SB 694, authored by Sen. Alex Padilla, has proven to be a significant topic of division within the leadership of California dentistry. The most controversial part of this bill calls for the development of a study to examine the potential for, and ability of, traditional and non-traditional (mid-level) dental providers to perform safe and effective dental care for the reported "underserved" children in California. The bill has recently modified this category of "non-traditional providers" to now only include registered dental hygienists and expanded duty dental assistants. This potential new level of provider would be allowed to perform irreversible dental and surgical procedures on children such as tooth preparation and placement of direct restorations and the extraction of deciduous teeth, all with the application of local anesthesia.
Let's look at this legislation critically. It was not developed, as legislators will attempt to lead us to believe, because of a shortage of dentists in California. California leads the country in dentist-to-patient ratios. This legislation was really developed in response to various hot topic political pressures, including those from the Affordable Care Act. In many ways this is not an "access to care" problem, it is an "access to free care" issue.
Children are the most challenging population of dental patients, not only with respect to their care, but also with their management. How can we permit providers with training and experience less than the minimum requirements of a full dental education to treat these difficult patients? Would you want your children treated as such? Dentistry is not just "tooth carpentry." It is a complete profession of generalists and specialists, extensively trained to provide a full scope of oral and facial care. This requires a formal four-year doctoral training program after an undergraduate college education, and in the case of some specialties, extends as much as six to seven more years to complete training.
The profession has presented a number of options to serve truly needy populations, without creating a substandard level of care for these patients. As an example, the California Association of Oral & Maxillofacial Surgeons has aligned with Remote Area Medical, which this year provided humanitarian care to 4,893 needy patients at two events. The events provided just short of $1.8 million worth of free dental care. Similar programs actively exist and are promoted by the California Dental Association and other dental organizations.
Other options offered to address these care issues have included;
- Requirement of a fifth internship year for dental school graduates, part of which would be served in low-income facilities;
- Supervised externship programs for students in their last year of dental training; and
- Developing programs for underserved populations in dental schools.
Why not establish state-run, privately funded dental centers with fairly paid dental supervisors and dentists to provide care to this, so-called, underserved population? This would guarantee proper geographic placement, staffing and access for probably less money than developing a new level of provider who will require reasonable compensation. And that's not even considering the malpractice issues.
All of these options utilize dental providers who are already available, and most importantly, properly trained. The development of a "study to explore the possibility" of a new level of provider when providers already exist, in spite of it being financed by private funds, is yet another example of how inefficient and blind the California Legislature has become and why California is at the brink of bankruptcy. Any of these options would improve access to care, not just give the appearance of addressing the issue politically.