“States that require dental hygienists to be supervised by dentists suffer a 1 percent annual reduction in the output of dental services.”
The Effect of Licensing on Dentists and Hygienists by Morris M. Kleiner and Kyoung Won Park, NBER working paper No. 16560.
As states require occupational licenses for everyone from surgeons to interior decorators. Licensing in effect creates a regulatory barrier to entry into licensed occupations, and thus results in higher income for those with licenses.
In Battles among Licensed Occupations: Analyzing Government Regulations on Labor Market Outcomes for Dentists and Hygienists (NBER Working Paper No. 16560), co-authors Morris Kleiner and Kyoung Won Park use state variations in dental hygienists’ licensing, along with data from the 2001-2007 American Community Survey, to estimate the value created by limiting occupational competition through licensing.
Like dentists, dental hygienists clean teeth, apply sealants, take X-rays, and screen for dental problems. Because dentists are in the majority on the state licensing boards that license dental hygienists in most states, they can in theory create rules that limit the extent to which dental hygienists can compete with them. In fact, most states require dental hygienists to practice under the direct supervision of a dentist, but some allow dental hygienists to own their own practices, clean teeth, and apply sealants.
The authors find that in states that allow dental hygienists to have their own practices, hygienist employment is about 6 percent higher than in other states, and hygienist earnings are about 10 percent higher. At the same time, the growth rate of dentists’ employment is lower — 1.5 percent per year versus 2 percent — in these states.
Assuming that less stringent regulation of dental hygienists has no effect on the quality of services they provide to patients, the authors calculate that reducing regulation would reallocate about $1.34 billion from dentists to dental hygienists and would reduce the output losses caused by restricting employment by $80 million. Overall, Kleiner and Park estimate, states that require dental hygienists to be supervised by dentists suffer a 1 percent annual reduction in the output of dental services.
Your last paragraph says everything you need to know: If you ASSUME no effect on the quality of services … thats a pretty brave assumption to make with everyone elses health care.
Umm – at least from what the article says, they’re cleaning teeth and applying sealants. You think that several years’ training isn’t enough to ensure that’s done OK?
I am not sure I have ever met a professional standards regulatory body that didn’t operate to transfer wealth from the public to the profession.
Medecine and Law are merely the most egregious examples.
Nicholas – they get TWO years training most often, Dental Therapists ( a different category) get three, ans are able to treat people up to the age of 16, depending on the state. One thing hygienists dont get taught is how to recoignise oral pathology such as oral cancer (one of the most frequently occurring locations for cancer), or the medical issues underlying much of the practice of dental work – and that is exactly what they are doing. Yes, before you ask, I’m a dentist and a strong supporter of hygienists and Dental therapists, but not in unsupervised practice, there is a lot more going on in the mouth than just teeth.
Patrick, thats pretty glib of you. Would you prefer that health professionals were unregulated? I’m pretty sure you wouldn’t. Remember that these regulatory authorities are statutory authorities established by state or Federal governments and they exist to safeguard the public, not the professions. Just look at their charters and powers.
Patrick the regualtory bodies shouldn’t be confused with the professional associations.
They exist to do as you say and to screw the smaller practices or partnerships and anyone not within various self serving circles.
At times they will offer to confuse the public by conducting misconduct hearings but these are not much mor than conciliation sessions.That can be useful but are often a problem dodging exercise not a disciplinary hearing.
Thanks Michael, I guessed you were a dentist. And good on you.
You say that oral cancer is one of the most frequent locations for cancer – well it doesn’t turn up in the top ten areas unless perhaps other cancers like lung cancer are often detected through visits to the dentist. I’ve not heard of much of that, but obviously would defer to you on the subject.
Here’s the ABS on the top causes of cancer deaths, and oral cancers aren’t among them.
But how do we work out the costs and benefits here? Of course other things being equal it’s better to have more skilled than less skilled people. But other things aren’t equal. It would be equally possible to point out some possible inadequacy in dentists training and imagine the possibility that they would miss something that (for instance) an endodontist would not. Indeed an endodontist might be better at picking up the pathology of oral cancers. But that’s another umpteen years of training. Should we require all dentists to have that training also?
If dentists are better at diagnosing the pathology of oral cancer, and it’s an important service they provide, then is it impossible to train para-dentists to observe warning signs and recommend visits to the dentist?
And dentists just picking up oral cancers on visits is all very well, but if this is a worthwhile way to minimise suffering from cancer, couldn’t we do better than that? I for instance don’t visit dentists nearly as often as they tell me to. I’m afraid I detect over-servicing. Now without going into that, given that there are probably plenty of people who don’t do their regular 6 monthly checkup, mightn’t some more general campaign be useful. When doctors give you a checkup could they check you out for warning signs so they know when it would be worth sending you off to the dentist to be checked out?
And couldn’t para-dentists do the same? And given that almost all visits to dentists involve filling teeth, and many of those are relatively simple, couldn’t para-dentists be taught to do this – under appropriate supervision by dentists? Perhaps they already can.
Finally, don’t you find it cute that para-dentists are OK for kids but not for adults? Call me old fashioned, but in other areas of my life (other than the back seat of the car and sometimes even then!), if it’s good enough for my kids, it’s good enough for me.
Murph, yes, that is true pre-regulatory capture. See further: medecine and law.