ADA slams government on scope of practice

Dr Karin Alexander says the committee has used outdated data to draw erroneous conclusions.

Dr Karin Alexander says the committee has used outdated data to draw erroneous conclusions.

The Australian Government’s latest report into dental services was tabled in Parliament at the beginning of this week. The report (which is available online here) by the House of Representatives Health Committee called for innovative modes of service delivery, and a long-term commitment to funding public dentistry, among other things, but the Australian Dental Association (ADA) has slammed the report as “lacking credibility” on workforce recommendations, and described it as “under-researched and poorly prepared”.

The House of Representatives Health and Ageing Committee’s inquiry into adult dental services began last March, held four public hearings and received 46 submissions in its quest to identify priorities and inform the National Partnership Agreement (NPA) such that it can be framed to meet the particular and localised needs of each state and territory, as explained by committee chair Jill Hall MP when hearings began.

“With up to 400,000 adults currently on public dental waiting lists in Australia, the government needs to take action to improve accessibility to dental services for these individuals,” Bite reported Ms Hall saying at the time.

As a way of addressing perceived workforce shortages in regional and remote areas, the committee recommended that “The Department of Health and Ageing and Health Workforce Australia work with the Dental Board of Australia to amend the professional scope of practice registration standards to allow dental hygienists, dental therapists and oral health therapists to practice independently.”

It also recommended that “The Department of Health and Ageing investigate enabling dental hygienists, dental therapists and oral health therapists to hold Medicare provider numbers so that they can practice independently as solo practitioners within the scope of practice parameters stipulated by their professional practice registration standards.”

These recommendations appear to have upset the ADA, with President Karin Alexander saying, “With all due respect to the Parliamentary Committee, it has little, if any, expertise to evaluate any evidence upon which to base its recommendations. Allowing auxiliary dental care providers (some with as little as two years’ training) to provide dental treatment, without the supervision of a dentist, severely compromises the safety and quality of dental care delivery.”

“To allow these auxiliaries to provide services which can be potentially covered under Medicare may allow state and territory governments to employ less qualified people and shift the cost of services provided by public dental clinics from State budgets to Medicare,” stated Dr Alexander. “So instead of providing services by qualified and experienced dentists, working in a structured team with auxiliaries as they do now, many public patients will be treated solely by lower level providers – poor dentistry for poor people.”

The ADA pointed out that while the report makes a number of sensible recommendations about the delivery of sustainable dental services, in relation to workforce issues, it seems that despite the release of 2011 workforce data by the Australian Institute of Health and Welfare (AIHW) during the consultation period, the Committee has chosen to rely on out-dated data from 2006. The scenario presented in the 2011 study makes the basis of the Committee’s report fundamentally flawed.

“For example, the Report refers to 10,404 dentists in Australia when the 2011 study states there are in fact 12,734 practising dentists – the figure used in the Report is short by 22%! In 2013, with the increased number of dentist graduates and overseas trained dentists registering in Australia, the discrepancy is even greater. The ratios of dentist to population by remoteness area outlined in the Report are also out-dated and present an inaccurate picture of the public’s access to dentists,” the Association said in a press release.

“The Report of the House of Representatives Standing Committee on Health and Ageing demonstrates, yet again, that the Australian Government is not listening to those health professionals who best understand oral health issues,” stated Dr Karin Alexander, ADA Federal President. “The ADA presented at the Committee’s roundtable held in April. It was immediately concerned that only a small contingent of the members of the Committee even bothered to attend.”

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10 Comments

  1. The ADA is trying to protect the jobs of their members – the Dentists.
    Arguing that Dental Professionals such as Dental Hygienists with University Degrees of three years is inadequate compared to the education of it’s Dentists are naive to say the least.
    The role of these professionals is not as broad and wide ranging as Dentists and therefore does not need the same extensive training.
    In fact, many would debate that having three years specialist training in one or a few facets of Dentistry renders these professionals better equip than Dentists in their area of specialty.

    The Independence of these dental professionals will only help patients receive better oral care. Currently, these dental professionals who have been educated to provide preventative dentistry are being supervised by Dentists who rely on restorative dentistry to fill their back pockets.

    More Independence results in better patient care!

  2. Nearly all courses for dental auxiliary staff in Australia are offered as 3yr university degrees which means that graduates leave schools with good understanding of oral health. What’s more, majority of them is fully trained and able to perform a full mouth examination as well as a dentistry graduate. In fact, standard of knowledge in their field, particularly periodontics and preventive dentistry is often higher than the one among dentistry graduates. This, of course, is absolutely understandable, given that dentists undergo 4 year training in all aspects of dentistry as opposed to 3 yr training for oral health professionals in a few aspects only.

    The ADA’S view on the topic seems quite surprising as it should actually be in the interest of the dentists to increase the scope of practice of the auxiliary staff. More independence would significantly improve patient care as well as it would increase productivity of the dental officers because they would be able to focus on the treatment that a dental hygienist or a therapist cannot provide.

    Allowing the hygienists/ therapists to perform a full oral examination, for instance, would have a huge impact on the productivity of the whole dental practice or in public system, would actually add to reducing waiting lists and help to send patients in the right direction.

    In my view, dentists should start perceiving auxiliary staff as team members who can effectively make their lives easier rather than villains trying to “steal” work and patients away from them.

    It is hard to imagine that a number of independent hygiene/therapy practices would suddenly start coming up because majority of patients attend the dental practice when they actually need some dental work done. Therefore, without dentists these practices would simply not survive on the market.

    I would suggest ADA to review the scope of practice again and promote the view that oral health professionals are integral part of the dental care and therefore their role should be appreciated. Allowing them to perform certain tasks within their area of training would benefit the patients and other dental practitioners.

  3. To amend the professional scope of practice registration standards must be recognised as another boon to the corporate sector in the drive for profitable business opportunity. Whilst this is essential to our capitalist system there is the obvious need for increased safeguards to protect potential milch cows from being exploited. No such safeguards, seemingly, were worth mentioning.

  4. I completed a 3 year university degree in oral health where I attended the same lectures, same clinics and sat the same exams as the dentist. I had extensive training in children and teen dentistry as well as periodontics and oral health care. I believe it is an injustice and find it insulting that as registered dental practitioner in oral health I am not able to have a provider number. The comments above in the article suggest that giving our profession a provider number is so we can work inderpendantly. Says who? That’s not what we want a provider number for. We want a provider number so we can provide a service to our patients. There are many professions (who do not provide irreversal proceedures) who have provider numbers,eg massage therapist so why is it that we can practice dentistry but we can’t provide it. Ridiculous ! Also the services we provide cannot be measured because it under the dentist provider number therefore our true value to the dental profession and to the community is never reflected. I believe the majority of dentists don’t even know what an oral health therapist does. We are not a threat to dentist and we don’t want to have YOUR scope of practice but we do derseve a provider number and your respect for our profession.

  5. Ms OHT has it all wrong.Is it appropriate that massage therapist have provider numbers if this is actually correct?

    Simply having a provider number cannot alter the services provided unless I have missed something.How does a provider number alter the service Ms OHT provides to patients?

    A quick review of sights often quoted by OHTs eg Canada indicates independent practice but very restricted services. Is this what OHTs want? Also I noted in Canada massive unemployment of hygienists. This might be about to happen in Australia. If I were an OHT I would grab what ever job is on offer as they might be cooking fish and chips if the govt continues on the massive oversupply of dental providers – dentists and OHTs!

  6. “There are many professions (who do not provide irreversal proceedures) who have provider numbers,eg massage therapist so why is it that we can practice dentistry but we can’t provide it. Ridiculous!”

    Are you arguing that people who perform irreversible procedures should have less supervision and training. You may have attended all the same classes for the first three years but what happens in the last two years of dental degrees? That wouldn’t happen to be the time when the majority of advanced clinical training occurs would it?

    Perhaps all dental students should be given a provider number and allowed to practice independently.

    Even though we start our degree knowing we’re not aren’t allowed to do this we start our degree maybe we should change it because we feel less respected by the dental community than graduated dentists who have an unfair advantage over us being able to practice independently.

    Should I lodge a complaint with the DBA suggesting third year dental students be able to practice on their own in restorative dentistry & debridement because I feel that I’m hard done by?

    Maybe I can form an association and contribute to a workforce report showing there is a “dental crisis” based on authoritative sources such as the verbal responses of second year dental students and single mothers.

  7. I am a Dental Therapist with 35 years experience and have worked in NZ and Australia. For the past 20 years I have been providing quality dental care to a wide range of clients in rural and remote areas of the NT. At present I am the only dental professional for the whole of the East Arnhem region public or private. I have never heard such a load of unsubstantiated drivel in my life. The new ADA president is grossly out of touch with what is happening in the ‘real dental world’. Never before have I read an article that is all about protecting their patch as this. Wake up Karin and see what is really happening in rural and remote Australia denatlly and allow those dental professionals that are educated, trained and deemed competent in their field to provide quality dental care to those that need it rather than sitting in your ‘downtown private practice’ making such ridiculous statements.

  8. What are you objecting to here Debbie? Are you saying the data used in this report accurate and up to date?

    Or that OHT’s are more qualified than dentists to deal with a variety of dental problems, diagnosis of pathology and emergencies?

    Do you believe it is in the best interest of rural patients to reduce the cost of treatment so even less people & practices are attracted and retained in these locations?

    OHT’s need to realize this is not a move to improve their well being and freedom to practice. It is a move to cut costs and offer a reduced level of care.

    Creating an oversupply in metropolitan practices is like flooding a country so inland towns can get a water view and wastes the fortunes spent on dental schools and training facilities for dentists who cannot maintain full time employment.

    Do you people even think how OHT’s salaries and job prospects will change once there is an oversupply in your field, because it’s coming and you will be the underqualified ones trying to get a job in a sea of unemployed dentists. Be careful what you wish for.

  9. To Terry (and anyone else who is interested):
    The oversupply of hygienists in Canada is a result of the creation of countless new dental hygiene schools, as a response to a previous undersupply and great demand for hygienists. I’m not sure who is responsible for the proliferation of all the new schools… I can only assume it was in the dentist’s interest to create them, because when there was an undersupply the hygienists could get paid much more. Some of these schools only have “pending” accreditation, but the dentists don’t care where the hygienists trained, and they now have the luxury of a significant drop in wages for the hygienist thanks to the massive competition for jobs. I hear similar schools like this are trying to crop up over east in Australia, so I guess we’re headed for a repeat of the Canadian situation here.
    As a Canadian who recently tried to move home and found myself unemployed, I am ashamed of what has happened to the practice of dental hygiene in Canada. As for Australia, I think dentists need to remember that hygienists are not interested in being dentists, if they were, they would have obviously trained to be dentists. Hygienists see on a weekly basis patients who step into the dental clinic for the first time with horrible dental and periodontal problems, and that is why we dream of being able to be present in their lives at a much earlier stage, in a purely preventive way. This cannot happen at a private dental clinic.
    I don’t think this discussion should have emphasis on “the provider number”.. it’s not the point. We are not pretending to be dentists. Not sure why the ADA thinks we are trying to be. I am not sure exactly what they think we will be performing on patients. Why would we practice outside our scope of practice all of a sudden, in the event that we become allowed to work without supervision? We would not spontaneously start doing crown preps or root canals, or whatever it is the ADA thinks we might start doing.
    We are not low level providers… we provide a different service, that doesn’t mean it’s a lower level, I find that language not only demeaning, but downright strange. There needs to be alot of education here.

  10. Is it in the competency of a hygienist to “drain” an abscess (root canal treated tooth $ 23)?
    – My dentist told me that this can only be done by a dentist.

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