KDA Today

KDA Today

For Immediate Release

Date: Feb 4th, 2011
Contact: Dr. John Thompson
Phone: 800-292-1855
Email: info@kyda.org

Adjusting Attitudes

It is winter, it is cold, and it is snowing.  It has truly been winter since December 1st this year and cold and snow are four letter words.  To escape the dark, dank and dismal days of January in Kentucky, I generally adjust my latitude to South Carolina in an attempt to adjust my winter attitude.  I must have SADD because the sunshine seems to reinvigorate me even if the beach is cold.  A couple of weeks of sun will help me survive a Kentucky February.  It is a short month.

Man is the only animal that is given credit for being able the increase the temporal space between a stimulus and a reaction.  It is this spacing or disconnect that allows intellect, training and attitude to interject and modify resultant behavior in a given situation.  It is my observation that the entire profession of dentistry is on the brink of a situation that will require a reaction in much less temporal space than we are going to prefer.  That situation has been created by the Affordable Care Act, or the health-care reform bill.

The November election has changed the makeup of the congress.  Legislation to repeal the act is on the table, but to believe that repeal will occur is irresponsible.  It is here and it is going to go forward.  Hospital Corporations and University Medical Centers are forming alliances to protect their turf and insure their viability in the new realm of national or socialized medicine. This nationwide trend is exemplified in this commonwealth as both the University of Kentucky and University of Louisville Medical Centers have forged agreements that carry their influence and provider networks into each other’s back yards. Medicine is already forever changed and morphing into a system that will be radically different in less than two years.

In this issue of KDA TODAY we have published a recent release from the Pew Foundation and the ADA’s response.  If you have been reading your ADA NEWS, talking with any of our ADA delegates, or read the interview with Dr. Andy Elliott, candidate for ADA President-elect,  you have noted that a key phrase is “mid-level provider”.  This term is becoming the stimulus to which the entire profession is going to have to react, and it is only the first shot across our bow as we sail into a tempest we will not be able to avoid.  There will be no change of latitude that will provide respite from this storm.

Mid-level providers already exist, and I am not referring to our hygienist partners.  The issue will not be “what if”, but who has control.  Dr. Elliott states in this issue of KDA TODAY; “the intrusion of outside entities into decisions affecting the delivery of dental care to our patients is a major threat.  This includes under educated, non dentist providers performing procedures that should only be performed by a dentist.  We must not compromise our stance on surgical/irreversible procedures. Surgical/irreversible procedures should only be performed by a dentist who is educated to know the why, along with the how. A second tier of care is not acceptable for the needy/underserved patient population in this country.” 

The description of services, or scope of practice, a mid-level provider may perform with and without a dentist’s supervision will evoke conflicting responses within our own profession.  I am not at all certain that a “second tier of care” is not acceptable to some who frame their position based on a means to an end.  If we truly feel that a second tier of care is “not acceptable” then we will have to retain control of both the concept and the reality of mid-level providers.

We are going to have to make our case in the face of facts that do not support an argument that the current system of providing dental health services is working.  Social planners have too many statistics to demonstrate a significant underserved population.  Their solutions do not include the best interests of this profession.  Dr. Elliott states, “It has been said that we can’t drill our way out of the problems of rampant dental disease, and the lack of access to care, and I agree. Unfortunately, we likely have lost a generation to the ravages of dental disease, but we cannot allow this trend to continue. We must better educate the population, and support the public health infrastructure to do what it was intended to do, serve as the safety net for the underserved.  Further collaboration within the tripartite on effective solutions to the complex issues of serving Medicaid patients must be a priority.”  The question will be, “How much time do we have to talk about this?”

We  have spent too much capital in both proving and promoting the fact that oral health is an integral part of overall physical health to even conceive that we can distance ourselves from the net effect of the Affordable Care Act.  I personally believe that the ADA’s efforts to create Community Dental Health Coordinator (CDHC) model training program is a very worthy step in the right direction.  I also believe that it will not be perceived by social planners as the answer.  It is my belief that the ensuing argument will lead to the creation of some form of mid-level provider.  The attitude we adopt will have to be developed intellectually and with a win-win mentality.  The net result must be that the profession does control the result, if not the outcome, and that patients are provided a level of care that is truly appropriate.

These comments do invite controversy, but the dialog must begin now.  The storm is on the horizon and how we trim our sails and set our course will determine how we negotiate the storm.  I have been spending a lot of time with my very wise mother in Chattanooga.  She is facing her final days following a massive stroke that has wrecked her body, but not her mind. Her positive attitude and the grace with which she endures a totally hapless situation has been an inspiration to the family, her physicians and her caregivers.  She had often said, “There will be things that occur in life that you will not want to do, but that you must do.  Do those things with grace and whatever you do, do it well.”  I hope you are having a good day!

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