I am not in favor of establishing a DA II category to "improve access" to care unless there is an established clinical training program at an accredited facility.  "On the job training" is not an option!  As an Assistant Director of an AEGD Program, Restorative Department Head, Affiliate Faculty at VCU and private practioner, I have seen many aspects of the delivery of dental care.  From the Military Dental care system and the Free Clinic underserved system to the Fee for Service system and I have worked for and with many talented professionals who have worked hard to achieve a high level of competence in their area of expertise.  I have also seen many "expanded functions" individuals, given adequate training and supervision who perform adequately but not to the same level of those individuals who were trained to be Dentists or Dental Hygienists.  Unfortunately, I have also seen many individuals in the "expanded functions" role who perform at levels that I feel are not adequate.  The service that they would provide for my patient would not be acceptable to me and I think it would be a disservice to the public to lower the standards of care just to provide better access.  The state of Colorado is one of only a few states that have allowed Dental Hygienists to open their own clinics without having a Dentist on-site.  This was supposedly done to improve access to care....a retrospective study showed very few independent hygiene clinics with little or no improvement to access and only created issues with continuity and delivery of care.  I think we are ultimately responsible for the health of our patients and should be very careful when considering changes to our present system.  Before I would agree with establishing a DA  II position, I would like to review the educational and clinical training requirements to ensure the DA II candidate would receive a proper education and clinical supervision to prove that they have the skills required to provide the service that they will be certified to provide.