Tuesday, November 2, 2010

Dental Turf Issue

Our dental friends are now going through what doctors have gone through and the same playbook is being used for them as it was used on us. What started as a way to help people in rural Alaska is now spreading. Dental therapists are performing extractions and administering fillings up there and dentists aren't liking it. A dental therapist has two years of training and now ten other states are considering "midlevel dental provider systems for underserved residents". Sound familiar? The article states that in Connecticut, where there is NO shortage of dentists, the midlevel providers “can be trained to do certain simple procedures safely,” and they would most likely work in public health clinics, seeing patients whom “most dentists will never see in their offices.” Sure they will. Beware the onslaught of the trojan horse....er, trojan tooth.
So to summarize today's and yesterday's blogs, I think that doctors and dentists would welcome more peers who decide to go through the rigorous training they did. Taking shortcuts, having less training, and hiding behind the ruse that you only want to do rural or poor care is not acceptable. We want colleagues and not competitors. The reason that the local or federal government or the hospitals or the insurance companies want you is economic only. You are being used as a pawn until they find someone cheaper than you.


Pat said...

Ah hell, let's have the pretenders go whole hog. Why should the poor and under-served in rural areas have to do without Botox or liposuction? A fun weekend course should make any competent dental assistant or CRNA or midwife perfectly capable in these areas, and at a fraction of the cost (to the taxpayer) that a high-falootin' plastic surgeon with all that expensive training would run. For that matter any family doc with an adequate fund of video game experience should be able to handle a laparoscope, so why can't they start doing cholecystectomies? Reminds me of a podiatrist a few years back at a hospital where I worked applying for privileges to do - Taa Daah - HIP REPLACEMENTS (true story). Well why the hell not?

Patrick J Foy, DDS said...

“Poor care is better than no care.” That is the slogan that should be printed on the side of the “Trojan Horse”. The unsuspecting poor or disadvantaged are mused into receiving care from individuals who lack the training and the expertise to save lives, yet once the vulnerable patient receives the “poor care” they are under the misconceived notion that they have received all the care that is required.
My favorite reply to the lack of information or the lack of knowledge is; “You do not know what you do not know.” High quality definitive applied healthcare may come at a cost and if we as a society or as individuals do not value quality healthcare, then we will compromise our own and the community’s quality of life. Also, we will accept a compromise to improved long-term outcomes. Is there a an acceptable cost/risk potential when applied to something as precious as a life. The “Horse” is not full of doctors, since in order to survive the rigors of a doctorate degree one must not only excel academically, but will also understand the responsibility that comes when trusted by one’s valued patients. Patrick J Foy, DDS

Michael said...

Doug your quote: "I think that doctors and dentists would welcome more peers who decide to go through the rigorous training they did." I agree, however, I would prefer "physicians and dentists". Or would you prefer to call me "Doctor, Doctor"?

The simple procedures that they are comtemplating include "uncomplicated extractions". The politicians have forgotton that that the uncomplicated extraction is attached to a person. That person may be on multiple drugs, for instance, coumadin, or bisphosphonates, or have severe CAD or immune system deficiency. I am sure that a HS grad with a couple of years of training can recognize when to operate and when not to. Right?! Wrong!

A favorite quote from dental school is "You are not training to become tooth mechanics." That is exactly what these mid-level providers will be. And they will be uneducated enough to get into serious trouble and cause irreversible harm to the patient.

Michael Cadra, MD, DMD

Esme said...

As a physician working in a rural area, I see so many people with basic issues of dental hygiene. Yes, simple brushing and flossing can go a long way but much needed extractions and management of dental caries is beyond the financial means for these folks. I do understand that dental care requires a significant amount of "overhead" costs but there is simply no place for the poor/working poor to go...all the "free" dental clinics have dried up. I give my time weekly to a free clinic, why aren't more dentists doing this? If midlevels can provide these ground level services, I say, bring them on.

Anonymous said...

As a board certified plastic surgeon with 5 years of general surgery residency and then 2 years of plastic surgery residency most at 100 hours a week , I find this amusing. My colleagues in medicine find no problem in they themselves taking a weekend course and being a botox or laser expert. But when someone steps on their turf they jump up and down.
Or that I am the only one qualified to sew up a l cm laceration on little Johnny in the ER (which his HMO pays $60) or the drunk in the next room (zero dollars) but everyone is qualified to do a facelift.

So we need to do the same in medicine and have everyone only do what they were trained for, and do the same rigorous training. Otherwise it is hypocrisy. Family doctors cant scream foul when about nurse practitioners then open a medical spa.

Pat said...

hey Anonymous Plastic - I am a certified bored FP and you are absolutely on target. Well said!

Anonymous said...

Absolutely positively correct! How 'bout PAYING physicians/dentists to work in the rural areas? If they get paid, they will come!

Anonymous said...

Well as a rural PA working where physicians don't care to practice, I find this offensive. I am held to the same standard of care that my physician associates are.