Howard Speaks: Who Needs a Therapist? by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

Dentaltown Magazine - Howard Speaks

An influx of dental therapists won’t help the industry where it needs the biggest boost—in nonmetropolitan areas

by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

Let’s be honest: When we first became fully trained dentists and were let go on the streets, we barely knew what we were doing. Basically, all we had was the minimum legal requirement to be turned loose on the public.

That’s why, for the past 30 years, my advice to all dentists has been that you need to take 100 hours of continuing education a year. CE has been a big mission for Dentaltown, and it follows my four-finger rule that when you have an idea, everything has to be:

1. faster,
2. easier,
3. higher quality
4. and lower cost.

We launched Dentaltown’s online CE in 2004, and we’re coming up on 1?million views of our courses; currently more than 400 courses are live on our site.

The patient has power of choice
Meanwhile, one of the nation’s largest nonprofit think tanks recently came out in favor of legislation that suggests that dentistry would improve if people had less training.

A bill to approve dental therapists in Arizona just went up before the state legislature, and the only group that opposed it was the Arizona Dental Association. More than 30 different lobbying groups, meanwhile, including insurance companies and the Pew Research Center, testified in favor of allowing dental therapists to begin practicing dental care.

We don’t need people who have two years less training than doctors—we need doctors, and we need those doctors to get more training. I notice when you ask most people who support bills like this one whether they personally would go to a doctor or a dental therapist, they usually say, “Oh, the best doctor, of course.” Don’t promote this half-baked idea that half a dentist is good, when you yourself would never go to half a dentist. In fact, here in Phoenix, I can’t tell you how many dentists I’ve met because they’re flying out to have procedures done at the Mayo Clinic, one of the most renowned health care facilities in the country, because their local doctors just wouldn’t do.

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The clinician has power of choice, too
Around 20,000 small towns in America don’t have dentists or hygienists, and the thinking is that if we increase the number of dental therapists, they’re going to go into these rural areas—get on dog sleds, go halfway across Alaska—and that is absolutely not true.

You know where most of the dental therapists I know are headed? To big cities. Instead of performing essential dentistry in areas where it’s needed most, they’ll be helping dentists with the tasks that don’t pay as much as other procedures. I predict that dentists who have hygienists in Rooms 1 and 2 doing their cleanings will now install dental therapists in Rooms 3 and 4 to do all their fillings, while the dentists spend their time in Rooms 5 and 6 doing molar endo, placing implants and doing big cosmetic cases. Which may be great for that dentist, but it’s not solving America’s dental problem.

Competitive schools are bad news for rural communities
Let me tell you how we’ve been hurting rural dentistry for literally decades. In my earliest book, The Business of Dentistry, I mention how dentists would call me and say, “Howard, you don’t understand, I’m two hours away from Wichita, Kansas, and none of the hygienists from Wichita will commute out to my rural area.” So I suggested that they sponsor a “Why I Want to Be a Hygienist” essay contest at their small-town high school, and award the best one a scholarship for the tuition.

After that, one dentist called asking for help: Two students had submitted great essays, and he wanted me to help him pick a winner. I said no, and instead suggested that he give them both the deal. “You’re right,” he said. “I mean, my practice would go to a different level if I had two full-time hygienists—I’ve never had even one in the past 10 years.”

Both students applied to hygiene school … and they didn’t get accepted! The deans and admission departments think that the most important thing is a student’s DAT scores—their grades in algebra, calculus, physics, geometry and biology.

They’re loading up their dental and hygiene schools with people who get straight A’s in algebra and calculus. Most of those students are from big cities—and when they’re done with school, they go back to the big city. If schools accepted a quota of students from small towns, they almost always go back to those towns after they graduate.

You can be one of the greatest dentists or hygienists in the world and absolutely hate algebra, trig and calculus. I still am mesmerized that at least 50 percent of my nine years of college had nothing to do with dentistry. And so, if you want rural doctors, physicians, lawyers, you need to start working with the deans to get off their stupid entrance exams and start looking at the students themselves.

It’s not happening just in dentistry, either
Another example: The last time I was out driving in the countryside with my son, we stopped to check out a mine in northern Arizona. When I asked the manager what his biggest problem was, he said that they needed more mechanical engineers but none of the ones in Phoenix wanted to move to a small town of 5,000 people.

When the students from that mining town of 5,000 apply to colleges, they probably don’t have high-enough GPAs to get accepted and become mechanical engineers. Why do state schools think that it’s better for state mines—the profits from which are funding the taxes that pay for the schools—to have too few mechanical engineers than to admit some that made B’s and C’s in high school? Small towns don’t need just dentists and hygienists, physicians and nurses. They need engineers and electricians—they need all the degrees—but all the universities are obsessed with entrance exam scores and it’s killing the rural towns.

Do you see any solutions to this problem? Should schools instill a quota—a percentage of students that come from smaller towns—similar to what Title IX did for women?


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