Strategies to assure access and equity: State dental practice acts as covert barriers: Case studies

The LMC and its LFHCN (FQHC) sponsors 5 innovative CODA-accredited dental residency training programs. Over 125 residents practice in 13 states through service-learning partnerships with FQHCs other facilities. Well over 125,000 visits are provided to underserved and vulnerable populations. Implementing these partnerships includes a commitment to workforce amelioration, educational equity and access to oral health.

Developing interstate partnerships is inextricably entwined with the intricacies of each state's dental practice act. No matter what the need, no matter the persistence of key stakeholders, regardless of supporting data; without the precise words being written and interpreted favorably many practice acts serve as both overt and covert barriers to access via residency training initiatives. Responsibilities of state boards include public accountability, yet in many cases they remain beholden to the perceived economic needs of the profession.

This paper will discuss, through the use of mini case studies throughout many states, these barriers and resolution. Strategies used by state boards to delay and thwart these educational programs will be analyzed. Review of the language currently in use serving as a barrier to access within states and suggestions on how that language may be modified will be presented. Experiences dealing with the self protective actions of state boards are a telling example of the barriers that lie in the road of increasing access and workforce enhancement. These case studies, despite some successes, suggest that state boards are protecting their perceived economic interests while denying access to care for the underserved through a multitude of barriers.