From charity to Philanthropy: Supporting Dental Therapy and Proven Models of Care
When I accepted the first CEO position at the REACH Healthcare Foundation more than 11 years ago, I was introduced to the important distinction between philanthropy and charity. While charity is critical to addressing immediate and urgent human need, I have since come to recognize the power of philanthropy to achieve its full potential—identifying solutions to address long-standing social problems and accomplish sustainable change.
This realization came after a series of well-intentioned but insufficient attempts by our foundation and many others to address complex health problems such as untreated oral disease and the severe lack of access to oral health care. What did we learn from those early foundation investments? That hope is not a strategy.
We hoped that by providing funding for dental care to school nurses, nursing homes and organizations serving the disabled that we would have an impact on their oral health. We did effect some change for a limited number of beneficiaries in critical need. However, we also hoped that by launching a regional children’s oral health initiative that utilized extended permit dental hygienists to provide screenings, preventive care and referrals to participating dentists, and attempting to address barriers cited by dentists wanting to serve low-income populations, that our dental schools and dental provider communities would continue those collaborations and institutionalize this model of care. Many children received those services for a few years, but the maldistribution of oral health providers who accept Medicaid relative to the people who need care remained.
Frail seniors in nursing homes, children of parents who work in jobs that don’t provide health insurance, families who live in isolated rural areas, and people residing in urban areas who lack transportation are all individuals who still need a healthy mouth in order to achieve overall health and be productive members of society.
In the United States today, all health professions have effectively incorporated other advanced practitioner providers on their teams, with one exception: dentistry. In the medical profession, physician assistants and nurse practitioners have provided safe and effective care in the United States for decades. And if you’ve been to a vision center recently, it isn’t likely that the ophthalmologist is conducting your routine eye exam, but rather an optometrist.
Why? Because it doesn’t make practical or economic sense for the practice, for you, or for your insurer—if you are fortunate enough to have insurance—to have the most highly trained and compensated member of the team providing routine care that can safely be provided by another member of the team. More importantly, your health outcomes are likely to be the same or in many cases better because those advanced practitioners are practicing a narrower scope of procedures with greater frequency.
Organized dentistry cites a number of reasons for its decision to continue to oppose the inclusion of a licensed professional commonly referred to as a dental therapist—an educated, trained oral health provider—on the dental team. I won’t belabor their rationale. Suffice it to say it has little to do with addressing the growing disparities in oral health care for vulnerable populations.
Six years ago, the REACH Foundation became a proponent of legislation introduced in Kansas to establish a dental therapist in our state. We did not enter into that decision lightly; nor did we assume it would be without controversy. Extensive research—literally hundreds of peer-reviewed, well-designed studies—on the safety, quality, economic feasibility and opportunity to reduce health disparities through the addition of dental therapists to the dental team have been conducted. Not one study justifies organized dentistry’s ongoing opposition to this approach to care that is being used effectively in more than 50 countries around the world and now several states in our own country.
In fact, dental therapists are practicing successfully in the United States. In Alaska, dental therapists have increased access to care for 40,000 previously underserved Alaska Natives. In Minnesota, the state dental board reported that dental therapists are improving access to care for underserved populations, reducing wait and travel times for patients, providing cost-effective care, and have the potential to reduce ER visits. Soon, dental therapists will begin practicing in Oregon and Maine.
The evidence and growing success of dental therapists in the United States led the Commission on Dental Accreditation (CODA), the same organization that accredits dentists, to adopt standards for the education, training and practice of dental therapists last month. The CODA decision to implement standards recognizes the need and support for the dental therapy profession and represents growing recognition that dental therapists can provide high-quality, safe and effective care. The time has come for policymakers in Kansas to do what organized dentistry has been unwilling to do, despite the science that supports the value of dental therapists—that is, create the opportunity for those dentists who do want to address unmet need and are willing to add a trained dental therapist to their team to do so. Those who don’t see the value of having a dental therapist as part of their practice can continue to conduct their business as usual.
REACH is one of several Kansas health philanthropies proud to stand in support of the Kansas Dental Project, a coalition of more than 50 organizations across the state that understand the benefits of adding dental therapists to the dental team. We also stand with the growing number of dentists in Kansas who are interested in finding more economical ways to serve populations in need, but find themselves on the wrong side of their dental colleagues for their stance. We invite them and anyone else interested in this cause to contact the Kansas Dental Project at www.kansasdental.com to learn more about this model of care and how to get involved in the campaign to bring oral health care to those who need it most.
Brenda R. Sharpe
President & CEO
REACH Healthcare Foundation