Dissecting the Workforce Debate

1. Dissecting the Workforce Debate • Tim Calnon • District 2 Trustee • 2011 Eastern Regional Meeting

2. 2 Overview • What is a MLP? • Navigating Acronyms • Rationale of Alternative Workforce • History • American Programs • ASDA Stance • ADA Stance • Protecting our Profession

3. 3 Objectives • Educate, Educate, Educate • Pay it forward

4. Dental Workforce 4

5. 5 MID-LEVEL PROVIDERS

6. 6 MID-LEVEL PROVIDERS = BAD

7. 7 Thanks for coming! Any Questions??

8. 8

9. 9 MID-LEVEL PROVIDERS

10. 10 Alternative Workforce Models

11. 11 NTAOAWM EFDA CHDC ADT DHAT DT PDT OPA ADHP

12. 12 Rationale of Alternative Workforce • Underserved Populations • Too Few Dentists • Geographic Dispersion • First Line of Care • Liaison to Dentist • Analogous Programs Abroad

13. 13 Deamonte Driver • 12 year old Maryland Boy • Evidence of Medicaid Red Tape • Emotional, but evidence?

14. 14 Historical Perspective of the Dental Team

15. 15 History of Dental Assistants • 1985, First Female Dental Assistant • Dr. C. Edmond Kells of New Orleans hired Malvina Cueria, who is generally regarded as the first dental assistant • 1900- Dentists start advertising assistants

16. 16 Dr. C. Edmund Kells “The assistant is one of the dental institutions of the day and is due to survive as long as dentistry lives. The assistant is absolutely essential to the modern dental office.”

17. 17 1985, Courtesy of ADHA

18. 18 History of Dental Hygiene • Dr. Alfred Fones is generally regarded as the Father of Dental Hygiene • 1913, first hygiene school in Bridgeport, CT • 1947, the ADA endorses a two year training program with requirements for accreditation

19. 19 History of Dental Hygiene • 1972, the Forsyth Experiment begins • Hygienists were trained in restorative procedures • Results indicated that a dentist in solo practice using hygienist-assistant teams to provide restorative care could increase their productivity

20. 20 New Zealand Dental Nurses • Present for Decades • 18-24 month Education • Many work in schools • Independent • Able to perform restorative procedures • Deciduous Extractions

21. 21 Dental Team Observations • Evolving Dental Team • Large initial investment • Necessary Dentist buy-in • Not always successful

22. 22 Specific Workforce Models • Expanded Function Dental Assistants • Dental Health Aide Therapists • Dental Therapist • Advanced Dental Therapist • Advanced Dental Hygiene Practitioner • Pediatric Dental Therapist • Community Dental Health Coordinator

23. 23 Specific Workforce Model • Location: State (Enacted, proposed, pilot) • Population: Public, private • Settings: Office, clinic, schools, unspecified • Education: Post secondary • Supervision: From direct to collaborative • Surgical: Yes, no • Diagnosis: Yes, no • Comment: Additional pertinent fact

24. 24 Expanded Function Dental Assistants (EFDA) • Location: 27 states have some form of EFDAs • Population: Public and private • Settings: Clinic and Office • Education and/or OJT: Two years (Varies by state) • Supervision: Direct and/or indirect • Surgical: No • Diagnosis: No • Comment: Different states use different acronyms*

25. 25 Dental Health Aide Therapist (DHAT) • Location: AK (Not licensed by state)* • Population: 85,000 native people of all ages • Settings: Clinics in remote tribal villages • Education: Two years (DENTEX in Anchorage) • Supervision: Public health • Surgical: Yes • Diagnosis: Yes • Comment: DHAT scope is competency based

26. 26 Dental Therapist (DT) • Location: MN (Enacted 2009) • Population: Patients with access barriers • Settings: Clinic and office • Education: Four to six years (28 month program) • Supervision: Indirect and collaborative • Surgical: Yes • Diagnosis: No • Comment: Scope differs with level of supervision

27. 27 Advanced Dental Therapist (ADT) • Location: MN (Enacted 2009; no ADTs yet) • Population: Patients with access barriers • Settings: Clinic and office • Education: Two add. years? (Master’s program) • Supervision: Collaborative • Surgical: Yes • Diagnosis: No (May assess, authorized by DDS) • Comment: Must be DT with 2000 hours to apply

28. 28 Advanced Dental Hygiene Practitioner (ADHP) • Location: Proposed in several states • Population: Unspecified • Settings: Unspecified • Education: Six years (Two year MS degree) • Supervision: Collaborative • Surgical: Yes • Diagnosis: Yes • Comment: ADHA model, certified as ADHP

29. 29 Pediatric Dental Therapist • Location: ME (State bill introduced in 2009) • Population: Limited to children age 0-12 • Settings: Fed-designated dental shortage areas • Education: Two years • Supervision: Indirect • Surgical: Yes • Diagnosis: No • Comment: Licensed by dental board

30. 30 Community Dental Health Coordinator • Location: OK, CA, PA (University pilot programs)* • Population: Underserved • Settings: Public Health • Education: 18 months (12 mo. didactic) • Supervision: Direct and/or indirect • Surgical: No • Diagnosis: No • Comment: Community health with dental skills, ADA supported

31. 31 REVERSIBLE

32. 32 IR REVERSIBLE

33. 33 What do WE think?

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35. 35 C1 Expanded Functions of Dental Assistants and Dental Hygienists • The American Student Dental Association endorses expanded functions for dentalauxiliaries only when each has received the appropriate education and training to guarantee competence, and when such functions fall within the laws established by their respective state of employment. • It is incumbent on the profession to assure that expanded functions for dental auxiliaries will not adversely affect the health and well-being of the public. • The practice of dentistry entails more than the simple performance of routine technical procedures. A dentist must possess a wide range of knowledge of the biological, anatomical, and physiological sciences in order to successfully and safely perform such procedures. A dentist must also be able to process and apply both the knowledge and the skills acquired in dental school in order to successfully and safely perform these tasks. • Thus, only the dentist should perform the following functions. These functions include but are not limited to: • Examination, diagnosis and treatment planning • Prescribing work authorizations • Performing irreversible dental procedures • Prescribing drugs and/or other medications

36. 36 C2 Independent Practice • The American Student Dental Association is strongly opposed to independent dental hygiene practice, and favors the team approach for providing comprehensive dental care.

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38. 38 Opposition to Pilot Programs Which Allow Nondentists to Diagnose Dental Needs or Perform Irreversible Procedures • Resolved, that the American Dental Association opposes pilot programs that are in violation of the ADA policy stated in Resolution 24H-2004 (Trans.2004:291), no. 13 (stating that, “The ADA is opposed to non-dentists making diagnoses, developing treatment plans or performing irreversible procedures.”)

39. 39 Diagnosis or Performance of Irreversible Dental Procedures by Nondentists • Resolved, that the American Dental Association by all appropriate federal legislative and judicial means resist any effort compromising the quality of dental health care services by allowing any nondentist to diagnose or perform irreversible dental procedures except as otherwise authorized by state law with reference to physicians.

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42. What is the root of the debate over Alternative Workforce models? 42

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44. 44 ...”must guard against focusing on any one barrier to the exclusion of others that are equally critical.”

45. 45 “Everyone deserves a Dentist.” - Dr. Ray Gist, ADA President

46. 46 What about our future...?

47. 47 Legislative Updates 2011 • CT- ADHP bill : DEAD • NM- CHDC, DT, EFDA : DEAD • OR- DT : Held by Sponsor • WA - DT, ADT : DEAD • KS - RDP : DEAD • ME - OHP : DEAD • VT - DT : DEAD

48. In Washington, if you’re not at the table, you’re on the menu. 48 JOIN TODAY! $5 = Your Future

49. 49 A D V O C A C Y

50. 50 Moral of the story: Don’t let the tail wag the dog!