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October 17, 2024
By Kelly Schroeder, RDH, MS, Evaluation Specialist, CareQuest Institute
Five years ago, license portability was only a dream for many dentists and dental hygienists who needed to practice in more than one state. No matter the reason — a need to relocate or the desire to volunteer at an out-of-state event — oral health providers were either unable to practice or had to find the time and patience to navigate the new state’s sometimes-expensive licensure process. This led to frustrated clinicians and contributed to a shortage of staff, which hurt access to critical preventive care.
The times, they are a-changin’.
Now, don’t pack your bags and move to a new state just yet. Yes, it is true that the Dentist and Dental Hygienist Compact has been activated, but there are a few more things that need to happen before compact privileges are issued. To start, privileges must be issued by the state where you are seeking to practice, not your existing state. (It’s not like a driver’s license, where a license from your home state makes it legal for you to drive in the other 49 states.)
There are a few other things you need to know right away if you’re looking to practice in a new state:
- You must have a valid dentist or dental hygiene license in a compact member state and be in good standing.
- The state you want to work in has to be signed on to the compact.
- You have to apply to the Dentist and Dental Hygiene Compact to gain privileges to practice in another compact state.
Right now, most states are not signed on to the compact. (You can check to see if your state has active legislation on the Dentist and Dental Hygienist Compact map.) To make it easy for states, the National Center for Interstate Compacts has published model legislation on the Dentist and Dental Hygienist Compact webpage. Jessica Thomas, senior policy analyst with the Council of State Governments (CSG), clarified that although her organization helps states sign on to the compact, it does not tell states what to do or pressure them into signing.
“[The dental compact] reached seven states this year, and since then, we’ve gotten three more. So, there are 10 states at this time that are part of the compact,” Thomas said. “It typically takes 18 to 24 months to get the compact’s commission set up, get the data system in place, set the rules, and then have an application ready for people to apply to those compact privileges. We've done this several times before [with other professions], so there’s hope that it could be a little faster this time around.”
How Did We Get Lost with Licenses?
If you’ve found yourself trying to get a license to practice in another state, you know the frustration. The process can include retaking the written boards exam, retaking the clinical exam, and providing proof of qualifying education and work experience. It can be expensive and time-consuming. Depending on the responsiveness of the individual state’s dental examining board, it can take three to six months after all requirements have been met before the new state license is granted.
How did we get here?
As early as 1969, when the Northeast Regional Board of Dental Examiners was founded (now the Commission on Dental Competency Assessments), oral health providers have been working to standardize oral health education and oral health provider testing for licensure. However, states still do not agree on the education requirements oral health professionals should follow to maintain their licenses, making maintaining multiple licenses challenging and costly.
Since November 2020, several entities have been working together to reduce barriers related to working in other states, including the Department of Defense (DoD), the American Dental Association (ADA), the American Dental Hygienists’ Association (ADHA), and the CSG.
Wisconsin, my home state, joined the compact in 2023. Dr. Chris Hansen, president of the Wisconsin Dental Association, was quick to point out the benefits.
“The licensure compact will streamline the licensure process and will work to attract dentists and dental hygienists from nearby states through participation in the compact,” he said. “License portability is an important issue with younger dentists and dental hygienists and will encourage the migration of dental professionals from neighboring states to Wisconsin.”
Seven Key Questions about the Dentist and Dental Hygienist Compact
Thomas, who has worked at CSG for almost three years, was kind enough to take a few minutes to provide more details about the process of enacting the compact and what the process will look like for dentists and dental hygienists who are interested in gaining privileges to practice in other states.
What will the process look like for dentists or dental hygienists who want to work in other states? How do they get started?
On the Dentist and Dental Hygienist Compact website, we have a new tab about the compact commission that will show the representatives from each state that are in the compact. Their commissioner, the meeting minutes, agendas — everything like that — will be on there. When an application is ready, that will be on that website as well. So, they won’t have to go through their individual state boards anymore; they’ll go through that compact commission and apply for privilege that way.
Do the individual states stay involved with the Compact, or is their role done after they sign on?
No, no, they’re very involved after the fact, too. It’s all really up to the states and up to those members. We don’t make any decisions. There will be one compact commissioner from each state that will get a vote on the commission and that will come from the regulating board. Then those commissioners will come together to establish the data system and the application process. Each state gets one vote, and then as far as like the chair and the executive board, they’ll vote on those people, too. They’ll nominate somebody, and then they’ll vote to elect the executive committee.
Have you had any feedback from individual dentists or dental hygienists about this? Do you hear directly from those who are going to be affected the most?
Sometimes we hear from people, mostly if they’re giving an educational presentation, but I know that a lot of people are pretty excited about it. When the seventh state joined, we got a lot of questions about “how do I apply?” Of course, it’s not automatic, so it’s kind of disappointing to hear that you have to wait a little longer. People are excited in the compact states and ready to use it, for sure.
Once the application process is ready, do you have an expected timeline for how long it will take from application submission to practice privilege?
It’s kind of impossible to predict right now about how fast that application process will go. From other compacts, we know the process is faster than if you had to apply to each state individually, but that whole process is going to be laid out by the commission.
So there isn’t really anything set up for it yet. If you look at other professions, like the physical therapy compact, for example, they can issue a compact privilege in a matter of minutes. It's our goal that DDH have that same level of ease of use.- Can you talk more about the difference between having a license in one state and the privilege to practice in another state?
The language gets a little confusing, but for all intents and purposes, a privilege is a license. We have to call it something different so it doesn’t get too confusing when you’re applying for different things, but [dentists and dental hygienists] should be able to do everything in that state that a licensed holder can do.
The state that you’re practicing in, that is the scope of practice that you follow. And those are the laws that you follow. We like to compare compacts to [a] driver’s license because everyone’s so familiar with “when you drive in a different state, you have to follow that state’s rules while you’re there.”
- Once a state does sign on to the compact, are neighboring states more inclined to also sign on?
We sometimes see this happen in regions because, like you talked about with border states, it really is a big advantage to have the states around you also join. It also sometimes happens where some states kind of wait and see. So, the states around them will join, and then they'll say they won’t want to miss out on the benefits that they’re seeing and they’ll hop on.
- Is there anything else that you think is important for people to know about where we are today with the compact?
We talked about advocating for the compact and reaching out to your state associations. People can also reach out directly to their legislators if they’re so inclined. We hear a lot of stories from individuals about how the compact can benefit them at a personal level, and I know those can really resonate. So just sharing those stories can be helpful if having licensure portability is important to you.
If you would like more information on the Dental and Dental Hygienist Compact, the website is full of information for states who are interested in signing onto the compact and individuals who are interested in applying for licensure privileges. If the website doesn’t have the answer you are seeking, reach out to dentalcompact@csg.org.