In response to Drs. Michael Glick and O.T. Wendel’s March JADA editorial, "Lessons Learned: Implications for Workforce Change" (JADA 2008;139[3]:232, 234), I can stand silent no longer. As a private practice, wet-gloved dentist, I feel the American Dental Association is letting me down. This editorial sums up exactly what I mean when the authors stated, "the effect will be felt mostly among working dentists." And yet the only concern the authors and the ADA exhibit is for dental assistants and dental hygienists.
The efforts under way to establish workforce change use the medical delivery system as an example of what dentistry should be. I say that is exactly the model we need to use to demonstrate what not to be. The costs for medical care have done nothing but go up. How has their model improved "access"? I do not believe medicine is better off, and I would bet the majority of dentists not in academia would agree.
The real issue should be what is best for our patients. The authors claim having an expanded workforce will improve access to dental care. We all know there are plenty of dentists to address access. I realize it is politically correct to say "access," when we are really saying "free or subsidized by the taxpayer." The creation of more layers of providers will dramatically increase costs to the patient or the system and not improve care.
How would a patient benefit by seeing an advanced dental hygiene practitioner, having a temporary filling placed and then having to see a dentist to receive a definitive restoration?
Where does the money come from to cover liability insurance and facility costs for a privately practicing hygienist? I’m not sure if the ADA has noticed, but there is a Medicaid crisis nationwide, and the fees allowed to cover dental care are quite often below the costs to provide the care. How would adding more providers improve "access" when the dollars are diluted?
For the hygienist who wants to be a dentist, why not find better ways for them to attend dental school? That would address the shortage of dentists that the authors mentioned in their editorial. Why not focus on raising Medicaid fees nationally? If the ADA is not having much success with Congress now, what makes them think it will get better with more layers of care? Why not develop programs that effectively educate schoolchildren that are reimbursable to a dental office? Why doesn’t the ADA look for more creative funding sources or alternative methods that would allow more dentists to provide care? There are too many ways the ADA could address this problem of "access" without harming the dentist.
I’ve said my piece.
