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What's up with MN? You just elected a comedian to be your senator so I'm not too hopeful more rational minds will prevail.
"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
what's going to stop dental mills/corps from opening offices with a senior dentist and hiring nothing but "dental therapists" to work under them for 60-70% the price of an associate if the dental therapist could "pull teeth, drill and fill and do other complex procedures"?
still bad in my book.
Dentists 0, DH 1
Actually, I'd like to push for assistants to be able to do SC/RP. Not that I really want assistants to do SC/RP particularly; it would just make the ADHA more concerned with protecting their education and turf vs. trying to expand and encroach on the dentists' turf.Now that I think about it, you're right, PAs and NPs are screwing MDs in the A. Esp the primary care ones. I hope the ADA learns something from the AMA's mistake and start cracking down on these midlevels early. I'm hearing all sorts of stuff now like EFDA (expanded function dental assistant) who is basically an assistant that can do restorative, make temporary crowns etc, and then theres these new oral practitioners or something. I hope the ADA can do something about this madness.
So basically they can perform cavity preps, provide diagnosis, pulpotmony on primary teeth, pulp capping, prescribe meds, perform extractions, supervise dental assistants, place sutures, etc, as long as a licensed dentist is present..... if I am reading this correctly (correct me if I am wrong pls)....wow so we get to twiddle our thumbs... this will allow us to make more cheese by cutting our work out and delegating it to others... which works for me... however why wouldnt this dental hygienist with an advanced masters degree just go to dental school and be able to dictate their own life... it seems like logic that if this passes it won't be too long before the hygienist will be able to run a practice....
I pray i read this wrong
substandard care? I worked as an assistant for years before hygiene school and I can tell you that majority of dentists let their assistants, who have no training or education background do polishing, fl, scaling, and even drilling in some cases. I know, because that's what I was expected to do as an assistant. Now that I have the indepth knowledge in oral anatomy, perio and such, I realize how so shockingly careless it was of the dentist to allow me to do 10+ polishings a day, without any knowledge of pulpal damage, tissue trauma, fl poisoning etc. just so he could increase his production?? and you're complaining about someone with 2-4yrs of clinical training and master's level education, calling that "substandard"?????
substandard to a DDS.
I hate to break it to you, but analysis of the care rendered by mid-level providers in places that currently have the mid levels treating patients, shows that the level of care rendered by the midlevel is equivalent to that of the average dentist.
Where the difference is though is in the speed that the dentist can deliver care vs. that of the mid-level provider, with the dentist be significantly quicker. How this becomes a factor is that under the current models of treatment for a mid-level they're designed to have mid-level providers working on the underserved, who more often then not are having their work done for medicaid level reimbursement fees, and at those fee levels speed = volume which is often the difference between being a financially viable clinic and a clinic that needs government support to stay open.
with regard to speed, wouldn't a quicker procedure be of higher quality? I shadowed a few oral surgeons and they mentioned many times that atleast when it comes to wisdoms, oral surgeons are faster, allowing for less flap time, meaning less inflation and less pain. I would imagine that this would be try for many other procedures too.
When did an associate's degree become equivalent to a master's?substandard care? I worked as an assistant for years before hygiene school and I can tell you that majority of dentists let their assistants, who have no training or education background do polishing, fl, scaling, and even drilling in some cases. I know, because that's what I was expected to do as an assistant. Now that I have the indepth knowledge in oral anatomy, perio and such, I realize how so shockingly careless it was of the dentist to allow me to do 10+ polishings a day, without any knowledge of pulpal damage, tissue trauma, fl poisoning etc. just so he could increase his production?? and you're complaining about someone with 2-4yrs of clinical training and master's level education, calling that "substandard"?????
...and from a quality level standpoint, a mid-level can do just as good a #30 MO amalgam as the average dentist,
After working with EFDAs (those allowed to place restorations) there are some great ones and some terrible ones... similar to dentists. For the most part, they are trained not to think but to do. Don't think I'm just blowing hot air... I have had significant experience working with EFDAs.
Why spend 4 years in professional school and study at the level of a doctorate education? Because it takes more than just "drilling" a tooth and "filling" a hole. It is beyond insulting that politicians believe that anyone can perform to the competency-level and standard of a recent graduate general dentist with such little education and at such a lower standard.
It is appalling that dentists can actually believe this non-sense and actually go to the level to publish their support in leading dental journals.
Winning the war of words regarding importance of education and knowledge of the whole body for performing irreversible dental procedures will be impossible with politicians because they all think our jobs are simplistic in nature. DrJeff is right in many ways that we need to be working with them to regulate the impact of a mid-level provider but not in the ways that many feel they need to be.
EFDAs who may place restorations (not extract, or prepare teeth) nationwide may be of some benefit to providing some facet of increased access to care in welfare or public health offices. But in our society, allowing deregulation of irreversible procedures is merely the beginning of the slippery slope. Give them a few years and it will become "well, this model works so great in welfare, we should be allowed to go wherever we want... this is America!!" Then they will be in right next door to the dentist or in the shopping mall right next to the bleaching kiosk providing "cosmetic makeovers for less!"
Fantastic... if that happens, I'll also be in that shopping mall... but working at the Starbucks stand.
Stats show that cleaning and exams take up 76% of all dental services and are estimated to grow even higher in the future. Plus, the fake dentists are not limited only to these procedures.
Taurus had made a good point. We should learn from the NP case and not hire nor take any referrals from the cleaning clinics of these midlevels if that nonsense bill goes through.
- and I apologize to all the hygienists I am about to offend -
Now imagine that these community college grads were set free on the public to perform surgical procedures
That's why the ADHP program is a MASTERS DEGREE PROGRAM.
I hate to break it to you, but analysis of the care rendered by mid-level providers in places that currently have the mid levels treating patients, shows that the level of care rendered by the midlevel is equivalent to that of the average dentist.
Where the difference is though is in the speed that the dentist can deliver care vs. that of the mid-level provider, with the dentist be significantly quicker. How this becomes a factor is that under the current models of treatment for a mid-level they're designed to have mid-level providers working on the underserved, who more often then not are having their work done for medicaid level reimbursement fees, and at those fee levels speed = volume which is often the difference between being a financially viable clinic and a clinic that needs government support to stay open.
I have a feeling those studies are done by people who want mid-levels to get approval
can a midlevel provider be a financially viable model?? That's where the dentist wins out
If you allow a dentist to "supervise" 4 cheaper midlevels who do fill and drills vs. hire new associates directly out of dental school, then the model is attractive. This will decrease demand for dentists no doubt. It then is only a matter of time before the midlevels demand autonomy.
Dentistry is at a critical junction in its history. Does it keep the traditional model or go down the same, regrettable road that medicine took? I don't know if organized dentistry can stop midlevels from entering the field. Once current dentists realize how much more money they can make by hiring midlevels, they will sell out the profession and leave future generations of dentists with a shell of a profession that once was.
If you allow a dentist to "supervise" 4 cheaper midlevels who do fill and drills vs. hire new associates directly out of dental school, then the model is attractive. This will decrease demand for dentists no doubt. It then is only a matter of time before the midlevels demand autonomy.
Dentistry is at a critical junction in its history. Does it keep the traditional model or go down the same, regrettable road that medicine took? I don't know if organized dentistry can stop midlevels from entering the field. Once current dentists realize how much more money they can make by hiring midlevels, they will sell out the profession and leave future generations of dentists with a shell of a profession that once was.
Yea thats already happening with EFDAs and it's disgusting.
That is what the hygiene associations have been arguing but the comparison falls pretty flat. First of all - and I apologize to all the hygienists I am about to offend - hygiene education is not very broad-based. Hygienists are the dental equivalent of techs or phlebotomists; they are trained to do one task. They are trained to do that task very well, but their entire education is geared to the single task of cleaning teeth.
If phlebotomists were allowed to attend a 2 year community college program that would result in a PA degree the comparison would be valid. But that isn't how PA school works, is it?
Now imagine that these community college grads were set free on the public to perform surgical procedures (extractions) that commonly result in poorly controlled bleeding, perforation of the maxillary sinus, communication between the antrum and oral cavity and nerve damage. Do you want YOUR family treated by these people? Or do you think it might be more appropriate to be treated by professionals trained to manage these complications with the appropriate surgery and/or drugs?
I'm a bit offended as a practicing hygienist.
We take Anatomy Phys I and II, Microbiology, Chemistry, Biochemistry and all of the courses associated with dental knowledge. It does not compare to that of a dentist but it is more than just cleaning teeth.
If that was all we needed to learn, then we would just have hygiene clinic and be done with it.
We take dental pathology, histology, periodontology, nutrition, a statistics type course for dental, radiology, dental materials, .....that's off the top of my head from when i graduated in '96.
Unfortunately when you're a doctor you might find it easy to look down upon those who are less educated or assume we are just techs. The fact is we have a vast body of knowledge from our schooling and it just gets better with practice over the years.
Sometimes you need to take a step back and remember that many of the dental STUDENTS that post here have yet to realize that in a successfull general practice/pedo practice/perio practice/any practice that employs a hygienist(s) that a successful, SYMBIOTIC, relationship between the dentist and the hygienist is one of the key components (read as happy, returning patients who refer their friends to the practice and as a result help make $$ for the practice).
I strongly feel that the sooner a dental student/new dentist learns that ALL the employees of the practice make up a TEAM, and the smoother the TEAM works together, the better the patient experience. And more times than not, the better the experience the patient has, the more profitable that patient becomes to the practice (both in the form of work done on them/their family AND referrals to the practice). The dentist may be the leader of that team, but one also has to remember that a team is only as strong as its weakest member
so true. and what compounds the problem is that in most dental schools the hygienists are the biggest b*tches in the world.. i graduated hating hygienists, and until i started working with my two existing hygienists i never knew how easy they can make your life. i definitely view my entire staff as a team; but i am the head of that team (and the only un-fireable one!) lol
If you really believe that hygienst only learn to clean teeth, then you are very confused.
?So you feel like you don't have to assume the same financial risk as everyone else? There is a lot more to being a dentist than just your proclaimed and untested ability to handle the academic rigors of dental school. If you don't have the gall to take the same financial and personal risks as everyone else in dental school than you should not be practicing dentistry. Many people in my class quit their jobs with kids and moved across the country to go to dental school. In fact there are two practicing hygienists in my class whom I have profound respect for. To say that ADHP's are the same stuff as dentists is lying to patients.
Wow! I have read some pretty pathetic comments on here! All you guys are concerned about is $$$. What about the patient who doesn't have access to dental care or the patient who cant afford the outrageous prices of private practices?I haven't read one comment where the patient was the main concern. Not many dentists go out and provide care to under served areas so the ADHP is a necessity and I only see room for growth. This is an untapped market and could open up many opportunities for all of you future dentists if you would actually work together with the hygienist instead of opposing the ADHP. No, we don't have as much education as a DDS or a DMD but you don't need a doctorate to provide hygiene services which is all we're trying to do. It is a proven fact that prevention costs 10 times less than dental tx and I don't see any problem with that. I am in the process of becoming a ADHP and I can't wait to break free of all the politics and work for myself. Dentists are like a ball & chain to the hygienist!
?No one in their right mind would ever say or even hint that a dental hygienist should perform any tasks except dental hygiene.
?The next thing they'll do is to open their own "Dental Clinics"
It's just unfortunate that the public won't be able to distinguish between these mid-levels and actual dentists. It's a lot more important to address the public perception of dentists as a whole, rather than fighting these mid-levels. The ADHA will obviously want to push for the creation of a mid-level practitioner.
It's our duty as a profession, to stop that dead in it's tracts.
?Thoughts on this email being sent out?
Dear Friend:
Dentistry is under attack again!
The New Mexico Dental Hygienists' Association is introducing legislation to create an Advanced Dental Hygiene Practitioner (ADHP). After just two years of extra training, an ADHP would be allowed to perform surgical procedures, including drilling teeth and extractions, right here in New Mexico.
I am outraged by the audacity of the Hygienists' Association and their followers in Santa Fe to propose such an obvious and dangerous encroachment upon the profession of dentistry.
This hasty and drastic measure could put patients' safety at risk.
For my part, I have personally opened up my checkbook and given to the New Mexico Dental Association's Political Action Committee (NMDPAC).
?I have not done a lot of research on this subject, although now I definitely will be. So far, however, I have noticed that a lot of arguments have centered upon the hope that most patients will choose to go to a DDS over an ADHP if they have the choice (i.e. metro areas and non-underserved areas). Not only that, but the RDH's and ADHP proponents have been arguing on here that ADHP's will logically choose lower compensation as they are not as highly trained as dentists.
BUT, what happens when PPO/DHMO plans find out that an ADHP is charging lower fees than what they are allowing their DDS preferred providers charge? I can't predict the future, but I am pretty sure I understand the innate nature of insurance companies and they could lower their fee schedules OR just not raise the fee schedules until inflation allows the ADHP fees to catch up to their fee schedules. Granted, the DDS has two choices: take the hit on the fees to get insured patients through the doors, or quit accepting the insurance plan.
Obviously, we have already pointed out that DDS's will most likely have a HUGE disadvantage in terms of loan repayments after school. At this point, what do you do? We all know that a lot of times patients choose not only their provider but will change treatment plans based on what insurance dictates. Who is to say that an ADHD doesn't become a preferred provider and with less loans to pay off can accept the lower fee schedules and therefore the DDS's previous patients?
I know that I will get knocked for suggesting this, but I do want to point out that I am all for public service. I do not believe money=happiness, but I do want to be able to put food on the table, pay my bills, and live a semi-comfortable life after spending 8+ years after high school studying my rear end off. I also know that this is an exaggerated example of what could happen, but I just wanted to point out where insurance companies may start to jeopardize the situation even more.
?this is scary business. Legislation is like this is already in the works in other states like Maine, Arizona and few others.
The scariest part to me is this.
The services authorized under this subdivision
7.31and the collaborative agreement may be performed without the presence of a licensed
7.32dentist and may be performed at a location other than the usual place of practice of the
7.33dentist or dental hygienist and without a dentist's diagnosis and treatment plan, unless
7.34specified in the collaborative agreement.
Also, no where does it say that the ADA/CODA has to accredit these schools, (most likely community colleges) rather the hygiene board is responsible.
It passed 9 to 4 and there is a pretty good chance it may get through the financing committee.
This is really not good for dentistry.
The main responsibility of the ADHP is to provide preventative dental services to people who have limited access. You really think this is bad for dentistry? So it's better to let this part of the population who doesn't have access to care to receive no care at all?
We wouldn't have to do anything other than hygiene. 80% of the work performed at a dental office is hygiene...maybe more!
If the government really wanted to help rural Americans get dental care, why not set up satellite clinics and give financial incentives for dentists to work in those areas (i.e. loan repayment)? It's a much cheaper option than creating, opening and maintaining a midlevel program that train subeducated individuals to perform limited procedures in dentistry.
The main responsibility of the ADHP is to provide preventative dental services to people who have limited access. You really think this is bad for dentistry? So it's better to let this part of the population who doesn't have access to care to receive no care at all?