Recently, legislation was introduced advocating for dental therapists in Michigan, despite a lack of proof that dental therapists will make a meaningful impact in addressing the barriers to dental care. A better idea is to build Michigan’s successful strategies using our current dental workforce.
As a Michigan dentist for over 40 years, I’m proud that our state has been proactive in increasing access to care. Healthy Kids Dental, a program to improve access to dental care for Medicaid-eligible children, has now been expanded into all Michigan counties, and all children are covered up to age 21. Under the traditional fee-for-service Medicaid program about 46 percent of children receive care, while under Healthy Kids Dental, we’ve been successful in increasing that number to 61 percent (and that number continues to improve).
For purposes of comparison, for children with private dental benefits the utilization rate is about 70 percent. In addition, the Healthy Michigan Plan, Michigan’s Medicaid expansion program implemented in 2014, has seen similar utilization trends when compared to traditional Medicaid. This is in part due to the Healthy Michigan Plan offering dental benefits comparable to Healthy Kids Dental.
The dental therapist program proposed in Senate Bill 1013 is based on a Minnesota program, which hasn’t been proven successful. Since the law creating dental therapists passed in 2009, only 54 dental therapists have entered the workforce. Additionally, proponents claimed it would get providers into underserved rural areas. But in the seven years since its creation, just seven dental therapists have gone into rural areas.
A recent study by the Health Policy Institute shows that 35 percent of low-income people in Michigan report having trouble finding a dentist. According to the same study, 44 percent of low-income Minnesotans say they have trouble finding a dentist, even with a dental therapist program in place since 2009. Michigan’s strategy has proven successful; Minnesota’s has not. There is no reason to think a dental therapist would have a positive impact here.
A better way to address access is to improve utilization of Michigan’s existing dental workforce. Currently there are 7,500 dentists, 10,300 registered dental hygienists, and 1,700 dental assistants. Of the 10,300 hygienists, over half are unemployed or underemployed. In addition many dentists say they could see more patients. Why add another provider when there is so much unutilized capacity?
The Michigan Dental Association supports solutions with better chances of helping fix the access problem and is working with Sen. Pete MacGregor to introduce a bill to allow individual dentists to send hygienists into underserved areas to provide hygiene services. If follow-up care is needed, patients would be referred to the dentist that sent in the hygienist.
A key concern with the dental therapist model is it sends people who have much less training than a dentist (i.e. the dental therapist) to treat a population with the most complex dental and medical problems. The underserved should have access to the same quality care as people with insurance or who pay out of pocket.
The association welcomes discussion on ideas to improve access to care, but it is important to look at the facts and put forward ideas that will work.
Dr. Larry DeGroat is the president of the Michigan Dental Association, and practices dentistry in Bingham Farms.