Analysis of Stakeholder Landscape in Midlevel Dental Provider Policy Initiatives

Objectives: To analyze stakeholder characteristics and involvement in midlevel dental provider policy initiatives in the United States (US). The US dental care delivery system is unique in its lack of incorporation of midlevel providers in the division of labor. The role of midlevel medical providers in the US and elsewhere and comparable dental providers in more than fifty countries in providing safe and effective care while expanding access to underserved populations is well documented. A few states have recently instituted midlevel dental providers and efforts are afoot in many other states. This analysis explored the impact of the nature of stakeholders on (potential) fate of such efforts.
Methods: A review of legislative databases and stakeholder organization documents on midlevel dental provider policy initiatives in all fifty states was conducted. Initiatives and organizations were identified through literature review, citation trail, and by searching for terms “dental, therapist, hygienist, advanced, midlevel” in the National Conference of State Legislatures database and Google. Types of stakeholders and size and strength of coalitions on each side of the initiative were categorized and reported according to the current legislative status (organizing, pending, successful, and unsuccessful).
Results: Twenty three states are making efforts to incorporate midlevel dental providers into the dental workforce to improve access to dental care. Differences in political reality, nature of the coalition behind these efforts, and boundary-spanning and turf-protecting interests of various professional groups resulted in wide variation of approach and scope of these efforts.
Conclusions: Establishing broad-based coalitions, savvy of the political process, early negotiations with opponents, and persistence seem to be the hallmarks of the initiatives that have succeeded so far. Similarities in approach between recent initiatives in several states and involvement major philanthropic organizations suggest increasing momentum behind widespread establishment of midlevel dental providers in the US.