District Meeting

Tuesday, May 6th at 7:00 PM 
Dr. Ty Ivey's office 1902 Forsyth Street, Macon

All Committee Chairpersons, Delegates, and Officers are members of the Executive Committee and are required to attend. Other interested district members are welcome to attend.

Governmental Affairs Committee

ADA Report - part 1

In the last newsletter, we talked about exploring all of the ramifications the decisions that we make relative to the profession before we accept a suggestion of face value. We hinted that the federal government and insurance companies could take control of the profession without the approval of the dentists who provide the services.

Once again the disclaimer here is that you are reading the world according to Ty and the GDA and the ADA may or may not subscribe to anything that I say. In fact, I can assure you that the current leadership of the ADA does not subscribe to anything that I am saying. In other words this is an editorial and you can
believe me or not.

It all began with Alaska Dental health Therapists (ADHT). This was the beginning of the support for a mid level provider in dentistry. While those of your who have been subjected to my ranting on this subject are tired of
hearing it, it is a watershed event. Our association overruled the protestations of the Alaskan Task Force that I served on and not only sat by and allowed the development of the ADHT, but it also decided that we had to have “an answer”. This answer was passed in the HOD of the ADA by a 57% margin after a two year fight and your delegate fought it all the way. That answer has a name and it is called the CDHC (Community Dental Health Coordinator). Volumes can be written on this subject alone.

Suffice it to say that is was billed as a kinder and gentler mid-level provider that would assist in getting the underserved (don't forget that work) into a pipeline controlled by dentists. Because of the acceptance of this, the American Dental Hygiene Association began stepped up efforts concerning their plan to develop an Advance Dental Hygiene Practitioner (ADHP). You can think of this entity as a “junior dentist” who can perform
at least 80% of what you do on a daily basis as a general dentist (Specialist, should not feel that they are immune, that is a topic for another editorial). Now the war is on to see what the final shape of the ADHP will
be. In Minnesota as I write this editorial the scope of the eventual midlevel provider is expanding farther and farther.

Now here is a little Politics 101 refresher course. You went to dental school. If you passed, they gave you’re a diploma. At this point you were educated, and had a piece of paper. End of story. You took a board. If you
passed a board, the governing body that controlled that board gave you another piece of paper that said that in their sphere of influence you could go out and practice Dentistry. The diploma was worthless as a modality to
let you practice dentistry. Now you might say, well, they wouldn't let me take the board if I didn't have the diploma. Well, that same state or Congress can pass a law that says that anyone that they want an take the
dental “test”. Just rewind things about 070 years. The curriculum, scope and exam can be designed to be anything that the state wants it to be. 

Now let’s suppose that the federal government thinks that more people need treatment and that they need to get the costs down. Well, let’s send kids from high school to a Therapists school and teach them to do basic dentistry. One dentist can oversee five to then of them and we can get a lot more bang for the buck. This would be an Alaska Dental Health Aide Therapists, except that person doesn't even have to have a dentist present. Now, let’s ask what can the insurance industry or Wal-Mart, yes, Wal-Mart , can do with that model? Is the picture starting to focus? It is too late to stop the train completely; the best that can happen is that some
sanity can be brought to the process before it gets out of hand. Oh, and in Politics102, for you Republicans who think that the Republican Party is going to be the savior of our profession...it ain't gonna happen. After the
election of 2008, everybody is coming after health care.

So here is the bottom line. Government can do what it jolly well pleases. But as a Health Professional, you better watch your Scope of Practice just like you watch your 401K Plan. There are many ways which you can be hurt in the marketplace. Your Delegate will have a clear conscience. The cost for fighting the fight has been to be branded a fool and a trouble maker, but for those who refuse to read the tea leaves that outcome will be the same, it will just come as a bigger surprise. If you have any questions, you might start by asking your delegates to the ADA and your state officers what is going on. All people in politics (yes, politics) are here supposedly to serve their constituents.

ADA Report - part 2

In the last two editions of our newsletter, we dealt with thoroughly researching the subject matter that affects our profession and sticking together with our brothers and sisters even though some of us are general dentists and some of us are specialists. We promised to talk about why the specialist should be concerned by the problems of the general dentist. When we look at many of the tests to the scope of practice of the general dentists by the American Dental Hygiene Association and their Advanced dental hygiene practitioner (think junior dentist) and the other mid level providers that are being proposed such as the Alaska Dental Health Aide Therapists, we see a picture where the general dentists will have scope competition which will allow the Wal-Mart and insurance clinics to prosper.

So why should the specialist be that concerned? In case you have been on Mars, you guys who got the extra letters behind your name for staying in school two to three years longer should understand the beliefs of that organization called the Academy of General Dentistry. The group known as the AGD for the uninitiated specialists believes that the general dentist is sending much too much dentistry to specialists in the form of referrals. Well, this philosophy has been the mantra of the AGD for the last 30 years and the AGD has rightly protected the right and privilege of the general dentist to perform treatments that sometimes might be considered the purview of the specialists. The last thirty years have been very good years for the dentists and the dental patient. Insurance reimbursements have been good and once the profession recovered from the overpopulation of the late 1970’s, we have had a pretty good balance of providers and patients. But now, the times are “tuffer” and the insurance coverage “shrinketh.” What is the average general dentist going to do when he/she looks at those holes on the appointment book? Root canals will look a little less daunting when you have 2 hours free to do that bicuspid canal. Suddenly, the bicuspid extractions don’t look that bad. After all they invented Articaine for better and more profound anesthesia and what with the Docs courses; maybe we don’t need the oral surgeon as much as we thought that we did. I was surprised years age when Bobby Boone pointed out to me that a large percentage of orthodontics was being performed by general dentists. Furthermore, the business of continuing education has produced a market where someone will teach any one else how to do something for a buck. You guys get the same CE ads that I do.

Of course the hygienists are going to take over periodontics if they can’t get enough of the scope of the general dentist for the moment. Then the schools are teaching GPR residents to do implants (100 per year). What’s a periodontists to do? Do you get the picture? If the general dentist is losing on one end of his scope of practice, he has got to look for help at the other end. That would be the area of his practice that he is currently sending to someone else. Maybe, he has time after all to do some of those less pleasant tasks. That may be preferable to not eating or explaining to the banker why you are late with your equipment note.

We are all in this boat together. And if we start giving up the scope of practice, for every action (think lost scope) there must be an equal and opposite reaction (think one group taking scope from another group.) So, when the oral surgeons are being affected in Washington State, the periodontists and general dentists in Florida need not think that they don’t have a problem. If one of us has a problem, we all have a problem. It might just take a little while for the problem to materialize.