NYTimes: "Short of Dentists, Maine Adds Teeth to Doctors’ Training"

[NonTradMed]

This is an interesting article about training doctors to provide basic dental care in rural areas. A snippet:

Dentists are in such short supply in Maine that primary care doctors who do their medical residency in the state are learning to lance abscesses, pull teeth and perform other basic dental skills through a program that began in 2005.
....
Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.

Nationally there is one dentist for every 1,600 people.

Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state's largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state's southernmost town.
....
In Maine, training physicians in dentistry provides a dental safety net for the rural poor who have never had one, doctors and dentists said. About two-thirds of the residents who have trained at the dental clinic now practice in the state, many in rural areas.

Given the recent turf wars in medicine, I thought it was interesting that this one has physicians on the other side (i.e playing in someone else's backyard). Comments?

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[cpants]

I think it's an interesting case. It's similar to the NP movement into the physician scope of practice only in the justification--filling a shortage.

This widening of scope is very different, however. Maine is not adding a few classes in dentistry and saying physicians are now qualified to be dentists, which is essentially what the NP's have attempted. Instead, they are setting up a safety net, so that in an emergent situation, a physician who is already in place in a remote area can do something to help a patient who is probably in desperate pain. The doc will have the skills to pull a tooth when there is simply no dentist available. This will be admittedly substandard care, but in this case, substandard care is better than no care.

The system utilizes doctors who are already in place in rural communities, and actually would increase access to rudimentary dental care. This stands in stark contrast to the NP situation. While they attempt to justify the increase of scope as a remedy to the PCP shortage, NP's have as little incentive to practice in underserved areas as physicians do. Furthermore, they are not sticking to primary care. NP's are flocking to anesthesia, derm, surgery, and every other more lucrative field in which there is no shortage of physicians.

 

[LADoc00]

the problem is do dental CPT/ICD-9 codes all exist?? Dentists have a totally different billing structure to ensure their payment vs standard primary care MDs.

I see serious issues with the business end of this model unless the docs are very smart about it..and the fact they are doing primary care in rural Maine may argue against the biz skills here.

Dx: recipe for fail.

 

[meister]

It's always mystified me why dentists and podiatrists have separate schools. In my opinion everyone should just get a medical degree then specialize during residency.

Dentists and podiatrists have way more in common than psychiatrists and neurosurgeons. Our current paradigm is a bit perplexing.