I came across this interesting study from the National Bureau of Economic Research titled, “Battles Among Licensed Occupations: Analyzing Government Regulations on Labor Market Outcomes for Dentists and Hygienists” (November 2010). I don’t know how accurate the conclusions are, but I do know one thing for sure. Any legal effort to make dental hygienists (or any occupation for that matter) more independent is a good thing in my book.
Some of the more interesting excerpts from the study:
“…legally allowing hygienists to work independently of dentists is associated with an approximately 10 percent higher wage and a 6 percent increase in the employment growth of dental hygienists.”
“…we find that the typical state would lose approximately 1 percent of dental expenditures due to licensing, and by not allowing hygienists to practice on their own.”
“…when hygienists are able to work without the supervision of a dentist, there is an associated increase in the state-level employment growth of hygienists, but lower employment growth and earnings for dentists.
“Dental hygiene is unique among licensed professions in that it is regulated by dentists, rather than self-regulated, in most states…”
“Until 1988, when Colorado first allowed hygienists to practice without the direct supervision of a dentist, hygienists have been required to work for or be under the direction of a dentist. Since that time, seven states have allowed hygienists to be self-employed without the direct oversight of a dentist.”
“In the late 1970s, the American Dental Hygienists’ Association (ADHA) supported alternative practice methods that would allow the dental hygienist to become the primary provider of initial services in accordance with state dental and dental hygiene practice acts (Motley, 1988). In response to these policy changes, the American Dental Association (ADA) passed a resolution stating that dental hygienists are auxiliaries who must work under the supervision of a dentist, who also retained ownership and managerial authority (Beach, Shulman, Johns, and Paas, 2007). Over time, hygienists have been able to gain greater authority in state legislatures as their numbers have increased in overall dental practice, and consequently their influence in crafting licensing laws has grown. These policy provisions by both dental service organizations set the battlegrounds for conflicts in state legislatures, licensing boards, and the courts.”
Link to full study: http://www.nber.org/papers/w16560
Mark Frias, RDH
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“Until 1988, when Colorado first allowed hygienists to practice without the direct supervision of a dentist, hygienists have been required to work for or be under the direction of a dentist. Since that time, seven states have allowed hygienists to be self-employed without the direct oversight of a dentist.”
—-so, at the end of 2014 when you cited that, what was the number of RDH independent practices in those states and what is the rate of growth in the number of RDH independent practices? What scenario do RDHs tend to seek for their independent practice, eg. Mobile practice, solo RDH practice in their own office space, space rental within a dental practice, etc?
Hi Spencer,
I don’t know those stats, but my general understanding is that the concept of independent hygiene practice has not really gained traction. I believe Colorado and California are the only states that allow truly independent practices with few restrictions. Some states, like my state of Massachusetts, only allow independent hygienists to work in “public” health settings. With or without restrictions, I personally believe that the vast majority of hygienists have no interest in being business owners. They want the best of both worlds so to speak. They want the security and lower stress of employee status, but also want independence in that same setting.
Mark,
I have the feeling you are right about few RDHs really wanting to be business owners. Time will tell.
What do see in the future as far as independent RDHs and the proliferation of large “corporate” multi-office practices and dental insurance run DMOs and closed network-PPOs? Will RDHs care if their employer is that large-scale practice which is so different in character from a private practice or perio practice? For that matter, how about RDHs who aren’t in ‘independent practice’ states…how do they feel about those huge practices?
I would say again that the majority of hygienists want the best of both worlds. It seems they generally prefer the small, traditional type practice, but want full-time hours with benefits that the large corporates tend to offer more often. But generally speaking, hygienists don’t like the trend of corporate involvement in dentistry.
I’m curious if RDHs have taken a stand regarding the push to create “mid-level providers’. Do you know if the ADHA has an official position on that?
It would appear to me that the RDH career could be directly cut into by MLPs, who would be trained to be super RDH/mini-DDSs…and the need for RDHs would gradually disappear. Do RDHs see that as a possibility like I do?
The ADHA is definitely behind the MLP model. http://www.adha.org/workforce-models-adhp
I’m not sure the MLPs will cut much into RDH job opportunities. I think young associate dentists will be much more effected. Minnesota is the only state implementing the MLP model the way the ADHA is envisioning it. But even there it’s not exactly the same. I believe one program trains Dental Therapists and Advanced Dental Therapists with no hygiene background. In that case, I don’t think the dental therapist can do scaling and root planing. Another program in the state, I believe, only accepts hygienists into the program. Spencer, you might be interested in the RDH Roundtable we did in January. We get into this topic. https://markrdh.com/?p=1060
I’d be surprised if Therapists/MLPs trained to do fillings and extractions would not be qualified for scaling and root planing. There is zero logic there. (It also gets confusing because there are too many different job-descriptions and terms used for the position.)
IMHO, the only Therapist/MLP model that makes sense is the one that builds on the career path of an RDH. So IMHO, the ADHA ought to have a stance on that, meaning opposition to Therapist models that don’t care about prior training and experience. Otherwise, RDHs will find that there is a shortcut to a better job and they’ll be left out.