As a dentist and owner of a multi-site practice in Minnesota, I’m writing to respond to the letter from the president of the Arizona Dental Association, Dr. Robert Roda entitled, “Don’t follow Minnesota’s failed dental therapist experiment,” published on March 29. A number of his comments about the Minnesota experience with dental therapy are, at best, misleading. I’d like to set the record straight as a private practice dentist and an employer of dental therapists. For me, dental therapy has been an important tool to help expand care to more people, especially patients on Medicaid, and a way to grow my practice.
Dr. Roda claims dental therapists “solve nothing.” Tell that to the patient in a community health center dental clinic who is able to get his tooth ache handled with a shorter wait time because the dental therapist was available to treat him weeks before a dentist could have seen him. Tell that to the mother in rural Minnesota who is able to get her children’s needs addressed regularly and avoid them developing decay or needing painful extractions. Tell the thousands of patients on Medicaid who are now receiving regular care that having a dental therapist treat them “solves nothing.”
Dr. Roda also naively notes that dental therapists have not led to lowered dental costs in Minnesota. We authorized dental therapists in Minnesota to address two major problems: too few dentists were accepting Medicaid patients and in most of our counties – many of them rural – we had a dentist shortage. Dental therapists have started to make an impact on both of these fronts. Because of dental therapists’ lower labor costs (about 30 – 50% the average hourly wage of dentists in my state), those of us in private practice who have hired them are finding it financially viable to serve more Medicaid patients – we are not taking such a hit on the state’s low Medicaid reimbursement rate. Federally qualified health centers using dental therapists are able to use the savings in staff salaries to provide more free and low-cost care to the uninsured. And a number of practices are deploying dental therapists to rural community locations because it’s more affordable than sending a dentist. In fact, dental therapists are being used to address what Dr. Roda called the “real challenges that parents face getting to the dental office.” Children’s Dental Services, the largest nonprofit dental operation serving children in my state, sends dental therapists to low-income schools to fill decayed teeth—at a substantially lower cost than what it would take to send a dentist.
In Minnesota the Medicaid agency decided to reimburse dental therapists at the same rate as dentists. In Arizona, the precedent is to reimburse midlevel providers at a lower rate. That would offer the state budget immediate savings. But let’s think in the long-term. Right now the most expensive member of the dental team is performing routine restorations that a qualified, lower-cost provider could perform. That’s highly inefficient and one factor in why dental costs are high. If dental therapists become a fixture in Arizona’s dental delivery system, the cost savings they would bring to dental practices would help keep dental costs from continuing to spiral up – as labor is the most expensive component of a dental practice, while also providing care to more lower-income people.
Apple Tree, another nonprofit provider, has a mobile team that provides on- site care at a veterans nursing home. Without Minnesota’s law they would have to hire a dentist to do the thousands of restorations now performed by a dental therapist, at an additional cost of $52,000 annually.
For all these reasons and more, dental therapy graduates are in great demand and dentists are hiring them as quickly as we can train them.
Arizona, like Minnesota, has a significant access problem. Solving it will take a multi-faceted approach. Making dental practices more cost-efficient and geographically flexible is part of the solution – an important part. Dental therapy can help get us there. Medical practices and their patients have benefitted from incorporating nurse practitioners and physician assistants for decades. Arizona’s dentists and patients deserve – and need – the same opportunity to benefit from midlevel providers that thousands of Minnesotans have had.
I would say to those Arizona dentists who believe it won’t help their practices – don’t hire them. But don’t deprive your colleagues—especially those working in safety net clinics and rural communities—of the opportunity to improve their practices and the health of their patients.
John T. Powers is a dentist who is licensed to practice in Minnesota.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.