June 23, 2018
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Why Maine needs mid-level dental providers

By Mary Kate Scott, Special to the BDN

So Maine’s dentists don’t want competition. I don’t blame them for wanting to preserve their income and monopoly. It’s no surprise they are against LD 1230, “An Act to Improve Access to Oral Health Care” which creates a new mid-level dental provider. It’s just not fair to the people of Maine.

Why might Mainers want a mid-level oral health care provider? In the same way that many Mainers appreciate their advanced nurse practitioners who provide health care for many people, these new providers could provide preventive oral health care where we have a shortage of dentists and even fewer of them providing care to children covered by MaineCare.

Most of the medical professions have a suite of licenses, with a range of training and credentials to provide the right care, at the right time, at the right cost. We all appreciate the many levels of nurses that have a range of training and credentials. We appreciate optometrist assistants that extend the care provided by optometrists. The list goes on but not for dentists. There are hygienist or dentists, no mid-level providers to provide needed preventive care.

We have a shortage of dentists. We can fill it with more dentists. Other countries and states have chosen a different path: Create a suite of licensed, appropriately trained oral health care providers that includes dentists, advanced dental therapists and hygienists. We can, too. The research is compelling; it’s a proven model with demonstrated high-quality care that improves rural access and saves money primarily for the state and also for private individuals.

More preventive care will lead to better health and fewer emergency room visits. The most recent data shows that In Maine, dental problems were the main reason for emergency room visits among Medicaid patients and uninsured young people in 2006, but it’s no surprise that the Maine Department of Health and Human Services is now tracking the number of emergency room visits for dental emergencies as a key quality indicator. No need to discuss the cost of emergency room visits by the individual and the taxpayer; Mainers understand this issue.

So why are dentists against this? Dentists enjoy a monopoly and want to preserve the dental scope of practice (what the provider is allowed to do) for their own use. Dentists also control the training of dentists and thus the supply of dentists.

Here’s the really important part: This bill does not prevent or limit a dentist from delivering the same preventive care as this bill proposes for the mid-level provider. The bill simply allows more appropriately credentialed oral health care providers to deliver care. So, yes, there will be more qualified providers for preventive dental care service delivery.

Maine could have more oral health care practitioners delivering more preventive services and providing better oral health at a lower cost, throughout the whole state. Again, if dentists would like to continue to provide preventive care in rural or urban areas, they can continue to do so. This bill does not limit their scope of practice or their opportunities. This bill is about creating licensed skilled professionals with a career path, to deliver in-demand services, at a reasonable cost for the people of Maine. Services could be delivered within current dental practices or through new practices (owned by dentists or these mid-level providers).

I hope our legislators can look through the looking glass of the dentists’ interests and their lobbying funds and create a path for an appropriately credentialed professional to improve oral health and deliver savings to the people of Maine.

Mary Kate Scott is a national health care economist, writer and researcher with expertise on new business models in health care and oral health. She lives in Hartland with her husband Charlie Cianchette.

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