Midlevel Practitioners –
Are They Needed in Dentistry?
A letter expressing candid opinions on the now in vogue concept among politicians
by Gordon J. Christensen DDS, MSD, PhD
To view and discuss this issue online, please visit
As a long-time educator, practitioner and researcher, I
have watched opinions vary as history has repeated itself
for over the last half century. At this time, we are in yet
another movement to satisfy the “access to care” challenge
by saturating the dental manpower marketplace. Several
factors are evident currently that relate to this movement:
There is no question that auxiliary dental staff persons
can accomplish some oral preventive and treatment procedures.
I am well known to be a proponent of dentist supervised
staff persons accomplishing many clinical tasks.
However, does dentistry need another category of practitioner?
In my considered strong opinion – definitely not!
As I provide courses around the country – 80 programs
in 2012 – I see thousands of dentists in major
financial distress. There are dentist bankruptcies in almost
all cities. Although the recession appears to be slightly
recovering, dentists’ financial challenges are still present.
Many specialists have nothing to do, since GPs are not
busy and are accomplishing specialty procedures. There is
no dental manpower demand, and there will be none in
the foreseeable future. Many dentists are unemployed.
New dental schools are opening across the country.
Most of them are not in conventional research and service-
based universities. These schools are further saturating
the dental marketplace with dentists. Numerous other
dental schools are in the planning stages.
New dentists have school debts that average about
$250,000 to $300,000. They are financially stressed and
forced to do anything to survive.
Many new dental hygiene schools have opened in
recent years. In numerous geographic locations, dental
hygienists cannot find employment. The misguided plan
that saturating the market with dentists, midlevel practitioners,
dental hygienists and others will satisfy the access
to care problem has been disproven numerous times in
recent history and in other countries. Practitioners of any
type choose the place they prefer to practice, and market
saturation has not improved access to care in those locations
where others have tried it.
A few months ago, I made a survey of the profession
relative to the challenges “real-world” practitioners see,
and I provided that survey to the ADA Board of
Trustees. The survey supports my points.
It is time for those who actually deliver oral health
care and see the challenges on a daily basis to speak up!
Currently, midlevel practitioners are not needed and have
not in the past and will not in the future satisfy the access
to care problem.