Mid-level Providers in the U.S. Dental Practice

Access to care is a major concern for the dental profession and legislators at all levels of government. In recent years, workforce issues have come to dominate debates about improving access to care. One proposed solution to this dilemma is to provide more dental providers in the form of mid-level providers. The success of this new level of provider hinges on whether or not the practicing dentist will embrace the concept of utilizing mid-level providers to treat those who are economically disadvantage and/or reside in remote rural communities. Further, this model of care must be profitable in order for it to be successful. In turn, the Medicaid system must be attractive to dentists. The Pew Foundation has issued a report supporting the mid-level provider model and its potential to be profitable to dentists. Opponents point to issues of level of education, state subsidies, confusing regulation, liability, and financial feasibility as reasons to reject the mid-level provider model. The American Dental Association asserts in its report, “The Role of the Workforce,” that the U.S. dental workforce is adequate for now and for the foreseeable future. The ADA further states that the Pew Foundation’s conclusions about the potential role of mid-level providers are flawed and can lead to erroneous conclusions regarding the contribution mid-level providers would make toward accessing care. An analysis of key variables and financial considerations raises serious concerns and questions about mid-level provider model as a cost effective solution to accessing care.