Friday, April 13, 2012

More on dental “practitioners”

Yes, there is a war, but not sure this is the one that should be at the top of the list. However, I Thought this should be kept around for reference.

The War of the Dentists and their Competitors
A shout-out to Kansas Public Radio
By Trudy Lieberman

Campaign Desk — April 13, 2012 06:15 AM  Every once in a while an interesting, well-done piece from public radio comes along that makes you think. This week came a story about a new war in the Great Plains region. You might call it The War of the Dentists and their Competitors. Kansas Public Radio health reporter Bryan Thompson examined a simmering dispute between traditional dentists—the ones who like to treat well-heeled patients in big city suburbs—and those professionals who want to become licensed as Registered Dental Practitioners (RDPs). These practitioners’ training places them somewhere between a regular dentist and a dental hygienist, and they would be able to fill cavities and perform simple extractions of children’s teeth.

Most important, they would fill a big void in rural areas of western Kansas, where some counties have no dentists at all. That is, they would if the state legislature allows them to do that. But the old-line dentists represented by the Kansas Dental Association have “fought this idea all the way,” Thompson reported, noting that 99.9 percent of the dentists oppose the registered dental practitioner model. The head of the association, Kevin Robertson, says the legislative proposal goes too far, claiming that the new class of practitioners might not be up to the task of pulling teeth and other procedures. He argues that the legislation would allow RDPs to perform procedures which are by definition considered surgery. As Robertson told Thompson:

The bill is written to allow the extraction of all primary teeth, or meaning baby teeth. Now a lot of listeners might think, well, baby teeth, I’ve pulled out my son’s or my daughter’s baby teeth. Well, there’s nothing in the proposal that says it has to be loose.

Think of this particular turf war as a variation of rationing. You know, the denial or limiting of care that many claim does not occur in America, only in European countries with national health systems. But tell that to the Kansans Thompson met when he visited a free, makeshift dental clinic staffed by volunteer dentists in a vacant Walmart store in Kansas City. Not long ago, the clinic, operated by the Kansas Dental Charitable Foundation, opened its doors at 8 p.m. the night before dentists were to see patients. Those who arrived then spent the night in the empty store to make sure they got a slot. By 5:30 the next morning, 1200 people were in the building, and organizers closed the parking lot to new patients. The 165 dentists and many more hygienists could not handle more. More than 2000 patients were treated during the two-day clinic.

“Analysts have known for years that Kansas has a severe shortage of dentists, and that shortage is getting worse,” Thompson reported. It’s that way all over the country, where people who need dental services must depend on philanthropic organizations to get their teeth cleaned or filled.

Thompson interviewed Shannon Cotsoradis, who heads an advocacy group and leads the effort to license RDPs. She told listeners the reason for the dentists’ opposition is “based on fear and misinformation.” Well, maybe, but like all things in American health care, the real issue is money. I wish Thompson would have delved more into the reasons the dentists are hoppin’ mad. It isn’t just fear and misinformation that motivates the dentists to join forces and lobby the legislature to prevent RDAs from becoming a reality in the state. New competitors are a threat to their livelihoods. And no health care professional wants that, for heaven’s sake—even if it means some people don’t get care.

All in all, Thompson’s piece was an example of what good radio journalism should be. It found a problem in need of a solution and placed it in a health, political, and national context. Fifteen states including Kansas are trying to train and license RDPs, but only Alaska and Minnesota have been successful. This story touched on a serious health issue with which this country will continue to be confronted, whether or not health reform takes effect. Who will serve all the people needing care?

A couple of years ago, Sarah Varney of KQED asked CJR how journalists can keep the dental story alive after reporting the obvious point—that people need treatment. Thompson’s story offers a new angle.