Mid-level Oral Health Provider Now Law in Minnesota

Republican Minnesota Governor Tim Pawlenty has signed the bill previously passed by the legislature into law enabling a new Mid-Level Oral Health Provider.

History was made on May 13, 2009, as Minnesota became the first state to pass legislation allowing a "mid-level" oral health provider into state statute - enabling students who are educated under the Advanced Dental Hygiene Practitioner (ADHP) model to become licensed to practice. The Minnesota state House and Senate overwhelmingly passed Senate File 2083, a bill establishing the Dental Therapist and Advanced Dental Therapist providers in the state. Minnesota Governor Tim Pawlenty signed the bill into law on May 16.

The new providers will focus their practice on care for underserved populations in the state and will administer educational, preventive, palliative, therapeutic, and restorative services. The bill is supported by the Minnesota Safety Net Coalition, which has taken the lead in advocating for a new provider. Proponents of the OHP, including the Minnesota Dental Hygienists' Association, have also lent support to the effort. The Minnesota Dental Association is not opposed to the legislation.

The Dental Therapist/Advanced Dental Therapist provider language was the culmination of nearly two years of work spearheaded by Minnesota State Senator Ann Lynch who first brought legislation to establish a new oral health provider forward in 2008. Senator Lynch along with Representative Cy Thao in the House were integral in both supporting legislation for the new providers and forging a compromise among the various stakeholders.

American Dental Hygienists' Association President Diann Bomkamp, RDH, BSDH noted, "The leadership demonstrated by Senator Lynch, Representative Thao and their colleagues who worked closely on this effort is to be commended. Forging consensus on workforce issues is never easy but Minnesota is a demonstration to others throughout the country that solutions can be developed and implemented."

As previously mentioned, the legislation paves the way for the first students in the country who are educated under the Advanced Dental Hygiene Practitioner model to become licensed and enter the workforce. Minnesota licensed dental hygienists who have met admission requirements are entering the Masters program offered by Metropolitan State University in St. Paul, Minnesota. These students will obtain the competencies needed to practice as Advanced Dental Therapists in the state.

Interim Dean of Health Sciences of Normandale Community College and Co-Chair of Metropolitan State University Dental Hygiene Program Colleen Brickle, RDH, EdD, noted, "We are proud that our efforts in Minnesota will be part of an access solution and pave the way for meeting the needs of underserved in other states."

ADHA developed the AHDP provider model beginning in 2004 and finalized ADHP Competencies in 2008. Providers educated under the ADHP model build on their dental hygiene skill set by learning additional clinical skills and will also become competent in skills necessary to navigate the complex health care system, advocate for patients, and effectively manage a clinic or practice. The providers will focus on providing care to underserved patient populations.

This is a symbolism over substance turf war between dentistry and dental hygienists which will make little difference in low income underserved and rural communities.

All this law accompllshes is a reduced training schedule for dental hygienists allowing them to practice a limited form of dentistry.

Why the state of Minnesota did not sponsor scholarships for hygienists to go back to dental school and become dentists is anyone's guess? - except that it costs the state money.

But, who is going to subsidize the training of the mid-level practiitoner?

Answer: The State of Minnesota.

Strange, huh?

This program will not effectively solve the dentist manpower distribution problem in Minnesota vis a vis underserved rural communities. My guess is that it will have little effect at all - until the mid-level providers want to branch out and practice regular dentistry in upscale Minnesota cities and suburbs.

Then, the turf war with mainstream dentistry will reignite again.

But, by then, the hygienists will argue that they are cheaper than dentists so why not replace them entirely. Everyone will be mid-level providers and the bad rich dentists will be no more.

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