I read with interest Drs. Michael Glick and O.T. Wendel’s March JADA editorial, "Lessons Learned: Implications for Workforce Change" (JADA 2008;139[3]:232, 234). The main question that comes to mind is how much of our scope of practice can we give away without reverting to trade status in dentistry?
The basic premise of the authors’ "commentary" seems to be that we must emulate the medical model if we are to deliver oral health care in the 21st century. If this is the case, why is it that most of the grass-roots dentists in this country believe, and are being led to believe by the leadership of our Association, that we have been fortunate in the last 20 years because we have avoided the mistakes that our medical colleagues have made in dealing with scope of practice issues and the loss of the physician as the primary provider of health care to patients?
While the authors’ opening remarks forecast a dramatic increase in demand for dentistry in the next decade, the American Dental Association has been stating to its leadership and councils for the last 10 to 12 years that we do not have a shortage of dentists in this country. We have stated over and over again that our only problem is a maldistribution of dentists, and that we have adequate workforce to meet the needs of the public for the next 20 years.
In recent times, the ADA has dismissed suggestions that we train more dentists, but suddenly, one to two years later, we need midlevel providers who are going to provide dentistry. Dental workforce is dental work-force, regardless of the name. Depending on the model, the scope of the midlevel provider is planned to be far-reaching to the point of including extractions and restorations.
The authors state that these new midlevel providers will give patients access to affordable, high-quality, comprehensive oral health care. First, these midlevel providers will require dentists to supervise their actions. If there are no dentists in these underserved areas, what are the plans that will allow the midlevel providers to function there? How long can we hide behind the ruse of teleconference oversight before these midlevel providers decide that they should have independent practice?
When the authors call for new state laws to deal with the new "stratified oral health service delivery model," it would appear that we are seeking to emulate the medical model, in which the patient often is confused by a convoluted treatment program and does not know who is treating him or her for what.
My last concern is the call to arms for the education community to redefine the future of dentistry. The role of dental education historically has been to support the needs of the profession relative to the technology available for the average practitioner. Now we see that the authors would ask the educators to develop a model that would define the profession, rather than the other way around. It might be a good idea if the average dentist had a clearer picture of his or her job description in the future than that which is being portrayed in The Journal and ADA News.
