KDA Today

KDA Today

For Immediate Release

Date: Dec 19th, 2011
Contact: Dr. Kevin Wall
Phone: 800-292-1855
Email: info@kyda.org

Access to Care?

We have been told by people who take those healthcare polls, that there are barriers to dental care in the state of Kentucky and across the United States. One of the barriers is the absence of dental practitioners in less desirable locales such as remote areas in Alaska, rural areas, and urban areas where crime is a problem. Ideas have been developed, studies have been done, and now implementation is now underway. Our profession is now under assaults which could affect the way we practice in the future.


New Zealand uses a dental model which utilizes a "dental therapist" or mid-level provider. These therapists go to remote areas of the country and perform duties such as fillings and extractions. In the United States these services have, for now, been reserved for dentists only. To address the access issue in remote areas of Alaska, the Kellogg Foundation funded a study where dental therapists were trained and sent to these remote areas. Their performance was then evaluated and compared to the performance of a dentist. The conclusion was there were no statistically significant differences when comparing the work done by the two groups. As a result, a broader study is being conducted in five states across the country, including Ohio, one of our border states. The Kellogg Foundation is investing $16 million in this project.


The other disturbing trend is the opening of new dental schools across the country.  In the 1980's the trend was to close dental schools because running schools was expensive and not profitable.  We are now seeing the opening of up to 20 new dental schools by 2020.  These are in many cases,  for-profit schools not connected to research institutions. They will utilize community health care centers for the clinical experiences.  Are we watering down our profession in terms of education and numbers?


Do we really have an issue with distribution of dentists in this state? In my travels around the state during component visits, I have found the same thing that I have found in my own practice; my schedule is not always full and my practice could accommodate more patients. In our discussions with the new Medicaid MCOs, we were told that they would have a network if the patients were within a 60-mile radius of a dentist. These are apparently federal guidelines and, based on this definition, I doubt we have anyone outside this radius. How can we be told we have an access issue if this is the criterion on which we are judged? Because we don't know for sure what the distribution of dentists is, Dr. Lee Mayer from the University of Louisville is trying to initiate a comprehensive study to determine where dentists practice and how often. This would let us know for certain if there are underserved areas and where they are.


My opinion is that the barrier to dental care in our state is not the number of practitioners, but the number of dollars. People are looking for free dental care and as the economy continues to struggle, this demand will rise. Higher Medicaid reimbursements would attract more practitioners, but the state is broke. Student loan forgiveness programs for graduates who go to practice in under-represented areas could help to alleviate some problems. Community outreach programs such as the RAM projects or free clinics could be a stop-gap solution. We don't need more dentists or mid-level providers, we need more money. In the medical model, nurse practitioners have not reduced costs and the same would hold true for mid-levels. They would likely demand the same compensation as a dentist for a given procedure, and they would want to live in areas where the quality of life is better. The two things that they would be created to address, affordable care and access in remote areas, would still be an issue.


What can we do? Having a strong association is the key. Having a strong and unified voice in Frankfort and Washington is vital. Encourage non-members to join the KDA, donate to our KDPAC, and get involved. The practice you save could be your own.

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