sfdda Volume 60, No.2a www.sfdda.org Special Issue
Legislative Edition A Must Read!
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In My Opinion
The Myths, “Fake News” and “Alternative Facts” of Dental Therapists/Mid-Level Providers - Richard A. Mufson, DDS
A Call to Arms: Please make every effort to attend FDA Dentists’ Day on the Hill in Tallahassee on Tuesday, March 12, 2019! I previously wrote an article on this subject in our SFDDA Fall 2017 Newsletter. The theme was to inform and alert our grassroots members of the metaphorical hurricanelike threat of outside forces (Pew Charitable Trust, Kellogg Foundation, certain dentists in academia and a few other groups) attempting to force upon the dental profession and citizens of Florida – a new member of the dental team we did not ask for, and do not need – so-called “dental therapists” or dental “mid-level providers.” The first big legislative push by Pew and others came upon us last year during the 2018 Legislative Session in Tallahassee. The key angle utilized was to find and convince a freshman legislator to create and file such a bill allowing the unwanted and unnecessary insertion of these lesser-trained individuals into our already well-functioning dental team. Fortunately, as a result of our very formidable presence at two “Day on the Hill” events hosted by Florida Dental Association (FDA) and Florida Society of Oral and Maxillofacial Surgeons (FSOMS) during the 2018 session, in addition to our FDA leaders attending and speaking at other legislative committee meetings – the bill (at least for the time being) was defeated. However, it is a well-known fact that in Florida, and some other states, and much like hurricanes, the yearly threat is ongoing and (for now) is here to stay. To wit, bills have already been filed for this coming 2019 legislative session – sponsored by House Representatives Rene Plasencia and Juan Fernandez-Barquin and Senator Jeff Brandes. We need to educate our legislators and work once again to defeat the bills. I would encourage all of you (as I said in the previous article) to please, “put down your mirrors, explorers, hand-pieces and other dental toys we hold dear,” and plan on attending FDA Dentists’ Day on the Hill on Tuesday, March 12, 2019. FSOMS recently held our annual Day on the Hill this past February 20.
Please refer to the attached (last page) full-color “Dental Therapists - Fact versus Fiction” Table. We found it to be very useful when presenting it to legislators at our recent Day on the Hill. Knowing how challenging it is to adequately describe the breadth and complexity of this issue in a 5 to10 minute conversation with a given legislator – we felt the single page hand-out was an effective visual aid for readily pointing out information on both the common misconceptions on one hand (column on the left) and then the real facts and answers to each point on the other (column on the right). Please feel free to print and use the table as an effective communication tool at the upcoming FDA Day on the Hill, if you so choose. More on the Myths and Misconceptions: When speaking with others who may be unfamiliar with the facts surrounding this issue – including our state legislators, and even the very sponsors of the bills – it becomes readily apparent that the outside entities involved in pushing for dental therapists have stoked a campaign of misinformation and misconceptions. The “alternative facts” usually begin with two related concepts, both of which are patently untrue. The first is that there is a “dental access crisis,” a “void,” or “not enough dentists in Florida,” resulting in an “access to care problem” for those who need dental treatment. The second is that dental therapists can fill that void and thereby solve the access to care problem in Florida. Nothing could be further from the truth. Among the actual facts - there is no shortage of dentists in our state. Florida presently has about 14,000 licensed dentists and an equivalent number of dental hygienists. And, with three dental schools pumping out over 300 new dental graduates on a yearly basis, Florida most assuredly does not have a deficiency of dentists, hygienists and other dental team members. There is admittedly an uneven distribution of dentists, with less practicing in rural areas. The terms “deficiency” or “shortage” are terms conveniently thrown about by these outside groups to refer to a lower number of dentists in certain areas, implying less numbers/access overall – but in reality, there is anything but a general statewide shortage. Studies and experience have also shown that when dental providers and even free dental care (such as Medicaid) are made available – the public in large part does not appoint and utilize the offered care and available services. As a result, many proponents of the push for dental therapists fail to recognize the difference between “lack of access” and “lack of utilization.” Access Solutions From Within Organized Dentistry The FDA, as part of a broad and comprehensive plan of finding “real” solutions to “access,” has put forth and supported legislation – the “Dental Student Loan Repayment Program,” specifically designed to place more dentists in rural and underserved areas in our state in exchange for state funds to help recent dental graduates repay large student loans.
This legislation passed the Florida House and Senate in 2016, but was vetoed by our then-Governor Rick Scott. In 2018, there was hope that Governor Scott would not veto the bill, as he was trying to look good in the public eye as a candidate running for US Senate. However, the next time around, the bill failed to pass through the legislature and never made it to Rick Scott’s desk. This effectively was the equivalent, for those crying out for solutions to access – of shooting one’s self in the foot. However, the bill is once again before the Florida Legislature in the current 2019 session, for which you can add your voice and make a potential impact by being in Tallahassee on March 12. Regarding the assumption that dental therapists will move out to rural underserved areas – this actually has not been shown to be consistent with reality. Experience and data from Minnesota, the one and only state (in the lower 48) allowing such practice, have thus far demonstrated that the roughly 80 dental therapists working there are not moving to rural areas to fill a void, but rather, most are remaining in urban areas. The state has also ironically been at risk of losing federal funding due to a failure to provide adequate dental care to children in low-income families. Another misconception: Dental therapists are often compared to other “mid-level providers,” such as physician assistants (PAs) and nurse practitioners (NPs). However, such comparisons are “apples and oranges,” and far from factual. The education, training, time requirements, knowledge base and clinical skills of NPs and PAs far outweigh that of their dental quasi-counterparts. ______________________________________________________________ “… the bill is once again before the Florida legislature, in the current 2019 session, for which you can add your voice and make a potential impact by being in Tallahassee on March 12.” ______________________________________________________________ It is also worthy to note that as highly trained as they may be, NPs, PAs are not permitted to perform the same/similar function as physicians – and most notably cannot perform surgery, for example (except for a limited number of PAs with additional specialized training). This then becomes an oxymoronic dilemma for those pushing for dental therapists. With far less education and training – how can one possibly make a credible argument for dental therapists being virtually the only mid-level providers in our state allowed to perform surgery? This includes, among a lengthy list of other dental procedures, the irreversible cutting of tooth structure and even dental extractions. Other Unspoken and Understated Solutions Before Us: (1) Increasing Education/Awareness: I would like to borrow an analogy learned from FDA staff. When it became apparent back in the 1950’s and 60’s that lung cancer was on the rise due to the harmful effects of smoking cigarettes, the solution did not involve training and dispatching more thoracic surgeons to remove the diseased, cancerous lungs. Instead, a major educational campaign was undertaken to inform the public about the harmful effects of smoking and its cause-and-effect relationship to lung cancer, heart disease and other medical illnesses. As a result, there was a massive increase in awareness, and efforts to quit
smoking grew significantly in years since. Lung cancer and other related health problems have declined. Much can be said about the similarities between this example and educating the public on how to prevent dental disease – i.e., the importance of performing adequate dental hygiene techniques with reduction in caries and plaque/tartar accumulation, benefits of placing sealants on occlusal surfaces of at-risk children and some adults, proper diet and other health habits, and maintaining regular dental visits for evaluation/treatment. Therefore, a significant reduction in dental disease of the underserved and the general public, similar to smoking and lung cancer, could be accomplished with such educational efforts alone. (2) Medicaid reimbursement rates – of which Florida ranks among the lowest, if not the lowest, in the nation - is also a major obstacle to access for the under-insured and underserved. For many years on end, we (FDA, FSOMS) have called upon our state legislature to appropriate more funds for Medicaid and thereby improve access, but once again, the much-needed request has repeatedly fallen on deaf ears. For a state with the largest budget in the country (over 92 billion dollars), and exceeding that of many countries, many have considered our lack of expansion and funding for the poor and underserved to be unacceptable. To those who may be unaware of our commitment to access, we must clearly point out to others, and most notably our state legislators, that – that above and beyond the aforementioned solutions readily available to us, should we choose to enact and utilize them (education/awareness, increased Medicaid funding) - a number of other real and legitimate efforts are also actively underway. The ADA tripartite, including our own FDA, is on the cutting edge of such initiatives including Project: Dentists Care, Mission of Mercy - a recurring event in several states, including Florida, delivering free care in major metropolitan areas to many thousands in need - and others. The aforementioned “Dental Student Loan Repayment Program” has been yet another bona fide effort toward solving access, but as stated, it has fallen on deaf ears relative to Governor Rick Scott in 2016 and our state legislature in 2018. For more information on what projects our own FDA, in conjunction with ADA, is doing to advance the dental health and access of the public, please visit (and encourage others to visit) the “Florida’s Action for Dental Heath” web page at: www.dentalhealthfl.org In the meantime, in response to the dental therapist bills now coming before our state legislators, we need to do the following: (1) Educate ourselves, our colleagues, and most important, our legislators, about the myths versus facts regarding dental therapists/mid-level providers, (2) Identify the state legislators in your district (easy to obtain on-line) and make an appointment with them at their local district office or other venue of choice in your area to inform them of this issue, also why it is more harmful than helpful to dentistry and our patients, and moreover – why dental therapists are not by any measure a solution to an access problem, and finally,
(3) Close the loop by visiting the same legislators at FDA Dentists’ Day on the Hill on March 12, 2019. Special thanks to Joe Anne Hart, FDA Chief Legislative Officer and Jessica Love, Governmental Consultant for the firm of Gray Robinson Law Firm, Tallahassee, Florida, for their assistance in editing portions of this article. ______________________________________________________________ Dr. Richard Mufson is the editor of the South Florida District Dental Association Newsletter, and may be contacted at (305) 935-7501 or MufsonOralSurg@aol.com (see attached “Dental Therapists Fact versus Fiction” Table)
Dental Therapists/Mid-Level Providers - Fact versus Fiction
Myths and “Alternative Facts” There are “not enough dentists in Florida,” resulting in an “access to care” problem.
Reality and Actual Facts There is no shortage of dentists in Florida. We presently have about 14,000 licensed dentists and an equivalent number of dental hygienists. And, with three dental schools pumping out over 300 new dental graduates on a yearly basis, Florida most assuredly does not have a deficiency of dentists, hygienists and other dental team members.
There are not enough dentists in rural or underserved areas
The dental profession is not doing enough to solve the “access” problem
Dental Therapists are similar to other “mid-level providers” such as Physician Assistants (PAs) and Nurse Practitioners (NPs)
There is an uneven distribution, with less practicing in rural areas. A recent legislative solution, a bill brought forth by FDA – The “Dental Student Loan Repayment Program” – that could have dispatched numerous dentists to underserved areas in exchange for state funds to help repay student loans - was vetoed in 2016 by then-Governor Scott, and did not pass the legislature in 2018. In addition to the above legislative effort, The ADA tripartite, including our own FDA, is on the cutting edge of other initiatives – including “Project: Dentists Care,” Mission of Mercy (a recurring event in several states, including Florida, delivering free care in major metropolitan areas to many thousands in need), and others. Please visit “Florida’s Action for Dental Health” web page to learn more at: www.dentalhealthfl.org Such a comparison is “apples and oranges,” The education, training, time requirements, knowledge base and clinical skills of NPs and PAs far outweigh that of dental therapists and their several years of post-high school basic level training. Also important: NPs, PAs are not permitted to perform the same/ similar function as physicians – and most significantly – cannot (except for a limited number of PAs with added perform surgery specialized training) , whereas dental therapists - with far less education and training – would be virtually the only mid-level providers in our state allowed to perform surgery - including, among a lengthy list of other dental procedures, the irreversible cutting of tooth structure and even dental extractions.
If dental therapists were allowed into the dental workforce – they would go into rural areas and fill the void.
Experience and data from the one state allowing this practice (Minnesota) have thus far demonstrated that dental therapists are not moving to rural areas, but rather, most in urban areas. The state has also been at are remaining risk of losing federal funding due to a failure to provide adequate dental care to children in low-income families. - courtesy of Richard A. Mufson, DDS
Affiliates C.E. Meetings and Events...
Renew your ADA Membership and continue attending affiliate society dinner meetings.
Dr. Rita Steiner, President March 5, 2019 6:30 - 9:00pm Novecento Restaurant 18831 Biscayne Blvd Aventura, FL, 33180
Member’s Night with:
Dr. Tim Franklin Dr. Evan Rubensteen Dr. David Garazi * Programs are subject to change
Dr. Sawan Malik, President March 13, 2019 6:30 - 9:00pm
Dr. Carlos Gonzalez, President
Member’s Social Mixer
“Understanding Legal Tools: Keys to Lawsuit Prevention, Tax Reduction and License Protection.”
Funky Buhdda 1201 NE 38th St, Oakland Park, FL 33334
February 13, 2019 6:30 - 9:00pm Casa Juancho 2436 SW 8th St, Miami, FL 33135
The SFDDA Affiliate Meetings are Graciously Sponsored by:
Visit our website at www.sfdda.org for lecture details 12
ACCESS TO DENTAL CARE NOW OR LATER By Joe Anne Hart, FDA Chief Legislative Officer The Florida Dental Association (FDA) supports promoting legislative initiatives to help Floridians access dental care now rather than investing state resources in proposals that will delay care for up to five years. As we prepare for the upcoming session, several bills have already been filed to support the FDA’s legislative agenda for this year. HB 465 by Rep. Mike Grant (R-Port Charlotte) proposes to re-instate the dental student loan repayment program by providing a financial incentive for dentists to practice as full-time Medicaid providers in rural and underserved areas. Since this is not a new program, the dental student loan repayment program could be implemented quickly and will create immediate access today for many people who struggle to find routine dental care in their community.
Additionally, HB 465 will look to codify in statute the Donated Dental Services program and establish financial support from the state to fund two full-time coordinators and operating expense for dentists and dental labs to donate care to individuals who are medically compromised, elderly and/or disabled. Sen. Ed Hooper (R-Palm Habor) has agreed to sponsor the Senate bill, that hasn’t been filed yet.
Legislation will be filed this year to create a new licensed dental provider in Florida called a dental therapist. The FDA does not support dental therapy legislation. This proposal would create pathways to allow individuals who are not trained to the level of a dentist to perform irreversible surgical procedures like extractions and partial root canals. Proponents of dental therapists argue that this provider is like a nurse practitioner and a physician assistant. After a review of the procedures a dental therapist would be authorized to do under limited education and training, compared to the education and training of nurse practitioners and physical assistants – there is no comparison. There are groups, like the James Madison Institute (JMI), that are getting behind this legislation and publishing opinion pieces about the impact it would have on Florida. To view a copy of the JMI policy brief, click here. Since there are no dental therapy programs accredited in any state, it could take up to five years to implement dental therapy legislation. Groups pursuing dental therapy in Florida would attempt to provide Floridians with perceived access to dental care later, which is not increasing access to those suffering today.
Not only will the FDA pursue legislation that will provide immediate relief for patients, but the FDA will also look at ways to18 start educating our children and youth on the importance
of practicing good oral health habits at home. Sen. Gayle Harrell (RStuart) has filed SB 374 to add a dentist to the Florida Children and Youth Cabinet. The Children and Youth Cabinet was created in 2007 to promote and implement collaboration, creativity, increased efficiency, information sharing and improving service delivery between and within state agencies and organizations. The FDA supports the promotion of early oral health education and prevention as a key component to addressing overall dental care and being a part of this Cabinet will provide an opportunity for dental care to be a priority for our children and youth. The FDA will also continue its efforts to secure state funds for community water fluoridation. For the past four years, the state has allocated approximately $200,000 for grant money for cities and counties to use for their local efforts. This year, the FDA will be asking the Legislature to appropriate $1 million for community water fluoridation. For the first time, the FDA will ask that state general revenue be appropriated for the Florida Mission of Mercy (FLA-MOM). The FDA Foundation has managed to host these two-day dental clinics on donations and grants received from various organizations, foundations and even dentists. The impact that a FLA-MOM has on a community is extremely valuable and will provide a great return on the investment for the state by reducing the number of people going into hospital’s emergency departments with dental pain. The FDA will ask the state to allocate $580,000 to support future FLA-MOM events. This year’s FLA-MOM is scheduled for March 22-23, in Orlando. For additional information on the FLA-MOM, click here.
Don’t forget to register for the 2019 Dentists’ Day on the Hill (DDOH), scheduled for Tuesday, March 12, with a legislative briefing the night before at 6 p.m. on Monday, March 11 in Tallahassee. To register for DDOH, click here.
For additional information on legislative issues, you can reach Joe Anne Hart at jahart@floridadental.org or 850.350.7205.
sfdda
South Florida District Dental Association Annual Business Meeting April 17, 2019
6:30pm Doubletree by Hilton Grand Biscayne Bay Hotel 1717 N. Bayshore Dr, Miami, FL 33132
Register at www.sfdda.org
State of the Association Address
Life Member Certificates
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Installation of 2019-20 Officers
Election of Officers
Dr. Ernesto Perez, Jr. SFDDA Secretary Dr. Beatriz Terry - FDA Trustee Dr. Mark Limosani - FDA Alt. Trustee Dr. Gina Marcus - FDA Alt. Trustee