A recent guest commentary advocated for the creation of dental therapists in Michigan. However, the commentary did not include information that shows dental therapists have had a positive and successful impact on addressing the barriers to dental care.
Michigan has been very proactive in coming up with solutions to get people more care. Just this year, the Healthy Kids Dental program was expanded to all Michigan counties so that children ages 0-21 will now be covered by the program. Healthy Kids Dental has been proven to be very successful in increasing access to care. According to a report by the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan, the Healthy Kids Dental program has significantly increased utilization of dental care by underserved children. The program is working and the data shows it.
Under the traditional fee-for-service Medicaid program about 46 percent of children received care where as under Healthy Kids Dental the number increases to 61 percent (and that number continues to improve). For purposes of comparison, for children with private dental benefits the utilization rate is about 70 percent.
In fact, several programs serving Medicaid-eligible children throughout Michigan report decreases in the number of children being treated by their programs. The only reason they can determine why this is happening is that children are finding a dental home due to Healthy Kids Dental.
The dental therapist program proposed in Senate Bill 1013 is based on a program that exists in Minnesota, but the Minnesota program has not been shown to be successful. Since the law creating dental therapists passed in 2009, only 54 dental therapists have entered the workforce. Additionally, when the law passed proponents claimed that it would get providers into underserved rural areas. In fact, in the seven years since their creation, only seven dental therapists have gone into rural areas. The rest have gone into urban areas where they can make more money.
A recent study by the American Dental Association’s Health Policy Institute shows that in Michigan, 35 percent of low-income people report they have trouble finding a dentist. According to the same study, 44 percent of low-income people in Minnesota say they have trouble finding a dentist. Minnesota has had a dental therapist program since 2009. Michigan is doing a better job, and there is no reason to think a dental therapist would have a positive impact.
A better way to help is to improve utilization of Michigan’s existing dental workforce. Currently there are 7,500 dentists, 10,300 registered dental hygienists and 1,700 dental assistants. Of the 10,300 hygienists, over half are unemployed or underemployed. In addition, many dentists say that they could see more patients than they currently are seeing. It doesn’t make sense to add another provider when there is so much unutilized capacity.
The Michigan Dental Association (MDA) supports common-sense solutions with a better chance of helping fix the access problem than programs not proven to work. That is why the MDA is working with Sen. Pete MacGregor to introduce a bill that would allow individual dentists to send hygienists into underserved areas to provide hygiene services. If follow-up care is needed, the patient would be referred to the dentist who sent in the hygienist.
One of the many concerns with the dental therapist model is that it sends people who have much less training than a dentist (i.e. the dental therapist) to treat a population with the most complex dental and medical problems. Keep in mind, the dental therapist would be able to perform irreversible procedures that only the most trained providers should perform, such as extractions and drilling teeth. The underserved should have access to the same quality care as people with insurance or who pay out of pocket.
The danger with the dental therapist model is that it will create two standards of care: Those who can afford to see a dentist will enjoy the current high level of dental care, but those who cannot would receive irreversible procedures by a lesser trained dental therapist.
The MDA welcomes discussion on ideas to improve access to care, but it is important to look at the facts and put forward ideas that will work.