I would like to know why the dental hygiene profession is not working toward independent practice so dental hygienists can reach vulnerable populations to prevent disease. With such great emphasis placed on creating the mid-level practitioner, I am disheartened by the fact that while clinical hygiene can definitely prevent disease, we have such limited access to the patients who need us most.
California continues to work toward independent practice. The main reason it appears that dental hygiene is not moving in this direction is because dentistry has created a practice model in all states with the dentist as employer that has worked for individuals able to access care through this traditional model. State legislators have to be convinced that this model will not increase access to care for patients unable to visit a traditional dental office or those who would like to receive preventive care from an independent dental hygienist. Colorado is the only state thus far to have independent practice for dental hygienists. As is evident in many states, the dental hygiene profession has been able to convince state legislators to pass laws that will increase access to care for the populations without access to the traditional dental office. In California, it is through the registered dental hygienist alternative practice category and in other states it is through the advanced dental hygienist practice model. As more dental hygienists increase access to care for underserved populations and as health care moves toward utilizing healthcare practitioners to the full limits of their scope of practice, more avenues will be created for independent dental hygiene practice. Unfortunately, with the dental associations’ stronghold on the traditional practice model and the political power they hold, independent dental hygiene practice will not come without a fight. In my experience as a legislative advocate for the dental hygiene profession for more than 25 years, the majority of the dental hygiene practitioners work in the traditional private practice setting and those dental hygienists are not interested in joining the battle. The majority are not members of their professional association, which works to strengthen the profession and advocates for an independent practice model. Without more dental hygienists becoming involved, efforts to move toward independent practice by state associations will continue but it will not be an easy task.
When you ask why the “dental hygiene profession” is not working toward independent practice, I am not sure what you mean. Are you referring to the American Dental Hygienists’ Association (ADHA), state associations, etc? The term “independent practice” is somewhat outdated when related to the goals of increasing access and improving oral health. Merely having the ability to “hang out a shingle” and establish a practice achieves no more than a private dental office does in easing access-to-care issues. The ADHA’s core ideology is focused on leading the transformation of the dental hygiene profession to improve the public’s oral and overall health. The ADHA’s vision is that dental hygienists are integrated into the health care delivery system as essential primary care providers to expand access to oral health care. There are now 39 states where patients have direct access to dental hygiene services. In Colorado, dental hygienists are co-locating in pediatrician practices. Progress is occurring across the country. But, most progress can only occur on the state level through changes in individual state practice acts. ADHA has resources and staff that work with states pursuing legislative initiatives. It is important for all dental hygienists to be involved with their state associations and to have set goals and a strategic plan to bring about the needed and desired changes. The body of evidence is growing in support of change. Dental hygiene must form allies with other health care professionals and work toward a common goal of improved health that includes oral health. Only then will real change occur.