By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

In 1926 Dr. William J. Gies published a landmark report that created a roadmap for modern dental education. Among his recommendations was the creation of a national licensure examination that would allow licensed dentists to move among states.

Nearly 100 years later, many states and their professional licensing boards still cling fiercely to their ability to control who may practice within their borders. These policies are intended to safeguard the public, but some have argued that forcing health professionals to obtain multiple state licenses is both costly and outdated, especially at times of heightened need. This proved true during the COVID-19 pandemic, when all U.S. states implemented an emergency licensing waiver for healthcare professionals, allowing them to practice in all 50 states.

The Case for License Portability

Even under ordinary circumstances, enabling health professionals to practice in multiple states has value. According to the American Dental Association (ADA) Health Policy Institute, roughly one in 13 dentists moved across state lines between 2015 and 2020, and among dentists 40 and younger, the number was one in six.

Dental educators and academic institutions would benefit tremendously from license portability. The American Dental Education Association (ADEA) reported that 17% of dental faculty moved from one school to another during the 2021-22 academic year. How many of those folks had dentist spouses or wanted to set up their own private practices in a new state is unknown. What we do know is that faculty recruitment is always challenging, and with seven new dental schools opening soon and four more in the planning stages, it will only become more so. Anything that reduces barriers to dentists’ mobility will be welcomed by both academic dentists and their employers.

The lack of license portability for dentists and dental hygienists is also concerning to the U.S. military. Service members are regularly transferred between duty stations, and roughly a third of military spouses in the labor force work in licensed professions. The process of obtaining a new state license can be so cumbersome, costly, or time-consuming that many military spouses are forced to temporarily step out of the workforce, depriving their families of income and the public of their services. Sidelining these health professionals also impacts military morale.

One Solution: Interstate Licensure Compacts

In a country where professional licensing falls within the purview of the states, interstate licensure compacts offer one solution. In 2000, nursing became the first health profession to establish an interstate licensure compact, which 39 states and 2 territories have now enacted. Medicine launched a compact in 2017, and 37 states plus the District of Columbia and Guam have already signed on. As of 2022, six other health professions had licensure compacts as well.

Each of these agreements functions differently, but all of them create a framework for cooperation. States retain control of professional licensing and how professions are practiced within their borders while also agreeing to a set of rules that allow practice by professionals licensed in other states. These rules reduce administrative burdens for states and streamline license portability, making it possible for health professionals to practice in other compact states without going through the process of obtaining a second license from scratch.  

According to Anthony (Tony) Ziebert, DDS, MS, the ADA’s senior vice-president for education and professional affairs, the ADA has supported facilitating license portability for dentists and dental hygienists for decades. In 2018, the ADA House of Delegates revised a policy statement supporting “freedom of movement across state lines for all dental professionals” to include a recommendation that states consider adopting licensure compacts to accomplish this end. At the time, leading such an effort independently and lobbying state legislatures one by one felt like a “heavy lift” for the organization, he told me.

Then in 2020, the Department of Defense (DOD) announced that it would make grants available to support the development of licensure compacts. Both the ADA and the American Dental Hygienists’ Association (ADHA) applied. Their support of each other’s applications impressed the DOD, which awarded them joint funding in 2021 and the opportunity to partner with the Council of State Governments (CSG) to develop model legislation establishing an interstate licensure compact for both professions. The DOD’s financial support and CSG’s technical expertise and political connections “made all the difference in the world,” Tony told me.

The DDH Compact

With the launch of the Dentist and Dental Hygienist (DDH) Compact earlier this year, dentistry and dental hygiene now have a mechanism in place to facilitate license portability. The DDH Compact creates a streamlined way for dentists and dental hygienists to obtain the privilege to practice in any DDH Compact state where they don’t hold a license.

To qualify, a dentist or dental hygienist must:

• Hold an unencumbered license in a state that has joined the Compact
• Have graduated from a dental or dental hygiene education program accredited by the Commission on Dental Accreditation (CODA)

States may also ask applicants to pass a jurisprudence exam demonstrating their knowledge of the state’s practice act. This law determines the scope of practice for all dentists and dental hygienists practicing in the state, including those licensed out of state and practicing under a Compact privilege.

Since the Compact’s finalization in March, three states — Iowa, Washington, and Tennessee — have enacted it into law. Five more states have legislation pending. Once seven states enact the Compact, it will go into effect.

Tony is hopeful that enough states will enact it so it goes into effect in early 2024. After that, he expects additional states to get on board. The Compact will be administered and governed by a commission comprised of one representative from the state dental board in each Compact state. Early Compact adopters will be influential in setting the commission’s rules, an opportunity Tony hopes will motivate states to enact the Compact in the coming year.

In addition to facilitating mobility, the Compact should make it easier for state dental boards to identify license holders with disciplinary violations. According to Tony, sometimes it can take weeks or months to get a response to a disciplinary inquiry. States that join the Compact will be obligated to upload all disciplinary information to the Compact commission database. This should prevent dental providers with disciplinary violations from simply moving to another Compact state. “The biggest complaint we hear from boards all the time is that they have no idea what’s happened in other states. This would address that issue,” Tony says.

Entering the Mainstream

It’s great to see dentistry and dental hygiene collaborating in this effort. The Compact provides yet another example of our professions entering the mainstream. I don’t think this would have occurred were it not for previous efforts within our community to bring the dental professions into the 21^st century. Increasing license portability was a key goal of the Coalition for Modernizing Dental Licensure, which ADEA, the ADA, and the American Student Dental Association formed in 2018. The coalition now boasts 125 members representing both educational programs and oral health advocates. We have more work to do on the licensure front, but establishing the DDH Compact is a critical step. Kudos to the ADA and ADHA for making this happen.