Wednesday, April 2, 2008

A changing profession

As of now, you must be able to tell what kind of guy I am. I take what happens to me everyday and laugh about it. I am very passionate about dentistry and doing what I do better. I love what I do but am wired a certain way.
I practice dentistry and HOPE someone else it taking care of my advocacy issues. That is why I love being a part of the AGD.
I have never been very political. But thank goodness some are. Some dentists are just wired to do advocacy.

There is some really scary crap going on around us and Mark (not really a ghost writer if you know his name) has some really good points.
At the end if you feel like commenting do so and we can have a discussion (especially if you have an opposing comment).

Ps. I told you I was going to talk about consent forms but I thought this blog takes some precedent.
So here it is...

Change is always happening around us – sometimes good, sometimes not. Some changes we have to accept but others we can resist and fight against.

I sense a change in the practice of general dentistry. The change I am sensing in the practice of general dentistry is not natural. It is also not good for the practice of general dentistry. As a matter of fact, I think it is an attack on the practice of general dentistry. This change will transform the practice of dentistry as we know it today. If this transformation takes place, I believe the practice of dentistry will no longer be the esteemed profession that it is today. You may be asking yourself, “What is he talking about?”

Consider the trends; in 2004, the American Dental Hygienist’s Association (ADHA) House of Delegates passed a resolution for a mid-level provider to diagnose and treat dental disease. At their recent winter meeting, the ADHA Board of Trustees adopted the Competencies for the Advanced Dental Hygiene Practitioner (ADHP). Their Web site says “The ADHP model has been created by ADHA as an answer to the oral health crisis in America.” In the summer of 2006, the ADHP language was in the U. S. Congressional Committee Report, S. Rep. 109-103, which accompanied a bill making appropriations for the Departments of Labor, Health and Human Services, and Education and related agencies. The report “encouraged HRSA to explore development of an advanced dental hygiene practitioner... which prepares the dental hygienist to provide diagnostic, preventive, restorative and therapeutic services directly to the public in rural and underserved areas.” Now, the Minnesota legislature is seriously considering expanding the scope of the dental hygienists on the ADHP model that would allow the mid-level provider to perform extractions and restorations without the supervision of the dentist. Also this year, Senate Bill 2723 has been introduced and has language for an Allied Dental Health Professional. The most recent attack came from the American Dental Association in an editorial in JADA entitled Lessons Learned: Implications for workforce. The editorial basically asked the profession to embrace the mid-level provider and that the dental education community was in the “driver’s seat” to bring about this change in the profession.

These trends should cause most private-practice general dentists in America to take notice and be concerned. Change is always occurring around us – sometimes the change is good, sometimes not. I know this issue can be debated because some, even AGD members, feel it is time to have a mid-level provider that will diagnose and treat dental disease with less training and education than a dentist. The mid level provider will not affect the practice of any dental educator or dental specialist. It will only affect the practice of general dentistry. AGD President, Dr. Vinny Mahyer, wrote a letter to the editor in response to this editorial. I am very appreciative of Dr. Mayher’s quick and pointed response, but I want to carry it somewhat deeper. What are your thoughts about these trends – I’ll share some more of my own on Friday but I am interested to hear what you think.


Okay, to me this is some heavy deep stuff. Usually, when someone starts with the committee report section 109-103, I check out.
Today I stuck with it.
Is anyone lost?
Does everyone know what the mid level provider is?
Does everyone understand the crux of this argument?
The benefit to the blog is you can comment anonymously.
Okay so you have lots to comment on...
Give Mark you opinion so he feels wanted.

Talk to you later,


Anonymous said...

As an x-hygienist, I understand the need for care to the underserved population. However, to achieve a mid-level practitioner a hygienist would need to attend approximately the same amount of training as a dentist. If this level of practitioner is created, it will further segment our profession. I commend the AGD's President Vinny Mayer's response. We, as in the "we" in the JADA article, need to identify the obstacles in serving the underserved population and then make informed decisions. We do not need to follow the medical profession in the same manner. The medical community continues to have their own ongoing set of problems. The general dentist has maintained a high degree of integrity for many years and will continue to do so without the creation of a mid-level practitioner.

Cheryl Billingsley

Anonymous said...

We, of the AGD Dental Care Council, have had advance notice of this "issue", and have given our comments.
Vinny's response was excellent, to the point, and I believe what all of us want to say.
I'm anxious to find out if the ADA will print his "letter to the editor".
Every GP should be very concerned and upset with this article.
John Drumm

Anonymous said...

Vinny’s response is spot on!
The answer to the current dental problem is not further stratification of the dental delivery team. The problem is access to and awareness of oral health care and its importance. Diluting the field with midlevel practitioners will not change that. Glick is addressing the wrong side of the equation. We know that the classic dental school education has kept the public safe for over 100 years. We need to look at ways to encourage the dentist to practice in these areas, such as education debt relief.
We need to hit this one hard.

On a personal note, the Advanced Dental Hygiene Practitioner, in my opinion, will never achieve parity with the Nurse Practitioner.

GIgi Meinecke, RN, BSN, DMD, FAGD

Anonymous said...

Cheryl and Gigi, great points. You both have valuable perspectives.
As for my thoughts, I hear alot of ominous language in Dr Glick's editorial. He states that we are on the verge of "a similar evolution ... the medical profession ... began in the 1970s." Well, I sure don't want to see the dental profession go in the direction the medical profession has gone, nor do I want to see our profession compared with the medical profession. First, the medical model does not match our model. It's comparing apples to oranges, and sound policy will never develop from comparing the these two models. Secondly, I would have to say the evolution of the medical profession has NOT improved the quality of care delivered nor has it increased access to care. They have the same access issues we have and they have seen their graduates flee general family medicine and flock to specialties. Thirdly, this "evolution" of the medical profession has allowed the insurances companies hijack the profession to some degree. The result, crowded waiting rooms, higher turnover, shorter appts, much lower fees, and more lawsuits. These are just a few of the problems from this evolution.
Also, am I missing something? Where are all these extra hygienists and assistants that will fill in as midlevel providers? I forsee a shortage of them if we go this direction. Of course I realize the answer is we need to train more. But that answer is much to simple. I see all dental professionals working longer hours, earning less, and still having shortages with staff, midlevel providers and dentists.
I think this all goes to money. It doesn't cost much to endorse this kind of "evolution". Certain groups would rather see costs decrease at the expense of a decrease in quality. If they really cared about a solution, the would fund dental education, medicaid reimbursements, school debt relief,and other solutions as if they really cared. You are seeing this evolve so less money can be spent on dental care, and the general dentist is the main target.
Brian McAllister

Anonymous said...

I am not a mid level provider supporter. If we begin to allow our profession to go down a path traveled by our medical counterparts, we should have our heads examined. The dental care delivery system in this country is the best in the world. I do not buy the argument that this new form of auxiliary will solve the access to care problem. I truly believe that there is a segment of our population that will be left untreated no matter what alterations we make in our dental care system. If we elect to incorporate a mid level provider into our practices and allow them to perform procedures that have taken us 4 years of formal education and countless hours of CE to master, we have devalued our DDS and DMD degrees. I guess you understand my position.


Anonymous said...

I totally agree with Kirk and couldn't state it any more succinctly.


Anonymous said...

I am a general dentist in the armed services, and have witnessed first hand the problems created by a mid-level practitioner model. In general, the fillings placed by these personnel are substandard, and have to be replaced far more often than usual. It is even more frightening to me that the Minnesota model suggests that oral surgical procedures could be performed. We would be reducing the quality of care that we deliver to patients, and lose control over our profession in the same way that general practitioners in medicine have. When is our country going to learn from our mistakes?


gatordmd said...

I didn't know you all were so passionate. AWESOME.
Hey is there anyone out there that has an opposing opinion. It would be nice to dialogue. Maybe you see some things that might paint a different picture.
And like I said, "It can be anonymous."
Keep it up.

Anonymous said...

The government always has these "great" solutions to these seemingly enormous problems. The masses usually get what they want. It's a numbers game where we are simply the minority. They, the general public and your congressmen, don't care about the quality of care and certainly could care less that we have sacrificed what we have to become dentists. They have never considered our burden. All they see is a bunch of elitist dentists refusing to care for the underprivildged. It's clear from the way nearly every level of government (city, county, state, and federal) runs their budgets (deficits mostly) that they have no concept of what's required to turn a profit on services rendered. No idea as to what makes our overheads what they are.
I just read an article last week where Al Gore personally gave approximately .02 of his earnings to charities but while in public service he was giving tax payer money away in record numbers. The point is that it is easy to be generous with other people's money for these politicians and in this instance they want to give away ours. All about votes.

Anonymous said...

Hi Mark,

I support Dr. Mayher. After reading this blog here are my ideas. Let's use our resources to discover why people are not being treated before hastily pushing the mid-level provider. Are we sure that these underserved populations even want to seek routine dental care? Can we ensure mid-level providers will flock to underserved areas? It may be more advantageous to have high school graduates provide dental education to the underserved, instilling the value of oral health in these communities. This is definitely something worth researching on the academic level. Before dental educators push the mid-level provider, I encourage them to do the research. Thanks for the information.


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