastline(which is where most of Maine's population resides) as opposed to their more dentally populated urban/suburban areas. No big deal in my book, since afterall they will be held to the standard of care that us dentists are held to, and we're talking emergent care here.

 

[Taurus]

If dentistry doesn't address its labor shortage by opening new schools and expanding class sizes, others -- namely hygienists and legislators -- will come up with their own solutions.

Should 'dental therapists' be allowed to drill and extract?

Dentists are concerned about a bill -- cleared a Minnesota Senate committee -- that gives clinicians more responsibility.​

 

[Guy Smiley]

There are enough dentists out there. There just aren't enough willing to live in the middle of nowhere - and there aren't enough willing to accept the ridiculously low reimbursement the state and federal governments give. I work for public health in a small town. The other day I sent a partial to the lab to have a tooth added. Our charge to the patient was $105 plus the patient got half off from the sliding scale based on income so the patient paid about $50. The lab bill to add the tooth was $110. How can a private dentist afford to lose money the way a federally funded clinic can?

 

[shabu2]

how much head and neck anatomy and pathology do they do in med school? At my school the med students do minimal h&n.

I think we spent about a total of one week on the head and neck in med school, plus 1 or two lectures on the oral cavity. Scary

 

[Cold Front]

There are enough dentists out there. There just aren't enough willing to live in the middle of nowhere - and there aren't enough willing to accept the ridiculously low reimbursement the state and federal governments give. I work for public health in a small town. The other day I sent a partial to the lab to have a tooth added. Our charge to the patient was $105 plus the patient got half off from the sliding scale based on income so the patient paid about $50. The lab bill to add the tooth was $110. How can a private dentist afford to lose money the way a federally funded clinic can?

The government is cheap, they nickel and dime with everything. I am certain that there will be a tipping point for medicaid within the next 10 years, as the participation of dentists continue to decline, and more eligible low income individuals are turned away from access to dentistry.

The government is contributing to the access problem with lower disbursements. Look at Florida for example, it has one of the lowest Medicaid reimbursement rates in the nation, providing dentists with only 25 cents for every $1 of services performed. The other 75 cents comes out of the dentist's pocket. How are they suppose to cover the overhead? The cost of doing business increases every year, but the Medicaid reimbursement remains unchanged.

I would only do it for pediatric patients, and not adults. Unfortunately, it's all or none for many states.

 

[Dr. Dai Phan]

Hello all,

I read the people comments on the article and one thing stands out loud and clear. That is ignorance of public on dentistry. People think of dentists as a bunch of rich people who just drill and fill who do not want the dental therapist to get a piece of the pie (and in turn the patients suffer). Drill and fill... Shez.. how hard can this be? True, doing an amalgam or extracting a loose tooth on the healthy patient hardly requires 8 years of education. Technically it is easy even I admit. But how about a patient with medical conditions such as on blood thinner, history of oral radiation, undergoing chemotherapy while in dental treatment, how about anatomical considerations, treatment planning (should this tooth be removed or be kept?), what does extracting the tooth/teeth affect the overall restorative plan? What if the restoration or extractions run into some complications (where are you going to find an oral surgeon or a prosthodontist to consult if the nearest one is 500 miles away?)? There is much more than just "pulling and filling". With the limited dental training for DT, I do not think they are capable of making the proper decision for the patient. Sure anyone can be taught to pull a tooth or do a filling but the critical analysis in the overall treatment plan can be only rendered by a dentist with proper training. DP

 

[Pikeyman]

If dentistry doesn't address its labor shortage by opening new schools and expanding class sizes, others -- namely hygienists and legislators -- will come up with their own solutions.[/INDENT][/URL]

The way I see is that opening more schools is not going to help. No matter how many people you get into the profession, they are going to practice where they want to live. States have to make it worthwhile for dentists to practice there. Accept any licensures.

I personally find it hypocritical (even irresponsible) of states like North Carolina and Maine to claim shortages of dentists, but do nothing to attract/recruit new dentists. How about accepting different licensure exams (WREB, CITA, ...) like others have done to overcome similar problems (Virginia, Connecticut, California, ...) ?

How about increasing loan repayment programs in underserved areas ? How about actually adding and funding new GPR/AEGD/VA programs or adding dentists to more and more hospitals as staff members ? What radical ideas ...

Stubborn state boards and their poor constituents ...

ADA is planning on opening 3-5 more schools on top of East Carolina and Western. North Carolina, for example, doesn't accept NERB licensure, which is, by the way, accepted by > 40 states. Crazy shiz...