Multistate licensure bills dredge up dental duel at the State House

A dental hygienist who called for Massachusetts to join an interstate compact intended to ease licensure requirements for dentists and hygienists garnered swift pushback Monday from other providers who argued the framework poses safety risks for patients.

A dozen states have already joined the Dentist and Dental Hygienist Compact, which allows providers to practice in other participating jurisdictions without needing to deal with the administrative and financial burdens of maintaining multiple licenses.

Amanda Berthiaume, a dental hygienist and assistant professor at Springfield Technical Community College, touted the compact featured in first-time legislation from Rep. Bud Williams and Sen. John Cronin (H 2563 / S 1494).

“Unlike similar bills, this compact was carefully developed by the Council of State Governments, in partnership with the Department of Defense, the American Dental Association and the American Dental Hygienists’ Association,” Berthiaume told the Public Health Committee on Monday morning.

“It was intentionally designed to respect and incorporate existing accredited education and various accrediting bodies, but left broad on purpose, as we do not back a specific examiner group in pursuit of income,” she continued. “By contrast, the competing legislation being considered has been promoted by groups including the American Dental Examination Committee and certain board organizations, whose revenue models depend on requiring their proprietary examinations.”

Berthiaume told the News Service the competing compact bills from Rep. Ted Philips and Sen. Paul Mark (H 455 / S 257) would require that dentists and dental hygienists pass the ADEX licensure exam that was developed by the American Board of Dental Examiners. Those proposals are awaiting a hearing before the Joint Committee on Consumer Protection and Professional Licensure.

Pat Connolly-Atkins, a dental hygienist and past secretary to the Massachusetts Board of Dental Examiners, called the compact on Monday’s hearing agenda “dangerous for the safety of the citizens of Massachusetts.” She stressed the importance of evaluating clinical skills — specifically hand skills that are needed to perform complex surgical procedures — through exams like ADEX.

“You cannot determine competency of these clinical skills by administering a didactic test alone, but that is exactly what the CSG compact proposes,” Connolly-Atkins said. “Massachusetts, along with 46 other states, does require a hand skills assessment for licensure. The ADEX exam is one of the exams that is comprehensive with a strong hand skills component.”

Berthiaume disputed that claim, telling the News Service that every state that has joined the compact requires that licensed providers pass a hand skills exam in addition to written assessments. Berthiaume added the hand skills test is done on a mannequin, which she said is “not even a very good gauge of skills” and that “there is a push to get rid of the hands-on exam.”

Dr. Mina Paul, dental director at NeighborHealth and former chair of the Massachusetts Board of Registration in Dentistry, sounded the alarm about the proposed compact’s governing body.

“The compact establishes an unaccountable multistate commission that makes binding rules over Massachusetts licensees, stripping away your authority as legislators and the board’s authority as our regulator,” Paul said. “This is not theoretical. Similar concerns have led to lawsuits in Virginia, amongst other states.”

A judge in Richmond dismissed a lawsuit on Dec. 5 from Virginia dentists challenging the state’s participation in the compact. The dentists had argued the compact had “inappropriately” given “state power to a non-state entity,” according to the news site of the American Dental Association.

Those dentists filed an appeal Dec. 30, according to the Dentist and Dental Hygienist Compact, which says the complaint is based on “a mistaken belief about the purpose, function, and practical application of the Compact.”