If the Virginia Dental Association believed Virginia was facing a shortage of dental hygienists, the answer should have been to work with the Virginia Dental Hygienists’ Association to identify the causes of that shortage and develop solutions together, rather than transferring a core dental hygiene function to dental assistants and legislatively going behind their backs.

There were many alternatives worth exploring. Why are hygienists leaving clinical practice? Are compensation, benefits, scheduling, workload, childcare, burnout, or working conditions contributing to the problem? Could Virginia expand hygiene-school capacity, increase clinical training opportunities, improve recruitment and retention, develop re-entry pathways for licensed hygienists who have left the workforce, or make it easier for qualified hygienists from other states to practice here?

And there is another elephant in the operatory: insurance reimbursement.

Dental practices face enormous pressure from insurance companies over reimbursement rates and what insurers will and will not pay. If inadequate reimbursement makes it increasingly difficult for practices to compensate licensed dental hygienists competitively while remaining financially viable, why isn’t that problem receiving the same legislative attention? Why are insurance companies allowed to exert so much influence over the economics of providing dental care?

The VDA should be directing far more of its advocacy toward the insurance companies and reimbursement system that place financial pressure on dental practices, rather than addressing those pressures by expanding clinical duties to less extensively trained personnel. Reducing the cost of delivering a service is not the same thing as solving a workforce shortage.

Those conversations should have occurred before redefining who may perform a procedure historically associated with trained and licensed dental hygienists.

The VDA and VDHA represent professionals who work side by side every day. A genuine workforce problem called for collaboration between those professions, educational institutions, the Board, legislators, and other stakeholders. Instead, legislation was pursued that has created considerable division within the dental community and left the Board of Dentistry with the difficult task of implementing a law it did not create.

Most troubling is the precedent. If a licensed health profession experiences a workforce shortage, the solution should not automatically be to transfer portions of that profession’s scope to less extensively trained personnel. A shortage should prompt us to strengthen the workforce, not find ways around it.

Virginia can and should address access to dental care. But access, workforce sustainability, and patient safety are not competing goals. We should have asked how to put more qualified dental hygienists into Virginia practices, how to keep them there, and whether the reimbursement system itself is contributing to the problem.

That is the conversation the VDA should have led.