Maine licensing regimes separate qualified professionals from meaningful employment


Kimberly Fichthorn exemplifies what Maine is looking for.

A 47-year-old transplant from Texas, Fichthorn has three young children and operates an independent dental hygienist practice in Winthrop called Maine Dental Boutique.

A longtime registered dental hygienist (RDH) turned entrepreneur, Fichthorn moved to Maine in April 2017 and invested $40,000 to open her practice in one of the state’s many federally designated dental health professional shortage areas.

Fichthorn’s arrival checks many boxes for Maine.

Considering the state’s well-documented demographic woes, all readers can appreciate her laying roots in Maine. But Maine is also trying to overcome a significant dental care shortage, and nearly half of the state’s practicing dentists are over the age of 55.

Both a talented in-demand professional and mother of a young family, Fichthorn is precisely the type of person Maine must attract to improve current conditions. And, given our shortcomings, you would think that the State of Maine would welcome Fichthorn and her family with open arms.

You’d be wrong.

Fichthorn first considered moving to Maine in 2008 when her mother-in-law, a resident of Madison, ME., informed her that the Maine Legislature passed LD 2277, a law that allows RDHs to own and operate independent dental hygienist practices in Maine. However, she did not move in 2008 for the same reason her arrival was delayed in 2017: the State’s onerous licensing regime.

“At the time it just seemed like so much work,” Fichthorn said. “I started looking into applying for a license [in 2008] and it seemed pretty intensive. That’s why I did not want to do it at the time even though we come up here twice a year and knew we’d eventually move here.”

Fichthorn officially relocated to Maine in April 2017, four months after she began the process of applying for a license with the Maine Board of Dental Practice. Before moving, she practiced as a registered dental hygienist under a cosmetics-focused general dentist in Austin, Texas for 18 years and co-owned and taught at a dental assisting school for 15 years.

However, due to the lack of licensing reciprocity (the Maine Board of Dental Practice does not recognize licenses issued by other states), Fichthorn could not simply pack up and move to Maine. Instead, she had to battle with the licensing board to practice despite her obvious qualifications.

“It was quite an ordeal,” Fichthorn said.

To legally practice in Maine, Fichthorn first had to pay $33.70 to have the Texas State Board of Dental Examiners issue her a license verification form and have it shipped to Maine. She was then required to compile all of her official state and national board scores and college transcripts – records more than 20 years old – to be sent to the Maine Board of Dental Practice for review. She also had to prove up to date CPR certification, pass a jurisprudence exam, and was subject to a criminal background check. Finally, Fichthorn had to pay another $80 fee to submit the 17-page licensing application.

To make matters worse, the licensing board in Maine somehow managed to lose Fichthorn’s initial application, forcing her to re-file and pay an additional $33.70 to obtain another copy of her license verification from Texas. The Maine Board of Dental Practice also denied her first submission for listing too much work experience in one section of the application, a minuscule error that should not warrant denial considering Fichthorn’s experience exceeds the board’s requirements.

“I called the dental board and said, ‘Now this is ridiculous,’” Fichthorn said. “Things just kept getting lost. They had [my application] and then they didn’t. It felt like they were making it harder for out of state hygienists to come in.”

Once the dental board deemed Fichthorn to be qualified, she had to pay $140 to obtain a hygienist license and another $140 to obtain her independent practice license. Now officially licensed to practice in Maine, Fichthorn must pay $140 and complete 30 hours of continuing education biannually to renew her license. In total, Fichthorn paid $561.40 to obtain a license to practice in Maine.

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According to Fichthorn, the four-month period of waiting for approval could have been avoided.

“If the Texas State Board of Dental Examiners recognizes me as being licensed, I’m current with my continuing education and appear on their website, it should be as simple as looking at [the website] to verify who I am and what my qualifications are,” Fichthorn said.

The vast majority of Maine’s licensing boards do not recognize licenses issued by other states. The Plumbers’ Examining Board, for example, will not recognize an occupational license issued by another state unless “that state or territory has licensing standards and experience requirements at least equivalent to this State’s…” In other words, a master plumber who moves to Maine cannot legally practice unless the state they vacated required them to accumulate 2,000 hours of experience as a journeyman plumber or 1,460 days of experience as a trainee.

While granting occupational licenses to a qualified professionals from out of state should be as simple as checking a website or conferring with another state’s licensing board, most are forced to jump through hoops upon arrival in order to earn a living in Maine. Research shows that the lack of licensing reciprocity limits interstate mobility and primarily affects women, who are more likely to hold licensure than men.

Since the passage of Maine’s independent practice dental hygienist (IPDH) law in 2008, the industry has seen growth in the number of practicing licensed professionals. In 2012, Maine issued 37 IPDH licenses. According to the Kennebec Journal, there are 99 active IPDH licenses in 2018.

More than a year removed from her trek to Maine, Fichthorn has settled in Winthrop with her husband and three young children. At her small practice that feels more like a spa than a dental office, Fichthorn focuses on preventative care such as cleanings, fluoride treatments and oral health screenings.

Primarily serving patients without dental insurance, Fichthorn charges $75 for adult cleanings and $55 for children; rates more affordable than what most pay in premiums and out-of-pocket costs with dental insurance. Fichthorn’s services are more accessible than a traditional dental office, she says, and her flexible schedule allows patients to arrange appointments on short notice.

“When you come into my office, you know the price ahead of time and there are no hidden fees,” Fichthorn said. “Some of these corporate dental offices charge sterilization fees or submit insurance fees, and it all adds up.”

“With me, what you see is what you get,” she added.

While currently alone in her practice, Fichthorn hopes to grow her business by adding a receptionist and finding another hygienist to come on board.

For now, however, she just wants to educate Maine people that low-cost, high quality dental services exist in their communities.

“There is a choice,” Fichthorn said. “People need to know that there is an affordable and accessible option. If they come in, they will receive quality care because we [as hygienists] are looking out for them. We care about people.”

Even in professions where licensing is necessary, Maine’s onerous rules dissuade qualified professionals from relocating to Maine and deter current residents from pursuing employment in licensed fields.

If Maine wishes to attract more people like Kimberly Fichthorn to our state, it must address the laws and rules that separate qualified professionals from meaningful employment opportunities.

Had these barriers not existed in 2008, Fichthorn may have arrived nine years sooner.