More than 300,000 people in Massachusetts lack access to proper dental care, and health advocates said increasing the number of licensed dental therapists in underserved communities could help.

Dental therapists are similar to nurse practitioners and can perform the most commonly needed treatments such as preventive cleanings or fillings, helping uninsured patients avoid costly trips to the emergency room.

Dr. William Giannobile, dean of Harvard Dental School, said schools in Massachusetts hope to train dental therapists but first require legislative and regulatory approval.

"There's a bottleneck in the whole approach," Giannobile explained. "Because many in organized dentistry still; they're grappling with the dental therapist model on how they can build it into a practice setting."

Recently introduced legislation would allow for the licensure of dental therapists in the Commonwealth, and Giannobile emphasized he envisions them working in public health clinics as well as emergency rooms, where dental visits cost the U.S. nearly $2 billion annually.

Increasing the availability of dental therapists can also create a more diverse dental workforce, helping bridge language and cultural barriers in low-income or immigrant communities.

Dianne Smallidge, dean of the Forsyth School of Dental Hygiene at Harvard University, said overall community health improves when dental care improves.

"We have a much higher success rate with patients being compliant, understanding what their needs are and continuing to seek treatment and getting it at our clinic if they've had a clinician that speaks the same language," Smallidge observed.

The training required for dental therapists is shorter and less expensive than regular dentistry, making education more accessible for therapists in rural communities. Dental therapists can also help reduce wait times for appointments, something anyone who has ever suffered from dental pain can appreciate.


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More than 20% of nursing positions in the Commonwealth remain vacant, according to the Kentucky Hospital Association - and combined with workforce shortages in other medical professions, the state is facing a massive health-care workforce crisis that could have crippling effects.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, said the shortages are both straining overworked existing providers and making it more difficult for residents to access quality care.

"We're seeing shortages, really across the board. We're certainly seeing shortages in nurses," said Chandler. "We're also seeing shortages for primary-care physicians. These are important entry points into the health-care system."

The state needs at least 16,000 additional nurses to meet demand by 2024, according to data from the Kentucky Healthcare Collaborative.

State Sen. Stephen Meredith - R-Leitchfield - will be the keynote speaker at the Foundation for a Healthy Kentucky's Bost Forum next week in Lexington, highlighting the challenges facing the medical community and proposing potential solutions.

He said the health-care system is the backbone of rural economies.

"If the health system in rural Kentucky collapses, then it's just a chain-reaction event," said Meredith. "It's going to cause a crisis throughout the state. It's something we need to take seriously, and it needs solutions today."

According to the Bureau of Labor Statistics, nationwide around 1.8 million job openings are projected yearly between now and 2032, driven by increased demand and the need to replace workers who have permanently left health-care occupations.




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In rural Arkansas, access to healthcare can be a distant dream - literally - as almost 60 counties in the state do not have enough providers to serve their populations. A new initiative with the Health Resources and Services Administration is working to improve access in these areas, through telehealth.

Heather Dimeris, director, Office for the Advancement of Telehealth at the Health Resources and Services Administration, said delivering care remotely online fills a crucial gap. Arkansans can visit telehealth.hhs.gov to explore their options, including behavioral and mental-health services.

"You can look at anxiety or depression screening through telehealth," she said. "You can also receive treatment for your anxiety or depression and other mental health needs, through one-on-one therapy as well as group therapy. And telehealth has also been extremely helpful in treating patients with substance-use disorders."

Dimeris noted 40% of all behavioral healthcare is now done virtually, including therapy, addiction counseling, and mental-health screening. She adds HRSA also provides telehealth services for treatment of chronic diseases, like diabetes, and information for healthcare providers.

However, the growth of telehealth spotlights another challenge for rural Arkansas - the lack of reliable, affordable internet service. Dimeris added some people can use their cell phones for telehealth services. Or they can apply for discounted internet access through two programs offered by the Federal Communications Commission.

"The Affordable Connectivity Program, as well as the Lifeline Program," she continued. "Both of these programs have eligibility requirements. But if you meet them, you really are able to access either free or reduced cost for broadband services and cell phone services."

Lower-income households can get up to $30 a month off their internet service bill, or $75 a month if they live on tribal lands, according to the FCC.

California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.