Thursday, October 9, 2008

Back to Dentistry, Access to Care

xOkay, rating turned out to be a big mistake.
What I didn't realize is that some people don't like the blog.
So I got a .9 by one reader. Yeah, I said, "POINT NINE".
Now I can handle constructive criticism but...
Why not give me a zero? Am I better than a zero but not as good as a one?
That hurt.
But I must go on.

I wanted to talk to you about something that is going on in Dentistry.
I have enough knowledge of this topic to be dangerous, but I will do my best.
The topic is about Access to Care.
This is a very important topic so I hope to do it justice.

It is a heavy topic so I will do my best to lay the ground work for you (and I think it will be interesting to you non-dental people).

The problem....
People in rural areas are not getting Access to Care.
What does that mean?
For example (and a lot of this started) in Alaska. There are areas of Alaska that there are people and there are no dentists. In some areas you might say, "just go to the nearest town" but the nearest town is just too far to go.
The problem is how do we get dental care to these people?
This is a problem for these patients. It is problem for the dentist. It is a problem for the government (that has promised to care for their citizens).

So in Alaska there idea was to train a "Mid-level provider". This is someone from that particular community that goes and studies for a year or so and that can deliver to their community some emergency dental care and some basic dentistry.
They would teach these people how to pull teeth. They taught these people how to do a simple filling, Then they taught them how to take care of some kids stuff, like sealants and a prophylasis.
Just think of these people like a nurse practioner in the medical field.

This plan kind of went under the radar of organized dentistry for a bit.
I think some things started to filter down to the great 48. The same kind of things started to happen in Maine and Minnesota.
Now the ears of organized dentistry started to perk up.
You remember in the AGD Impact there was an article about this. Now it is really beginning to be on a lot of people's radar.
Here is the deal. It is not about the eskimos any more. It is become about everyone that doesn't have access to dental care. Meaning everyone that can't afford dental care.
Think about the people that can't afford dental care in your community. Instead of going to the local dentist they can go to a less expensive dental pracitioner. Not only the less expensive provider the less educated provider.

So the Mid-level provider (MLP) want to not only provide dental care in the snow in Alaska, they want to set up shop in our towns. They want to set up shop in California, Texas, North Carolina, Florida, Georgia and all the others.
The people that want the MLP say there isn't enough dentists to go around.
Now the dentists say they have the ability to treat everyone. We are in the same towns and we have openings in our schedules....we can do this.

The government says it wants all its citizens to have dental care.
The government has a system called Medicaid.
But as you may know there are very few dentists that take Medicaid.
You all know me...I am a dentist who cares deeply about my community and the people in my town that can't afford dentistry...but in its present state I cannot take Medicaid any time soon. See, if I took Medicaid I would loosing money doing dentistry.
Now I am not talking breaking even I am talking loosing money. So it is not about dentists being greedy.
As an aside, I run with a couple of urologist and they say that 30-40% of their practice is Medicaid. They say Medicaid pays well and is easy to work with. Not the case here.
So now the choice of the general dentist is to loose money treating patients or offer patients an untrained dentist. One year of training does not even scrape the surface of the stuff I see in my practice daily.

The American Dental Association (ADA) is backing the MLP initiative. I find this very hard to believe that the members really know what is going on because this seems to be ludicrious. Trust me, I am an ADA member and I didn't know about this.
There are plenty of dentists and there it is a desire of most dentists to care for people but for some reason this is not good enough. This isn't cheap enough.

So, I am proud to say, the Academy of General Dentistry (AGD) has taken exception.
This is the "hill to die on". They are fighting the ADA on this with a passion.
A passion for its members and a passion for its profession.
The AGD is trying to educate its members to wake up.
Wake up and educate themselves. And when they feel like they have a grasp of the subject then call their ADA representative.
(You see the voting in the ADA is much like our government. There are representatives that vote on behalf of its regional members).

So today I am asking you to do the same. Educate yourself. The AGD has published a bunch of ariticles that may help.
Access to care:
White Paper:

About the White Paper:

Call your ADA representive. Have a voice.

Have a great weekend,

Ps. Hey John V...was that enough dentistry for you. POINT NINE?!!!


MarkD said...


I have been reading your blog and this is the best one yet. I have always believed that the AGD should advocate for its members and general dentist. This is evidence of how far that AGD has come since deciding to be better advocates (AGD 2010). You make some very strong points. Many ADA delegates just vote party line and do not take issue seriously. This issue is serious. It will change oral health care for our patients and our practices.
You hit the nail on the head. This is not an access to care issue. It is an access to cash issue. Government, especially state legislators, continue to underfund Medicaid but place the blame on practitioners and then tell the ADA they have to solve the problem.
Anyway, enough of me being on the soap box. Go AGD.

BTW - have you seen Fireproof yet? Great movie.


MarkD said...


I forgot to let you know that I am a Medicaid provider and understand the loss that takes place when treating these patients. It is not just financial. It is a loss of time, effort and hair. Hair when I am attempting to decide to give up. HA.


gatordmd said...

You say this is the best one yet.
That is a pretty bold statement.
I don't know...I have had some pretty funny ones.
Parenting 101 was an instant classic.
My Marathon one, the first week in February, was hysterical.
I am just messing around.
Thank you for the compliment. Feel free to write anytime.
I hope you continue to read.
No, I haven't seen Fireproof yet. I am totally out of it...I didn't realize it was still in the theater.
You are saying it is worth $10?
I don't see very many movies in the thearter...because I am cheap.
Thanks again,

Anonymous said...


Excellent blog. Keep up the great work!

Anonymous said...

How long before this becomes an issue that the general public is aware of and we (dentists) are viewed as a special interest group? Next, there will be political ads condemning politicians who oppose "access to care". Dateline will do a story about the kid who died from an infection up in DC and suddenly dentists are portrayed as the evil small business owners with self preservation being their only concern. Ghost


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.