In What Universe is the ADA?

alanrw Location: SoCal Is there an alternate universe we don't know about? LIke Bizzaro world in Superman comics where everything is the opposite of the real world?

In addressing shortage, new dental school to open in Western Texas

From ADA News El Paso, Texas — In an effort to address a shortage of dentists in the region, Texas Tech University Health Sciences Center El Paso announced Sept. 6 that it will open the state’s fourth dental school, estimated to open in 2020.

The Woody L. Hunt School of Dental Medicine will be the first dental school to open in the state in nearly 50 years and the first to be located in West Texas and on the U.S.-Mexico border. The school is expected to admit about 25 students in its first year.

“Our region is severely underserved when it comes to dentistry, and by establishing a school here in the heart of the [region], we expect to retain dentists in our area to help fill this gap,” said university President Richard Lange, M.D.

El Paso County has been classified as a dental Health Professional Shortage Area by the U.S. Department of Health and Human Services, according to a news release. The county currently has about one dentist for every 5,000 residents, compared to the state average of one for ever 2,760, according to a Texas Department of State Health Services study.

The shortage has significant consequences on access to health care and overall health, according to Texas Tech University Health Sciences Center, adding that less than half of El Paso adults visit the dentist annually.

The opening of the new dental school is made possible due to a $25 million gift from the Woody and Gayle Hunt Family Foundation, a private family foundation founded in 1987.

alanrw Location: SoCal : The problem is that the underserved are most likely on MedicAid which is not known for fair fees or easy submission for payment. So you really can't say the profession is avoiding the underserved when the reimbursement program created to address it is basically a mine field to negotiate.

Richard1234 This is all about economics. Dental Grad = cash register to new school = Debt Slave for life. Wall street's latest bubble...Get with the program guys

rsott Location: Green Mountains : The ADA News is just reporting this news. The powers that be at the schools made these decisions. Your ADA cannot control the creation of new schools. They only accredit schools and if the school meets the requirements they receive the "seal of approval"

alanrw Location: SoCal : I would think one of the cornerstones of good journalism is to point out the reality of the situation warts and all.

mouthjanitor It will put them so far in debt they will have to stay. The government will finance them.

Dentistry's biggest vulnerability is the amount of debt held by new graduates. You will always find someone who will pay anything to be called "doctor."

WTP: Location: Plainfield , IL Trust me, if you could make a living out there in west Texas, there would be plenty of dentists. There's a reason nobody is out there. No Country for Old (or New) Dentists

Doug MacLeod Location: Raleigh, NC The ADA's HPI which has published many reports that show we are training too many dentists. But the ADA IS POWERLESS. As one dental school dean told me "The decline in the net income of dentists is a major concern for all Deans. Because following this decline there will be default on loan payments and following defaults there will be a decline in dental applications…"

twmdds Location: Bellevue, WA In reality there's not much of an "access to care" problem. More a "disinterest in dentistry until it hurts" problem.

mouthjanitor: What if every one did it, negating "the access to care problem?" There would be nothing for them to talk about, then.

Timmy G Location: Raytown, MO: First off--a good portion of the people requiring Medicaid assistance are NOT in areas of great dentist concentration. Take KC where I'm at. The vast majority of dentists are bunched 8-10-15 miles from the areas of the bulk people on Medicaid. How do you propose these people make their way from where they live--inner city, for example, to the suburbs where the concentration of dentists are? Or how about a rural area where distances to town of much size are spread apart. Logistics. It's not enough to have the dentists available--the patients have to be able to get there and get that at a time when the dentist can see them. So now in addition to seeing a few Medicaid patients we should maybe be open on some weekends or evenings to accommodate as well?

TomWhitdmd Location: Al i can help you on the "rural area where distances to town of much size are spread apart" question. the answer is the same way they get their groceries and everything else they need from town. in rural areas 15 mile = 15 minutes for the most part so when someone says there is not a dentist for 15-20 miles, its not that bad and its part of living in the country. im pretty rural and our schedule is never so full that if someone NEEDS to be seen that they cant ( and there are 2 other offices that i know are the same schedule wise). its not an access to care issue its a care to access issue ( and a money issue obviously). Hoping someone calls right now that needs endo or ext so i can get to work.

SkiDoc Wade: Why can't they come to us. a few hour drive ain't a big deal. They chose to live away from society. Not me. Food is more important then Teeth but you don't see suggestions that Grocery stores should deliver to hill billies. There is no access to care issue. Just access to $ to pay for it for some. I also refuse to see medicaid patients. I prefer to see them for free then to deal with the gov't mobsters.

jmslps Location: keller, TX I did it for almost 20 years. I did volunteer work on kids multiple days per year in the county dental office. It was really rewarding at first. The kids and parents were appreciative, and really fun to work with. That was 30 years ago. They got snottier and less thankful and eventually rude. The cars in the parking lot and the cell phones the mom had were better than mine. Of the hundreds of DDS in the county, there were only a few of us that did it. I finally quit. The no show rate was over 50%. Even the paid staff would not show up. I quit going overseas because the governments made it too hard. Even the people became rude and entitled. They did not care because another health care group would be along next week anyway. Call me burned out on trying to help.

The Mommy Dentist Location: SD Mouthjanitor-can I ask how long you've been practicing? I ask because I used to think the same thing, 10 years ago. I think most of us went into dentistry to help people but you can only be burned so many times before getting pissed. My final straw was a Medicaid patient who no showed 3 kids then showed up and told me how great their trip to Disney world was. New car, acrylic nails, cell phone, kids were getting laptops for Christmas. I'm sitting on $300k student loans, 3 kids, mortgage and 400k office debt. I had never been to WDW and wasn't sure how I was even going to take my kids to the Black Hills for a vacation. We all get burned out at some point.

fliegenfischen what if every dentist dropped DELTA DENTAL, CIGNA etc?

Timmy G Location: Raytown, MO: Seriously? While I agree that it is far more access to money, to suggest there aren't logistic issues of transportation and schedule--especially in some metropolitan areas- is uneducated. You can do better than that.

v0g3L: How about the government lets us tax deduct all the work we do for free to people who need it .... That would open up the doors real quick

Timmy G Location: Raytown, MO: Now there you onto something that has a chance of actually being beneficial. I could see it being ripe for being abused but if we assumed for a second that not every other dentist would abuse this (and that's a large assumption), you have a good idea.

v0g3L: Like all welfare programs .... abuse would be inevitable. Then all dentists would be accused of "Trumping" the system :-\

shesky: Location: grand rapids, MI: What if the government paid 70% of our normal fees?

What if the government paid what ever they wanted but allowed us to bill in addition, what we needed to work on them. Wouldn't cost the government a dime. I personally would still give them a discount to normal fee's. Yes I know some couldn't afford that but many could. And I like everyone having a little skin in the game.

deanmersky: Location: Doylestown, PA: What if...50,000 dentists agreed (signed on) to treat "those in need" with the condition that the Pew Charitable Trust, Robert Wood Johnson Foundation, Santa Fe Group, Oral Health America, multiple others, the ADA, Henry Schein, Dentsply, Ivoclar, 3M, the CDA and others, Delta Dental, and the others, plus the ADEA, direct their current funding to support those 50,000 dentists in providing the care they worry about...Would they still promote MLPs? Would they still need to spend money on Public Relations and lobbying? Wouldn't those extraneous expenses be better spent on those they are so concerned about? What if we changed the narrative?

SkiDoc Wade: Uber. Bike. Car. People find rides to what they truly want. Very few exceptions truly can't find a ride to the dentist due to disability or something else. If they can't get money for a ride they can't afford the dentistry. Hence this is a $ issue not an access issue. See. I can do better.

mouthjanitor: Can we look beyond the individual and see where all the money is going? You people are stuck on "medicaid people." It's much, much bigger than this.

scandalouslj: Doesnt one of the states- Minnesota? Require every dentist to see a certain number of Medicaid patients or something like that? That hasn't seemed to help as they are also the ones with the Midlevel providers now? I used to take Medicaid and still see about 50 patients that are deserving, appreciative, etc...But we had to cut out taking new patients, because 50% didn't show up, the fees were too low to even break even without compromising care, and a lot of them were rude, unappreciative, and you couldn't have them in the same room with PPO patients. We have a community clinic- I as well as a lot of other dentists volunteer at- I do 2 days a month. Malpractice is taken care of by the state, and if the patients don't show, no sweat off our back- and most do and are very appreciative as they know they get kicked out if they don't show. They pay something small- like $5 every visit; the facilities are brand new. We need more places like that.

marksmal: Location: Cranston, RI: I think that most dentists do give back in some way. It may be a mission trip, a Mission of Mercy, Donated Dental Services, or a down and out person or family in your own practice. What about the cash contributions that we give to various charitable groups?

In the past, the powers that be (Pew, Kellogg, department of health, Medicaid, etc.) have asked dentists to just take one person or kid that has medical assistance and treat them. Charity is not a health care system and it would not make a dent in the so-called "Access to Care" problem. There needs to be a change in attitude. People choose not to spend money on their mouths. A $600 cell phone and a monthly cell phone plan is more likely to be paid for than an exam, x-rays, cleaning, or filling. The Medicaid program in RI has not increased its fees since 1992! A choice on behalf of the legislature. Pew and Kellogg choose to spend their money lobbying state legislatures to create new dental providers, but not to provide funding for the ones already trained and working. Never mind funding for these new positions that they want to create. It has been discussed in the past to make treating medical assistance patients a requirement for maintaining your license. I am certain that if you are forced to treat this group of patients that the government will not pay anywhere near your full fee. They will expect you to provide the best service with perfect documentation. Anything less and fines, fees, and prosecution will be your fate.

mouthjanitor: So we agree, that:

1. It's broken.

2. Non dentites are fixing it.

3. Non dentites have the power and

4. Non dentites have the money...

mikebarrdds: Location: FL: Wouldn't touch it with your 10-foot pole. Not even for DOUBLE my fees. Why? Ask Dr. Roy Shelburne. Ask Dr. Leonard Morse. Ask Dr. Anthony Sanchez. The government goons will put some serious ruin on your life, even just for allegations... even if you are exonerated.You will have lost everything. EVERYTHING. I won't risk that... not even for money.

snowdoc: mouth janitor: I don't agree with you--especially #'s 2 & 3. The day I am FORCED to provide charity, it by definition ceases to be such. Thankfully my student loans are paid off and I have skills in other areas, beside dentistry. I look forward to leaving this profession--not because I don't enjoy it -- but rather because there are those who won't stand up and defend it. Out of curiosity, are you an Arizona School of Dentistry and Oral Health (ASDOH) graduate and/ or a Jack Dillenberg disciple? Your line of reasoning makes me wonder...

ricky-ticky-tavy: RDH Location: southeast: Anybody who has spent years working with Medicaid patients can become burned out quickly. I have worked in several different Medicaid offices over the years, different cities in my state. Without a doubt, most Medicaid recipients do not appreciate the services. As others have mentioned, nails, cars, phones, clothes, hair.....This stuff is put before teeth. Just show up for your appointment. That's it, it's paid for. There are some recipients that are grateful and make getting to the office a priority. Less than should be. I had a patient last week complaining about pain, esthetics (decay 8 and 9) and could we fix all the same day, she had an event coming up. I told her in a diplomatic way that if she had fixed the areas we had treatment planned the year prior she may not be in this predicament. Her reply; "I was busy" " I said so are we, that she will have to come back" I don't try to soft soap some of these folks anymore, it is their choice, but I'm not going to baby anyone that doesn't make their own teeth a priority with stupid answers. Medicaid or not. This especially goes for parents whose kid's have destroyed teeth. I'm not as young and idealistic as I used to be. Jaded is the word. Ricky, RDH

mouthjanitor: I've been in this game long enough and I've seen a lot. I am not looking at this problem at the individual level as a 50% cut on my fee for payment, or a now show rate. Besides, if you have a properly managed office, your no-show rate should not be a problem (I'm just saying). This is my opinion. Stuff like this -This is humiliating to the profession and the public that needs it. And the numbers do not make sense, either. I would rather keep the $650 in my practice. What is a patient worth to a practice? I remember someone saying it's $500 a year. 1000 active patients is 500,000 a year. Not bad for one doctor. So, at this event, it is claimed that 2,295 people received more than $1.5 million worth of free cleanings, extractions, root canals and other work. Each person received $654 worth of work. In a 3rd world country set-up.

Teeth27: Location: Montana; Do you think if every single dentist took Medicaid that the states could afford it? Instead of a 50% write off assuming access was 100% in every office. Do you think the write-off would be 80 %. I wonder if lawmakers would simply lower reimbursements in an attempt to slow access or would start prosecuting dentists accusing them of fraud.

scandalouslj: This story and your reasoning don't quite add up. How do you prevent no-shows- having a properly managed office does not prevent that as there is no penalty for not showing up. My FFS and PPO no show rate is almost non-existant, we took Medicaid and the no-show rate for that was between 25-50%. The $650 was most likely based on a FFS number, while you are getting Medicaid fees which are most of the times more than a 50% cut in rates. The $500 per patient once again is based on PPO and FFS fees, not Medicaid fees. I took Medicaid for about 3 years, and have slowly cut it out to only patients that continue to keep their appointments, we saw 0 loss in production, as the fees actually would just let us break even, and if they didn't show up or there was a redo you lose money.

mouthjanitor: Forgive me I am not that good at putting into words my thoughts. The problem is public perception. People see us not the way we do. Lawmakers and policy makers want to please the biggest number of people. The biggest number of people is the public, in our case.

Policymakers (and others) are taking into their own hands to change the landscape of dentistry.

We - as individual doctors (and as a collective) can take their initiative away - if we want to.

deanmersky: Location: Doylestown, PA: First, come to grips with the fact that there is a contingent, a very strong contingent trying to put private practitioners largely out of business. Not all, but most. They are organized and have some of the biggest companies we know backing them. Schools are involved, and all the other entities I have already mentioned. They want to control dental care in order to control the money. Thinking myopically, such as "chair time," and "no shows," blurs the vision of the larger picture. That is individual thinking and is the reason private equity calls dental a fractured industry ripe for consolidation. It is what happened to medicine. Forget about Medicaid patients. They are a distraction and only pawns in the larger efforts being made to substantiate MLPs and other changes.

The focus of the OP, I think/IMO, is take away the argument. Take away their support structure by denying them their cause..."underserved." But you don't just show up. That would be stupid. You organize and layout the conditions for working with them to solve the so called problem they intend to serve: "You want to help the underserved? So do we. We will do it using a smaller budget than you now operate with. Here's our proposal to help you get the job done. Here's a copy of the press release we will circulate." You set the rules of engagement, business arrangements. Begin with looking at their public tax records to determine who is donating, how much is received, how much is being spent, and on what. I believe the majority of expenses are not going to dental care. Take that information and use it in smart ways. This has almost nothing to do with Medicaid patients. This has everything to do with your futures.

The more individual dentists only consider their own independent autonomy, the myopic view, the more the PE guys print money. You help them just like the physicians did. Think bigger picture, because that's where the action is.

mouthjanitor: MLPs are coming which will allow dentists to hire them, PE, et al will likely open massive operations to capitalize on it, pay MLPs less for the same work we do. Really, how hard is it to do an occlusal filling? Hygienists already give local - why not take it a step further and let MLPs do it? All it takes is public support, write law, and with the stroke of a pen from the governor.