Mid Level Provider program at my school.

[Oracle DMD]

So what went down?

so dr. simonsen put together a presentation but it was during our lunch. he went kind of fast through the slides but i'll try to get it from him and post it on sdn. here is the break down of points:
- the research indicates that mlp's improve the dental health of communities in which they exist.
- 40% of children in arizona have active decay, 60% of k-5th graders haven't been to the dentist in the last year.
- change is coming whether we want it or not, and dentists need to get on board so we can dictate the terms of the change rather than the terms being dictated by others.
- mlp's will work for dentists. they can only be hired by dentists. they are required to have a contract that states what the dentist allow them to do and when, and that needs to be sent to the state dental board annually for approval. this gives the dentist the ultimate say on the scope of practice.
- mlp's will have to pass their own boards and possibly renew their licence every so often, like PA's.
- a dentist can only hire a max of like 5 mlp's.
- only a dentist can tx plan or prescribe meds. you can do that over the phone or visit the office and do a day of exams and then have mlp's carry it out. this gives dentists a lot of freedom to practice and supervise how they see fit.
- no mlp program will be made without that states congressional approval.
- mlp programs will be subject to CODA (commission on dental accredidation) like dental schools are)
- there will be specific language (underserved areas) to where a mlp can practice outside of direct dentist supervision.



mlp's will make dentists more money and elevate the job responsibilities/ respect of dentists. the role of the dentist will have a heavier emphasis on diagnostician and supervisor of a dental team.

just like a dentist is not required to have a hygienist or assistant, dentists are not required to employ a mlp. however i believe that mlp's will become an integral part of a dental team and provide a valuble service to our communities.

---

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[Oracle DMD]

also:

- will you be responsible/liable for mlp's? -yes
- will malpractice insurance go up if you employ them -probly
- why would dentists hire recent grads if mlp's are around? -can't sell a practice to a mlp, mlp's can't do perio surg, rpt's, endo, implants, much of oral surgery, etc...
-how much would they make? more than hygienists less than dentists. starting around 60 or 70k and toping out around 120k, whereas a recent dental school grad starts around 100-120k.
-how much will their tuition be? idk but it will probly be based on their graduating earning potential like the rest of the programs at MWU.

i tried to write everything i remembered but i hope this helped a bit. hit me with any other q's and i'll try to get them answered!

 

[txlonghorn]

also:

- will you be responsible/liable for mlp's? -yes
- will malpractice insurance go up if you employ them -probly
- why would dentists hire recent grads if mlp's are around? -can't sell a practice to a mlp, mlp's can't do perio surg, rpt's, endo, implants, much of oral surgery, etc...
-how much would they make? more than hygienists less than dentists. starting around 60 or 70k and toping out around 120k, whereas a recent dental school grad starts around 100-120k.
-how much will their tuition be? idk but it will probly be based on their graduating earning potential like the rest of the programs at MWU.

i tried to write everything i remembered but i hope this helped a bit. hit me with any other q's and i'll try to get them answered!

Thanks for the information! I guess the malpractice portion can be passed on to the mlp, so it seems like this won't affect dentists. However, we just need to ensure that the quality of work done by mlp's is at par with dentists for the simple restorations, etc. That is the main concern.

 

[pickledickle]

To tell you the truth, Dr. Simonsen sounded just like a used cars salesman today. He was trying to pitch theories and ideas to us that he really had no substantive answers for himself. Every single question that followed his presentation was doubt laden, and he did not answer any of them in a way that made us students feel more comfortable. In stead, I feel as though everyone was more confused than when we came into the presentation. Tell me this, if the purpose of the midlevel provider is to increase access to care why not simply give tax right offs to the dentists that provide free care to poor patients. I suppose that people in this country (right now) are soooo fed up with politicians, law makers, etc, telling us what to do and what is best for the COMMON GOOD, that people are fighting back against these beaurocratic, shotgun approaches to problems.

 

[coolslugs]

To tell you the truth, Dr. Simonsen sounded just like a used cars salesman today. He was trying to pitch theories and ideas to us that he really had no substantive answers for himself. Every single question that followed his presentation was doubt laden, and he did not answer any of them in a way that made us students feel more comfortable. In stead, I feel as though everyone was more confused than when we came into the presentation. Tell me this, if the purpose of the midlevel provider is to increase access to care why not simply give tax right offs to the dentists that provide free care to poor patients. I suppose that people in this country (right now) are soooo fed up with politicians, law makers, etc, telling us what to do and what is best for the COMMON GOOD, that people are fighting back against these beaurocratic, shotgun approaches to problems.

Mid-level dental provider is really an easy way out for the government. Instead of training dentists to serve the underserved areas or fully fund Medicaid, our government choose to limit the poor to getting their services from dental therapists. There will be 35 spots in the dental lab used to train dental therapists. Why not use these spots to sponsor 35 dentists who are willing to serve in the underserved areas. A better use of resources would be to set up scholarship/partnership programs with community clinics/IHS, such that if 2 years of tuition is paid for, then the student would have to serve 2 years at that clinic after graduation (something similar to military scholarships). I believe there are plenty of dental students that would love to have such an opportunity to graduate with less debt.

 

[Oracle DMD]

To tell you the truth, Dr. Simonsen sounded just like a used cars salesman today. He was trying to pitch theories and ideas to us that he really had no substantive answers for himself. Every single question that followed his presentation was doubt laden, and he did not answer any of them in a way that made us students feel more comfortable. In stead, I feel as though everyone was more confused than when we came into the presentation. Tell me this, if the purpose of the midlevel provider is to increase access to care why not simply give tax right offs to the dentists that provide free care to poor patients. I suppose that people in this country (right now) are soooo fed up with politicians, law makers, etc, telling us what to do and what is best for the COMMON GOOD, that people are fighting back against these beaurocratic, shotgun approaches to problems.

what answers were you looking for? he can't tell you that mlp's will be the ultimate solution will absolute certainty, because he can't time travel. what he can say, is that research shows that that it has helped in the places that it has been instituted.

tax write offs won't get providers to those underserved areas. so your solution is for the government to pay for it all, rather than creating more jobs and getting it done while making you more money? you want the govt. to pay for it and then complain about the beurocracy?

again, what question was asked that was given a poor answer? what exactly are you not comfortable with?

 

[Soda]

While I am just a dental student, I do have several years experience in the business field. So, I'll throw in my 2 cents.

Seems like MLP's are here to stay. If you can't beat them, join them. From a business model, it looks like a dentist can make money off of MLP's if he plays his cards right. It would probably require the dentist to move into a bit more of a management role however.

Theoretically it looks like the dentist can focus on the more difficult and profitable procedures and give the easier ones to the MLP and pay him/her less.

 

[MrkMichael]

I think it is ridiculous that you are getting your information on MLP from the very guy who is trying to get the school off the ground. I have spoken with several faculty members on this topic and they all and I do mean all, have stated that is will be detrimental to the profession. You should listen to the people that are actually practicing dentistry, they know better than anyone.

I pursued dentistry because it is a skill, it is respected, its in demand, and you can make a difference. With the implementation of the MLP, the respect is lost because now any one can obtain it in a 4 year degree. The demand will be lost because of an influx of individuals practicing (and they are not going to be practicing in underserved areas, so get that out of your mind). Most important the, the skill and quality for service will be reduced. If dental students are not even competent out of dental school (which many schools say, you will have the bare minimum skills to practice dentistry), then how are they going to train MLP in 2 years?

Listen Midwestern is a business. Period. They are exploiting dentistry since it is an exploding profession and they are making bank off of it. If they want dentistry to be more affordable and accessible, how about lowering the cost of tuition. How about they do their part? They don’t need to charge 55k a year plus 10k in fees. They charge that because they know they can. Just like your statement about how much will MLP tuition be “idk but it will probly be based on their graduating earning potential like the rest of the programs at MWU.” They are going to be using your lab space, your instrument, ect. They should pay the same amount per year. They don’t need to charge the price that they do? Maybe if dentist graduated with only 100k in student loans, they would be more prone to practicing in underserved areas, and less concentrated on paying down the huge student loans

 

[baseballjunkie]

If adding MLPs are going to cause an increase in malpractice costs, that malpractice can be passed off to the MLP.

But then how is that cost made up? Answer is increasing the cost to patients. The idea of MLPs is to reduce costs and creating more access to care, but isn't this coming back full circle and putting us in the same boat that we're already in? Let's face it... the "underserved" population is going to be those that have a hard time paying for dental procedures. I feel like we are defeating the purpose.

The better way to increase QUALITY ACCESS TO CARE is to provide INCENTIVES for current and future practitioners. Decrease the paperwork nightmare for medicare/medicaid patients and increase incentives to take these patients. For students, increase funding for National Health Corps and public service loan forgiveness. You can combine the Public Service Loan Forgiveness option and the 25yr income contingent loan repayment option. Doing this, you'll pay ~200K of that 400K that it took to go to that expensive school, and you'll be serving an "underserved" population....all while getting paid by the Federal gov't and being able to practice without overhead cost...

THIS option not only helps provide access to those underserved areas, but also puts educated, fully trained dentists to treat these patients. After all, isn't that the whole goal... increasing access to patient care?

 

[Oracle DMD]

I think it is ridiculous that you are getting your information on MLP from the very guy who is trying to get the school off the ground. I have spoken with several faculty members on this topic and they all and I do mean all, have stated that is will be detrimental to the profession. You should listen to the people that are actually practicing dentistry, they know better than anyone.

I pursued dentistry because it is a skill, it is respected, its in demand, and you can make a difference. With the implementation of the MLP, the respect is lost because now any one can obtain it in a 4 year degree. The demand will be lost because of an influx of individuals practicing (and they are not going to be practicing in underserved areas, so get that out of your mind). Most important the, the skill and quality for service will be reduced. If dental students are not even competent out of dental school (which many schools say, you will have the bare minimum skills to practice dentistry), then how are they going to train MLP in 2 years?

Listen Midwestern is a business. Period. They are exploiting dentistry since it is an exploding profession and they are making bank off of it. If they want dentistry to be more affordable and accessible, how about lowering the cost of tuition. How about they do their part? They don’t need to charge 55k a year plus 10k in fees. They charge that because they know they can. Just like your statement about how much will MLP tuition be “idk but it will probly be based on their graduating earning potential like the rest of the programs at MWU.” They are going to be using your lab space, your instrument, ect. They should pay the same amount per year. They don’t need to charge the price that they do? Maybe if dentist graduated with only 100k in student loans, they would be more prone to practicing in underserved areas, and less concentrated on paying down the huge student loans

i think listening to both sides is important as well. dr. simonnsen isn't trying to "sell" us on mlp's. its not like he needs our permission to carry out the university's buisness. what he will do is take time out of his day to try and show us where he's coming from, and to dispell needless fears.

he did agree that there are valid arguements for not having mlp's and that he respects those points of view. he admitted that he is not positive that this is ultimately going to solve all of the problems, but its the best option so far and research supports this. i will try to get those research links from him soon to read and post on sdn.

you are 100% right in that MWU is a buisness. so are dental offices. like all buisnesses, they make moves when there's money in it. dr. simonsen also thinks it will be good for patients, and good for the profession given some of the other options out there (ADHP-by hygienists , and community oral health coordinators- by the ADA)

i would love lower tuition like everyone else, but i also enjoy being a spoiled rotten dental student (5:1 faculty:student ratio, brand new everything, digital everything, sick technology) so i won't carry on about the cost of education too much but to say that i think it's fair enough.

 

[haisha ni narou]

First off, a house keeping item for my classmates. My screen name, "Haisha ni narou" is Japanese for "Let's become a dentist!". It sounds dumb in English, but in Japanese it makes sense, and it IS spelled correctly for those of you who were told otherwise, I lived in Japan for years and speak the language. I missed the beginning part of the presentation so I wasn't there to defend myself.

Oracle, you might want to go through your posts before you post them, I noticed a few spelling mistakes! (I'm sure I have some too!)

I have a host of questions still. I understand the concept. I think I get it, but I do not see how in the reality of things it will really work? The idea is great, but once I get past the concept and try to make sense of it, I run into some issues. If you had MLPs working in rural areas addressing the need for those without access to care, the facility is still going to have to be profitable to pay for the overhead including the salary for the MLPs. Assuming the Pt base for these facilities are going to be treating those who cannot otherwise afford care, the clinics will probably be doing lots of extractions (can they do extractions? If there are complications, any oral surgeons around?) and amalgam restorations. I would assume reimbursement and production will be low (assuming you won't have a full staff at these clinics), management effort and time demand will be high for the supervising dentist. As a business owner, I would assume that your benefit-cost ratio would have to be high enough to make the added effort worth it.

I understand if your production speed as the dentist is the limiting factor in production in your own office, it makes sense to hire a MLP to delegate some of the workload, but how does this address the driving factor which justifies the whole program in extending access to care? This is where I see the real role of the MLP, not in the altruistic form it has been presented. Will there be dentists who dedicate their practice to treating those who cannot afford it, absolutely, there are already dentists that do that. I think all dentists need to personally decide how much they can give back, and be proud to bless the lives of those in their communities by charitable work.

I will make this very clear, I am not anti MLP nor am I pro MLP, I am "sitting-on-the-fence" MLP, but before I feel like I can back up this program 100%, I am going to have to be convinced that it is a viable solution to address "access to care" issues. I like the fact that this program is trying to do good for others, I really do!

On the other hand, MLPs could be a good tool for dentists whose driving force is to extend access to care. Will MLPs make dental care more accessible than it is now? I think so, but I do not think that this should be the only approach at addressing the issue. Don't forget that there are already programs set up to extend care to those who cannot afford it. I know in AZ there are. I would be interested to see how many Pts benefit from these programs every year. At MWU, they teach us to be skeptical about the research that is presented to you by someone trying to persuade you. I'm not saying that what we have been told by our dean emeritus is inaccurate, but I've been conditioned to dig a little deeper on my own to come to my own conclusions. I value what my professional and student organizations have to say as well. If this program becomes a reality, I hope everyone profits from it.

 

[Oracle DMD]

First off, a house keeping item for my classmates. My screen name, "Haisha ni narou" is Japanese for "Let's become a dentist!". It sounds dumb in English, but in Japanese it makes sense, and it IS spelled correctly for those of you who were told otherwise, I lived in Japan for years and speak the language. I missed the beginning part of the presentation so I wasn't there to defend myself.

Oracle, you might want to go through your posts before you post them, I noticed a few spelling mistakes! (I'm sure I have some too!)

I have a host of questions still. I understand the concept. I think I get it, but I do not see how in the reality of things it will really work? The idea is great, but once I get past the concept and try to make sense of it, I run into some issues. If you had MLPs working in rural areas addressing the need for those without access to care, the facility is still going to have to be profitable to pay for the overhead including the salary for the MLPs. Assuming the Pt base for these facilities are going to be treating those who cannot otherwise afford care, the clinics will probably be doing lots of extractions (can they do extractions? If there are complications, any oral surgeons around?) and amalgam restorations. I would assume reimbursement and production will be low (assuming you won't have a full staff at these clinics), management effort and time demand will be high for the supervising dentist. As a business owner, I would assume that your benefit-cost ratio would have to be high enough to make the added effort worth it.

I understand if your production speed as the dentist is the limiting factor in production in your own office, it makes sense to hire a MLP to delegate some of the workload, but how does this address the driving factor which justifies the whole program in extending access to care? This is where I see the real role of the MLP, not in the altruistic form it has been presented. Will there be dentists who dedicate their practice to treating those who cannot afford it, absolutely, there are already dentists that do that. I think all dentists need to personally decide how much they can give back, and be proud to bless the lives of those in their communities by charitable work.

I will make this very clear, I am not anti MLP nor am I pro MLP, I am "sitting-on-the-fence" MLP, but before I feel like I can back up this program 100%, I am going to have to be convinced that it is a viable solution to address "access to care" issues. I like the fact that this program is trying to do good for others, I really do!

On the other hand, MLPs could be a good tool for dentists whose driving force is to extend access to care. Will MLPs make dental care more accessible than it is now? I think so, but I do not think that this should be the only approach at addressing the issue. Don't forget that there are already programs set up to extend care to those who cannot afford it. I know in AZ there are. I would be interested to see how many Pts benefit from these programs every year. At MWU, they teach us to be skeptical about the research that is presented to you by someone trying to persuade you. I'm not saying that what we have been told by our dean emeritus is inaccurate, but I've been conditioned to dig a little deeper on my own to come to my own conclusions. I value what my professional and student organizations have to say as well. If this program becomes a reality, I hope everyone profits from it.

i couldn't care less about spelling! people type fast and often so im sure ill miss something here or there too.

i think that is very well put haisha. i would say if it were up to me whether mlp's would start training right now, i would say no. i am in favor of mlp's but it won't work unless more of our collegues are on board, and i think they will be more OK with it as the discussion continues.

 

[TedyBearSuicide]

dr. simonnsen isn't trying to "sell" us on mlp's. its not like he needs our permission to carry out the university's buisness.

i am in favor of mlp's but it won't work unless more of our collegues are on board, and i think they will be more OK with it as the discussion continues.

How will your colleagues get on board unless he goes around selling the idea?

 

[Oracle DMD]

How will your colleagues get on board unless he goes around selling the idea?

people need to hear more about it. we'll talk about it, review the reseach, stay up to date on the legislative progress and debate good points from both sides. there is no need to get hyperbolic about it. it took PA's like 30 years to really get integrated into our healthcare system, so i suspect this is really going to be a long debate that changes course several times before its all settled.

 

[kdawg]

First off, a house keeping item for my classmates. My screen name, "Haisha ni narou" is Japanese for "Let's become a dentist!". It sounds dumb in English, but in Japanese it makes sense, and it IS spelled correctly for those of you who were told otherwise, I lived in Japan for years and speak the language. I missed the beginning part of the presentation so I wasn't there to defend myself.

Oracle, you might want to go through your posts before you post them, I noticed a few spelling mistakes! (I'm sure I have some too!)

I have a host of questions still. I understand the concept. I think I get it, but I do not see how in the reality of things it will really work? The idea is great, but once I get past the concept and try to make sense of it, I run into some issues. If you had MLPs working in rural areas addressing the need for those without access to care, the facility is still going to have to be profitable to pay for the overhead including the salary for the MLPs. Assuming the Pt base for these facilities are going to be treating those who cannot otherwise afford care, the clinics will probably be doing lots of extractions (can they do extractions? If there are complications, any oral surgeons around?) and amalgam restorations. I would assume reimbursement and production will be low (assuming you won't have a full staff at these clinics), management effort and time demand will be high for the supervising dentist. As a business owner, I would assume that your benefit-cost ratio would have to be high enough to make the added effort worth it.

I understand if your production speed as the dentist is the limiting factor in production in your own office, it makes sense to hire a MLP to delegate some of the workload, but how does this address the driving factor which justifies the whole program in extending access to care? This is where I see the real role of the MLP, not in the altruistic form it has been presented. Will there be dentists who dedicate their practice to treating those who cannot afford it, absolutely, there are already dentists that do that. I think all dentists need to personally decide how much they can give back, and be proud to bless the lives of those in their communities by charitable work.

I will make this very clear, I am not anti MLP nor am I pro MLP, I am "sitting-on-the-fence" MLP, but before I feel like I can back up this program 100%, I am going to have to be convinced that it is a viable solution to address "access to care" issues. I like the fact that this program is trying to do good for others, I really do!

On the other hand, MLPs could be a good tool for dentists whose driving force is to extend access to care. Will MLPs make dental care more accessible than it is now? I think so, but I do not think that this should be the only approach at addressing the issue. Don't forget that there are already programs set up to extend care to those who cannot afford it. I know in AZ there are. I would be interested to see how many Pts benefit from these programs every year. At MWU, they teach us to be skeptical about the research that is presented to you by someone trying to persuade you. I'm not saying that what we have been told by our dean emeritus is inaccurate, but I've been conditioned to dig a little deeper on my own to come to my own conclusions. I value what my professional and student organizations have to say as well. If this program becomes a reality, I hope everyone profits from it.

 

[BadgerLoveSmile]

I must say, it was quite interesting (entertaining?) reading through this thread.

I am one of the 9 Dental Therapy students at the University of Minnesota School of Dentistry. I am obviously not going to answer all the questions posed on this thread but I will throw out some basic information about our program in Minnesota, simply to clarify some things and clear up some misconceptions about our program. Feel free to message me if you have any specific questions...

-There is a Master's of Dental Therapy and a bachelor's program in dental therapy. (I am in the Master's program). The Master's program requires a 4 year degree, meeting general science and liberal ed requirements. The Bachelor's program requires all those classes to be completed by the time that student graduates. There are 8 Master's students and 1 Bachelor's student. All dental course work is taken together. The dental course work takes 7 semesters (vs. 9 semesters for DDS at UofM).

-Half of our dental course work is taken with the dental hygiene students, half with the DDS students. Many courses include all 3 professions. All operative courses are taken with DDS students (obviously).

-We work in clinic with DDS and DH students, as a dental team.

-It is required that 50% of our patients be "underserved." This could mean HPSAs, MA patients, low-income patients, etc...

-We must work under the supervision of a dentist, whom is on-site. As of right now, it is not possible for a dentist to manage a dental therapist from a satellite clinic. This means we must be hired by a dentist, working as an employee of the dentist. A dentist is limited to hiring 5 dental therapists.

-Our tuition and fees are roughly $10,000 per semester (x7 semesters).

-Our scope of practice includes: all composite and amalgam restorations on primary and permanent teeth. Extractions of primary teeth, sealants, anesthesia (including Nitrous), F- varnish, placement of crowns...that is all I can think of right now (feel free to ask about specific procedures).

I believe that covers most of the basics. Again, feel free to message me with any specific questions.

 

[dentalWorks]

Question:

Are mid-level providers allowed to open private practices without a dentist in the building? (I am refering to the 2 states that have them - minnesota and some areas in alaska)

If not... so why would a dentist hire mid-level provider? I just don't see the argument of why someone would hire a person to do the same job he can normally do and pocket all the profits to himself.....

I am not trying to start an argument here, but I think its MORE logical to allow mid-level providers to open their own practice in rural/undeserved areas because initially, these are the areas that don't have oral health coverage..... But then again, this will lead to a whole new set of problems especially in regards to "how well equipped are they when things go wrong"

 

[mike3kgt]

As of right now, it is not possible for a dentist to manage a dental therapist from a satellite clinic.

This sums up the whole argument right here. It's a slippery slope. Flash forward 10 years from now and we are having the same argument but worded "as of right now, we can't practice independently, but's it's coming" and it will still be the same access to care argument.

Why not go to dental school instead.

 

[Simiam]

I must say, it was quite interesting (entertaining?) reading through this thread.

I am one of the 9 Dental Therapy students at the University of Minnesota School of Dentistry. I am obviously not going to answer all the questions posed on this thread but I will throw out some basic information about our program in Minnesota, simply to clarify some things and clear up some misconceptions about our program. Feel free to message me if you have any specific questions...

-There is a Master's of Dental Therapy and a bachelor's program in dental therapy. (I am in the Master's program). The Master's program requires a 4 year degree, meeting general science and liberal ed requirements. The Bachelor's program requires all those classes to be completed by the time that student graduates. There are 8 Master's students and 1 Bachelor's student. All dental course work is taken together. The dental course work takes 7 semesters (vs. 9 semesters for DDS at UofM).

-Half of our dental course work is taken with the dental hygiene students, half with the DDS students. Many courses include all 3 professions. All operative courses are taken with DDS students (obviously).

-We work in clinic with DDS and DH students, as a dental team.

-It is required that 50% of our patients be "underserved." This could mean HPSAs, MA patients, low-income patients, etc...

-We must work under the supervision of a dentist, whom is on-site. As of right now, it is not possible for a dentist to manage a dental therapist from a satellite clinic. This means we must be hired by a dentist, working as an employee of the dentist. A dentist is limited to hiring 5 dental therapists.

-Our tuition and fees are roughly $10,000 per semester (x7 semesters).

-Our scope of practice includes: all composite and amalgam restorations on primary and permanent teeth. Extractions of primary teeth, sealants, anesthesia (including Nitrous), F- varnish, placement of crowns...that is all I can think of right now (feel free to ask about specific procedures).

I believe that covers most of the basics. Again, feel free to message me with any specific questions.

So "as of now" MLPs can perform what 60-70% of the procedures that Dentists perform... Basically the bread and butter of our profession. So not only will we be facing increased competition from increased amount of dental school graduates from the numerous new dental schools, but also the new MLPs. The idea of MLPs is being pushed for the "underserved population" but you're kidding yourself if you think they won't simply be in the areas already saturated with dentists. MLPs, corporate dentistry, etc Doesn't it seem like dentistry is following in the footsteps of medicine?

 

[DrJeff]

So "as of now" MLPs can perform what 60-70% of the procedures that Dentists perform... Basically the bread and butter of our profession. So not only will we be facing increased competition from increased amount of dental school graduates from the numerous new dental schools, but also the new MLPs. The idea of MLPs is being pushed for the "underserved population" but you're kidding yourself if you think they won't simply be in the areas already saturated with dentists. MLPs, corporate dentistry, etc Doesn't it seem like dentistry is following in the footsteps of medicine?

Here's one of the big picture things you're missing right now with MLP's and why, if ever, MLP's won't be a big factor in "reducing the volume" of patients for regular dentists.

There are 9 students in the class of MLP's in Minnesota. There's a few thousand new grads from dental school each year. That places a minute amount of MLP's into the work force. Additionally, the entire concept of the MLP is to put it mildly controversial amongst the governing bodies of dentistry, and given the strong opposition from *most* members of the ADA workforce taskforce (they basically come up with the ADA's policies on the entire Access to Care issue which is then brought to the ADA House of Delegates for approval) theire won't be a widespread voice of approval from the ADA for a MLP anytime soon. And in many cases, the ADA recomendation/policy does carry some weight with lawmakers considering new policy.

Lastly, the vast majority of time, the basic pool of patients that the MLP will treat isn't the pool of patients that most dentists will treat in their practices. Also, most of the time, if MLP's are put into place by lawmakers, their idea(the lawmakers) is that an MLP will allow access for 100% of medicaod patients to dental care, when the relity is that even if dental care is "free" to medicaid patients, what is seen time and time again from North to South to East to West is that the actual utilization rate (the key figure) of those mediciad patients is at best about 50%, which isn't that much different than is seen from "private" insurance patients.

 

[Kenny117]

Wow, I recently had an interview at Midwestern, AZ and was really impressed and excited with the university. However, after reading through this forum and seeing not just how Midwestern is supporting these MLP's but how certain students from Midwestern, Oracle specifically, act in trying to defend their stance, I'm definitely reconsidering my initial impression of the school. If the lack of respect and professionalism I've seen on this thread from Oracle is representative of students from Midwestern in general then it makes me want to stay as far away from Midwestern as possible. Honestly, I have my stance on MLP'S and I'm not ignorant enough to be mad as someone who has his/her own stance, but slandering a dental professional you don't really know, and making threats (on a forum!!) is totally out of line oracle. I'm not trying to resurrect old arguments in posts but I'm just a little bummed. I was extremely excited about Midwestern as a school of dental medicine, however now I am extremely disappointed to say that I probably won't be considering Midwestern if I get the opportunity.

 

[GTFOOMICT]

Wow, I recently had an interview at Midwestern, AZ and was really impressed and excited with the university. However, after reading through this forum and seeing not just how Midwestern is supporting these MLP's but how certain students from Midwestern, Oracle specifically, act in trying to defend their stance, I'm definitely reconsidering my initial impression of the school. If the lack of respect and professionalism I've seen on this thread from Oracle is representative of students from Midwestern in general then it makes me want to stay as far away from Midwestern as possible. Honestly, I have my stance on MLP'S and I'm not ignorant enough to be mad as someone who has his/her own stance, but slandering a dental professional you don't really know, and making threats (on a forum!!) is totally out of line oracle. I'm not trying to resurrect old arguments in posts but I'm just a little bummed. I was extremely excited about Midwestern as a school of dental medicine, however now I am extremely disappointed to say that I probably won't be considering Midwestern if I get the opportunity.

Haha. Don't let 1 student on the internet change your opinion. I know 2 people there and they didn't feel oracle was an appropriate Internet voice for the school.

BUT, do yourself a favor and go to a cheaper school. That campus and buildings sure are nice but you will be saddled with quite some debt.

 

[Oracle DMD]

Wow, I recently had an interview at Midwestern, AZ and was really impressed and excited with the university. However, after reading through this forum and seeing not just how Midwestern is supporting these MLP's but how certain students from Midwestern, Oracle specifically, act in trying to defend their stance, I'm definitely reconsidering my initial impression of the school. If the lack of respect and professionalism I've seen on this thread from Oracle is representative of students from Midwestern in general then it makes me want to stay as far away from Midwestern as possible. Honestly, I have my stance on MLP'S and I'm not ignorant enough to be mad as someone who has his/her own stance, but slandering a dental professional you don't really know, and making threats (on a forum!!) is totally out of line oracle. I'm not trying to resurrect old arguments in posts but I'm just a little bummed. I was extremely excited about Midwestern as a school of dental medicine, however now I am extremely disappointed to say that I probably won't be considering Midwestern if I get the opportunity.

ok don't come here then. no sweat. it's a pretty good place to go to school tho, IMHO don't be such a pushover for dentists. unless they are talking specifically about dentistry, then they are no better/smarter/ more ethical than you. speak your mind or don't, come to MWU or don't. apparently your impressions of schools are very fragile.

 

[Oracle DMD]

Haha. Don't let 1 student on the internet change your opinion. I know 2 people there and they didn't feel oracle was an appropriate Internet voice for the school.

BUT, do yourself a favor and go to a cheaper school. That campus and buildings sure are nice but you will be saddled with quite some debt.

i don't think any 1 person is an appropriate, all encompassing voice for ANY school. also, i tend not to place nice w/ others if they wanna say something on SDN or anywhere else, then they certainly can.

 

[needa20]

I posted this in another thread yesterday, but feel like this is a relevant place for it:

Im a D2 at a private dental school and am going to come out with about 300K in debt.
Im not really up in clinic much yet, but have been out on several local trips to do dental work. as mentioned earlier, things look easy, but these MLP's wont have the training or education when they need it (what we receive). I was on a local mission trip recently and I was assisting a D3 with what looked like a straight forward extraction of #3. about 45 minutes into it, the two DDS's we had with us had to get in there and it turned into a 3.5 hour surgical extraction.
--So I agree, what looks easy can turn into a nightmare 4 hr surgical extraction. Luckily we will have the training for that by the time we graduate (as the 2 DDS's with us did)
--These MLP wont have the experience or know what to do when faced with this unforeseen situations.

Second, the stuff we take such as systemic path, biochem, micro ect.., that seems pointless at this point, is not pointless. For example I was at another clinic assisting a D4 last week. The D4 was out of the room doing something else and the patient told me she had a heart murmur and the dentist used to put her on antibiotics before treatment. so she asked me if she needed antibiotics.... I explained to her that antibiotics are not longer recommended for heart murmurs to prevent IE and I explained the reasons.
---There have been a few other situations that I have been in (such as reviewing medical health historys) that I can see where my seemingly pointless classes are Extremely relevant. These MLP's wont have the training (of 4 years) to learn these types of things.

So I agree that MLP's will do a disservice to patients as I described above. Now in my second year, I understand why dental school is 4 years and it is so much more the pulling teeth out and drilling and filling. the MLP's will not have the necessary training to treat the patient as a whole. Sure they can be taught to drill and fill a prep in 6 months, but they wont understand the necessary medical and dental info to safely treat patients.

Also on a business note, Im going to be over 300K in debt and 4 years of busting my ass to earn the opportunity to practice dentistry. (actually 5 yrs of undergrad, 1 year masters, and 4 yrs of D-school). why should someone with a highschool diploma and a year of training be able provide the same 'healthcare' as me?

Lastly, as someone mentioned earlier, the MLP's (or dental hygienists with some extra training) wont stay in the 'underserved' area they say they are going to serve in. They say they will only practice in these underserved areas, but we know this is just a gateway. Just some comparisons: MD's partially being replaced by nurse practitioners, physician assistants. A great example of how Anesthesiologists are being run out of town (and just keeping one on for legal reasons) by Nurse Anesthetist's. I know of a smaller town where this occurred.

Same thing will happen with the MLP's and 'higher trained' dental hygienists. They will start in the under served area then 10-15 years down the road (when im still trying to pay off my 300K+ debt) I will be competing with them for business.......

sorry for my rant, but its my feelings as a D2, business major and MBA, and having family in the medical profession this is what I forsee

 

[dentalWorks]

This just came out today from dr.bicuspid, they are saying mid-level providers are providing safe and effective dental therapy in alaska

http://www.drbicuspid.com/index.aspx?d=1&sec=sup&sub=pmt&pag=dis&ItemID=305995&wf=669

 

[Seahawk]

Yeah, I went to a presentation last night about mid level providers and access...and the presenter, from the ADA, told us that that would be coming out today...He also said he knew who did it, and that it would say they "did just as good as you doc." no matter what the true results were.


Scary stuff if you ask me.

 

[DrJeff]

This just came out today from dr.bicuspid, they are saying mid-level providers are providing safe and effective dental therapy in alaska

http://www.drbicuspid.com/index.aspx?d=1&sec=sup&sub=pmt&pag=dis&ItemID=305995&wf=669

Yeah, I went to a presentation last night about mid level providers and access...and the presenter, from the ADA, told us that that would be coming out today...He also said he knew who did it, and that it would say they "did just as good as you doc." no matter what the true results were.


Scary stuff if you ask me.

Ok, lets do what CLINICIANS are supposed to do for a moment here, which is seperate EMOTION from science/logic and look at this.

#1 from the perspective of the politicians, there's a problem with access to care for the underserved. In some areas of the country there very well maybe (such as rural Alaskan villages) whereas in others the data shows that there isn't an access problem, atleast for kids (I'll use my home state of CT as an example). These same politicians may hear from hundreds, if not thousands of medicaid recipients in that state(read as VOTERS) that they can't get into see a dentist that will take their insurance (the fact that in many cases what medicaid reimburses us dentists either just barely covers our overhead, or has us operating at a loss isn't relevant to a politician since in general us dentists are pretty apathetic politically, so that politician may only hear from a few dentists (read as VOTERS) about why so few of us see medicaid patients. These same politicians, who in most states are dealing with budget deficits, are looking for ways that THEY THINK will provide more services for less $$. Most politcians have likely also had a medical visit where either a nurse practitioner or physicians assistant did most of the work, so in their mind, why couldn't something silimar work in dentistry???

#2 if you look OBJECTIVELY (once again, eliminate the emotional component), the data out of places like Alaska and also New Zeland where some mid-level works has been going on for sometime now, shows that a trained mid-level can do most procedures (especially basic restorative ones) as well as a licensed dentist. What that data doesn't take into account is that in most cases, the licensed dentist can accomplish the work faster than the mid-level, plus in the tougher procedures, a licensed dentist can do more work than the mid-level (feel free to insert all the clinical anecdotes one wants to about how many times a procedure starts off looking like it will be easy and then turns into a very complicated one). And time is $$, or atleast in the case of medicaid patients, which is the target group that mid-level providers would work on, the faster one can finish, the more patients one can see per day, the less gov't subsidies will be need to make it a financially viable practice.

#3 there's not very many mid-levels being trained, far less than are graduating d-school, and while some d-schools do have plans to start a mid-level program (IF THEY GET THE STATE/FEDERAL $$ TO DO SO), there won't be a large quantity of mid-level providers anytime soon. And likely once further studies are done, the financial viability of the mid-level provider will become a very relevant question, since it's not like a dental chair would cost a mid-level any less than a dentist, or a hand piece would be any cheaper for a mid-level, etc.

As tough as it is with this topic, you need to look at it from a logical, not emtional issue, the same as when we're discussing treatment options with a patient

 

[MXDenty77]

Ok, lets do what CLINICIANS are supposed to do for a moment here, which is seperate EMOTION from science/logic and look at this.

#1 from the perspective of the politicians, there's a problem with access to care for the underserved. In some areas of the country there very well maybe (such as rural Alaskan villages) whereas in others the data shows that there isn't an access problem, atleast for kids (I'll use my home state of CT as an example). These same politicians may hear from hundreds, if not thousands of medicaid recipients in that state(read as VOTERS) that they can't get into see a dentist that will take their insurance (the fact that in many cases what medicaid reimburses us dentists either just barely covers our overhead, or has us operating at a loss isn't relevant to a politician since in general us dentists are pretty apathetic politically, so that politician may only hear from a few dentists (read as VOTERS) about why so few of us see medicaid patients. These same politicians, who in most states are dealing with budget deficits, are looking for ways that THEY THINK will provide more services for less $$. Most politcians have likely also had a medical visit where either a nurse practitioner or physicians assistant did most of the work, so in their mind, why couldn't something silimar work in dentistry???

#2 if you look OBJECTIVELY (once again, eliminate the emotional component), the data out of places like Alaska and also New Zeland where some mid-level works has been going on for sometime now, shows that a trained mid-level can do most procedures (especially basic restorative ones) as well as a licensed dentist. What that data doesn't take into account is that in most cases, the licensed dentist can accomplish the work faster than the mid-level, plus in the tougher procedures, a licensed dentist can do more work than the mid-level (feel free to insert all the clinical anecdotes one wants to about how many times a procedure starts off looking like it will be easy and then turns into a very complicated one). And time is $$, or atleast in the case of medicaid patients, which is the target group that mid-level providers would work on, the faster one can finish, the more patients one can see per day, the less gov't subsidies will be need to make it a financially viable practice.

#3 there's not very many mid-levels being trained, far less than are graduating d-school, and while some d-schools do have plans to start a mid-level program (IF THEY GET THE STATE/FEDERAL $$ TO DO SO), there won't be a large quantity of mid-level providers anytime soon. And likely once further studies are done, the financial viability of the mid-level provider will become a very relevant question, since it's not like a dental chair would cost a mid-level any less than a dentist, or a hand piece would be any cheaper for a mid-level, etc.

As tough as it is with this topic, you need to look at it from a logical, not emtional issue, the same as when we're discussing treatment options with a patient

This is all good to hear but the fact of the matter is you pointed out the most important factor to a politician... votes... more medicaid patients than dental providers are appealing to the govt. about their issues. They will be passed into law and neither you nor I can predict the number of MLP's we will see in the future, and to say our government only chooses the rational choice is a false statement as well. I say get involved from the beginning and take an active role in shaping the integration of the MLP's into our industry before the carriage passes up the horse. I have become involved in my ASDA chapter at my dental school and will continue to write my legislators regarding this issue. I urge others to do the same so we create a cohesive voice on this issue rather than a fragmented single voice.

 

[DrJeff]

This is all good to hear but the fact of the matter is you pointed out the most important factor to a politician... votes... more medicaid patients than dental providers are appealing to the govt. about their issues. They will be passed into law and neither you nor I can predict the number of MLP's we will see in the future, and to say our government only chooses the rational choice is a false statement as well. I say get involved from the beginning and take an active role in shaping the integration of the MLP's into our industry before the carriage passes up the horse. I have become involved in my ASDA chapter at my dental school and will continue to write my legislators regarding this issue. I urge others to do the same so we create a cohesive voice on this issue rather than a fragmented single voice.

The biggest "problem" that dentistry has with repsect to the MLP(and access to care in general), is that as a whole, we're in denial that there is a problem(which in some cases there isn't but more often than not there is). And as such, most dentists feel like if we just tell our legislators that "we're dentists, and only WE have the power to use the all mighty hand piece to fix the world!" that all will be fine - and for many, as witnessed in multiple recent sessions of the ADA house of delegates, and across the country at many state house of delegates, this is the attitude that we have. It's this attitude which if we (dentistry) isn't carefull, will cause us (dentists) to loose some control over how oral healthcare is administered in this country, since some legislators will enact some measures that THEY feel will work. See Alaska as a prime example - the ADA basically just said "nope, it can't work" and now there's a study out there by a reputable research firm that shows that MLP's can do clinically acceptable work (which is similiar to what other studies from around the world have shown). What doesn't get put forth in that study is the costs assocaited with a MLP, and are thos extra costs worth it, especially if the true problem IMHO, which isn't access, but UTILIZATION of services isn't changes (afterall what good is it to try and legislate a plan that *could* provide access to 100% of the population - the goal in most utopian political worlds - when only 1/2 to atmost 2/3rds of the target population, will end up seeking care?????)

The key in general for dentistry is member involvement, which is always tough to get. Since unfortunately, for so many dentists, as "involved" as they want to get, is once a year when they write out their check for their ADA dues. And its this apathy, especially if we as a group are talking to a politician that will cause problems for dentistry in the future

 

[New2Philly]

The biggest "problem" that dentistry has with repsect to the MLP(and access to care in general), is that as a whole, we're in denial that there is a problem(which in some cases there isn't but more often than not there is). And as such, most dentists feel like if we just tell our legislators that "we're dentists, and only WE have the power to use the all mighty hand piece to fix the world!" that all will be fine - and for many, as witnessed in multiple recent sessions of the ADA house of delegates, and across the country at many state house of delegates, this is the attitude that we have. It's this attitude which if we (dentistry) isn't carefull, will cause us (dentists) to loose some control over how oral healthcare is administered in this country, since some legislators will enact some measures that THEY feel will work. See Alaska as a prime example - the ADA basically just said "nope, it can't work" and now there's a study out there by a reputable research firm that shows that MLP's can do clinically acceptable work (which is similiar to what other studies from around the world have shown). What doesn't get put forth in that study is the costs assocaited with a MLP, and are thos extra costs worth it, especially if the true problem IMHO, which isn't access, but UTILIZATION of services isn't changes (afterall what good is it to try and legislate a plan that *could* provide access to 100% of the population - the goal in most utopian political worlds - when only 1/2 to atmost 2/3rds of the target population, will end up seeking care?????)

The key in general for dentistry is member involvement, which is always tough to get. Since unfortunately, for so many dentists, as "involved" as they want to get, is once a year when they write out their check for their ADA dues. And its this apathy, especially if we as a group are talking to a politician that will cause problems for dentistry in the future

I agree with your above comments. What would be some of the avenues in which dentists could influence the outcome of this situation? Volunteer more time in clinics? Do more research that fleshes out the EFDA scenario? Take a hit on their bottom line to accommodate more medicare patients? Accommodate EFDA's into our practice? As a practicing dentist could you see a business model where EFDA's could be incorporated, and be financially viable?
Or will this go the way of the denturist?

I hate to make an opinion off of a slippery slope, but I can't help but feel that EFDA's will want more, and create the specious public opinion that dentists are over educated and overpaid.

 

[DrJeff]

I agree with your above comments. What would be some of the avenues in which dentists could influence the outcome of this situation? Volunteer more time in clinics? Do more research that fleshes out the EFDA scenario? Take a hit on their bottom line to accommodate more medicare patients? Accommodate EFDA's into our practice? As a practicing dentist could you see a business model where EFDA's could be incorporated, and be financially viable?
Or will this go the way of the denturist?

I hate to make an opinion off of a slippery slope, but I can't help but feel that EFDA's will want more, and create the specious public opinion that dentists are over educated and overpaid.

My take on what we as dentists need to/should do.


Step #1, Even if it's just 1 patient, or maybe one family, all dentists should see some medicaid patients. I'm not saying this from a social conscious standpoint, since the vast majority of dentists are very giving of their time and $$ already, but I'm saying this from a political standpoint. This way, not if, but WHEN, we as dentists actually take maybe 2 hours out of our YEAR, and attend a local component society "legislative night" and talk with our elected officials, we can talk directly with them about our actual experiences with treating the underserved/medicaid population. I can't tell you how much it can undermine the points were trying to make to politcians when what happened recently in my own component society occurs - we had our legislative night a few weeks back. My component society has roughly 65 members in it. We marketed the heck out of this night to the members of the society. We had 8 our our local state reps/senators show up and only 6 of the society members showed up Tough to make a solid point about how we dentists care about the access issue to our legisaltors when we can hardly get any members to show up for a 2 hour dinner meeting. Bottomline, we need to get involved and stay involved.

#2, once we've made the contact with our legislators, and it might actually take a few of us, especially if we happen to have an elected official as a patient, to become that politicians "dental liason" we need to stress the conception, not of access, but of utilization to our legislators. Like I posted earlier, most politicians seem to think that 100% access is needed, when the reality is that even with 100% access that the utilization rate, even in the best case scenario, is going to be 50-60%. So therefore the politicians are trying to create this utopian plan that already has atleast 40-50% excess (read as extra costs) associated with it - politcians, especially in this day and age are quite cost conscious, and if you can have a rational conversation with them about how they would be trying to create this big, bloated plan, that works in most cases.

#3 If and EFDA is doing the work, what they're getting reimbursed for a procedure will be the same as if a dentist was doing the work. There is no seperate EFDA fee schedule and dentist fee schedule, less the legislators feel like creating a "2nd teir" fee schedule, which inherently implies "2nd class" work, and they don't want to touch that concept. Then it gets down to what type of provider can accomplish things in a quicker, more efficient manner?

#4 you need to stress to the legislators that in most situations, especially if you're talking about the adult underseved/medicaid patients, that one of the biggest problem is that the reimbursement rates being paid for most procedures don't allow us to cover our costs, and since the materials/supplies that we as dentists use, aren't any different than an EFDA would use, the EFDA wouldn't be a financially viable model, without significant gov't financial assistance, especially since the EFDA the vast majority of time takes longer to accomplish a procedure than a dentist.

Sure there are a small percentage of dentists that will spend far more than 1 2 hour dinner per year with their politicians to help the cause of dentistry, but for the vast majority of this profession, this is all that it will really take to help the profession, but unfortunately many in this profession won't do that.