Advanced dental hygiene practitioner

[pietrodds]

MDs do not as a general rule understand the business component of delivering health care. Many of them have only learned it the hard way with reductions in income and increased demands which prevent them from what they actually trained to do. Most would now disuade future docs from going into the profession.

On top of not grasping the business of their own field now they're delving into dentist. The business of dentistry is much more complicated and just plain more expensive. Dentistry is not expensive so much as because dentists charge for their professional touch as it is inherently expensive because of the overhead of doing dentistry. The only way gov't intervention can lower costs and improve access(which is a farce) is to finance the overhead of dentistry which means openning tons of clinics nationwide and paying staff. This is a lot more than just signing a bill permitting anyone with a pulse to do dentistry. In the end, they'll find that raising medicaid reimbursement to be a much cheaper option but they're too ignorant to realize that til after the fact.

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[DrJeff]

MDs do not as a general rule understand the business component of delivering health care. Many of them have only learned it the hard way with reductions in income and increased demands which prevent them from what they actually trained to do. Most would now disuade future docs from going into the profession.

On top of not grasping the business of their own field now they're delving into dentist. The business of dentistry is much more complicated and just plain more expensive. Dentistry is not expensive so much as because dentists charge for their professional touch as it is inherently expensive because of the overhead of doing dentistry. The only way gov't intervention can lower costs and improve access(which is a farce) is to finance the overhead of dentistry which means openning tons of clinics nationwide and paying staff. This is a lot more than just signing a bill permitting anyone with a pulse to do dentistry. In the end, they'll find that raising medicaid reimbursement to be a much cheaper option but they're too ignorant to realize that til after the fact.

Agree 100%! In CT, after a LONG legislative labbying efforts (and the state looking at the very real possibility of loosing a court case and a bunch of $$ about access to care for the medicaid population) the state DRAMATICALLY increased the medicaid reimbursement rates. You know what happened?? In the basically 8 months from when the rate increase took effect, the number of dentists enrolled as providers with the State of CT and it's medicaid program went from less than 100 to now over 700!

While the current rates for most providers in CT aren't 100% of their regular fees, for most they are over 80% of our regular fees(so we're atleast covering our costs and in most cases making a few bucks too), whereas before the fee increases, the rates were at a level where very few, if any dentists could even cover their costs.

Since they upped the rates in CT, my partner and I have taken in as new patients over 150 medicaid patients(we see all the kids in a family and 1 adult as the over 21 medicaid rates still don't allow us to cover our operating expenses for many procedures). Nice thing atleast from a business perspective is as the economy has slowed and job losses(and dental insurance losses) have occurred in the private sector thus resulting in an increase in patient cancellations, this medicaid population of patients with the now fair reimbursement level has filled many a potential void in a schedule(especially the hygiene schedule) with a profitable patient. And in my book atleast both seeing a previously underserved population that very often had significant treatment needs and at the same time being able to make a few $$ isn't a bad thing at all.

 

[capisce?]

Gee, I wonder why the most accurate posts on here are from actual private practice dentists

While everyone is bickering over expanded function dental hygienists I'm out with my partner expanding our practice and using my 6 year odyssey in dental education to wow the parents of our patients and to provide the highest level of dental care to the kids I see.

You can cram a 'dental education' down someone's throat but doesn't always translate into competence. People/parents are smart and when they break it down to who they want to see, it's going to be the people with the better training. Sure there are those who want that 20$ extraction and think that the health of their teeth is on the same level of importance as buying a pack of gum...but those aren't the patients I would want in my practice anyways.

 

[KOM]

If only I could convince the U of MN to look at some of these proposed #'s in CT. Are there any reliable sources as to how these new legislative measures in CT are affecting the access to care issue?

That's very interesting to hear though and I'll be sure to bring it up with staff and faculty here at the U of MN so perhaps they can stop this asenine idea of theirs.

 

[DrJeff]

If only I could convince the U of MN to look at some of these proposed #'s in CT. Are there any reliable sources as to how these new legislative measures in CT are affecting the access to care issue?

That's very interesting to hear though and I'll be sure to bring it up with staff and faculty here at the U of MN so perhaps they can stop this asenine idea of theirs.

Since we're still in the first year since the fee increase went through, there isn't an official data thats been released about the amount of increased care that has occurred(probably mid summer we'll see actual $$ figures/#'s of procedures). The only concrete data that's been put out, and it came through our state dental society BTW, is the increase in enrolled providers by 600+. Apparently now, through the part of the state medicaid system that oversees the dental side of things, they've gone from a situation where a year ago they had enrollees complaining about not being able to find a dentist in their area to a situation where now they have people complaining that they don't like the provider they went to and want to see a different doc in the area.

The issue that is slightly concerning about the entire situation, is that with CT now looking at a close to 1 BILLION dollar state budget deficit for next year, the issue that's going through some of our minds is how will it be looked upon when a line item of the budget that used to be in the neighborhood of 5 Million/year is say potentially 15-20+million a year(just the scale of the fee increase alone for the same amount of treatment would turn 5 million into 10 million a year, and then add in the extra 600 providers now participating and those treatment $$'s are going to add up.

The other factor to with the current bufget crisis in CT, is that we went from a state where it was expected that legislation WOULD be introduced to create a mid-level provider(one of our state reps who sits on the public health committe is a still licensed, non practicing hygienist and as said that she was going to introduce the bill to committee), to now a situation where becuase of lack of $$ to fund the new programs that would be needed to educate, oversee, and provide a location to practice for the mid level provider, this legislation apparently won't be introduced in the current legislative session.

 

[DrJeff]

The other factor to with the current bufget crisis in CT, is that we went from a state where it was expected that legislation WOULD be introduced to create a mid-level provider(one of our state reps who sits on the public health committe is a still licensed, non practicing hygienist and as said that she was going to introduce the bill to committee), to now a situation where becuase of lack of $$ to fund the new programs that would be needed to educate, oversee, and provide a location to practice for the mid level provider, this legislation apparently won't be introduced in the current legislative session.

Boy I wish I had held off posting this last paragraph for a few hours, as i just got notification of the introduction of the bill to the CT state legislature for the creation of the advanced dental hygiene practitoner.

The plot thickens

 

[Cold Front]

Boy I wish I had held off posting this last paragraph for a few hours, as i just got notification of the introduction of the bill to the CT state legislature for the creation of the advanced dental hygiene practitoner.

The plot thickens

So, does this mean that there is a good chance the bill will pass despite all efforts to resolve the access crisis has been exhausted?

Once the word goes out about the passing of middle level practitioners' bill in CT, you will see other states flocking together to create and pass their own bills within couple of years or so.

 

[DrJeff]

So, does this mean that there is a good chance the bill will pass despite all efforts to resolve the access crisis has been exhausted?

Once the word goes out about the passing of middle level practitioners' bill in CT, you will see other states flocking together to create and pass their own bills within couple of years or so.

The bill is by no means passed. It's just been introduced to the public health committee. After hearings are held, then if the public health committe decides that it's a worthwhile bill, then it will be introduced to the entire CT House of Representatives, and if they think it's a worthy bill and vote to pass it, then onto the CT Senate, and if they think it's worthy and pass it, then onto the Governor's desk to be signed into law or vetoed(in CT we have a democratically controlled house + senate and a republican governor, so a bill making it through the house and senate isn't necessarily a given that it will become law).

Essentially, our governor has said that in this budget crisis that we're in, basically no new spending programs will be approved, and most existing programs can expect budget decreases. This last part will probably mean that this bill won't become law.

The interesting thing that was done will this bill,is prior to now, the hygienists were looking to have the bill be solo essentially and not have an expanded function dental assistant clause attached to it. However, the bill that was introduced yesterday had BOTH an advanced dental hygiene practitioner and an expanded function dental assistant component.

To give you and idea though about why organized dentistry can be a good thing politically and how quickly it can act, since it was released yesterday AM around 9:30 that this bill was introduced, there have been 2 e-mail sent to the all the members of the CT State Dental Association (1 from the president and 1 from the executive director) about this bill introduction and also asking for hard numbers from the membership who are providing care to state medicaid patients(it's called the HUSKY program here) about how many new patients, # of procedures done, and billable $$'s. Data like this can be VERY effective to legislative committee members when as dentists we can say, "since the fee structure was increased, over 600 additional dentists are now providing care to HUSKY patients, seeing over X # of patients, doing Y number of clinical procedures at a cost of $Z"

This will in all likelyhood a LONG process, and if it is defeated, probably not the last time we'll have a bill of similar nature introduced in CT

 

[Cold Front]

The interesting thing that was done will this bill,is prior to now, the hygienists were looking to have the bill be solo essentially and not have an expanded function dental assistant clause attached to it. However, the bill that was introduced yesterday had BOTH an advanced dental hygiene practitioner and an expanded function dental assistant component.

To give you and idea though about why organized dentistry can be a good thing politically and how quickly it can act, since it was released yesterday AM around 9:30 that this bill was introduced, there have been 2 e-mail sent to the all the members of the CT State Dental Association (1 from the president and 1 from the executive director) about this bill introduction and also asking for hard numbers from the membership who are providing care to state medicaid patients(it's called the HUSKY program here) about how many new patients, # of procedures done, and billable $$'s. Data like this can be VERY effective to legislative committee members when as dentists we can say, "since the fee structure was increased, over 600 additional dentists are now providing care to HUSKY patients, seeing over X # of patients, doing Y number of clinical procedures at a cost of $Z"

This will in all likelyhood a LONG process, and if it is defeated, probably not the last time we'll have a bill of similar nature introduced in CT

I think increased medicaid funding will play a big role against bills like this, as more dentists continue to enroll in government funded programs, mid-level practitioners will have little to make their case on. It's all about access, specially the geriatric folks.

 

[nevi09]

I really do not think many of you realize what dental hygienists go through for schooling. We are more than ‘teeth cleaners'. It's not just 2 years in a community college then you get your associates. Most schools actually require 3 years (just for an A.S.) and some are actually moving towards a curriculum that is 4 years and awarded a Bachelor's of Science. We have to take the basic sciences (biology, chemistry, organic chem, microbiology, anatomy and physiology). Then it is two solid years of dental hygiene courses: head & neck, pharmacology, theory, community, ethics, periodontology, oral pathology, nutrition, and local anesthesia to name a few. After that we too go through national boards, clinical exams, and if we want, separate tests for LA and nitrous oxide licensure. I'm not saying that the intensity is the same as dental school, but we don't sit around in school twiddling our thumbs.

I am from Maine and the top half of the state is in dire need of dentists. If dentists are not willing to go to underserved areas or accept patients on Medicare/Medicaid assistance, then why is it not feasible for willing hygienists to further their education and possibly service these areas? In order to get into the Master's Program for the ADHP the DH needs to complete their B.S. degree. I actually came upon this forum when I googled ‘ADPH'. Some of the ignorant comments regarding hygienists amazed me. I originally was going to go to dental school. I received my B.S. in Biology and got accepted to Tufts and Dalhousie. However I decided I wanted to make sure I loved dentistry before dropping a couple hundred grand on something I may regret. I do not regret my decision for a minute. I don't see this being the end of my education either, whether its getting my Master's in Public Health, going into Independent practice (allowed in ME), going for the ADHP, or possibly going to dental school.

You're afraid if we become practitioners we are going to head straight to the city and take your patients and $$$. That is not a reason to oppose it. The ADHA is trying to produce a solution to the access to care issue that the government and the ADA are not. You're afraid we are going to be delivering substandard care, but I have seen poor care provided by dentists.
Hygienists are an important part of the dental office. About 45% of patient visits are for hygiene services and bring it 60-65% of the earning to the office. They deserve your respect, just as you deserve theirs.

I'm curious to your thoughts on the Vermont ADA's response to the passing of the Independent Practitioner. They gave a Vermont license to an Alabama hygienist. If you don't know, in Alabama a hygienist is on the job trained (absolutely NO schooling or licensure requirements). That is scary. It is also sad that a group of professionals needed to stoop to childish behaviors.

Several of you scoff at our attempts to better the nation's oral health with such programs as ‘Give Kids a Smile'. Please don't think you're superior because you have a DMD or DDS behind your name.

 

[aphistis]

I really do not think many of you realize what dental hygienists go through for schooling.

I know you don't realize what dentists go through for schooling.

I'm curious to your thoughts on the Vermont ADA's response to the passing of the Independent Practitioner. They gave a Vermont license to an Alabama hygienist. If you don't know, in Alabama a hygienist is on the job trained (absolutely NO schooling or licensure requirements). That is scary. It is also sad that a group of professionals needed to stoop to childish behaviors.

I'd say it makes the point pretty elegantly. If you can have a license, why can't she? In other words, now who has the superiority complex?

Please don't think you're superior because you have a DMD or DDS behind your name.

We don't think we're superior. We think we're dentists.

 

[KOM]

I'd say it makes the point pretty elegantly. If you can have a license, why can't she? In other words, now who has the superiority complex?

Checkmate.

 

[KOM]

I originally was going to go to dental school. I received my B.S. in Biology and got accepted to Tufts and Dalhousie. However I decided I wanted to make sure I loved dentistry before dropping a couple hundred grand on something I may regret. I do not regret my decision for a minute.

Sorry, but I don't buy this for a second.

But, even giving you the benefit of the doubt, you chose hygiene period. If you want to expand your scope, go back to dental school. We have 3 people in our class that did exactly that.

 

[EvilTeaDDS]

Rambo2006 or anyone else ....

Do you still have a copy of that pre-written letter to send to senators??? I know a lot has changed since that letter and some wording will need to be changed in the letter, but I could really use a copy asap. Thanks to everyone!

 

[Taurus]

If dentists are not willing to go to underserved areas or accept patients on Medicare/Medicaid assistance, then why is it not feasible for willing hygienists to further their education and possibly service these areas?

If I got 5 cents for every time I heard this argument from a midlevel, I would be a freakin' millionaire by now. The argument is pure fiction. After other midlevel groups such as NP's and CRNA's got their autonomy by making this argument, they did not fulfill their promises. People, not surprisingly, want to live in places where there are good schools, culture, sporting events, etc. That often is in large cities, where the physicians mostly are. People do not want to live in the boonies. The newly autonomous NP's and CRNA's went on to compete with the physicians for the same patients. If dentists allow hygienists to gain autonomy and expanded scope, the same will happen.

 

[Theillestill]

Just do what they do in Australia. Force students to do rural rotations.

 

[LicensedDH]

Who are you KOM? I would watch your quick tongue. You don't want to embarass yourself and your representation of the U of M Dental School

 

[Frank Cavitation]

Hi,

I haven't visited this forum ever since I graduated in '05. I have since started my own practice in Canada and hired a hygienist. In my area it is now legal for hygienists to start independent practices, and while most of them are in the overserved metro areas a few do stay in the rural communities.

I browsed a dozen threads at the same time, and as an outsider I would like to remark that this discussion is very similar to the one about Mexicans being allowed to practice dentistry in California. Dentists don't want newcomers sharing the $ pie, and newcomers suggesting that there is actually a second pie (underserved population).

Denturists are supposed to lower the cost of dentures. I have found that in many cases, they charge whatever the market can bear, resulting in minimal benefit to the public. This is a potential undesired result for the legislation regarding OHPs and Mexicans.

In undergrad I learned that entropy in the universe only increases. As does human society; laws get piled on and life only gets more confusing.

 

[KOM]

Who are you KOM? I would watch your quick tongue. You don't want to embarass yourself and your representation of the U of M Dental School

Nah, we already have you for that.

Nothing will change with this new legislation. Nothing. As far as the U of M hygiene students are concerned, I would argue that they're a very talented bunch, receive great training at the U of M, and if they were going to implement something like this I'm glad they're doing it here.

However, money will always be the driving force. With the price of your education increasing and the time invested out of the workforce, you're going to demand higher wages as well. The only way to overcome the financial barrier to access to care is for everyone else to reduce their fees (schools, dental labs, real-estate owners.) As far as the geographical barrier...your guess is as good as mine. I'd say expand the rural health care scholarship program.

 

[NyCzPeter]

Why don't we just make them like our PAs. As long as they practice within our scope and can't practice independently.

 

[Aceofspades]

Why don't we just make them like our PAs. As long as they practice within our scope and can't practice independently.

Dentists can't do that to hygienists because they have a different governing body. The relationship is very similar to physicians and nurses and you see similar battles brewing in that field.

 

[aphistis]

Dentists can't do that to hygienists because they have a different governing body. The relationship is very similar to physicians and nurses and you see similar battles brewing in that field.

What? Hygienists are governed by the board of dentistry. Nurses are not governed by the board of medicine, but by independent boards of nursing. You've got it backwards here.

 

[NyCzPeter]

yea I vote turn hygenists into the PA model where they can practice under the scope of the dentist and under supervision. Well not that my vote really matters but who thinks it's a good idea say ayyayy

Question. Are hygenists allowed to open independent dental hygiene clinics?

 

[Aceofspades]

What? Hygienists are governed by the board of dentistry. Nurses are not governed by the board of medicine, but by independent boards of nursing. You've got it backwards here.

Really? Are you sure? If that's the case then dentists literally brought this upon themselves. Why would they water down their own profession?

 

[aphistis]

Really? Are you sure? If that's the case then dentists literally brought this upon themselves. Why would they water down their own profession?

You're being awfully condescending for someone who doesn't know which professions are governed by which professional boards. I encourage you to come back to this discussion after doing some basic research on the relevant topics.

 

[Aceofspades]

You're being awfully condescending for someone who doesn't know which professions are governed by which professional boards. I encourage you to come back to this discussion after doing some basic research on the relevant topics.

What's condescending about what I said? Dentists go through 4 years (5 including GPR/AEGD) as part of their comprehensive education about the oral cavity as well as overall systemic health. The fact that another group of people, regardless of governance, is being approved to do some of the same procedures with less education suggests:
1. Dentists are over-educated and one does not need to go through 4-5 years of training to do ADHP procedures
2. The dental profession is being diluted or
3. 4-5 years of training are necessary to be a dentist and ADHP's lack of the full dental education can lead to the administration of lower quality care.

-Edit-
Hell, even foreign trained dentists have to go back to dental school to practice general dentistry.

 

[lotexigeus]

What's condescending about what I said? Dentists go through 4 years (5 including GPR/AEGD) as part of their comprehensive education about the oral cavity as well as overall systemic health. The fact that another group of people, regardless of governance, is being approved to do some of the same procedures with less education suggests:
1. Dentists are over-educated and one does not need to go through 4-5 years of training to do ADHP procedures
2. The dental profession is being diluted or
3. 4-5 years of training are necessary to be a dentist and ADHP's lack of the full dental education can lead to the administration of lower quality care.

-Edit-
Hell, even foreign trained dentists have to go back to dental school to practice general dentistry.

did you read the thread?

 

[lotexigeus]

yea I vote turn hygenists into the PA model where they can practice under the scope of the dentist and under supervision. Well not that my vote really matters but who thinks it's a good idea say ayyayy

Question. Are hygenists allowed to open independent dental hygiene clinics?

Question. Did you also see the leprechaun?

 

[KOM]

The first class of dental therapists will begin at the U of MN this fall semester.

 

[NyCzPeter]

The first class of dental therapists will begin at the U of MN this fall semester.

"Under the university's proposal, dental therapists could practice preventive care, such as applying sealants and fluoride, without a dentist on site. More complex procedures, such as pulling or drilling teeth, could be done by a therapist only under a dentist's supervision. And certain procedures would still be done only by dentists."

Not bad considering they need a dentist on site for extractions & stuff. So as long as they can't start popping out their own practices, I think it should be fine. Now we get our own PAs =D

 

[pietrodds]

Regardless of what these folks/politicians approve they still fail to understand the core issue... it is inherently expensive to operate a dental office! The average dentist's overhead is 35% and this is doing procedures more expensive and advanced than the proposed 'super-hygienist'. So let's say you discount your dentistry to the point where you're making absolutely no money... you pretty much knock of 35% of your fee. Someone still has to pay the 65% and it doesn't matter who is doing the dentistry whether it's a dentist or some guy who happened to stay at a Holiday Inn Express last night. The only way this ADHP benefits anyone is if the state gov't also pays all the overhead of the clinics in which they operate. I don't see states having the financial capability to do that any time soon.

What we as dentists should be getting behind is following states have greatly expanded the capabilities of assistants to allow them to place restorations and increase production. If the states want to then open clinics in severely underserved areas where dentists could volunteer or even get a tax deduction that would improve involvement of dentists. All of this though will increase gov't bureaucracy and cost and in the end they'll find that just increasing fees to dentists is more cost-effective for the state. However, just giving out licenses to ADHP isn't going to improve access as they're not going to be willing to nor make it financially viable to open they're own offices. The numbers just don't add up. At best, some entrepeneurial dentists may elect to start satelite offices and staff them with ADHPs and just travel between offices.

Let's assume I'm wrong, and it's a boom for these pseudo-dentists who get to practice dentistry(quality of care aside) without having to put in the time it takes to adequately train a dentist. We're going to have a ****load of young dentists with 300K in debt that are going to need a bailout like our banks and GM.

In some states there's a push to make a extra year GPR manditory due to the fact that dentists are faced with increasing amounts of info to pack into 4 years and then in others you see a push for providers with a fraction of the skill or training... it doesn't make sense except for the fact that the politicians want to look like they're doing something for the voting population that doesn't pay taxes and wants more free handouts.

 

[DrJeff]

The proposed ADHP bill in Connecticut died in committee for this legislative year today

 

[lotexigeus]

woot woot

 

[The Anhedonia]

Forgive me if I sound ignorant, but the mentality held by dentists about ADHP programs sound a lot like the current financier's mentality of hedge funds and mortgage backed securities before the economy's bubble popped.

There is nothing to prevent ADHP's from practicing in urban areas as well has rural. The argument that "people won't pay for cheap procedures" seems null. Look at the state of our economy and healthcare in general. At this point, a tremendous amount of people cannot afford top notch dental, so even in urban areas, an ADHP seems very advantageous.

To all predents, dental students, and dentists, is it not possible that you are overlooking the implications of an ADHP? To say that nothing will happen seems....short-sighted.

For context, I am a pre-dent student.

 

[Guy Smiley]

Forgive me if I sound ignorant, but the mentality held by dentists about ADHP programs sound a lot like the current financier's mentality of hedge funds and mortgage backed securities before the economy's bubble popped.

There is nothing to prevent ADHP's from practicing in urban areas as well has rural. The argument that "people won't pay for cheap procedures" seems null. Look at the state of our economy and healthcare in general. At this point, a tremendous amount of people cannot afford top notch dental, so even in urban areas, an ADHP seems very advantageous.

To all predents, dental students, and dentists, is it not possible that you are overlooking the implications of an ADHP? To say that nothing will happen seems....short-sighted.

For context, I am a pre-dent student.

Are you saying people should get substandard care then? There are many more options available to poor people in urban areas compared with rural areas. Most cities have public health clinics that accept all Medicaid and work on sliding scales. There are often free clinics in larger cities as well.

 

[aphistis]

Are you saying people should get substandard care then? There are many more options available to poor people in urban areas compared with rural areas. Most cities have public health clinics that accept all Medicaid and work on sliding scales. There are often free clinics in larger cities as well.

This is nice thinking, but it won't pay people's dental bills. Inadequate access to care is a real problem, and there are many more people needing this kind of care than there are facilities and providers offering it. As you pointed out, however, forcing people to accept substandard care from inadequately trained providers is not the solution.

 

[Plopper]

The proposed ADHP bill in Connecticut died in committee for this legislative year today

!!!!!

Forgive me if I sound ignorant, but the mentality held by dentists about ADHP programs sound a lot like the current financier's mentality of hedge funds and mortgage backed securities before the economy's bubble popped.

There is nothing to prevent ADHP's from practicing in urban areas as well has rural. The argument that "people won't pay for cheap procedures" seems null. Look at the state of our economy and healthcare in general. At this point, a tremendous amount of people cannot afford top notch dental, so even in urban areas, an ADHP seems very advantageous.

To all predents, dental students, and dentists, is it not possible that you are overlooking the implications of an ADHP? To say that nothing will happen seems....short-sighted.

For context, I am a pre-dent student.

excuse me, but entering dental school, coming out with 250K in debt and then another 150K for a practice (at least)...i don't want some ADHP whose "primary purpose" was to serve underserved areas competing with me for my patients...how am i supposed to justify 400K in loans (not counting my 155K in undergraduate) knowing i will have to struggle to find patients/cut profit margins even more to compete!?

I want people to have access to dental care, i really do, otherwise i wouldn't be becoming a dentist. But this is really scaring me, knowing that if this eventually passes, it will make paying off my loans even more difficult. I think every dentist should just have an incentive (tax break) to volunteer at a clinic in an under served area

 

[The Anhedonia]

!!!!!



excuse me, but entering dental school, coming out with 250K in debt and then another 150K for a practice (at least)...i don't want some ADHP whose "primary purpose" was to serve underserved areas competing with me for my patients...how am i supposed to justify 400K in loans (not counting my 155K in undergraduate) knowing i will have to struggle to find patients/cut profit margins even more to compete!?

I want people to have access to dental care, i really do, otherwise i wouldn't be becoming a dentist. But this is really scaring me, knowing that if this eventually passes, it will make paying off my loans even more difficult. I think every dentist should just have an incentive (tax break) to volunteer at a clinic in an under served area

that's exactly my point. i too believe that society at all economic tiers should have access to the finest health care available. however, is it not plausible to think that some people will choose a potentially lower cost alternative? An ADHP will not have 300k+ in loans to pay off, so it is reasonable to axe that portion out of their overhead.

this is precisely what worries me about the future of dentistry. i love the profession, i've worked at clinics to service those without access to care, and quite frankly (without any superficial cliche) making a tremendous amount of money is not my priority in the profession. however, i honestly fear that i will be diving into massive student debt to be unable to pay it off at a reasonable rate.

 

[Aceofspades]

I just hope we're not looking at a "dental bubble" that will pop before I start practicing. If income drops fine, but it's absurd that loan debt will remain the same if not increase.

 

[Lemons]

As someone who currently does not have Dental Insurance, this initially sounds like a great idea. I like the idea behind a midlevel practioner to lower costs but I really don't like how they're doing it.

It's pretty cool that Dental Hygensits can do cleanings and save patients a lot of money on preventive care but I don't think just any hygentist who gets a masters should be doing tooth extractions. I personally wouldn't let a dentist who didn't have at least 10 years of experince try to pull one of my teeth, let alone a "highly trained" hygienist.


There's a reason Dental School is 4years long in addition to 4 years of undergrad. What hygienists are trying to say is that current dental education is not efficient enough. They may or may not be right. If it wasn't for the unsupervised nature of the bill and some of the procedures involved, I would think it's a great idea to lower dental costs for everyone including those that can already afford it (bad for the dentist fresh out of school with $400,000 in student loans). The scary part being the lack of on-site supervision from a dentist for tooth extractions (correct me if I'm wrong about this aspect of the bill because even as I'm typing this, it sounds crazy).

Anyways, I thought everyone should look at this. Dentists are the only medical profession that doesn't have an "excellent" job outlook. Hygienists, are rated as having an "excellent" job outlook. I'm sure that "good" job outlook for Dentists may or may not be lowered because of this new development. Hard to say.

http://www.bls.gov/oco/ocos072.htm
http://www.bls.gov/oco/ocos097.htm

I'm thinking I should just apply to medical school or B-school, I don't want to be looking for work with $300,000 student loan debt. Time to reassess my career choice. I guess it's not too late to change. Sorry for everyone currently in Dental School or heading there this this year.

 

[Sbosu]

As someone who currently does not have Dental Insurance, this initially sounds like a great idea. I like the idea behind a midlevel practioner to lower costs but I really don't like how they're doing it.

It's pretty cool that Dental Hygensits can do cleanings and save patients a lot of money on preventive care but I don't think just any hygentist who gets a masters should be doing tooth extractions. I personally wouldn't let a dentist who didn't have at least 10 years of experince try to pull one of my teeth, let alone a "highly trained" hygienist.


There's a reason Dental School is 4years long in addition to 4 years of undergrad. What hygienists are trying to say is that current dental education is not efficient enough. They may or may not be right. If it wasn't for the unsupervised nature of the bill and some of the procedures involved, I would think it's a great idea to lower dental costs for everyone including those that can already afford it (bad for the dentist fresh out of school with $400,000 in student loans). The scary part being the lack of on-site supervision from a dentist for tooth extractions (correct me if I'm wrong about this aspect of the bill because even as I'm typing this, it sounds crazy).

Anyways, I thought everyone should look at this. Dentists are the only medical profession that doesn't have an "excellent" job outlook. Hygienists, are rated as having an "excellent" job outlook. I'm sure that "good" job outlook for Dentists may or may not be lowered because of this new development. Hard to say.

http://www.bls.gov/oco/ocos072.htm
http://www.bls.gov/oco/ocos097.htm

I'm thinking I should just apply to medical school or B-school, I don't want to be looking for work with $300,000 student loan debt. Time to reassess my career choice. I guess it's not too late to change. Sorry for everyone currently in Dental School or heading there this this year.

And I would love to spend $15 a week on food instead of $50, it would be great, but thats not how our society works. It is hard to have a business that treats patients and charges them less than it costs for your overhead which from what I understand is the problem with this "access problem" to dental care. I don't care if its a ADHP an OHP or whatever you want to call them, they will not be able to treat a patient if they are getting reimbursed less than it costs to do the procedure from medicaid.

 

[Lemons]

And I would love to spend $15 a week on food instead of $50, it would be great, but that's not how our society works. It is hard to have a business that treats patients and charges them less than it costs for your overhead which from what I understand is the problem with this "access problem" to dental care. I don't care if its a ADHP an OHP or whatever you want to call them, they will not be able to treat a patient if they are getting reimbursed less than it costs to do the procedure from medicaid.

Yeah, this will do little to nothing to address the real problem of access to dental care for the poor but it will lower the costs for those who can already afford it. By increasing the pool of people who can legally perform these services without the massive amount of student loan debt dentists have, the price of will go down enough so those of us who do not qualify for government programs can get it for a lower price and you can bet insurance companies will jump on this as well. The point is, it won't help the access problem when it comes to the poor because the government doesn't provide enough to cover overhead but the middle class will benefit greatly.

I calculated it out, even if there is bubble in dentists about to occur with these new hygienists, what will happen is dentists will have to make less money pushing out these "advanced" hygienists. Dentists will still make around $70,000 (around what I would assume the top half of these "advanced hygienists" will make) but that's little comfort when you have $250,000+ in student loan debt.

Like it or not, this the future of dentistry. The "super" hygienists aren't even the ones I'm worried about. It's a very specialized field that requires a massive amount of debt to enter and future advancements in dental care or changes in policy can have drastic consequences on one's earning power (aka ability to pay down that debt). If I go dental school I may have to accept that there might be a chance that I will never be able to crawl out of debt.

It's looking more and more like a risky proposition, I worked too hard all these years to take that bet. I don't what I'm going to do yet but I've already started to look at other careers. Too bad, dentistry was my dream career but I also want to be a home owner one day and have enough to retire on.

To all of you complaining about this, it's sucks but we live in a capitalist society. If something isn't efficient (dental care at this moment), our system will find a way. I have a friend where in his country there are two types of dentists, real ones who do to dental school for 4 years and black market dentists who just learn the procedures from someone and perform them for a fraction of the cost. This is the system the market wants and we should legalize it and regulate it and do our best to make sure it is safe while not trying to stop the streamlining of the dental process. I still think it's crazy for hygienists to be filling cavities or pulling teeth without a dentist on site. CRAZY, I'm still having a hard time believing someone thought it would be a good idea.

I honestly see the future of dentistry being 2 or 3 hygienists performing everything from cleanings to yes even extractions and one supervising dentist looking over their shoulder. Pharmacy is like this, pharmacists don't fill prescriptions anymore, they just look over the work of the technicians. Dental schools need to cut down on how many people they accept or drastically lower tuition if they want to keep a high standard for dentists because it's not looking like a good option for most people.

 

[The Anhedonia]

IMO, it boils down to supply and demand. And it seems that the supply side of this scenario is going to increase. Certainly, the quality may vary among the different suppliers of dental care, but hey, sometimes dentists do a crappy job too. (i can't tell you how many times the OMFS i shadow has said during an extraction, "wow his/her dentist did a crappy job on this crown/filling/bridge/etc.")

i think someone made an allusion to Wal-Mart earlier. to use wal-mart again as an example, think of the impact that Wal-mart has had on local economies. When i lived in MA, the community protested the development of any wal-marts so as to protect the local economies (e.g. mom n pop stores). but the problem is not intrinsic to wal-mart; it is the consumer that makes wal-mart possible. is it, therefore, not plausible that people will select the lowest cost solution? indeed, quality of care may vary, but many people will in fact take for granted the expertise of a dentist because they do not perceive the necessity of such a professional.

 

[aphistis]

Yeah, this will do little to nothing to address the real problem of access to dental care for the poor but it will lower the costs for those who can already afford it. By increasing the pool of people who can legally perform these services without the massive amount of student loan debt dentists have, the price of will go down enough so those of us who do not qualify for government programs can get it for a lower price and you can bet insurance companies will jump on this as well. The point is, it won't help the access problem when it comes to the poor because the government doesn't provide enough to cover overhead but the middle class will benefit greatly.

I calculated it out, even if there is bubble in dentists about to occur with these new hygienists, what will happen is dentists will have to make less money pushing out these "advanced" hygienists. Dentists will still make around $70,000 (around what I would assume the top half of these "advanced hygienists" will make) but that's little comfort when you have $250,000+ in student loan debt.

Like it or not, this the future of dentistry. The "super" hygienists aren't even the ones I'm worried about. It's a very specialized field that requires a massive amount of debt to enter and future advancements in dental care or changes in policy can have drastic consequences on one's earning power (aka ability to pay down that debt). If I go dental school I may have to accept that there might be a chance that I will never be able to crawl out of debt.

It's looking more and more like a risky proposition, I worked too hard all these years to take that bet. I don't what I'm going to do yet but I've already started to look at other careers. Too bad, dentistry was my dream career but I also want to be a home owner one day and have enough to retire on.

To all of you complaining about this, it's sucks but we live in a capitalist society. If something isn't efficient (dental care at this moment), our system will find a way. I have a friend where in his country there are two types of dentists, real ones who do to dental school for 4 years and black market dentists who just learn the procedures from someone and perform them for a fraction of the cost. This is the system the market wants and we should legalize it and regulate it and do our best to make sure it is safe while not trying to stop the streamlining of the dental process. I still think it's crazy for hygienists to be filling cavities or pulling teeth without a dentist on site. CRAZY, I'm still having a hard time believing someone thought it would be a good idea.

I honestly see the future of dentistry being 2 or 3 hygienists performing everything from cleanings to yes even extractions and one supervising dentist looking over their shoulder. Pharmacy is like this, pharmacists don't fill prescriptions anymore, they just look over the work of the technicians. Dental schools need to cut down on how many people they accept or drastically lower tuition if they want to keep a high standard for dentists because it's not looking like a good option for most people.

Nothing ventured, nothing gained.

If you think dentistry is unstable, I'd love to hear what you think after seeing what an MBA is worth nowadays. It doesn't help that this apocalyptic scenario is fueled by a number of assumptions that are improbable where they're not outright factually incorrect.

 

[Lemons]

Nothing ventured, nothing gained.

If you think dentistry is unstable, I'd love to hear what you think after seeing what an MBA is worth nowadays. It doesn't help that this apocalyptic scenario is fueled by a number of assumptions that are improbable where they're not outright factually incorrect.

True, MBA's are free because my company pays for them. Even if you get fired, that's fine, you're debt free and can easily switch to another career on a whim. There's freedom and peace of mind that comes with being debt free. I love dentistry and I'm trying really hard to justify still attending dental school but for me I need SOLID reassurance I will be able to pay off those loans. That's a scary amount of debt and unless I am completely sure I will be able to repay it, I'm not sure yet that I want to take the risk.

 

[lotexigeus]

It doesn't help that this apocalyptic scenario is fueled by a number of assumptions that are improbable where they're not outright factually incorrect.

kinda what i was thinking

 

[Plopper]

True, MBA's are free because my company pays for them. Even if you get fired, that's fine, you're debt free and can easily switch to another career on a whim. There's freedom and peace of mind that comes with being debt free. I love dentistry and I'm trying really hard to justify still attending dental school but for me I need SOLID reassurance I will be able to pay off those loans. That's a scary amount of debt and unless I am completely sure I will be able to repay it, I'm not sure yet that I want to take the risk.

true, i would love to have an SOLID assurance that i will be able to pay off my student loans as a dentist...

with that said, i've never met a dentist who didn't recommend the profession or who couldn't pay of his loans/buy a house/buy a practice/drive a nice car/loved what he did/loved meeting people all day long/love the nature of the work etc...it's a good (highly respected) profession

my $.02

 

[50 CAL BMG]

true, i would love to have an SOLID assurance that i will be able to pay off my student loans as a dentist...

with that said, i've never met a dentist who didn't recommend the profession or who couldn't pay of his loans/buy a house/buy a practice/drive a nice car/loved what he did/loved meeting people all day long/love the nature of the work etc...it's a good (highly respected) profession

my $.02

How about a SOLID ASSURANCE that you won't even fail out of your D1 year? Just quit.

 

[ou_jay]

I'm not sure I believe in an "access to care" problem. I think usually the problem is a lack of desire to access care.

First and foremost dental care is mostly elective. The only truly medically necessary dental care is extraction of an infected or painful tooth. Second for 99% of people the need for dental care is a result of their own actions. With the exception of a few, rare genetic problems with teeth, tooth decay and periodontal disease are caused by eating too much sugar and/or poor oral hygiene.

Also, most urban areas have a wide variety of free and sliding scale clinics that provide minimally necessary dentistry (extractions and sometimes dentures). Where I live there are several clinics that do extractions for free. The dental school does dentures for $220 per arch. If the dentures last at least five years then the total cost to the patient for two arches is $7.33 per month. This is more that many people who supposedly cannot access care spend on unnecessary expenses (e.g. cable TV, fast food, etc). For those who truly cannot afford $7.33 per month there are a few free clinics that provide dentures too.

Finally, the argument that rural people have no access is again about desire not true access. Thanks to modern technology, most places in the US are within a few hours drive of an urban center. To say you don't have access to care because you don't want to drive or ride a bus for a few hours isn't true. The truth is you don't desire to access the care enough to put a little effort into it.

Finally, if a rural community doesn't have public transportation access to an urban area, it makes more sense for our society to focus on access to transportation then on putting a dentist there. Transportation to the urban area allows access to a whole host of services not just dentistry.

 

[AZDMDhopeful]

Has anyone taken a look at UM's prereqs and curriculum for the new "dental therapist"?

http://www.dentistry.umn.edu/progra...erapyPrograms/MasterofDentalTherapy/home.html


Looks like a piece of cake compared to what DDS/DMD students have to go through just to enroll in dental school.