Dr. Mary Jennings' Editorial · Dear Santa:
Dear Santa: All I really want for Christmas is for the midlevel provider issue to curl up and die. I am tired of hearing about it and tired of writing about it! In September, our House of Delegates will meet, and it will once again be time to review our game plan. Like most dentists, I was thrilled at our success last year in Olympia. The ADA was so impressed that we won a Golden Apple Award. I get a lot of questions from dentists in other states wondering just how we pulled that off. My question is — can we pull it off again? I have to admit that I was one of the people who hoped, but doubted, that we could slow or stop HB1310. I thought we needed our own midlevel plan to control the damage. WSDA’s Board of Directors’ “tolerable” midlevel plan proved to not be in any way tolerable to our House of Delegates. They preferred we draw a line in the sand and say “hell no.” That was a gutsy decision. The stakes were that if we did not kill the bill and come in with a tolerable plan, an even more intolerable plan would be legislated for us by people who do not know how to drill. With that strong and allied front, we stopped the bill. We need to remember that we did not kill it. Technically, it timed out and got stuck in the House of Representatives Health Committee. Like a monster in a B-movie, it is still fully revivable. Most of us were very worried that the new July 2011 Institute of Medicine Report would back the midlevel provider. It didn’t. They said that we need to research how to utilize the existing team better. They pointed out that no single workforce model will meet all populations’ needs. They recommended further research on the impact of new workforce models on access to care. To my mind, the fact that they did not unilaterally support the midlevel — in times where there is heavy pressure to support it, and from a part of medicine that has been through the midlevel process — is significant. Put that on your list to mention to your legislator. So here is the playing field as best as I can figure. To the good for the anti-midlevel folks is the fact that the economy has most of our legislators so deep in thought that perhaps midlevel bills will stay on the back burner waiting for better times. With the advent of five new dental schools in the last ten years (and the promise of more to come), there is room to argue that the provider numbers are going up. As always, it is still fundamentally wrong to have a backward two-tiered system in the most progressive country in the world. To the bad, is that some of our Washington legislators seem to think that schools and students will pay for midlevel training, leaving nothing for government funding. To some, solving the access problem and renovating an entire profession for no money is a wonderful proposition! Groups like Kellogg, Pew and the Washington Children’s Alliance have their war chests and resources at the ready to put the bill through again. On a national level, the money that was voted in by congress to fund pilot programs for midlevel providers is currently on hold. So far, those programs will need to be looked at on a yearly basis to see if funding will be available. For us, this is one of the few silver linings of a poor economy. It is highly probable that a HB1310 will raise it’s ugly head again. Your WSDA Board is hoping that we can continue to hold the line as we did last year. We think that we should continue our grassroots efforts and add a proactive workforce bill of our own to reinforce that line. Take a look at HD-09-2011. It takes our existing EFDA team member and further expands them by allowing them to do supragingival scaling and local anesthesia. They can do gross debridement and save valuable time for the hygienists. The scaling part has been very successful in the Indian Health Service for over twenty five years. Both scaling and anesthesia will help the entire dental team to be more efficient and can have a positive impact on all of our practices. Pretty win/win to my mind. What needs to happen now is for you to take a good look at this plan, tear it up, add to it, and do whatever you feel you need to do, then talk to your local delegate. You won’t hurt my feelings. Loaded with your thoughts, the House will then hash it out and come up with this year’s plan. Do we need to be proactive? To my mind-Yes! I tend to take the Roman philosopher Seneca’s caveat that “luck is when preparation meets opportunity.” But, that is just me. Please think about this and help us keep our workplace effective, sensible and safe for all of our patients. Dig in, roll up your sleeves and participate — you might just enjoy it!