MacIver News Service | February 21, 2018
By M.D. Kittle
MADISON, Wis. – Christy Jo Fogarty became Minnesota’s first certified advanced dental therapist in 2011, about two years after the state Legislature passed a bill creating the licensure program.
Minnesota was the first state to recognize the mid-level therapist position, despite a campaign by the American Dental Association to kill it.
As is often the case, opponents issued dire warnings about this free-market solution to the state’s oral health care gap.
Fogarty will tell you the gloomy predictions didn’t pan out. In fact, Minnesota has become a national leader in the field, and a lot of doubters at the time have become true believers.
Wisconsin, now engaged in a similar legislative battle, could benefit from the experiences of our neighbor to the west – and from Minnesota’s first licensed dental therapist.
“What we are doing here in Minnesota is really amazing and helping open up access to care. I really hope our neighbors to the east join us in this legislation,” Fogarty, a member of the Minnesota Board of Dentistry and former president of the Minnesota Dental Therapy Association, told MacIver News Service last week on the Dan O’Donnell Show on NewsTalk 1130 WISN.
Filling the Gap
Legislation moving through the Wisconsin Legislature would, like Minnesota, create a dental therapist licensure program. Dental therapists are mid-level practitioners, similar to physician assistants. Under the general supervision of a dentist, DTs can perform routine dental procedures either at a dental practice or in satellite clinics in underserved areas.
Capitol sources give long odds on the bill making it to the Assembly floor this week, meaning it will likely die. That likelihood has much to do with the powerful lobby against it.
Assembly Bill 945, authored by Rep. Mary Felzkowski (R-Irma) and Sen. David Craig (R-Town of Vernon), is aimed at filling Wisconsin’s dental access gap.
Before a public hearing on the measure last week, Felzkowski said the legislation answers a human imperative, expanding access to dentistry in underserved areas of the state.Before a public hearing on the measure last week, @MaryFelzkowski said the #DentalTherapy legislation answers a human imperative: expanding access to dentistry in underserved areas of the state. #wiright #wipolitics Click To Tweet
“If people in the state of Wisconsin knew how bad access to oral health care is, especially oral health care to children, they would be horrified,” the lawmaker said. “Let’s be honest, we suck. We are dead last in oral health care to children.”
The federal Health Resources and Services Administration found that dental provider shortages exist in 65 of Wisconsin’s 72 counties, affecting 1.5 million Wisconsinites. Only one-third of poor children covered by Medicaid saw a dentist in 2016, according to the U.S. Department of Health and Human Services.
Minnesota faced similar access problems in 2011 when Fogarty became the state’s first dental therapist. Particularly in rural areas.
“There are literally counties in Minnesota that didn’t even have a dentist. No one (in those areas) had access to dental care,” Fogarty said. “Now we have dentists who are hiring dental therapists in those rural areas.”
Fogarty, a long-time dental hygienist fresh from earning her dental therapist degree, joined the team from the nonprofit Children’s Dental Services in northeast Minneapolis nearly seven years ago. The clinic does a good deal of mobile dentistry, taking oral health care to rural areas. They work in Head Start programs and schools.
“So we cut down some of those barriers, making sure parents don’t have to take off work to take their kids to the dentist,” Fogarty said. “We go right into the schools and offer care.”
Children’s Dental Services treats about 30,000 patients a year. Fogarty sees about 3,500 of those.Minnesota has become a national leader in the #DentalTherapy field, and a lot of doubters at the time have become true believers. #wiright #wipolitics Click To Tweet
As in Minnesota, dentists in Wisconsin have come out against the dental therapist bill.
The American Dental Association’s Health Policy Institute projects the number of dentists in the U.S. will continue to grow through 2035 and outpace population growth. They say the real problem is reimbursement.
“Rather than add a new category of providers, the ADA believes there is a critical need to connect underserved people seeking care with dentists ready to treat them. This can be accomplished through community health worker outreach and improved funding for dental services under Medicaid which in turn would increase the number of dentists participating in the program,” the ADA claimed in a statement last year.
Leon Assael, then-dean of the University of Minnesota dentistry school, in 2016 described oral health problems as a hidden epidemic. “It’s not [that] there [aren’t] enough dentists … It’s that dental services are costly and not included in other health insurance,” Assael told the Star Tribune in 2016.
Fogarty said she’s not surprised that the ADA, which spent “hundreds of thousands of dollars fighting” the same legislation in Minnesota and Maine, is now fighting against the proposal in Wisconsin. She said people often think of the ADA as a benevolent organization solely interested in patient protection.
“What they forget is that … they are professional associations whose mission is to protect the people who are their members,” she said. “The fact that they are fighting this doesn’t surprise me. They see this as competition.”
Medicaid reimbursement is indeed a problem affecting all health care categories. Another bill in the Legislature would expand a state pilot program that increases Medicaid reimbursement rates.
The Wisconsin Dental Association does support an “Expanded Function Dental Auxiliaries” bill that allows oral hygienists with advanced training to perform certain procedures in a dental office.
“This format allows more patients to be seen, while maintaining a high standard of care,” the WDA says on its website
A year after Minnesota created the dental therapist program, Sarah Wovcha, executive director of Children’s Dental Services, told the Star Tribune that there was a “crisis” in oral health care.
“We don’t currently have enough dentists who are able – or willing – to provide care to low-income people. Even insured people are having a harder time finding a dentist,” she said.
But Minnesota’s dental therapist program has helped make inroads in filling the gap. And many of the dentists once critical of the bill are now converts to the law, Fogarty said.
“Dentists are finding this is not only a fantastic free-market solution, that they can make more money, but they also can serve their communities and make sure everyone in their community has access to dental care.”
Case in point, Children’s Dental Services. Wovcha said the clinic is seeing the same quality of service and greater productivity, while paying 30 percent less for dental therapists to do the same restorative procedures dentists have long done.
Fogarty said protectionism is short-sighted, and it ignores the profit potential that Minnesota dental practices are realizing.
“Minnesota has really proven we’re safe, competent practitioners who do nothing but enhance the practice of dentistry,” she said.