Antitrust Law Daily Wrap Up, ANTITRUST NEWS: FTC staff urges revisions to dental therapist accreditation standards to encourage growth of profession, (Dec 4, 2013)

In comments to the American Dental Association’s Commission on Dental Accreditation (CODA), the staffs of the FTC Office of Policy Planning, Bureau of Economics, and Bureau of Competition indicated their support for accreditation standards for dental therapy education, but advocated revising language in CODA’s proposed Accreditation Standards for Dental Therapy Education Programs that, in their view, could be interpreted in ways that might hamper the competition therapists could provide in the market for dental services.

Dental therapists are a relatively new kind of dental services provider that offers some basic services traditionally offered by licensed dentists. Increasing the supply of dental therapists would enhance competition, particularly in otherwise underserved areas, the FTC’s comments note. The development of accreditation standards could help increase the supply of therapists by allowing them to more easily obtain licensure in other states, and by spurring the development of training programs.

States have recently begun considering legislation providing for the licensure of dental therapists. Minnesota became the first state to enact such legislation, in 2009, and eight other states have considered such bills, although no other bills have yet passed. The legislation has led to calls for the development of national accreditation standards, with two Minnesota universities, the Minnesota Board of Dentistry, and the Minnesota Dental Association requesting CODA to establish such standards.

However, CODA’s accreditation standards as written could be interpreted in a manner that would limit the competitive benefits provided by dental therapists, according to the comments. The standards could “constrain states’ discretion to select the level of supervision that they determine is appropriate for different types of dental training programs that they may create, and to define broadly therapists’ scope of practice to include oral evaluation and treatment planning.” The standards could also “deter the development of dental education programs that would train dental therapists to provide such services under the level of supervision required by each states,” thus “result[ing] in less development of innovative provider models and education programs.”

According to the comments, the proposed standards only address baccalaureate programs that would lead to licensure as a Dental Therapist, and not graduate programs that would lead to licensure as an Advanced Dental Therapist, and to a broader scope of practice. Moreover, the standards specify that dental therapists are supervised by dentists and that dentists are responsible for diagnosis, risk assessment, prognosis, and treatment planning, statements that could be interpreted as mandating “that a dental therapist’s role must be limited to execution of a dentist’s orders,” and that a dentist first examine a patient or be on-site for the patient’s initial examination. The comments note that such supervision and scope of practice limitations are generally a matter for state law, not dental education accreditation standards. The proposed accreditation standards could “chill expansion of the dental therapy profession,” in the FTC staffs’ view.

“CODA’s proposed Accreditation Standards for Dental Therapy Education Programs may help to encourage the development of a nationwide dental therapy profession that could significantly enhance competition in the supply of dental care services,” the comments conclude. “The standards’ effectiveness may be limited, however, by unnecessary statements on supervision, evaluation, and treatment planning. We respectfully suggest that CODA consider dropping such statements. We also encourage CODA to consider developing additional standards for master’s or graduate level programs that train dental therapists to conduct oral evaluations and develop treatment plans without an on-site supervising dentist or at other supervisory levels that states have adopted.”

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