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14 Concluding Remarks In this session, members of the planning committee reflected on the overall themes they perceived during the workshop. David N. Sundwall, M.D. Utah Department of Health Extraordinary efforts are underway to improve access to oral health care services for many populations including children, adults, rural popula- tions, and specific ethnic groups. The workshop provided a menu of op- portunities to address the challenges of access to oral health care services. These and other options not discussed should be adopted immediately. Sun- dwall thanked the audience for being active, engaged, and forthcoming. Marcia Brand, Ph.D. Health Resources and Services Administration HRSA has been interested in examining the adequacy of the oral health workforce for quite some time. Brand remarked that as a sponsor of the workshop, she was pleased to bring together people with different view- points to talk about the adequacy of the workshop, the challenges, and the opportunities for partnerships with HRSA that can continue in the future. Brand thanked the participants for their passion, scholarship, and dedica- tion to these issues. 125
126 THE U.S. ORAL HEALTH WORKFORCE Shelly Gehshan, M.P.P. Pew Center on the States When approaching solutions to oral health access, all types of profes- sionals need to remember that change often requires a legislative process. To help legislatures make these decisions, professionals need to help the legislators sort fact from fiction, especially by countering anecdotes with evidence. Expressing beliefs or opinions is valid, but should not be pre- sented as facts. Another point to consider is the economic crisis that is creating a situation in which much less money is available than is needed. However, this may help foster the creation of more innovative solutions. States are especially good at being innovative when faced with insufficient budgets. Along with this creativity, though, data needs to be gathered to create an evidence base. Two of the continuing debates in the new models of care are respon- sibility for restorative care and levels of supervision, much of which will need to be defined by an evidence base. As these issues are explored, more attention is needed for communication and messaging, especially in the consideration of terminology. Oral health professionals need to become more skilled at strategic messaging. For example, irreversible procedures can mean nothing to a policy maker or may imply a negative connotation that is not warranted. Communication within the professions is key to moving forward. In conclusion, there are great grounds for optimism. Oral health stakeholders need to enter into creative partnerships and reach out to nonÂtraditional practitioners to move forward on a number of different solutions. Elizabeth Mertz, M.A. Center for the Health Professions, University of California, San Francisco Many of the solutions to improving access to oral health services r Â equire developing a framework that includes new ideas, new ways to think about old problems, and ways to reframe current problems. The health care delivery system accounts for only a very small percentage of health outcomes, yet most of the money and debate centers around that part of the equation. More attention is needed on how to affect the social and behavioral environments, but the current health care delivery system has little capacity to address those broader issues. This lends to the impor- tance of bringing all stakeholders together to determine shared goals and outcomes in areas of financing, education, and regulation. More evidence
CONCLUDING REMARKS 127 is needed to inform these decisions and therefore curiosity and innovation should be fostered. Without evidence, threats and fear will continue. To create this framework, stakeholders need to consider the tools and pro- cesses at their disposal to overcome barriers and create a ripple effect of change. Moving ahead also requires recognition of a call to action. Many people are frustrated that the same discussions are taking place today that took place decades ago. In conclusion, solving these challenges requires consideration of new ideas, recognition of available tools, and acceptance of the call to action. Len Finocchio, Dr.P.H. California HealthCare Foundation It is not unethical to not be charitable. That is a personal choice. However, it is unethical for individuals or groups to unjustifiably and self- ishly stand in the way of dedicated and capable professionals caring for persons and groups that other professionals are not serving. Health profes- sions should be judged and, in part, regulated by how it stewards limited resources to best meet public needs. Students today need not only to have some idea of their professional responsibility to be a good clinician, but also about how the decisions they make affect the way resources are distributed to take care of public needs. Daniel Derksen, M.D. University of New Mexico Stakeholders need to move past talking and recommending and need to overcome their differences. There are many people who have been fighting these issues in the trenches for many years. This passion needs to continue in legislative offices, in universities, and in communities to make change a reality. More students from rural areas and underrepresented minorities need to be recruited into health professions, because they will be the ones most likely to practice in areas that serve the populations with the greatest needs. Finally, more recognition is needed for the power of a good story. The only way change will happen is if individuals take the courage to move their personal convictions into action within their institutions, their com- munities, and at the state and national levels.