Friday, April 4, 2008

A Changing Profession (editorial)

Here is the deal. I write 50 posts and get a comment here or there. Mark writes one blog and lights up the comment section. Now when I said lets do some dialoguing here I didn't mean make John look bad.
Now the powers that be are thinking....Hmm, maybe we got the wrong cat to do this blog. Nice, real nice, way to go.
No, in all seriousness, it was great. I appreciate all your passion, as well as Marks.

Have a great weekend and I will talk to you next week.

As promised, here are my thoughts on the article.

When I first read the editorial, my knee jerk response was one of anger. I wanted to personally send a verbal triad in response to the attack on the profession I care so much for. This is just another in a long line of attacks on general dentistry. A reoccurring theme of each of these attacks is the famed “access to care” issue.

It amazes me that all these different dental groups have a different definition of this “access to care” term. It is also amazing that the solution to solve this yet undefined problem lies in some types of gain for the organization or group. All the solutions will transform the face and practice of general dentistry drastically.

After a period of cooling down, I thought of who wrote the editorial. These are two educators who see things very differently than someone who is actually in the trenches treating these patients. I believe the more practical solution should come from someone who is actually treating these patients, day in and day out. One would think dentists who treat these patients have a pretty good grasp on the situation.

While this idea and that idea may sound great, in the real world, it would never work. Dr. Glick relates to the medicine model which he claims to be so wonderful and successful. In the past the ADA has championed the slogan, “Dentistry is health care that works.”

Is Dr. Glick implying that this slogan is no longer valid or applies to dentistry?

Even with the flaws, I still believe it works better than medicine. How can the editor of the ADA discredit that slogan? Even while Dr. Glick expounds on the success of the medical health care system in American, I hear the two Democrat Presidential hopefuls talk about how the health care system in the United States is broken and needs a major overhaul. Dr. Glick also talks about the Surgeon Generals Report on Oral Health. Again, two people looking at the same thing and interpreting it differently. I have studied the Surgeon General’s report on Oral Health and I do not believe there is a reference to a mid-level provider. I do remember much was said about prevention, specifically fluoridated water, and oral health literacy.

Being an educator, Dr. Glick surely knows that more dental schools are opening therefore in the near future; more dentists will be delivering care. Why perpetrate second rate care on the American public when there will be more highly educated and trained dentists entering in the workforce in the near future?

Lastly, I believe the access to care issue is a funding problem. Period.

The ADA has championed this in the past, but has not correlated it directly to a funding issue. In a 2003 issues of JADA, the ADA championed the Michigan Healthy Kids model to solve the access to care issue. What happened? It was decided in Michigan through legislation to raise reimbursement rates to market values. Within a year, utilization rates increased dramatically which directly correlated to the fact that the number of dentists that became Medicaid providers increase enrolled and treating patients. One fact that is over looked is that the distance traveled by patients for appointments was cut in half. Simply, the program was funded and dentists provided the treatment. Great news! Why can’t folks understand that this is funding issue not a workforce issue? If the program is properly funded, utilization rates will increase because more dentists will come on as providers.

I wonder if Dr. Glick’s embrace of the mid level provider is also the stand of the ADA. After all, the ADA 2007 House of Delegates agreed to the Community Dental Health Coordinator. This CDHC is not a mid level provider, but its creation does open the door for another provider of dental services.

You be the judge. Is the ADA advocating for the practice of general dentistry?

They have known about the ADHA’s ADHP for sometime and have not addressed the issue. They have remained silent. Where does that leave the general dentist?
The landscape of the practice of general dentistry may be changing. If it happens, it could be detrimental to the practice of general dentistry, all under the cloak of access to care.

The AGD is the only dental organization that has the general dentist’s best interests at its core. No other organization in the world will advocate specifically and solely for the general dentists.


1 comment:

Buckeyedental said...

Dear Mark and John

I am a Dental Hygienist also The Ohio State Univerisity Hyg 1984. So I have a little insite in the Hyg Curricilum. When I was graduating Hyg the big push was for independent practice for Hygienist. I believe Colorado has/or had independent practice but it did not go far because it does not make economic sense. As far as a mid level practice provider goes who will pay for the training? Of all the Hyg training schools only 48(I may have counted correct?) are degree BS granting and fewer master level programs.
Will the feds pay for this it would be better cheaper to increase medicad payments. Even if the mid level provider comes about it will be regulated by the state dental boards and I do not see them going along.

As far as access to care goes I believe that there is a small segment of the population that has no or limited access that we as a perfession and public need to care for. But ther are other parts of the population that has choosen not to make personal responsablity a priority. In the general population only 50% of the population see the Dentist yearly. This percentage is even lower in the lower socical economic group. It has more to do with education and education of prevention. In this group and the population as a whole.

A new provider is not the answer to the problem. It is increase the payments and education.


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