QUICK BITES WSDA and Delta Dental of Washington are teaming up on a comprehensive strategy to reduce dental workforce shortages in the state. The plan includes strategies to expand training programs and financial supports for those interested in becoming dental hygienists or assistants. The two organizations will propose legislation in 2022 to reduce barriers to entry and create a stronger career ladder for dental assistants and hygienists.

On the hit 1980s television show “The A Team,” squad leader Colonel Hannibal Smith routinely delivered his signature line, a smiling “I love it when a plan comes together.”

Framers of the 2020 Memorandum of Understanding (MOU) between the Washington State Dental Association (WSDA) and Delta Dental of Washington (DDWA) could be excused for sharing the Colonel’s sense of satisfaction.

One of the rationales behind the MOU was to provide a platform for collaboration between the two organizations to address important issues for the delivery of high-quality dental care in Washington. Although still in its early stages, that plan is most definitely coming together.

“The impact on access to care for patients puts dental workforce diversity and shortages at the top of our joint issue list,” said Diane Oakes, DDWA chief mission officer. “Tackling such a massive challenge requires a strategic effort to address the systems that perpetuate these problems.”

That realization led WSDA and DDWA to create a joint task force composed of board members and senior staff leadership from both organizations. The group began by gathering data to help quantify the size of the problem and has been meeting several times per month to identify solutions for tackling the state’s severe workforce shortages.

Surveys developed by WSDA and the Washington Dental Hygienists’ Association, administered by the Washington State Department of Health, and analyzed by DDWA put numbers to the problems dental offices across the state are experiencing every day. These surveys confirmed the severe shortage of both hygienists and dental assistants, with open positions for both averaging 4.2 months to fill statewide, and some markets taking up to six months.

“The survey numbers didn’t tell us anything we didn’t already recognize,” said Bracken Killpack, WSDA executive director. “But they were important in understanding the size and scope of the problem — for our own efforts and for our engagement with legislators and public policymakers. Data speak much louder than prose in these circles.”

PATHWAYS TO SUCCESS

After reviewing the data and engaging in preliminary discussions with a broad stakeholder group, the task force began its work in earnest. The first step was for DDWA and WSDA to develop a common approach for tackling these issues. According to Dr. Katie Hakes, DDWA director and co-chair of the task force, that shared approach has four key objectives: 

• To increase the number of hygienists and assistants in the field to meet current and future patient needs;
• To increase diversity among these professions;
• To improve accessibility and retention within these professions to help sustain the long-term oral health of the population; and
• To leverage multiple funding sources to affect these changes.

“With these shared objectives in mind, the task force identified a variety of strategies,” Hakes said. “They would require funding, but all of them would be smart investments in the future of oral health care in Washington.”

Some of these strategies include:

• Expanding capacity at existing dental hygienist and dental assistant training programs.
• Supporting establishment of new dental hygienist and assistant training programs, particularly in areas like Snohomish County that do not have an existing program.
• Creating public/private grant programs for dental hygiene and assisting schools to drive innovation (such as part time, evening, or virtual offerings) and to promote a more diverse pool of students in their programs.
• Developing on-the-job training resources for dental practices to use with new, untrained dental assistants.
• Standardizing curriculum of dental assistant training programs offered to high school students through occupational skills centers across the state.
• Promoting dental health professions to middle and high school students, with an emphasis on districts serving diverse student populations.

Many of these ideas are based upon successful programs that have increased the workforce in medicine and manufacturing in our state. Successfully implementing them could have a similar, measurable impact on the dental workforce and help close the gaps plaguing public clinics and private practices across Washington.

CREATING A CAREER LADDER

Creating a more robust career ladder between dental assistants and dental hygienists will also help address staffing shortages and promote a more diverse workforce. So, WSDA and DDWA plan to team up in promoting innovative legislation during Washington’s 2022 legislative session that would do just that.

If enacted, the bill would remove barriers to entry and create more rungs on the career ladder for assistants and hygienists alike.

“The first step is to create multiple pathways into the dental workforce for those who may face additional barriers in college education, such as candidates for whom English is a second language,” said Dr. Chris Delecki, former WSDA president and task force co-chair. “This is crucial for tapping a broader talent pool and increasing the diversity of the workforce.”  

The career ladder envisioned in the bill would provide multiple routes for growth for those looking to build their dental assistant or hygienist careers.

It would begin with the non-licensed position of dental assistant. Currently, the procedures performed by dental assistants must be done under “close supervision,” meaning that the dentist must personally diagnose the condition, authorize the treatment, and be continuously on-site and capable of responding while the assistant performs the procedure. The bill would enhance the role of the assistant by establishing a general supervision structure for their work.

Those dental assistants looking to move up the career ladder would have two options. One would be to become an expanded function dental auxiliary, an option that is available today. This position requires a license and allows the performance of all services of a dental assistant, as well as placing and carving direct restorations and taking final impressions. The bill would require those holding this license to fulfill some level of continuing education, to be defined by the Dental Quality Assurance Commission (DQAC), which is a long-standing DQAC request.

A second career advancement option for dental assistants would be to pursue a newly created “Preventive Dental Assistant” license. Those obtaining this license would be permitted to perform specific, routine cleaning procedures for patients who are in a healthy dental state. This option would increase access to basic preventative care and reduce the cost of that care for many patients. Applicants would need to demonstrate competency, as determined by DQAC, in order to receive this license and would also be subject to DQAC-established continuing education requirements.

Next, the bill would create a two-tiered license structure for dental hygienists. The first and new tier would be a core hygiene license without endorsements. Hygienists with this form of license would be authorized to perform the full range of preventative procedures currently allowed and would still be required to complete the currently mandated 15 hours of continuing education credits annually.

The second tier would be a full dental hygienist license with endorsements to also administer nitrous oxide and local anesthesia, as well as perform restorative procedures. This tier includes the state’s full dental hygiene scope.

The goal in creating a new tier in dental hygiene is to expand the size and diversity of the hygienist pool by providing a pathway to obtain a core hygiene license, begin seeing patients, and start earning a salary sooner. Experienced hygienists moving to the state would be allowed to practice upon documenting their license and good standing elsewhere. Meanwhile, in-state candidates would require less time and incur less expense to receive the training necessary to begin performing preventative care procedures. 

A WIN FOR EVERYONE

Taken together, these changes will provide clear benefits for everyone. The combination of a quicker path to employment and a defined career ladder will help attract more students to pursue dental careers as a post-high school option. Those who become dental assistants will have more routes to build their careers. Allowing properly trained and supervised dental assistants to perform less complex procedures will enhance the value of dental hygienists by allowing them more time to focus on more complex patient care requiring their more advanced training.

Dental offices will have more flexibility in caring for patients and fewer scheduling difficulties, changes that are especially important for Federally Qualified Health Centers, which face some of the greatest challenges in coping with today’s workforce shortages while caring for some of the state’s most vulnerable patients.

Most importantly, all patients in Washington will have access to a much larger pool of qualified dental professionals to meet their oral health needs.

Securing this brighter future for dental practitioners and patients in Washington is why WSDA and DDWA are working collaboratively to ensure that their plan comes together.

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This article originally appeared in the Fall 2021 issue of WSDA News.