Access to dental care is a major problem in our state. As a solution, some have proposed creating a new “midlevel” dental provider. Although this seems like a simple fix, I believe the real solution is more complex.
Washington state has one of the highest dentist-per-capita ratios in the country. Each dentist in Washington already has the ability to employ expanded-function dental assistants and hygienists trained in restoration. The dental workforce is robust in this state and does not need another level of provider to address the growing need for dental care.
Two solutions dentists have proposed this year will increase access to care. The first is a budget request for the expansion of the University of Washington’s Regional Initiatives in Dental Education program, which increases access to advanced dental training while distributing students to the most underserved areas of our state. This successful program has shown that students who train in these underserved communities are far more likely to return to these areas upon completion of their training.
The second is the continual work of dentists and dental educators to increase the number of dental residencies. This expansion adds trained dentists in both urban and rural areas of need, and allows them work in community health centers and hospitals where a majority of patients are adult Medicaid participants. Over the past decade, there have been more than 30 residencies added in our state.
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Another major problem with access to care is the chronic underfunding of adult Medicaid dental benefits. According to the University of Washington School of Dentistry, one of the state’s leading providers for adult Medicaid, the reimbursement rate is approximately 25 cents for every dollar spent providing care. With this low rate of return, no practitioner can provide dental care and sustain a viable dental clinic. Adding a midlevel provider to this scenario does not change the fundamental problem of the lack of funding for adult dental benefits.
It also should be noted that a majority of dental professionals oppose midlevel providers because of the risk that undertrained providers potentially pose to patients. Dental training is traditionally four years of graduate level training, and many states now require additional residencies beyond that. Midlevel providers would not have nearly the same level of training. Because dentistry has a strong surgical component, it is different than a basic medical practice and adequate training to perform these procedures cannot be done in only a few years. Undertrained providers would put patients at risk, as improper procedures can actually lead to increased pain and infection — which could increase emergency room visits and other dental issues.
Adding midlevel providers will not be a quick fix for the state’s access to care issue. The real solutions will be built through expansion of existing programs and residencies, by placing knowledgeable students and trained residents into vulnerable communities, and by looking at ways to expand funding for adult Medicaid dental benefits.