Yes, that's right, this one's for all you young dentists, at the request of a young dentist. Don't worry if you're an older dentist, like me, I think you'll find this issue relevant and useful for your dealings with our younger colleagues. I hope my young readers will share this piece with your same aged pals.
It turns out your ADA & FDA have done plenty for you in the past 20 years, much of which often goes unheralded and remains unknown to our grassroots members. Those accomplishments have been both things we've supported and (in some cases) even made law as well as opposed and successfully shut down. For those of you who see DDOH and wonder what the heck it is, it's Dentist Day on the Hill and it takes place every year during the legislative session in Tallahassee. I've attended every one but 2, where a last minute airline strike and a nasty storm resulted in cancelled flights. Most dental legislation is not federal, it's state law and must be fought at the state level. I'm gonna give you examples of what a strong dental association can accomplish and what happens in states with weak ones.
The first ever DDOH was in 1996 and the issues we faced included mandating all dental offices to hire a "medical director" for the small fee of ~$50,000 annual salary. Obviously, that salary would be much higher 21 years later. We shut that one down slam dunk and most dentists have no idea it ever happened. These types of asinine bills usually come up because some vested interest who stands to benefit from its passage into law will approach legislators with a large political contribution in exchange for their support. The other issue that year was denturism, I wonder how many of you young members even know what denturism is? I'll tell you, it's your denture lab tech being legally allowed to see pts. in a dental op they have in their denturism practice, taking impressions, doing the try-ins, finishing and delivering complete and partial dentures to people who used to be our pts.! This bill came about due to a nice lady in the FL House whose mother was frustrated with her difficulty finding a Medicaid dentist to make her nice, cheap dentures. We shut that one down, too. States like MT, UT, AZ, CO, OR & ME were too weak to stop it and it became law. From what I researched, MT & UT have repealed it, good for them! I don't have to tell you once a bad law sinks its claws into a state, it can be very tough to repeal. So, these are 2 we stopped.
Another issue we passed was coverage for partial dentures for Medicaid pts. Sounds like a no-brainer, but Medicaid used to only cover complete dentures. That meant dentists often found themselves removing perfectly good teeth for the sole purpose of the pt. getting his dentures! Can any of you imagine yourselves (with a non-Medicaid pt.) going before the BOD in a disciplinary hearing with the board members showing your pt.'s FMX or Pano on a big screen and asking you why you removed 5-6 teeth that were strong and free of caries? That was the talking point I used on legislators, I told them "if I were to do to my patients what your law mandates I do, I'd lose my license!". It worked and we got coverage for partials.
Next on our hit list was another effort to mandate every dental lab in FL to hire a CDT. Never mind that it would have taken 3-4 years for all the vo-tech programs in FL that produce CDTs to graduate enough for the 1,200 (legal) labs, it was a ridiculous, self serving effort by the FDLA, who gave $ to a FL legislator to push this. We demolished it in the first healthcare committee hearing!
More recently, there was an effort (2005) by a group called FIDA (Fla. Intl. Dental Assn.) to allow foreign dental grads to sit for the ADEX without any US dental training. Aside from the fact there's an enormous difference between what's taught in US dental schools, vs. Latin America, it was a kick in the teeth (pun intended) to young US dental grads with staggering loan debt. These folks don't have such a debt burden. would work for peanuts and cut you out of the marketplace. A Colombian dental grad who has US training and did things the right way, accompanied me to Tallahassee to meet with FIDA's Pres., a Rep. they were appealing to and their lobbyist. This clueless legislator felt what we did was no big deal and could be taught to these foreign dentists in a setting like plumbers or air conditioning technicians! We educated him and it went no further. The other big foreign dental grad issue has been around since 2010 and is always looking to surface again. That's from 50+ Cuban dental grads who practice under public health permit in CA but wanna come to FL and sit for ADEX sans US dental training. We've fought this for many sessions and always prevail. In 2011, they hired a former FL Rep. as a lobbyist and his sitting FL Sen. brother got it heard in committee. We stopped it right there and I was both validated and relieved when I heard 2 of those Senate committee members reading from the talking points I'd sent them, verbatim.
The current issue we face is that of DHATs (Dental Health Aide Therapist), which are currently legal in 4 states and operating in 2. Let's just call them dental therapists for simplicity. These are not super assistants, my friends, these are high school grads with 3 years tech training and they can inject anesthesia, do fillings, pulpotomies and extractions! They are promoted as the equivalent of a nurse practitioner, which they are not. Nurse practitioners have far more education and training, but they don't perform the irreversible and invasive procedures DHAT's do. There is power and big $ at play here and both the Pew and Kellogg's Foundations are heavily invested in getting this issue to pass in FL. They are aided and abetted by the former dean of the UFCD, Frank Catalanotto. This movement has a nationalist agenda, believes all healthcare (us included) should be delivered in a public health, one-size-fits-all model and have no problem with foisting lesser trained persons on unsuspecting patients. The DHAT model originated in New Zealand and has been a dismal failure in preventing dental disease, which remains rampant there. It's a well known reality that we cannot drill, fill & pull our way to dental health. Without prevention and education, nothing can improve.
The DHAT proponents cite lack of access to care as the reason for a non-dentist to do dental procedures but the true solution does not lie there. With 3 FL schools cranking out dentists and dentists who come to FL from other states, we do not have a lack of dentists, we have a maldistribution of dentists. The most successful model to put dentists where the low income, limited access pts. are is loan repayment. That's where a new dental grad agrees to work in a low access setting and the state gives them a financial return to help pay off their debt. It has worked very well in other states and we finally (after many years of trying) got it passed in FL last session, only to be vetoed by Gov. Rick Scott. Since he's gonna be running for U.S. Senate in 2018, I don't think he'll be dumb enough to veto it again, but one never knows with Rick Scott. The good news is we do have both a House & Sen. version of the loan repayment bill for this session. The bad news is we also have a newly elected Rep. Daniel Perez who's filed a bill that would allow DHATs to operate in FL. If he withdraws it, we'll treat it like a rookie mistake and move on. If he does not, he will face vigorous opposition! There are other issues we've dealt with successfully, of lesser impact, but these are big.
So, in closing, let me share with my young colleagues some things I've learned over 22 years of fighting in the political weeds:
1- Legislation will either be done FOR us or TO us, it all depends on how involved and engaged or disconnected and apathetic we choose to be. (I coined this one, myself)
2- We are either at the table or on the menu.
3- Party affiliation means nothing when it comes to our issues. We are the Tooth Party when in Tallahassee or DC, no Rs or Ds.
4- Historically, our issues have been both advanced as well as opposed by both parties. I'd have to say we've had more interaction with Republicans because of their majorities in both legislative chambers. Case in point, all the bad bills mentioned above were sponsored by GOP legislators. All you young dentists are threatened like no dental generation before you ever has been. We're told not to be perceived as self serving in the eyes of legislators, which is quite ironic when you consider they can be some of the most self serving people there are, LOL. In advocacy for one's profession and the benefit of the citizens (i.e. our pts.) it can sometimes get heated, tense and downright ugly. My advice to all of you is get involved, get tough, never give up, don't allow the opposition to intimidate you and always take the fight to them. Life is never fair and practicing good dentistry is a part of life.
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