Mid-level Practitioners: Are they needed in dentistry?

This letter expresses my candid opinions on the now in vogue concept among politicians — mid-level dental practitioners. As a long-time educator, practitioner, and researcher, I have watched opinions vary as history has repeated itself for over the last one-half century. At this time, we are in yet another movement to satisfy the “access to care” challenge by saturating the dental manpower marketplace. Several factors are evident currently that relate to this movement: There is no question that auxiliary dental staff persons can accomplish some oral preventive and treatment procedures. I am well-known to be a proponent of dentist supervised staff persons accomplishing many clinical tasks. HOWEVER, does dentistry need another category of practitioner? In my considered strong opinion–DEFINITELY NO! As I provide courses around the country–80 programs in 2012– I see THOUSANDS of dentists in major financial distress. There are dentist bankruptcies in almost all cities. Although the recession appears to be slightly recovering, dentist financial challenges are still present. Many specialists have nothing to do, since GPs are not busy and are accomplishing specialty procedures. There is NO dental manpower need, and there will be none in the foreseeable future. Many dentists are unemployed. New dental schools are opening across the country. Most of them are NOT in conventional research and service based universities. These schools are further saturating the dental marketplace with dentists. Numerous other dental schools are in the planning stages.

New dentists have school debts that average about $250,000 to $300,000. They are financially stressed and forced to do anything to survive. Many new dental hygiene schools have opened in recent years. In numerous geographic locations, dental hygienists cannot find employment. The misguided plan that saturating the market with dentists, midlevel practitioners, dental hygienists and others will satisfy the access to care problem has been disproven numerous times in recent history and in other countries. Practitioners of any type choose the place they prefer to practice, and market saturation has NOT improved access to care in those locations where others have tried it. A few months ago, I made a survey of the profession relative to the challenges “real world” practitioners see, and I provided that survey to the ADA Board of Trustees. A copy of it is included in this communication. The survey supports my points made above.

Gordon J. Christensen DDS MSD PhD
CEO Clinicians Report
Director Practical Clinical Courses
Adjunct Professor, University of Utah and Brigham Young University
Diplomat American Board of Prosthodontics

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