I had some comments about Dr. Sanchez’s recent Letter to the
Editor in the July/August 2015 Today’s FDA. My comments should in no way
imply endorsement of his comments about LECOM dental school; I do not know
enough about LECOM to agree or disagree with his comments. However, I do
question his equating the LECOM dental student’s statement that “she had no
aspirations of ever having her own practice, was fine with being an employee
and readily accepted dental therapists as part of the dental team” with the conclusion
that “the (dental) schools should aim high, not for the lowest common
denominator”. That disparaging comment makes no sense to me and is unkind
to dental schools and to students who think that way. Maybe Dr. Sanchez
has not read the reports for the ADA Policy Center
What also bothered me was the implication that “dental therapists”
are equated with “the lowest common denominator”. Maybe this student read
the extensive literature about dental therapists being safe, high quality and
cost effective members of the dental team? Maybe this student
attended the UFCD ASDA organized day of learning this past spring about
alternative dental workforce models including dental therapists and found
the arguments of the proponents intellectually honest and convincing.
Maybe this student found out that Minnesota
The most offensive statement in Dr. Sanchez’s letter was in point
# 5, implying (but not actually stating this) that encouraging dental students
to become Medicaid providers was somehow reaching for the “lowest common
denominator”. That is truly offensive to both dentists who do treat
Medicaid patients and to Medicaid patients. That kind of statement correlates
with our team’s recent finding of a “social stigma” associated with being a
Medicaid provider in Florida
Sincerely,
Frank Catalanotto, DMD
Let me begin by pointing out how many times Dr. C (for brevity, not disrespect) cites implication. Most of you have known me for years, read B-L, seen me in the HOD, and know I never imply- I say what I mean and mean what I say. Not once in my letter do I make the correlation of lcd (lowest common denominator) tied to my opinions about DHATs or dental students. If anything, I've devoted most of my advocacy energies to fighting the onslaught of unfair obstacles our future dentists face. Dr. C should ask our GAO team how many years and with what intensity I've been speaking out for loan forgiveness, removing clinical instructors who can't even pass NB 1&2, or stopping 50+ Cuban dental grads (in CA) from coming to FL and sitting for ADEX without any US dental training. That dental instructor issue was made a FL law, thanks to my advocacy in both House & Senate, with the help of dedicated legislators. That happened after a BOD member asked me to testify before them, much to the consternation of those who really didn't wanna hear it. I quickly realized the system was not interested in fixing itself and went the legislative route.
Maybe Dr. C thinks I'm unaware of the "choice" many new dentists make to practice in the corporate model. Sadly, I'm all too aware and know this is less a choice and more a necessity. It's what happens when a student gets minimal clinical experience, along with the lack of confidence that brings, and faces staggering debt that can easily range from $350,000 to half a $million! Tuition debt, in general, increased 46% from 2001-2012 and has doubled under Obama to $1.2 trillion. Imagine dental tuition? We have older, established programs graduating dentists with 2 anterior endos, do we wonder why so many feel the need to enter GPR programs? No bank will lend any $ to these young, indebted, high risk borrowers. I left USC in 1984 and plunged right into a full time satellite office in Indio, CA, with an in-house denture lab and 30 pts. per day. When I left to return to FL, in 1986, they had to hire 2 youngsters to do my job. What pre-dental student applies with the "dream" of making $70,000 working for McDentist? If you look at their loan debt vs. earnings, no bank would approve the same amount for a home loan. It's ironic that LECOM talks about self instruction and motivation but produces graduates who will work with someone looking over their shoulder. We bring the best, brightest and most gifted dental clinicians to our local, state and national meetings to share their talents and impart their wisdom, not to have few options aside from assembly line workers with no self determinism. That, my friends, is where the lcd lies. The deck is rigged against these new dentists from day one.
As for the UFCD/ ASDA Day, the report I got from colleagues who attended and FDA staff was that the students were none too pleased to be lectured to by proponents of the nationalist dental concept. Among them was one from CO who pounded home the "DHATs are here to stay" message as well as "we need to do something about the under served who don't trust providers who don't look like them", talk about offensive and disparaging!
Dr. C speaks lovingly of the DHAT model, one that has yet to reduce the incidence of dental disease, merely offering a cheaper way to drill it out. He also admits the real agenda behind DHATs, let them tackle the poor with lower skills than a dentist, then have the dentist do the big $ stuff. The only ones who "make more $" in McDentist are the bosses who run the youngsters and often own many practices, a scam they pull off via crony capitalism and a permissive dental practice act. The DHAT concept is not new, if it were so great, we'd have it everywhere. BTW, Dr. C's views on DHATs are at odds with most of his colleagues, including the current ADA President. He erroneously infers what I did not imply, that Medicaid providers are inferior or the lcd. My question #5 reads "since when did it become the primary mission of dental programs to train students to become employees of Medicaid or corporate masters?" Note to Dr. C, the biggest stigma to working for the govt. is not social, it's financial and regulatory. If that weren't the case, they'd have a waiting list of dentists wanting to sign up, wouldn't they? One way the DHAT option is made more attractive is by graduating dentists with little clinical experience, that blurs the distinction.
In closing, I realize Dr. C and I come from very different dental backgrounds and will probably never agree on most of these points. But I'll bet Frank dinner at Bern's most FDA members agree with me, not him. That would be a good poll to take, via email blast.
Maybe Dr. C thinks I'm unaware of the "choice" many new dentists make to practice in the corporate model. Sadly, I'm all too aware and know this is less a choice and more a necessity. It's what happens when a student gets minimal clinical experience, along with the lack of confidence that brings, and faces staggering debt that can easily range from $350,000 to half a $million! Tuition debt, in general, increased 46% from 2001-2012 and has doubled under Obama to $1.2 trillion. Imagine dental tuition? We have older, established programs graduating dentists with 2 anterior endos, do we wonder why so many feel the need to enter GPR programs? No bank will lend any $ to these young, indebted, high risk borrowers. I left USC in 1984 and plunged right into a full time satellite office in Indio, CA, with an in-house denture lab and 30 pts. per day. When I left to return to FL, in 1986, they had to hire 2 youngsters to do my job. What pre-dental student applies with the "dream" of making $70,000 working for McDentist? If you look at their loan debt vs. earnings, no bank would approve the same amount for a home loan. It's ironic that LECOM talks about self instruction and motivation but produces graduates who will work with someone looking over their shoulder. We bring the best, brightest and most gifted dental clinicians to our local, state and national meetings to share their talents and impart their wisdom, not to have few options aside from assembly line workers with no self determinism. That, my friends, is where the lcd lies. The deck is rigged against these new dentists from day one.
As for the UFCD/ ASDA Day, the report I got from colleagues who attended and FDA staff was that the students were none too pleased to be lectured to by proponents of the nationalist dental concept. Among them was one from CO who pounded home the "DHATs are here to stay" message as well as "we need to do something about the under served who don't trust providers who don't look like them", talk about offensive and disparaging!
Dr. C speaks lovingly of the DHAT model, one that has yet to reduce the incidence of dental disease, merely offering a cheaper way to drill it out. He also admits the real agenda behind DHATs, let them tackle the poor with lower skills than a dentist, then have the dentist do the big $ stuff. The only ones who "make more $" in McDentist are the bosses who run the youngsters and often own many practices, a scam they pull off via crony capitalism and a permissive dental practice act. The DHAT concept is not new, if it were so great, we'd have it everywhere. BTW, Dr. C's views on DHATs are at odds with most of his colleagues, including the current ADA President. He erroneously infers what I did not imply, that Medicaid providers are inferior or the lcd. My question #5 reads "since when did it become the primary mission of dental programs to train students to become employees of Medicaid or corporate masters?" Note to Dr. C, the biggest stigma to working for the govt. is not social, it's financial and regulatory. If that weren't the case, they'd have a waiting list of dentists wanting to sign up, wouldn't they? One way the DHAT option is made more attractive is by graduating dentists with little clinical experience, that blurs the distinction.
In closing, I realize Dr. C and I come from very different dental backgrounds and will probably never agree on most of these points. But I'll bet Frank dinner at Bern's most FDA members agree with me, not him. That would be a good poll to take, via email blast.
