Mid-level Practioner

[Tooth Extractor]

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I'm very disappointed in the direction that healthcare is going. The reason for my statement is because more mid-level providers are trying to be equal to that of a real practitioner.😡 For example, the nurse practitioners want autonomy because they don't like doctors looking over their shoulders (what the hell are you here for autonomy or teamwork?; the reason why they exist is to help doctors with the high demand of patient care! Another issue is the mid-level practioners for dentistry. Why do we want low educated people surgically work on our mouths. Good thing the EDA knows that only a few are practioners and the rest MID-LEVEL!🙂

Practitioners go thru a lot of school and for unqualified people to just barge in and take our jobs is

wrong!http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

 

[CleverThought]

Actually, a nurse practitioner doesn't become one to avoid the Dr. looking over the shoulder. In actuality most nurse practitioners choose to do so because they prefer the nursing model to the medical model. Other reasons may be lesser responsibility, more 9-5 hours (no or little on call, not much staying late).

It isn't because the want to play doctor nor avoid being under the doctor. Many NP's work in collaboration with a Dr. and in quite a few states NP's don't have full prescriptive authority or by law have to work in collaboration with a doc.

I can't really speak for dental mid-levels, but I suspect the case is the same. Mid-levels are not doctor wanna be's. They are a solution for everyone. They are an affordable option to those who don't have any complicated needs. There are many people who prefer a doctor to a NP/PA, the same will be for dentists.

 

[mike3kgt]

They are a solution for everyone. They are an affordable option to those who don't have any complicated needs. There are many people who prefer a doctor to a NP/PA, the same will be for dentists.

When you change delete your "pre dental" and replace with "dentist" I promise you will change your tune.

 

[CleverThought]

When you change delete your "pre dental" and replace with "dentist" I promise you will change your tune.

I don't think so, I understand the role of mid-level's and respect them for the role they play.

A lot of people just see them as phasing out the doctor, but that's far from the truth. To each their own, I suppose.

 

[Tooth Extractor]

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[Tooth Extractor]

Actually, a nurse practitioner doesn't become one to avoid the Dr. looking over the shoulder. In actuality most nurse practitioners choose to do so because they prefer the nursing model to the medical model. Other reasons may be lesser responsibility, more 9-5 hours (no or little on call, not much staying late)



I understand that a nurse practitioner chooses nursing for the lifestyle... what I don't understand is why in the world do nurse practioners wanna be independent when the new health care reform comes!😡 They are only suppose to help doctors! From my perspective once they started asking for autonomy, to me that gave me their insight to the plan of nurses future! Same goes to the future mid-level dental providers!😡

 

[sacapuntas]

OK, I don't think hardly any NP's are NP's for the lifestyle. They may say that now, because it helps them feel better about their choices, but must NP's are NP's because they were nurses first. They then decided being a RN or LPN wasn't fulfilling enough or they weren't making enough $$ so they just go to the next level of schooling. Some of them still don't find being an NP fulfilling enough so they go to med school. Not many 18 year olds become nurses and then NP's instead of the pre-med med school route for the lifestyle, they do it because they are capable of going the nursing route and may be overwhelmed or incapable of the challenge of becoming a medical doctor.

 

[Tooth Extractor]

All these mid-level providers want is more power or equal power to the practitioner with little education and tuition behind their credentials! They don't deserve to have that power because it's not fair for practitioners to go through a long rigorous training and pay big tuitions to be were they're and then have less educated people try to to do the same job and ask for autonomy (just help out and stop asking for independence from practitioners!). And watch later they're going to start crying about not getting payed enough! I hope that when I become a dentist, no mid-level provider tries to open up their practice right next to mine with less debt than me!

 

[slm266]

OK, I don't think hardly any NP's are NP's for the lifestyle. They may say that now, because it helps them feel better about their choices, but must NP's are NP's because they were nurses first. They then decided being a RN or LPN wasn't fulfilling enough or they weren't making enough $$ so they just go to the next level of schooling. Some of them still don't find being an NP fulfilling enough so they go to med school. Not many 18 year olds become nurses and then NP's instead of the pre-med med school route for the lifestyle, they do it because they are capable of going the nursing route and may be overwhelmed or incapable of the challenge of becoming a medical doctor.

wow. didnt know anybody could speak so clearly out of their butt.

 

[OU11BB]

I know some dental professionals are for dental assistants placing fillings.....I am completely against that for the fact that as a dentist you are putting your brand out there. Why would anyone want an assistant to place a filling, who does not have the training and education that is required. If it falls out, its not the assistants filling, its the filling you got at so and so dental office. It is messed up if you ask me.

 

[slm266]

All these mid-level providers want is more power or equal power to the practitioner with little education and tuition behind their credentials! They don't deserve to have that power because it's not fair for practitioners to go through a long rigorous training and pay big tuitions to be were they're and then have less educated people try to to do the same job and ask for autonomy (just help out and stop asking for independence from practitioners!). And watch later they're going to start crying about not getting payed enough! I hope that when I become a dentist, no mid-level provider tries to open up their practice right next to mine with less debt than me!

"its not fair to us practitioners" is not a valid argument at all. That's like blockbuster saying its not fair that redbox/netflix took over the market without having to invest much at all.

The valid argument is that its not fair to the patients. They do not receive the same standard of quality. Just like general dentists should not step outside their scope if they cannot provide the same quality of oral surgery, endo, etc... The poor would receive lesser treatment from these mid-level practitioners (aka expanded function hygienists) because it is all they can afford. In dentistry there is one standard of quality and if you cannot provide that quality, you shouldnt perform the treatment.

 

[sacapuntas]

wow. didnt know anybody could speak so clearly out of their butt.

What do you disagree with?

I work in nursing, and know a dozen NP's fairly well. What I laid out is the scenario of how almost all of them became NP's.

 

[slm266]

I know many too. Your statement comes off very ignorant to generalize all nurses like that.

If thats how you view those who work around you, I cant imagine the turnover of assistants/hygienists in your office if you become a dentist.

 

[sacapuntas]

I know many too. Your statement comes off very ignorant to generalize all nurses like that.

If thats how you view those who work around you, I cant imagine the turnover of assistants/hygienists in your office if you become a dentist.

Perhaps my statement came off as ignorant, but I don't believe it to be ignorant. I think I am in a position to make a statement like that based on my professional interactions with nurses/NP's. Also, why would I do anything but generalize? What good is it to talk about the exceptions? Of course there are a limited number of NP's who had the option to go to med school and opted instead to become NP's...that is far from the norm however.

Do you believe that assistants and hygienists were all debating whether or not they should become dentists or assistants/hygienists and opted not to become dentists for the lifestyle?

You are comparing apples to oranges. Being a NP is not the same as being a hygienist and being a dentist is not the same as being a MD. Try to be PC all you want, but facts are facts.

 

[SeattleRDH]

When it comes down to it it's all about the training. I have worked for some older dentists who went to school before composites were in use and I can say that I place better composites than them. This one guy did one increment, one light cure. Scary.

I don't agree that mid-level providers should be autonomous because if a dentist can get away with doing crappy work then what if a mid-level is subpar? They'll be prepping a large class II then...oops!... just punctured the pulpal horn....hmmm...can't do an open and broach...I guess we'll just extract.

I think dentistry needs to get over the "us vs. them" mentality. It comes from all sides. Dentists don't want a mid-level provider to undermine their profession. Hygienists want to be able to diagnose and refer their own perio patients. Assistants want to "open up the grooves" of their sealant patients. The public just wants someone to take Medicaid!
Maybe we should all get our heads out of our you-know-what's and start working as a team.

And guess who the team leader is.... Dentists!

 

[SeattleRDH]

Perhaps my statement came off as ignorant, but I don't believe it to be ignorant. I think I am in a position to make a statement like that based on my professional interactions with nurses/NP's. Also, why would I do anything but generalize? What good is it to talk about the exceptions? Of course there are a limited number of NP's who had the option to go to med school and opted instead to become NP's...that is far from the norm however.

Do you believe that assistants and hygienists were all debating whether or not they should become dentists or assistants/hygienists and opted not to become dentists for the lifestyle?

You are comparing apples to oranges. Being a NP is not the same as being a hygienist and being a dentist is not the same as being a MD. Try to be PC all you want, but facts are facts.

I would say the top 20% of assistants and hygienists are smart enough to be dentists. And yes, they chose not to take that route because of the lifestyle. 95% (or more) of hygienists are women and hygiene is more flexible for family life than dentistry.

 

[sacapuntas]

I would say the top 20% of assistants and hygienists are smart enough to be dentists. And yes, they chose not to take that route because of the lifestyle. 95% (or more) of hygienists are women and hygiene is more flexible for family life than dentistry.

My posting and experience is to do with nursing, yet you saying 80% (vast majority) are not making their decision with the option of being the dentist seems to prove out the trend is likely seen in dental offices also.


I don't care profession one chooses to take up, what is important is that they feel fulfilled in what they are doing. I respect people the same no matter their job, and believe occupation says nothing about a person's value. With that being said, we do fall into occupations based on our abilities, and to say that NPs or DA's or whatever could have been Doctors, dentists, or whatever else, isn't entirely true. Decisions are based on a lot more than potential lifestyle.

 

[seattlesun]

This is a hot topic, but before deciding that nurse practitioners and mid-level dental professionals such as dental therapists are bad (undermining your authority as a dentist) we need to consider why these specialties exists. They would not arise if there was not a need for them. Read the article below to make an educated opinion, get some data, become more empathetic, and why not form some thoughts for when your interviews roll in and for yourself as a future health care provider.

http://www.jdentaled.org/cgi/reprint/68/1/8

The mid-level professionals have received an education, and are licensed to do certain procedures. As for myself, I plan to have my hygienist and dental assistant do procedures to the full extent of their abilities, education, and authorization. This will help provide affordable treatment to more patients, keeping employee morale high and help break routine. Same would go for dental therapists if I would happen to work with one. If you are smart to pass your boards and get your license, you should be able to use that license.

 

[yappy]

I think those that are lucky enough to enjoy dental school and graduate should look into lobbying to end mid levels in dentistry.

Further, we need to do something about medicare/caid - The gov will continue to drop fudning; therefore, I think a good soluation is that for every dollar a dentist writes off by seeing a medicaid patient they then should be able to subtract that amount from their taxable income. This would allow dentists to see medicaid patients and essentially lower their taxes to zero if they see enough of them. The last thing on our agenda should be making certain that only a dentist may run a few dental offices, thereby eliminating corperate dentistry.

What say you!?

 

[SeattleRDH]

I think those that are lucky enough to enjoy dental school and graduate should look into lobbying to end mid levels in dentistry.

Further, we need to do something about medicare/caid - The gov will continue to drop fudning; therefore, I think a good soluation is that for every dollar a dentist writes off by seeing a medicaid patient they then should be able to subtract that amount from their taxable income. This would allow dentists to see medicaid patients and essentially lower their taxes to zero if they see enough of them. The last thing on our agenda should be making certain that only a dentist may run a few dental offices, thereby eliminating corperate dentistry.

What say you!?

Don't worry, the ADA has enormous lobbying power. We just have to keep mid-level providers from sneaking through the system in smaller states like has happened in Alaska and Minnesota.

It's funny, the more I learn, the more I realize what I don't know. There's nothing wrong with expanded functions hygienists and assistants, but independently practicing mid-level providers are just scary. One needs a large base of knowledge to be able to properly diagnose and nothing compares to the knowledge gained with a dental school education.

 

[yappy]

What do you think about my medicaid suggestion? I feel like both the AMA and ADA can get behind this. Imagine seeing a patients and getting to subtract any funds not paid from your taxable income! I can see docs and dents getting behind this and more patients would be scene. Do you think it's a realistic possibility?

Don't worry, the ADA has enormous lobbying power. We just have to keep mid-level providers from sneaking through the system in smaller states like has happened in Alaska and Minnesota.

It's funny, the more I learn, the more I realize what I don't know. There's nothing wrong with expanded functions hygienists and assistants, but independently practicing mid-level providers are just scary. One needs a large base of knowledge to be able to properly diagnose and nothing compares to the knowledge gained with a dental school education.

 

[7 Iron]

What do you think about my medicaid suggestion? I feel like both the AMA and ADA can get behind this. Imagine seeing a patients and getting to subtract any funds not paid from your taxable income! I can see docs and dents getting behind this and more patients would be scene. Do you think it's a realistic possibility?

It sounds really good to me as a future practitioner who will have taxes through the roof... but I don't have any optimism about tax code reform. Washington is full of a bunch of whining toddlers who can't solve any problems.

 

[Tooth Extractor]

I'll I can say from reading all these threads is that having a mid-level practitioner is a bad idea because they'll eventually ask for more income and more autonomy... the nurse practitioners is already looking for more strength... 'The American Academy of Nurse Practitioners released a position paper in 2009 denouncing the use of the terms "mid-level provider," "physician extenders," "limited license providers," "non-physician providers," and "allied health providers" when referring to nurse practitioners.The American Academy of Nurse Practitioners prefers that nurse practitioners are referred to as "independently licensed providers," "primary-care providers," "health-care professionals," and "clinicians."' Everyone please open your eyes if this keeps up, people will no longer respect doctors and dentist because now less educated people can do the same job (quakers)! Say no to mid-level practitioners! There has to be a better way for the sake of our patients and our careers (ego).

 

[youknowthedrill]

Yappy,

I back your suggestion about tax write-offs but it should also include all unpaid medical services. Many physicians and dentists provide some free care to their patients. It would be nice to deduct this care from ones taxes and it would increase access to care. It makes sense, so it unfortunately doesn't have a chance to become a reality.

 

[yappy]

With that attitude! lol.

Just keep it in the back of your mind. I will pick my old union bosses' minds about undertaking such matters.

Yappy,

I back your suggestion about tax write-offs but it should also include all unpaid medical services. Many physicians and dentists provide some free care to their patients. It would be nice to deduct this care from ones taxes and it would increase access to care. It makes sense, so it unfortunately doesn't have a chance to become a reality.

 

[Jackson-Ave-Dental]

I would say the top 20% of assistants and hygienists are smart enough to be dentists. And yes, they chose not to take that route because of the lifestyle. 95% (or more) of hygienists are women and hygiene is more flexible for family life than dentistry.

Nuts... I'm not even in dental school yet and I come in for emergencies... check phone calls twice after work and once before I go to sleep.

Some life style that is


A taste of the future, is what I've been told.

 

[chocchipcookie]

i'm shadowing my dentist this summer and the hygienist told me that several states are allowing dental hygiene practitioners (i think that's what they're called.. i don't remember exactly, sorry) to do routine exams and cleanings in separate offices with their own patients.

 

[SeattleRDH]

i'm shadowing my dentist this summer and the hygienist told me that several states are allowing dental hygiene practitioners (i think that's what they're called.. i don't remember exactly, sorry) to do routine exams and cleanings in separate offices with their own patients.

There are pilot programs going on from time to time in different states but ADHPs (advanced dental hygiene practitioners) are not coming into existence anytime soon. The ADA fights it too hard.

Here in Washington hygienists can practice independently in nursing homes, prisons, and community centers for the elderly. We cannot, however, perform our expanded functions like anesthetic and restorative without a dentist present. Nor should we.

The mid-level provider will never be able to practice independently and set up shop in competition with a dentist because the business model will fail. A dental office needs high production like crown and bridge to be able to pay the bills. The only way a mid-level fits in is as part of the dental team.

Perhaps first we should get hygienists in *all* states to be trained and licensed in restorative. No cutting teeth, just filling. And make the DH degree a B.S. only, no more 2 year associates degree, it ends up being 4 years with the prerequisites anyway.

 

[SeattleRDH]

What do you think about my medicaid suggestion? I feel like both the AMA and ADA can get behind this. Imagine seeing a patients and getting to subtract any funds not paid from your taxable income! I can see docs and dents getting behind this and more patients would be scene. Do you think it's a realistic possibility?

Well, I'm no accountant, but it sounds like a good idea.

I would like to see a loan forgiveness program in which a private practicing dentist can enroll. I would see 25% Medicaid patients for a number of years if I didn't have to worry about paying my student loans. Of course, any more than 25% and I wouldn't be able to keep my doors open.