Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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9 A Dental Work Force for the Future
9 A Dental Work Force for the Future
Pages 254-280
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From page 254... ...
Are the composition and distribution of the dental work force satisfactory? Should enrollments in dental schools be increased, decreased, or held steady?
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From page 255... ...
Chapter 5 discusses the oral health research work force and notes the shortage of qualified researchers. It cites the recent report of the Office of Science and Engineering Personnel of the National Research Council.
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From page 256... ...
However, nearly two-thirds believed that the country would be undersupplied with dentists in 15 years {Table 9.1~. A majority of respondents reported that the supply of dental hygienists and formally trained dental assistants was too Tow currently and pro TABLE 9.1 Deans' Responses to Supply Questions in Institute of Medicine and American Association of Dental Schools Survey For the following questions, please indicate your opinion.
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From page 257... ...
Composition of Work Force Dentistry used to be a profession of white mates, but that is changing. The proportion of women in the dental work force has grown dramatically since women began entering dental schools in substantial numbers in the 1970s.
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From page 258... ...
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From page 259... ...
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From page 260... ...
According to a 1994 report, African-Americans have not achieved overall population parity in dental school enrollments but are closer to educational parity {GAO, 1994~. Population parity compares the percentage of African-Americans in dental schools to the group's percentage of the total population.
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From page 261... ...
The committee did not find specific quantitative projections of population "requirements" for dental personnel similar to those that have been developed for the physician work force {FeiT et al., 1993; Wennb erg et al., 1993; Weiner, 1994~. This analytic disparity presumably reflects the greater concern of analysts and policymakers about a physician work force that is compared to the dental work force much larger, much more specialized, more expensive, and more routinely involved in more diverse practice sites and organizational systems.
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From page 262... ...
Nonetheless, the numbers raise the possibility of some reserve capacity in the dental work force, although differences in work load may reflect different choices about lifestyle, income, and other factors that might limit the extent to which dentists would increase their work load in response in an increase in the demand for their services. - Whatever the national supply picture, state or regional circumstances may differ.
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From page 263... ...
Most of the deans surveyed by this committee believed that the current supply of dental hygienists and formally trained dental assistants was too Tow now and would still be too low in 15 years (see Table 9.1~. Although no government or private organization routinely makes formal projections of trends in the supply of hygienists, assistants, or laboratory technologists, the Bureau of Health Professions predicts the number of jobs that will be available for hygienists in the future.
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From page 264... ...
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From page 265... ...
us 'A ~ ~ o ~ o be cat O cn 4J - ~ ~ o ~ o .
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From page 266... ...
TABLE 9.2 Projection of Active U.S. Dentists by Year of Published Prediction Year Prediction Year Predicted Organization Published 1990 2000 2010 2020 American Association 1988 149,680 154,007 148,187 137,365 of Dental Schools 1989 140,699 142,379 137,197 133,214 American Dental 1988 149,970 156,611 Association 1989 140,842 143,057 1990 CensusJ ~ 150,762)
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From page 267... ...
As an example of the prediction errors that can arise from incorrect assumptions, the 1978 Bureau of Health Professions overestimated supply because it incorrectly assumed that the decline in school enrollments would level off in the early 1980s. Because enrollments continued to drop instead, the resulting enrollment estimate was too high by 7,500 over an eight-year period.
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From page 268... ...
In addition, although the demand for dental services is sometimes measured by utilization of office visits, this measure does not reveal variations in the quantity and types of service that may be delivered during a visit. {For further discussion, see the background papers on oral health status by White et al.
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From page 269... ...
The prospect for increased insurance coverage of dental services is uncertain, but an expansion of public or private coverage could increase demand, especially if additional efforts are made to reach those with significant unmet needs. The presence of reserve capacity in the current dental work force could, however, absorb some or all of any increased demand.
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From page 270... ...
For example, the closure of a large number of dental schools for financial reasons would require a reassessment of the future supply of oral health services and the appropriateness of compensat sing actions. Continued investments by government agencies and private organizations in the forecasting models and analyses are prudent as are similar investments in the quality and scope of data used in the models.
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From page 271... ...
The last broad increase in enrollments in health professions schools was spurred by increased federal and state funding, a simple replication of which seems highly unlikely given current fiscal stringency and past government experience with this strategy. Compared to most other fields, an increase in predoctoral dental school enrollments makes heavy demands for specialized and expensive physical space , ~ and many schools that have cut enrollments say they have given up space to other university divisions
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From page 272... ...
These roles involve a mix of new responsibilities and old responsibilities more intensively exercised. Studies suggest that dentists trained to work with allied dental personnel are more productive and that allied personnel working in less restrictive delivery systems can provide high-quality care within their areas of competency {Burt and Eklund, 1992; Freed and Perry, 1992; see also the background paper by Tedesco)
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From page 273... ...
is more accurately described as a failure to use the existing work force appropriately {ADHA, 1989, cited in ADHA, 1993~. Although dental hygiene enrollments have recently increased, inadequate recruitment for a broad range of allied health fields is still a concern (IOM, 1989a; Pew Health Professions Commission, 1993~.
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From page 274... ...
Although this committee did not systematically investigate how generalist or specialist physicians might provide oral health services in the event of undersupply of dental professionals, Chapters 3 and 4 of this report have called for increased attention by physicians to oral health concerns. Reducing the Use of Emerita]
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From page 275... ...
Such concerns are not restricted to an "undersupply" scenario as current debates over strategies to contain health care costs attest. They reinforce the committee's call for intensified efforts to measure oral health outcomes and to distinguish clearly beneficial interventions from those that are harmful or ineffective.
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From page 276... ...
2J. The Department of Health and Human Services developed an oral health initiative in FY 1994 in response to Senate concerns about limited access to "primary care oral health services" and inadequate identification of affected areas and populations {U.S.
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From page 277... ...
Americans has, in contrast, not grown. ~-~ _ ~ ~ , The GAO figures on population versus educational parity for African-American enrollments in dental schools underscore the importance of increasing the flow of individuals academically prepared from their earliest educational experiences to choose a health professions career.
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From page 278... ...
The problem of minority attrition after recruitment to dental school warrants particular attention. FINDINGS AND RECOMMENDATIONS After reviewing work force models and projections and their underlying assumptions, the committee found no compelling case, at this juncture, that the overall production of dentists will, in the next quarter century, prove too high or too low to meet public demand for oral health services.
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From page 279... ...
to meet demands for oral health care. To improve the availability of dental care in underserved areas and to limit the negative effects of high student debt, Congress and the states should act to increase the number of dentists serving in the National Health Service Corps and other federal or state programs that link financial assistance to work in underserved areas.
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From page 280... ...
Another legacy of past policies is tension between the education and practice communities that extends beyond enrollment questions to complicate efforts to broaden and enrich the educational and patient care programs of dental schools. This chapter has argued for caution in changing dental school enrollments and for continued efforts to reshape the distribution and composition of the dental work force.
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