May 2, 2022
By Kelly Schroeder, RDH, MS, Health Science Specialist, CareQuest Institute for Oral Health
If you pull out your wallet, you’re likely to see a driver’s license. Perhaps you earned that license in Maine, Minnesota, or Montana. Or maybe it was in West Virginia or Wisconsin. Although your education and licensure took place in one of those states, you can legally operate a vehicle in all 50 states. As the driver, it is your responsibility to know and follow the traffic laws of the state in which you are driving, even when crossing state lines.
This is how dental and dental hygiene licenses would work within states that agree to an interstate licensure compact. As a dental hygienist for many years, I can write with confidence that this would benefit the industry and the providers within it.
Fortunately, the American Dental Hygienists’ Association (ADHA), along with the American Dental Association (ADA), has been working with the National Center for Interstate Compacts to allow dentists and dental hygienists to work seamlessly within states that choose to join the compact. The session on the topic was one of the most popular ones I attended during the National Oral Health Conference (NOHC) last month in Fort Worth, Texas.
The work on the compact began in November 2020, with completion anticipated during the spring of 2023. This development will help increase access to care for patients and expand the ability for many licensed providers to practice in the oral health profession.
“ADHA is excited to be a part of the development of an interstate licensure compact for dental hygienists and dentists,” said Ann Lynch, director of advocacy at ADHA. “We are grateful to the US Department of Defense for funding this critical project and to The Council of State Governments for its expertise in crafting interstate licensure compacts. This is a transformative moment for the professions of dental hygiene and dentistry.”
The Complexity of Dental and Dental Hygiene License Portability
Dentists and dental hygienists must be licensed by the state in which they are practicing. If a person chooses to move to a different state, or lives near state borders, they may need to become licensed in more than one state. Applying for licensure in different states can be complicated and expensive, as each state has different requirements for continuing education.
“Professional licensure mobility can be an obstacle for all practitioners with additional fees, paperwork, and producing records to meet a new state’s licensure requirements,” said Lynch. “Dental hygienists and dentists who work in multiple states, who are moving, or are military spouses know the challenges of seeking licensure in a new state. Interstate licensure compacts improve license portability and are a solution to the many hurdles practitioners face in seeking a license in a new state.”
Costs for dental hygiene licenses vary by state. For example, the most expensive states include Louisiana ($270 for two years), Texas ($222 for two years), and Maine ($175 for two years). On the other end of the spectrum, Washington ($50 for one year), Utah ($37 for two years), and South Dakota ($95 for five years) are among the least expensive.
There are also a variety of continuing education (CE) requirements for dental hygiene license renewal. For example, Wisconsin requires 12 CE credits every two years, Utah requires 30 credits every two years, and Arkansas requires 40 credits every two years. Further, some states spell out specific licensure CE criteria needed such as CPR certification, human trafficking awareness, infection control, chemical dependency awareness, tobacco cessation, and/or jurisprudence. Some states put specific limits on how many CE credits can be earned in a specific area such as insurance, governmental relations, patient management skills, and methods of health care delivery.
Voices for Change in the Oral Health Industry
It’s no secret that the COVID-19 pandemic has disrupted the oral health industry in countless ways. Infection control, access to care, teledentistry, and growing inequities are just a few of the topics that have reshaped dentistry in the past two years. Staffing shortages among dental hygienists is on the list, too. And those shortages can lead to a gap between patient supply and demand.
Making it easier for dental hygienists to move from state to state can only help. A few minutes on the Wisconsin Dental Hygienists’ Association Facebook page reveals a compelling need among dental hygienists faced with state licensure challenges:
- “I am a travel hygienist based in Illinois. As I travel every 4–6 months, getting a new license in every state is challenging.” -M. Hussen
- “I live in MN, 1 mile from Iowa where I work, and 45 miles from WI and pay to have all 3 licenses current . . . It is a major pain to keep up with all the different licensure requirements and different renewal dates.” -M. Hirsch Coyle
- “I feel stuck in Wisconsin. The knowledge of how to do our job is the same in each state. There are nuances in each state, which could easily be learned.” -H. Jenness
- “I am a military spouse. We move on average every 2–3 years. I currently have 3 active state licenses and one additional state license that I didn’t renew, that require different amounts of continuing education (CE) to keep up, different renewal times, and costs. We currently live in a state that if I would try to get a dental hygiene license, I would have to start over like a new graduate. It’s a headache.” -K. Gall
The Path to Dental and Dental Hygiene License Portability
After her presentation at NOHC, Lynch provided additional details on the status of the interstate compact project: “It has formed a technical assistance group and is now forming a document team to draft a compact based on the recommendations of the technical assistance group,” she said. “Later this year, a draft will be available for all stakeholders to review and comment on.”
"Creating the case for an interstate licensure compact and writing the actual contract takes time, patience, and collaboration with key stakeholders,” Lynch said. For example, the US Department of Defense has been a key player in initiating and supporting the compact because of the high number of military spouses who were unable to work in their licensed dental profession when their military spouse was relocated to another state.
There are three phases to the process, including development, education and enactment, and transition and operation. Ultimately, the proposed compact will based on professional requirements that are already similar from state to state: education requirements from accredited programs, a written examination, a clinical examination, a jurisprudence exam, a background check, and CPR Certification.
“Once final compact language is developed, state legislatures will need to consider and enact the new legislation to implement the interstate licensure compact for dental hygienists and dentists,” Lynch said. “States that become members of the compact will improve licensure portability opportunities for their practitioners.”