Winter 2017-18

8 New Mexico Dental Journal, Winter 2018 X X XXX State of the Workforce | continued 2018 THE TEAM APPROACH By Tom Schripsema— NMDA Executive Director Throughout this edition of the New Mexico Dental Journal on the dental workforce you will find various sporting references. This is not an accident.  We often refer to “The Dental Team” when discussing the variety of oral health practitioners that are routinely involved in dental care and their function as a team.  Medicine is typically very hierarchical with primary, secondary, and tertiary levels of care.  Nurses, therapists, physicians, and surgeons each have very distinct functions that rarely overlap in meaningful ways.  Specialization and sub-specialization have occurred extensively in each of these professions to fill the hierarchical “gaps.” And where these expanding circles “touch” the next level, we often talk about “mid-level providers.” Dentistry has never functioned this way.  While there are recognized specialties, they almost never function in the same kind of hierarchy as medicine. Most of the care is delivered in general practices that provide preventive, health maintenance, and routine care. The same practices may provide urgent and emergent care, as well as chronic care for some conditions. Specialty care takes the form of team expansion, whether short-term or long term, with shared rather than segmented responsibilities. Most patients expect “one-stop shopping,” for all but their extraordinary needs, and when those needs arise, expect an integrated approach to specialty care with more of a collaboration than a hand-off. Within dental offices, the hierarchies have more to do with employer/employee relationships than levels of care. Since dental care reimbursement is procedure based, rather than condition based, a single procedure might be provided via multiple members of the team. On a single visit, a patient might have a hygienist give anesthesia for a cavity prepared by a dentist that is restored by an EFDA. Other assistants could assist with any of those functions, but might be responsible for sterilizing the instruments, providing post-operative instructions or appointment administration like records, scheduling, and billing. Most certifications are skills-based rather than achievement-based, so dental assistants and dental hygienist may be trained in certificate or degreed programs to a minimum level of competency, but both may be certified for many additional skills and competencies based on educational programs or demonstrated proficiency on an examination. Lacking the highly defined strata of medicine, “mid-levels” in dentistry just don’t make sense. All teams have players with different positions. While the quarterback may handle the ball on every play, receivers, runners, and blockers are just as essential to every play’s effectiveness. This is just as true for the dental team. As you consider the individual players in this issue’s “State of the Workforce,” you should not lose sight of how each contributes to the overall success of treatment. It takes a team.