"100% Dental Issue: Frank & Carlos"

Hello, my friends, you may recall that last post was sent as my usual issue, along with a link to a purely dental post re: LECOM's dental program. That same letter was just featured in TFDA (pg. 62), the FDA's monthly publication, and has already received backlash from members who disagree. Apparently they disagree so strongly that they upbraided the editor for publishing my piece! Funny how liberals will extol the virtues of the 1st amendment, until it's used to express any dialogue that does not fit their narrative. If you missed it, the piece I'm referring to is titled "Is Dentistry Already Succumbing to the New Normal?", you can look it up and check it out. I've been a reader of TFDA for decades and don't ever recall an editor feeling the need to mass email the entire membership with a list of the guidelines which determine what gets printed and what does not, as well as defend his decision. Most of you probably saw that email, several emailed me, asking what was the big deal with my piece? I just received a strong rebuttal from former UFCD Dean, Dr. Frank Catalanotto. I'll reprint it below, then give you my take.

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 showing the increasing trend of dentists be to employees rather than practice owners.  Just because these dentists choose that way to practice their profession as opposed to what Dr. Sanchez has chosen does not mean they are “the lowest common denominator”.  Does Dr. Sanchez have any evidence that being an employee dentist actually equates with poor quality?  If he does, please share it with us. Career choices are personal, professional and financial decisions that have nothing to do with quality. 

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 dentists are employing these therapists, increasing the numbers of Medicaid enrolled patients in their practices, and at the same time, allowing the dentists to practice at the top of their professional skill set, and to make more money.  Dr. Sanchez’s statement implies that dental therapists are not good members of the dental team; if he has any evidence to support this opinion of his, I would love to see such evidence. I will be happy to point him to factual evidence supporting this student’s (and my) opinions. 

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 dentists (Logan, HL, Guo, Y, Marks, J, Dharamsi, S, and Catalanotto, FA, Barriers to Medicaid Participation among Florida Dentists. Journal of Health Care for the Poor and Underserved. 2015;26(1):154-67. PMID25792734 .

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.