Unlicensed to drill, but still doing a good job
(posted by Angelica)
Aurora Johnson, and other dental therapists like her, is proving that you don’t need to go to dental school for four years post-collegiate training to fill and drill cavities. Ms. Johnson received a two-year dental therapy training program and refers more complex cases to qualified dentists. Although the program is currently confined to Alaska for now, with skyrocketing dental and medical costs, it’s hard not to see Ms. Johnson as the leading edge of a new paradigm of providing medical care that integrates less-highly trained professionals to provide some of the basic care currently only provided by doctors and dentists.
It’s hard to argue that Johnson is not doing the people of Ulaskeet, Alaska good:
She slipped a drill into Paul’s mouth and bore into one of his cavities, then laid down a filling of silver amalgam. A few minutes later, Paul stood from the chair, smiling broadly. He offered Ms. Johnson a bashful thumbs-up and walked out into the village, a community of 750 people, nearly all Alaska Natives, that can be reached only by plane or snowmobile. Before seeing Ms. Johnson, Paul had received no dental care in four years, a gap not atypical in the Alaskan backcountry, where few dentists want to live and residents are scattered into villages separated by 50 miles or more.
But of course, both the Alaska Dental Society and American Dental Association are against the program, because it purportedly wants to protect patients from inadequately trained therapists. Instead, they are offering their own “community health aide” program where the aids dole out hygiene advice, fluoride sealants, appointments to dentists but no drilling or filling.
In its endorsement of the program back in 2005, the American Public Health Association (APHA) pointed out that similar programs have been in operation in New Zealand for 84 (!) years as well as in 42 other countries since then. In the Alaska program, dental health aides are paid roughly a third to a half the salary of most dentists.
Lower costs, better access, no substantial slippage in quality of care. It’s hard to see what’s not to love about dental health aides providing basic dental services.
Other coverage of the program: NPR
Tags: Alaska, dental, health aides, rent-seeking
April 30th, 2008 at 7:52 pm
Great post, Angelica. I swear, woman, you have less of a big fat statist streak than you think ;).
The first time something along these lines pissed me of was some 25 years ago when what would come to be my guild, shut down a group of citizens in Wisc. called Pro Se Today, constituted of those who had been through the divorce courts and sought to advise others as to how to navigate the system with spending thousands on a lawyer. They were shut down for “practicing law without a license.”
Cui bono?
May 1st, 2008 at 12:23 am
I second that, Mona. As far as I know, under the terms of all those laws that require a dental assistant, physician’s assistant, etc., to worker “under a doctor’s supervision,” all that means is there’s a DD or MD somewhere in the building driving up the bill.
As you know, I spit when I hear the name “Wal-Mart.” But when the medical associations went after Wal-Mart for, running low-cost clinics under the control of PAs, was a good thing. The “public safety” the license cartels were defending meants, if you translate it into plain English, that the “public” is the MDs, and they’re being kept safe from competition.
May 1st, 2008 at 12:40 am
Many years ago, when first studying economics, I came across a good rule of thumb to check whether a licensing system was intended for/is still functioning as a quality control system or as a barrier to entry to maintain a privileged oligopoly (of course, there are also mixed cases, and sometimes yet other issues come up).
That test was, is the cost imposed only on the new entrants, or does it fall throughout a practitioner’s career? The former means privilege, and the latter means quality control. “Cost” may be measured in cash, but you have to remember to include compliance costs, e.g. continuous professional training costs even if you do it yourself. It may be harder to spot continuing non-cash costs than initial cash entry fees, so be careful applying the test.
For a dentist, the quality control argument would go something like “Ah, yes, those people can cope with, say, 95% of what comes up, but what will they do when, say, an anaesthesia emergency comes up? We need people trained for those eventualities all the time, because we never know which patient is going to be one of the 5%”. It’s a perfectly sound argument, but you can’t tell just from that whether it actually describes the case. The test tells you whether the professional dentist you are getting is in fact being kept up to speed with his competence in anaesthesia emergencies and everything else.
May 1st, 2008 at 6:41 pm
Ahem, Mona,
Great post, Angelica. I swear, woman, you have less of a big fat statist streak than you think ;).
It’s actually a federally-funded program. So it’s actually tres big fat statist of me to support it.
PM.,
Great rule of thumb. The funny thing of course, is that the people of Uslakeet are screwed anyhow if they did have an emergency because no dentists will go there to live. It’s dental health aides or nothing.
May 1st, 2008 at 7:10 pm
So it’s actually tres big fat statist of me to support it.
Nana nana boo-boo, uh-uh. It just means you support a federal program that isn’t insane about licensing requirements.