Leslie K, Moore J, Robertson C, Bilton D, Hirschkorn K, Langelier M, et al. Regulating health professional scopes of practice: Comparing institutional arrangements and approaches in the US, Canada, Australia and the UK. Hum Resour Health. 2021;19(15). Published online January 28, 2021. doi: 10.1186/s12960-020-00550-3.
Available at: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00550-3
Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals.
Surdu S, Langelier M. Teledentistry: Increasing Utilisation of Oral-health Services for Children in Rural Areas. J Telemed Telecare. Published online October 18, 2020. doi: 10.1177/1357633X20965425
Available at: https://journals.sagepub.com/doi/full/10.1177/1357633X20965425
The objective of this study was to evaluate factors influencing utilisation of follow-up oral-health services in general dentistry clinics among children subsequent to a teledentistry consultation and treatment with a paediatric dental specialist. The study found that case severity and compliance with treatment were predictors of utilisation of oral-health services in general dentistry clinics. An additional finding was that case-management interventions were important in facilitating specialty dental care.
Surdu S, Mertz E, Langelier M, Moore J. Dental workforce trends: A national study of gender diversity and practice patterns. Med Care Res Rev; Health Workforce Supplement. Published online August 28, 2020. doi: 10.1177/1077558720952667.
Available at: https://journals.sagepub.com/doi/10.1177/1077558720952667
The dental workforce is increasingly gender diverse. This study analyzed gender differences in dental practice using the American Dental Association’s 2010-2016 Masterfile and the 2017 Survey of Dental Practice. Between 2010 and 2016, the proportion of women working in dentistry increased from 24.5% to 29.8%. Overall, female dentists were more racially/ethnically diverse, more likely to be foreign-trained, and more likely to work in pediatric dentistry than male dentists. The likelihood of female dentists working as employees, part-time, and/or in metropolitan areas was 1.2 to 4.2 times greater compared with male dentists. Female solo practitioners were 1.2 to 1.8 times more likely to provide services to children and patients covered by public insurance than male solo practitioners. Gender diversification in dentistry and other factors, including generational differences and changes in the dental service delivery system and public policy, will continue to reshape the delivery of oral health services.
Fraher EP, Pittman P, Frogner BK, Spetz J, Moore J, Beck AJ, Armstrong D, and Buerhaus PI. Ensuring and Sustaining a Pandemic Workforce. N Engl J Med. April 2020; DOI: 10.1056/NEJMp2006376.
Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2006376?query=featured_home
Current efforts to fight the COVID-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the US health care workforce and sustain it for the duration of the pandemic.
Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. Modernizing Scope-of-Practice Regulations–Time to Prioritize Patients. N Engl J Med. February 2020;382(7):591-593. DOI: 10.1056/NEJMp1911077.
Over the past decade, numerous reforms have been implemented by the federal government and by states to expand health insurance coverage, change payment models, motivate organizations to reconfigure the ways they deliver care, modify eligibility for Medicaid, and better prepare the health workforce for pressing behavioral care, primary care, geriatric care, and community care needs. To realize the potential of these laudable reforms, we believe that states should eliminate overly restrictive scope-of-practice regulations that they impose on the health professions. Doing so would allow us to unlock the full potential of the country’s health workforce.
Lo Sasso AT, Armstrong D, Forte G, Gerber SE. M. Differences in Starting Pay for Male and Female Physicians Persist; Explanations For the Gender Gap Remain Elusive. Health Affairs 39, No. 2 (2020); 256-263.
A large literature has documented differences in salary between male and female physicians. While few observers doubt that women earn less, on average, than men do, the extent to which certain factors contribute to the salary difference remains a topic of considerable debate. Using ordinary least squares regression and Oaxaca-Blinder decomposition models for new physicians who accepted positions in patient care for the years 1999–2017, we examined how the gender gap in total starting pay evolved and the extent to which preferences in work-life balance factors affect the gap. We found that the physician earnings gap between men and women persisted over the study period. Interestingly, despite important gender differences in preferences for control over work-life balance, such factors had virtually no ability to explain the gender difference in salary. The implication is that there remain unmeasured factors that result in a large pay gap between men and women.
Langelier M. Innovations in Scope of Practice. Dimens Dent Hyg. January 2020; 18(1):16-17.
Over the past decade, legislatures across the United States have grappled with scope of practice issues for health professions, including dental hygiene. Almost every state has provided new permissions or enabled conditions for broader practice in response to new technology, improved science, novel dental materials, or alternative methods for delivery of care. Downstream effects of these changes include opportunities for innovative dental hygiene practice. In addition, the fundamental shift in health care delivery away from the medical paradigm of identifying and treating existing disease toward early intervention in prevention of disease processes has had collateral effects on dentistry and dental hygiene. Dental hygienists’ competencies are grounded in patient education, motivational interviewing, and preventive and prophylactic clinical services. This expertise has positioned the profession to play a pivotal role in efforts to improve the oral health of the US population. Dental hygienists are now more commonly viewed as primary preventive oral health specialists with separate and critical responsibilities in the oral health care continuum of care.
Surdu S, Dall T, Langelier M, Forte G, Chakrabarti R, Reynolds R. The pediatric dental workforce in 2016 and beyond. JADA. July 2019; 150(7):609-617.
Supply and demand projections came from a health workforce tool that investigators have used to model the health care workforce for a wide variety of health occupations, including dentists.We provide a brief summary of the data, methods, and assumptions for modeling supply and demand, with additional information provided in a technical appendix (available online at the end of this article).
Moore J, Goodwin N. Expanding Access to Care with Scope of Practice. Dimensions of Dental Hygiene. 2019; 17(3):12-14.
There has been longstanding concern about uneven access to oral health services, particularly for some groups, including children, the elderly, racial/ethnic minorities, and the economically disadvantaged. Stakeholders with an interest in expanding access to care and improving the oral health status of the underserved are driving efforts to identify and adopt innovative strategies to improve population oral health. Dental hygienists (DHs), who are considered experts in prevention education and services, often play important roles in programs that improve access to needed oral health services
State-based laws and regulations define legal scopes of practice (SOP) for health professionals within a state. This contributes to variation in what DHs in different states are legally allowed to do. It is challenging to systematically describe these SOP differences, assess their impacts on population oral health and translate this into policy-relevant information. With support from HRSA’s National Center for Health Workforce Analysis, researchers at the Oral Health Workforce Research Center (OHWRC), Center for Health Workforce Studies (CHWS), developed a professional practice index to describe DH SOP across states and studied impacts of this variation on state oral health outcomes. Subsequently, researchers developed an infographic based on this work to depict state-level variation in DH SOP to help oral health advocacy groups, policy makers and other stakeholders better understand these issues.
Moore J. Health Professions Regulation in the United States. J Health Law (Revista de Direito Sanitario). October 2018;19(2):131-155.
In the US, states are primarily responsible for the regulation of health professions. The structure and content of state-specific health professions regulation has significant impacts on the delivery of health care services. This is particularly important given that health reform initiatives are designed to improve population health through the provision of accessible, high quality, and affordable basic health services. There is concern that existing state-based, profession-specific regulatory structures cannot easily support the workforce innovations necessary for health reform. Aspects of the current system that constrain the effective and efficient use of the health workforce include mismatches between professional competence and legal scopes of practice, lack of consistency in legal scopes of practice across states, limited flexibility to support overlap in scopes of practice across professions, and the slow and adversarial process for changing scope of practice rules.