Dear Dr. Taylor:

On behalf of the Virginia Dental Hygienists’ Association (VDHA), it is my pleasure to offer comments on the proposed amendments relating to general supervision of dental hygienists by dentists (18 VAC 60-20).  VDHA is committed to the uninterrupted implementation of general supervision in Virginia.

For reasons stated numerous times before, VDHA believes that the implementation of general supervision will safely expand patient access to oral health care services.  We continue to see great success in the private practice setting as dentists use the flexibility of general supervision to increase office hours and improve patient scheduling.  With the recent passage of SB 1090 (Bolling), which allows dentists to prescribe the administration of certain topical drugs by a hygienist, the safe delivery of dental care under general supervision will be further improved.

Overall, we support the proposed changes to the 18-VAC 60-20 and encourage the Board of Dentistry to work closely with licensees and other stakeholders to continuously monitor and improve oral health care under general supervision.  VDHA’s primary goal is to ensure continuity and progress with regards to the implementation of general supervision.  However, in response to the Economic Impact Analysis (EIA) submitted by the Virginia Department of Planning and Budget (DPB) and to the Agency Response submitted by the Board, VDHA desires to highlight some areas of concern.

VDHA concurs with the DPB charge that the current “two hygienists per dentist” restriction is not only set at an arbitrary ratio, but it is anti-competitive, deters innovative practice management, and increases costs.  This restriction, as noted by current members of the Board of Dentistry in public meetings, is based on economics and the desire of dentists to prevent competitors from luring hygienists away.  It is workforce manipulation and restraint of free trade.  According to the American Dental Hygienists’ Association (ADHA), Virginia is one of only nine jurisdictions with limitations on the number of hygienists that a dentist may supervise at one time. 

(please see part 2)

In its response to the EIA, the Board concludes that removal of the ratio would decrease access to care and threaten patient safety.  Among the many assumptions made, all of which fail to address DPB’s arguments about economic fairness, the Agency Response claims that a hygiene program may be closing, a less restrictive limit or no limit would result in a mass exodus of hygienists from rural areas, the restrictive ratio prevents “hygiene mill(s)”, and that the current average salary for Virginia hygienists is “respectable”.  The Board goes a step further to speculate on the reasons an individual hygienist may work part time.

To respond briefly to these assumptions:

Ø      We have no knowledge of any imminent closings of dental hygiene programs.  In fact, Northern Virginia Community College plans to increase their next class by 50% and Central Virginia Community College is taking steps to establish a new program. .  In addition, the implementation of distance dental hygiene education through compressed video technology has increased the number of dental hygienists in rural and underserved areas of Virginia.  Germanna Community College distancing with Northern Virginia Community College has completed two dental hygiene cycles; Danville Community College distancing with Virginia Western Community College has completed three cycles and is beginning a fourth; and Lord Fairfax Community College distancing with Virginia Western Community College is in its second cycle of operation.

Ø      It has been demonstrated that dental hygienists, and most other professionals, are likely to locate and practice in or near their home communities.  If more opportunities exist in rural communities, more hygienists will locate there.

Ø      VDHA does not support the idea of a “hygiene mill”, which is an undefined term.  However, in the 42 jurisdictions with no dentist-hygienist restrictions there is limited or no evidence to suggest that patients in other states receive sub-standard care.

Ø      Regarding dental hygienists’ income, it is not the business of the Board of Dentistry to determine what a “high” or fair salary is for any licensees.  And, the suggestion that hygienists contribute to barriers to care by “choosing to work part-time” is unfounded.  It could just as easily be suggested that if dentists who offered competitive compensation and desirable work environments could supervise more than two hygienists at a time, then hygienists would have more attractive opportunities to work, in all areas of the Commonwealth.

For your consideration, VDHA suggests one specific change to the 18-VAC 60-20.  In 18-VAC 60-20-200 Employment of Dental Hygienists, we recommend striking the “Employment of Dental Hygienists” and inserting “Restrictions for Direction and General Supervision”.  This section no longer refers to an employer-employee relationship between dentists and dental hygienists. 

To avoid disruption of service under general supervision, we support moving forward with the proposed regulations.  Bringing general supervision to Virginia’s dental health system has taken too long to allow one existing aspect of the regulations to hold up progress.  However, we strongly believe that the Department of Planning and Budget EIA has afforded us an opportunity to have an open discussion about the reasons behind the current 2:1 ratio.  I would respectfully request that the Board establish a task force to study whether a ratio is necessary for the safety of patients and, if so, what an acceptable ratio would be.

Please contact me with questions or for additional information.

Sincerely,

Misty Sissom, BSHS, RDH

President