- Joined
- Dec 9, 2010
- Messages
- 41
- Reaction score
- 1
http://www.nytimes.com/2010/11/02/health/02dental.html
[Now a two-year foundation-supported study has reignited the debate over which practitioners are qualified to provide dental care, especially to underserved populations in high-poverty areas. It found that Alaskas dental therapists provide safe, competent, appropriate care. (The therapists refer cases beyond their scope to supervising dentists.)
The study, financed by the W. K. Kellogg, Rasmuson and Bethel Community Services Foundations, examined the work of dental therapists in five rural Alaskan communities. The positive results are consistent with findings from overseas, where dental therapy programs are well established, said Dr. Mary Williard, a dentist who directs the therapist training program for the nonprofit Alaska Native Tribal Health Consortium.
Ten other states, including Connecticut, are considering midlevel dental provider systems for underserved residents. These practitioners can be trained for relatively little money, said Dr. Allen H. Hindin, who is on the board of the Connecticut State Dental Association.
Partly for that reason, he said, the topic has become a turf issue not just economic, but intellectual and cultural.
Unlike Alaska, Connecticut has no shortage of dentists. But Dr. Bruce J. Tandy, the state associations immediate past president, agreed that dentists were wary of losing patients to midlevel practitioners. Many dentists dont understand how these individuals are going to be used, he said, so they feel threatened.
In fact, he said, the midlevel providers can be trained to do certain simple procedures safely, and they would most likely work in public health clinics, seeing patients whom most dentists will never see in their offices.
Still, the American Dental Association which went to court five years ago in an unsuccessful attempt to block the Alaska program is firm in its opposition. Dr. Gist, the groups president, rejected the accusation that dentists fear a loss of income or status if midlevel practitioners are widely allowed. We dont consider that it has merit, he said.]
So, here's my take on the situation......... As we all know, the national debt is ballooning to a point of unsustainability. In order to keep ourselves financially solvent, we're going to have to make very deep cuts to a large number of government programs, including Medicare and state-run Medicaid. If we keep the tax cuts, the cuts would have to be even deeper. If we keep ongoing military ops overseas, even deeper.... In this situation, reimbursements to physicians and dentists will definitely be cut pretty substanially. There's no way around it, as this country is going broke and there's not enough money to keep reimbursements at this level.
For dentists, Medicare/Medicaid reimbursement are much less important for income, than for physicians. However, with low-income Americans unable to afford a dentist, and with the underserved population likely to increase due to demographic change and Medicare/Medicaid spending cuts, we're talking a large and growing segment of people that won't see dentists.
The solution, for the politicians, is to bring in mid level providers. It allows them to provide a service for low income people and do it on the cheap. Dental franchises/mills or even WalMart can just hire a lot of MLPs and do inexpensive dentistry work, so they'll be in favor, especially since it allows them to tap Medicare/Medicaid funds efficiently and on a large scale. Owner dentists might want to get in on this too, as they can use the MLPs to do lower value activities for cheap, thereby freeing them up to more higher value work and increase revenue.
Of course, there will be losers. In this case, it's gonna be the less experienced dentists. MLPs are going to undercut them by doing the same procedures for less money, thereby reducing their potential earning power. A lot of these MLPs might work at public facilities or Dental Mills, but I'd bet a lot of the low cost dental work will be done at the offices of well established dentists with multiple large clinics too. So dentists will be undercutting other dentists, if they can make a buck, in my view.
Once their numbers hit critical mass, and once the dentist shortage becomes dire enough, there will be a push to give MLPs more autonomy, let them do more proceures, and let them have their own clinics.
With the seeming success of MLPs in Alaska and Minnesota, other states are going to want to get in on this, especially with the push by dental hygenists. It wouldn't be too difficult or costly, in terms of just creating 2 year training courses in universities, and will be popular with hygenists if they can increase their income.
The only alternatives, to more MLPs, are to either increase reimbursements a lot, which there is no money for...... Or we could just let a lot of people go untreated, which is politically not popular....... Besides, with the move towards PAs, NPs, and CRNAs, I think the trend is toward more MLPs in general.... Treat more people, cut costs, and cut dentist/physician salaries. Especially if training MLPs is cheap and fast.
If you thought that doing a DDS instead of MD was the path to secure money, I think you're in for a mid career surprise. I don't want to deter people away from dentistry. It's probably the best career I can think of, but there's just too much of a reason to open the floodgates for MLPs and too many places where MLPs will find work. Income should remain good, especially for specialists, but docs and dentists are going to be increasingly squeezed by lower reimbursements and more MLPs. Ultimately, dentistry will be like the other professions... If you want to really thrive, you need to be very skilled at what you do and a good businessman.
2 States have brought in MLPs and 10 are considering them. With this study, expect that number to go up.
[Now a two-year foundation-supported study has reignited the debate over which practitioners are qualified to provide dental care, especially to underserved populations in high-poverty areas. It found that Alaskas dental therapists provide safe, competent, appropriate care. (The therapists refer cases beyond their scope to supervising dentists.)
The study, financed by the W. K. Kellogg, Rasmuson and Bethel Community Services Foundations, examined the work of dental therapists in five rural Alaskan communities. The positive results are consistent with findings from overseas, where dental therapy programs are well established, said Dr. Mary Williard, a dentist who directs the therapist training program for the nonprofit Alaska Native Tribal Health Consortium.
Ten other states, including Connecticut, are considering midlevel dental provider systems for underserved residents. These practitioners can be trained for relatively little money, said Dr. Allen H. Hindin, who is on the board of the Connecticut State Dental Association.
Partly for that reason, he said, the topic has become a turf issue not just economic, but intellectual and cultural.
Unlike Alaska, Connecticut has no shortage of dentists. But Dr. Bruce J. Tandy, the state associations immediate past president, agreed that dentists were wary of losing patients to midlevel practitioners. Many dentists dont understand how these individuals are going to be used, he said, so they feel threatened.
In fact, he said, the midlevel providers can be trained to do certain simple procedures safely, and they would most likely work in public health clinics, seeing patients whom most dentists will never see in their offices.
Still, the American Dental Association which went to court five years ago in an unsuccessful attempt to block the Alaska program is firm in its opposition. Dr. Gist, the groups president, rejected the accusation that dentists fear a loss of income or status if midlevel practitioners are widely allowed. We dont consider that it has merit, he said.]
So, here's my take on the situation......... As we all know, the national debt is ballooning to a point of unsustainability. In order to keep ourselves financially solvent, we're going to have to make very deep cuts to a large number of government programs, including Medicare and state-run Medicaid. If we keep the tax cuts, the cuts would have to be even deeper. If we keep ongoing military ops overseas, even deeper.... In this situation, reimbursements to physicians and dentists will definitely be cut pretty substanially. There's no way around it, as this country is going broke and there's not enough money to keep reimbursements at this level.
For dentists, Medicare/Medicaid reimbursement are much less important for income, than for physicians. However, with low-income Americans unable to afford a dentist, and with the underserved population likely to increase due to demographic change and Medicare/Medicaid spending cuts, we're talking a large and growing segment of people that won't see dentists.
The solution, for the politicians, is to bring in mid level providers. It allows them to provide a service for low income people and do it on the cheap. Dental franchises/mills or even WalMart can just hire a lot of MLPs and do inexpensive dentistry work, so they'll be in favor, especially since it allows them to tap Medicare/Medicaid funds efficiently and on a large scale. Owner dentists might want to get in on this too, as they can use the MLPs to do lower value activities for cheap, thereby freeing them up to more higher value work and increase revenue.
Of course, there will be losers. In this case, it's gonna be the less experienced dentists. MLPs are going to undercut them by doing the same procedures for less money, thereby reducing their potential earning power. A lot of these MLPs might work at public facilities or Dental Mills, but I'd bet a lot of the low cost dental work will be done at the offices of well established dentists with multiple large clinics too. So dentists will be undercutting other dentists, if they can make a buck, in my view.
Once their numbers hit critical mass, and once the dentist shortage becomes dire enough, there will be a push to give MLPs more autonomy, let them do more proceures, and let them have their own clinics.
With the seeming success of MLPs in Alaska and Minnesota, other states are going to want to get in on this, especially with the push by dental hygenists. It wouldn't be too difficult or costly, in terms of just creating 2 year training courses in universities, and will be popular with hygenists if they can increase their income.
The only alternatives, to more MLPs, are to either increase reimbursements a lot, which there is no money for...... Or we could just let a lot of people go untreated, which is politically not popular....... Besides, with the move towards PAs, NPs, and CRNAs, I think the trend is toward more MLPs in general.... Treat more people, cut costs, and cut dentist/physician salaries. Especially if training MLPs is cheap and fast.
If you thought that doing a DDS instead of MD was the path to secure money, I think you're in for a mid career surprise. I don't want to deter people away from dentistry. It's probably the best career I can think of, but there's just too much of a reason to open the floodgates for MLPs and too many places where MLPs will find work. Income should remain good, especially for specialists, but docs and dentists are going to be increasingly squeezed by lower reimbursements and more MLPs. Ultimately, dentistry will be like the other professions... If you want to really thrive, you need to be very skilled at what you do and a good businessman.
2 States have brought in MLPs and 10 are considering them. With this study, expect that number to go up.
and another study regarding post op complications in general. My guess is that DHATs will be doing more harm than good. 
