Before actual discussion, a poll of the membership was distributed
which asked this question: If legislation is introduced in the
Pennsylvania legislature regarding dental therapists, what should
be the PDA’s position on this? There were five choices:
1. Welcome dental therapists to practice independently
in the state
2. Allow dental therapists to work under the direct
supervision of a dentist in a private practice
3. Allow dental therapists to work under the direct supervision
of a dentist in a private practice with a requirement that
50% of the patients treated have dental benefits covered
under medical assistance programs.
4. Allow dental therapists to work under indirect supervision
of a dentist using a collaborative agreement, only seeing
patients in federally recognized dental shortage areas.
5. Fight the introduction of legislation allowing dental
therapists to practice under any model in Pennsylvania.
Not surprisingly, 0 members chose to welcome dental therapists
to practice independently. And 22% of the members chose
to fight introduction of DTs in PA. However, that left 78% of our
members somewhat in favor of allowing dental therapists to
have a role in providing care in our state.
The presentation and discussion by the panelists were excellent.
We introduced information on what DTs are, how they are
trained, what procedures they are trained to perform and their
scope of practice in various states. Alaska was the first state to
allow DTs, and like in many states, these practitioners are
allowed to work in tribal lands. But in Minnesota, licensed DTs
can work in private practices seeing both private and Medicaid
patients. In fact, Dr. Dens mentioned that his dentist son has
acquired his practice and has hired a DT to replace him. He stated
that he could hire a DT at $50/hour vs. a dentist who would
demand $150 per hour. His son can concentrate on some of
the more complex cases while the DT provides basic care to his
patients.
In Minnesota there are two types of therapists. Oral Health
Practitioners are hygienists who spend an additional two years
gaining a Master’s Degree at Metropolitan State University
training to provide basic dental care. The MDA, which was taken
by surprise by legislation aimed to allow hygienists to pursue
this route, countered by pushing their own legislation allowing
high school graduates to spend three years at the University of
Minnesota learning their skill. These students work side by side
with dental students learning how to prep and place restorations,
provide prophies, treat primary teeth (pulpotomies, stainless
steel crowns, and extractions) and even how to extract mobile
adult teeth. Dr. Dens noted that the DT students do not have to
learn more advanced procedures as the dental students do, and
he feels that they have better training in basic dental procedures
than the dental students.
Dr. Mancini reported that the underserved areas of PA are in
great need of dental care and his clinics are overwhelmed, even
with the use of Public Health Dental Practitioners. Dr. Dishler
and Student-Dr. McKenzie provided strong arguments against
DTs, including that the dentist needs to be the head of the
dental team and that their training may not prepare them as
well as dentists. They also pointed out that a two-tiered system
of dental care is not in keeping with the code of Ethics of the
ADA. Members of the audience asked pertinent questions of
the panelists as well.
Concluding the discussion, the audience was polled again using
the same five questions. Once again, no one agreed that DTs
should work independently but now 30% thought that the PDA
should fight any legislative efforts to introduce DTs to PA.
However, that still left 70% of our members supporting DTs at
some level. So, where do we go from here?
By the time this piece is published, I expect to have a task force
in place consisting of members of our key work groups (GRC,
NDC, AOHAG, and DBC) along with a representative from the
Pennsylvania Academy of Pediatric Dentistry, Pennsylvania
Society of Oral and Maxillofacial Surgeons and the Pennsylvania
Dental Hygiene Association convened to further discuss this
and come up with an action plan in case this effort comes to
Pennsylvania. I have no doubt that there will be a strong push
by outside forces that will ultimately try to pass legislation in all
states. It is in our best interest to be prepared to both protect
and address the needs of the underserved citizens of our state
as well as those of our members when this happens. Now is the
time to act.
Thank you to all who attended and contributed to these
important discussions. As always, I am #PDAProud!
JAN UARY/FEBRUARY 2020 | P EN N SYLVAN IA DEN TAL JOURNAL
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