In the Albuquerque Journal of March 9, 2006, is a sad story by Leann Holt, Staff Writer. It has to do with dental care in New Mexico for children. She writes about decay, just the simple problem of tooth decay. However, she points out that the disease is serious, as it causes missed school days and can lead to mal-nutrition, school failure and low self-esteem.
Statistics from the story: 40% of New Mexico’s children suffer from tooth decay; only 6% of Medicaid-eligible children in New Mexico get dental care (third lowest in the nation); and only one-third of New Mexico’s dentists are willing to take patients based on Medicaid payments. One school nurse is quoted as saying that it is not unusual to see “crater-sized cavities” and children in pain, with no dentist to send them to.
The story features Small Smiles Dentistry, a clinic which is part of a chain, (one on the West Side, and now one at Central and San Pedro). One dentist there said it is not unusual to see children who have cavities in 18 out of 20 teeth.
Medicaid pays only about 66% of what other insurance companies pay. Red tape may be a problem, and undoubtedly is, but there is red tape in dealing with HMO’s and insurance claims people too. So is it money?
Where are out priorities? We pass laws to impose taxes to provide up front money for promoters, tax breaks (subsidies) for billion dollar corporations with highly paid officers and other executives, and for landscaping of highways and maintenance of golf courses, and so on. “First things first!”
Two suggestions to help remedy this problem. First, Medicare (federal taxpayer money) should cover all dental care, including prophylaxis, at least for the children. Such dental care should be provided for all children (no means test to be applied) in the schools.
Second (and here we rely on free enterprise as a solution), we should change the law to encourage more qualified people to offer the services. One change we might try is to allow people into dental school if and when they are ready for dental school; and defer the bachelor degree requirement until after the dental school graduate begins practice. As part of their continuing professional education, these dentists could take the undergraduate courses, so that within a few years they will have the same formal education as those who completed a bachelor’s before getting into dental school.
Give these people an incentive, such as this waiver (deferral) of the undergraduate degree requirement for license; and in return, require these dentists to accept Medicaid child patients for a number of years.
These Medicaid dentists would not be as formally educated as the dentists with undergraduate degrees: no English literature; no foreign languages, nor dead languages; no psychology, philosophy, economics, nor electives. But these dentists will catch up later, on their own time, while they are making a living and also performing a public service.
How can we be proud of our State; our space station; our airplane industry; our Intel, with its $32 billion off the tax roll; our multimillion dollar stadiums [sic]; our lottery which takes from the poor and gives to college students; and so on; when we fail to provide our children with dental care? We do not have to go from the present system to socialism; that is, from monopoly to socialism. How about let us go from monopoly to free enterprise? Educational requirements for a license are necessary to prevent the incompetent from practicing quackery; but unnecessary educational requirements are in restraint of trade, and immoral.
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Surpassing undergraduate requirements is not a feasible incentive, simply because the curriculum in dental school would devour any student lacking a strong science background. Furthermore, the Dental Admissions Test (DAT), while not the greatest measure of aptitude in the world, would certainly overwhelm anyone without such a background.
So the solution should point towards having more Medicaid-accepting dentists. This issue is multi-fold, beginning with the underserved population as a whole.
So few children on Medicaid were seen last year because the parents have trouble gaining access to dental care, they don't know where to go or who to call, and they simply aren't aware of the dangers of decay. The most profound correlate of child tooth decay is parental tooth decay--children are subjected to and eventually adopt the habits of their parents.
So why can't they just go somewhere? Most private practice dentists will not accept Medicaid because the billing system is so complex and tedious that it's not worth the effort, unless you accept Medicaid in very high numbers (which won't turn a profit without a physically enormous practice), which then gives you access to computerized billing, but brings on another problem--Medicaid clients typically have a missed-appointment rate of over 40%. Seeing 6 out of 10 patients every morning will not keep the lights on, let alone support a practice.
Offering dentists incentives to accept Medicaid patients? Great idea, but one incentive should not be to manufacture less qualified dentists. A good start would be to streamline the billing process so that small-scale private dentists could actually do Medicaid work and cover their overhead with it. A second idea would be to urge our political leaders to quit reducing Medicaid reimbursements. Medicaid will pay for child prophylaxis and enough of a variety of operative procedures to treat most children's needs, yet they continue to make cuts in adult dental care, which precipitates a lack of initiative on the parent's part to foster an orally healthy family. Children will never learn to value what parents cannot value themselves, and if parents cannot afford dental treatment, they will teach their children to live with the same oral health barriers and issues they live with.
But alas, we still have the issue of the no-show rate. One thing being done in Toledo, Ohio, and a relatively new concept in the dental world, is dental case-management. Most people on Medicaid are familiar with health-service agencies and social workers. This concept has been brought to the dental realm. The Dental Resource Center (DRC) in Toledo, OH, is taking referrals from other health service agencies and social workers. These families are then walked through the dental treatment process. The DRC provides underserved families with appointments, education, personalized attention, incentives, and even cab fare. They exist to remove barriers to children and families seeking dental care, and by doing this, they have been able to reduce no-show rates drastically. Perhaps if dental case-management were to become commonplace throughout the country, private practice dental offices would open their doors to Medicaid clients, provided they have been referred to them by a dental case management service (such a service however would almost certainly have to be either grant-funded or paid for under a referral rate by the private practice dentists that use such a service to obtain clientele).
(this was published in NMDA journal)
June 13, 2006
Dear Editor,
I am writing this letter with a simple solution to a huge problem that the residents of New
Mexico are suffering from. My suggestion is based on the following data:
According to Oral Health America, an advocacy group that researched the dental deficiency,
only 25 states and Washington, D.C. had sufficient number of dentists available for the general
public. The remaining 25 states had only one dentist available for every 2,000 people.
There were 616 dentists, 560 dental hygienists, and 1,520 dental assistants practicing in New
Mexico in 2000. There were 33.8 dentists per 100,000 populations in New Mexico in 2000, well
below the national rate of 63.6. New Mexico ranks 49th in the nation in dentists per capita.
The number of dentists in New Mexico increased 2% between 1991 and 2000 while the state’s
population grew 18%. The result was a 13% decline in dentists per capita, in contrast to a
16% increase nationwide.
(http://bhpr.hrsa.gov/healthworkforce/reports/statesummaries/newmexico.htm)
More recent information from the Geographic Access Data System (GADS) 2003, indicates 820
licensed dentists with a NM address for a rate of 44 dentists per 100,000 populations, still
significantly lower than the national rate of 63.6 per 100,000 populations. (Quick facts 2004-
Health Policy Commission)
Big billboard on I-25 can be seen with an 800 telephone number asking “New Mexico needs-
Doctors, Nurses and Dentists”. It has been observed that the majority of the dentists in New
Mexico, are over 40 years of age and will be reducing their dental practice and/or retiring in the
next ten years. Only 6 dentists from the WICHE program (Professional student exchange
program) have returned to NM after completion of their dental degree from the other states (The
Commission on Higher Education reports).
During the 2001 legislative session, M.S. 150A.06, Subd. 1 was passed and signed into law. The
law, which became effective on August 1, 2001, allows internationally-educated dental graduates
to apply for Minnesota licensure. Specifically, the law states that: “A graduate of a dental
college in another country must not be disqualified from examination solely because of the
applicant’s foreign training if the board determines that the training is equivalent to or
higher than that provided by a dental college approved by the Commission on Dental
Accreditation of the American Dental Association or a successor organization.”
http://www.dentalboard.state.mn.us/LicensingRegistration/InternationallyEducate
dDentists/tabid/130/Default.aspx
It is suggested that the NM may utilize a valuable resource that is being wasted; internationally
educated dentists.
Some suggestions that NMBODHC could utilize to evaluate and license qualified internationally
-trained dentist applicants:
Use existing evaluation services to help in finding the equivalency of a foreign degree
with a US degree.
According to the dictionary definition of accreditation; "the granting of approval to an
institution of learning by an official review board after the school has met specific
requirements". ADA only allows foreign qualified dentists to sit in NDB examination
when his/her degree is reviewed by an ADA recognized credentialing agency for
equivalency to ADA-accredited dental program.
If there is value in the national and regional dental board exams, successful
completion of the exams should determine if a foreign-trained dentist is qualified.
Just as the criteria used for the foreign medical applicants. I may suggest offering
"USDLE" just like "USMLE".
Require successful completion of one year of working under supervision in order to be
granted a license, as that will be more beneficial to the dentist and to the patients than
requiring one to sit in a classroom and learn things that they already know. This will also
help in evaluating the capabilities of the dentist and also would help alleviate the dental
shortage in the underserved population, thereby benefiting the community as well.
Professional background checkup can be done through PBIS, Inc just as it is done for the
local dentists.
Most of the international dental programs are 4-yrs duration just as USA dental programs. Most
of them require pre-dental education. In USA the pre-dental education is 2-yrs minimum after
high school because there is no structured option in the high school, while in most of the
international education system, qualified candidates have the option of clear and structured predental
or pre-medical education incorporated in high school curriculum.
NMDA has a female president for the first time in its history. A good change! Change is good
especially when it is for helping the under served population in this Land of Enchantment.
There are several ways to utilize my suggestion; License International Dental Graduates on the
same criteria as U.S. Dental graduates, Temporary license with extension possibility, Limited
license for specialty practice, Faculty dental practice License, underserved areas licensure, etc.
Sincerely,
Aamna Nayyar
aamnay@msn.com
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