I read with interest the March JADA editorial co-authored by my friend and colleague, Dr. Michael Glick, along with Dr. O.T. Wendel, "Lessons Learned: Implications for Workforce Change" (JADA 2008;139[3]: 232, 234). Editorials are best when they provoke deep thinking and meaty discussion, and it’s clear that this editorial did just that. I feel that it’s important for readers to hear my perspective as president of the American Dental Association, which is reflective of the policies of the ADA and in keeping with Board of Trustees and House of Delegates discussions.
While the growth of midlevel providers in medicine over the past few decades offers much food for thought as we look to improve access to oral health in America, I wonder if such variety is as workable in dentistry. Rather than just inviting emerging groups of oral health providers into our midst, acting as though all have equal merit, we need to do the hard work of determining exactly what type of additional allied help for the dental team might be needed first and evaluating their impact on increasing access to care.
For example, unlike the other models referenced in the editorial, the ADA’s community dental health coordinator will be tested in a variety of settings in demonstration projects before it is advocated strenuously to policy-makers as part of a workable solution to improve access. The ADA’s related oral preventive assistant is in the pipeline for curriculum development and field testing as well.
We also all need to focus on ways to convince the public and policymakers of the overwhelming importance of community and family preventive efforts and care (community water fluoridation, diet, improving oral health literacy, etc.). All of the workforce in the world won’t catch up with dental disease if these basics continue to be rebuffed, ignored or misunderstood. And while workforce issues attract much heat and light from all sides, the truth is that no new model will accomplish much if the government continues to fail in its responsibility to adequately fund public dental programs. Dentists’ participation and access increase dramatically in states that have done just that: paying for the care that they promise. The bottom line is that the issues surrounding the access to care dilemma are complex and multifaceted and will not be solved by anyone with a singular focus on a narrow and highly polarizing workforce "solution."
