KDA Today

KDA Today

For Immediate Release

Date: Oct 7th, 2010
Contact: Aaron Washburn
Phone: 573-634-3436
Email: aaron@modental.org

What Happens in Alaska, doesn’t Stay in Alaska


From Boston to New Mexico: Non-dental groups target several states for workforce changes

By Aaron Washburn, MDA Assistant Executive Director, Governmental Affairs and Finance


A small group of MDA members and staff (including myself) recently returned from a quick trip to Boston. During our stay we had a chance to visit with several other state dental associations and learn more about the workforce initiatives they are pursuing and the initiatives that outside groups are pushing in their states.


The Missouri Dental Association has been actively involved in workforce discussions for many years. However, despite the hours of work and countless conversations, we have seen very little change.

MDA has pursued legislation in the past that would increase access, maintain the dentists as the head of the profession and ensure safety. But the outcry legislators heard from dental team members, as well as some dentists, stalled those initiatives before they really even got started.


The concern has always been that if dentists and the dental association did not recommend changes, others (without dental knowledge) would push for changes that could place lesser trained individuals at the head of the profession and risk public safety.


Unfortunately, it appears these early concerns were justified.


Many dentists are aware of the workforce changes experienced in Alaska. Some are also aware that Minnesota has seen the addition of two new workers (their scope includes some irreversible procedures).


However, most people are not aware of the increasing impact those outside of the profession are having on workforce throughout the country.


The W.K. Kellogg Foundation has funded initiatives to expand the new Alaska worker (DHAT) into other states. They recently selected five states (including Kansas) to focus their efforts. In each of these states, they are providing local groups (not dental associations) hundreds of thousands of dollars to build coalitions and advocate for legislation that would create these new workers.


Additionally, the Kellogg Foundation is working with the Josiah Macy Jr., Foundation to develop a curriculum for this new category of worker. They expect their work to be completed early next year. Their work could provide a springboard for other states to adopt DHATs. Additionally, their work threatens to usurp CODA as the only certifying body of oral health education.


The Pew Center on the States recently issued a report, The Cost of Delay, which graded each state based on eight specific policy markers. According to their report, 1 in 5 children are “failed” by the current oral health system. (Missouri received a “C” in their study). (Read report at http://www.pewcenteronthestates.org/report_detail.aspx?id=56870.)


Pew has matched their report with additional resources from the Pew Children’s Dental Campaign. That campaign is working to make workforce changes in selected states. Pew is not advocating for a particular workforce model (unlike the Kellogg foundation), instead they are pushing for changes that would make oral health care more “accessible” to children. Pew has not selected the states they are working with yet, but they have considered Missouri.


Even smaller groups have suddenly begun to spring up. For example, Con Alma (which translates to ‘With Soul’) is working with groups in New Mexico to advocate for a new dental workforce. Their work is partially funded by the Kellogg Foundation.


Research institutions also have joined the call for change. The University of California San Francisco Health Policy Center has been involved in work that would impact dental workforce. And the National Academy of Sciences Institute of Medicine (IOM) recently launched two initiatives regarding dental workforce.


IOM’s first program, which is partially funded by the U.S. Department of Health and Human Services as well as the California HealthCare Foundation, will “assess the current U.S. oral health system of care, explore its strengths, weaknesses and future challenges, describe a desired vision for the oral health care system and recommend strategies to achieve that vision.” The project is chaired by a pediatrician who currently serves as professor of pediatrics at the University of Washington School of Medicine. Information about this study is available at the IOM website (www.iom.edu/Activities/HealthServices/OralHealthAccess.aspx).


IOM also has convened a committee to explore ways to increase the public’s understanding of the relationship between good oral health and overall health, and to promote prevention and oral health literacy. Neither of these projects will include dentists, despite ADA’s efforts to be included.


In response to all of this work, some state dental associations have begun to develop their own proposals for new workers in their states. The Maine Dental Association supported legislation last year that would allow hygienists to practice independent of dentists. The Washington State Dental Association recently announced their support for the establishment of a Therapist Hygienist in their state. This team member would be able to perform selected irreversible procedures under a dentist’s supervision.


The Missouri Dental Association does believe that we should develop new workers in our state (although we do not support allowing dental team members to perform irreversible procedures). In areas designated as “Health Professional Shortage Areas” we believe new workers would increase access.


The House of Delegates has instructed the Board of Trustees to pursue legislation in 2011 that allows for the addition of an Oral Preventive Assistant to the dental team. Additionally, the House’s resolution encourages the Board of Trustees to support legislation that would provide additional solutions to the access-to-care problem.


We all know that much of the access to care problem would be eliminated if the state’s Medicaid system provided appropriate reimbursement, was run in an efficient way (carve out) and provided coverage to all needy populations (including adults and the developmentally disabled). But this year’s budget crunch (which is projected to be worse next year) makes it clear that funding to make these changes is many years away.

At some point legislators are going to start looking for solutions that can provide care to needy populations without adding money to the state budget. The question is: Who is going to be there to offer these legislators solutions?

With so many initiatives going on throughout the country, it seems inevitable that outside groups will soon be recommending dental workforce changes in our state. It is important that your Association is actively engaged in these conversations and brings solutions to the table as well.


As soon as this legislative session closes, members of the Legislative and Regulatory Committee as well as the Board of Trustees will begin developing next year’s priorities. As mandated by the House of Delegates, those priorities will include workforce improvement.


As with all of MDA’s efforts, we hope that the work we are doing reflects the desires of the entire membership. But, that can only be accomplished if you share your thoughts with us.


Please take time over the coming months to learn about the numerous dental workforce initiatives going on, and about the solutions supported by your association. Then share your thoughts with your Trustees and LRC Representatives.


As always, MDA staff is always available to answer questions you may have, or even present information about workforce to local study clubs or small groups. We look forward to hearing from you.


Aaron Washburn is the Missouri Dental Association’s Assistant Executive Director, Governmental Affairs and Finance and serves as the MDA’s staff lobbyist. Contact him at aaron@modental.org or 573-634-3436.

Reprinted with permission from the March/April 2010 issue of MDA Focus, the magazine of the Missouri Dental Association.

I did not want this information to stay in Missouri. The KDA Executive board and House of Delegates have been receiving reports on these issues from Drs. Ken Rich and Andy Elliott for several years. This article provides an excellent summary of how this issue has migrated to a variety of scenarios. Our ADA  has been very diligent in attempting to control or mitigate the implementation of these programs.  John Thompson, Editor, KDA TODAY.

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