Dental Workforce Supply Demand Dental Workforce Supply Demand

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Dental Workforce Supply Demand Dental Workforce Supply Demand

  1. 1. Dental Workforce Supply and Demand CPCA Oral Health Summit June 7, 2002
  2. 2. Facts and Figures: Supply <ul><li>Ratio of dentist-to population is decreasing </li></ul><ul><li>Dentistry is the least diverse of the health professions </li></ul><ul><li>Financial incentives for private practice are high, very small percentage of dentists work in the public sector </li></ul><ul><li>Educational systems are just now beginning to address issues of public service </li></ul><ul><li>Professional incentive programs to serve the underserved are few and have mixed results </li></ul>
  3. 3. Dentists per 100,000 U.S. Population 1950-2020 (Valachovic et al. JDE, 2001) Source: Bureau of Health Professions, HRSA, DHHS. Data from the Eighth Report to Congress 1991 and unpublished reports. 1950 1960 1970 1980 1990 2000 2005 2010 2015 2020 Actual Projected
  4. 5. Estimated Additions of Dentists to the Dental Workforce: 1995-2040 (Valachovic et al. JDE, 2001) Assumptions: number of graduates remains at 4050 retirement age of 65 year 2014 year 2023 -1706 year 1995 year 2040 year 2031 Source: American Association of Dental Schools
  5. 6. MSSAs with a Shortage of Primary Care Dentists: California Counties, 1998
  6. 7. Percent of Professionally Active Dentists by Gender and Race/Ethnicity (Valachovic et al. JDE, 2001) Source: American Dental Association Bureau of Health Professions, HRSA 86.3% White/Caucasian 3.3% Hispanic/Latino 3.4% Black/African American 6.9% Asian/Pacific Islander 0.1% Native American 14.1% Female 85.9% Male
  7. 9. Percent Distribution of Professionally Active Dental Specialists: 1998 (Valachovic et al. JDE, 2001) <ul><li>79.4% of professionally active dentists are generalists </li></ul><ul><li>20.6% are specialists </li></ul>Source: American Dental Association 0.8% 5.7% 8.2% 11.9% 14.1% 16.3% 16.4% 26.6%
  8. 10. Value Trends of Entering College Freshmen: 1966-1996 (Valachovic et al. JDE, 2001) 1966 1977 1996 Be well-off financially Develop a meaningful philosophy of life Source: Higher Education Research Institute, Univ. of California, Los Angeles
  9. 11. First-Time, First-Year Minority Enrollees in U.S. Dental Schools: 1990-1999 (Valachovic et al. JDE, 2001) 971 576 205 245 174 215 15 25 Source: American Dental Education Association
  10. 12. Workforce Development <ul><li>Issues include: </li></ul><ul><li>Distribution and composition </li></ul><ul><ul><li>Learn from other professions struggles </li></ul></ul><ul><li>Diversity </li></ul><ul><li>Education and training </li></ul><ul><ul><li>AEGD/GPR/CE </li></ul></ul><ul><li>Competencies </li></ul><ul><li>Competition for young workers </li></ul>The current system does not have the capacity to serve the underserved
  11. 13. Workforce Programs <ul><li>Recruitment , Retention , Training , Placement , CE </li></ul><ul><li>Loan Repayment / Scholarships </li></ul><ul><ul><li>NHSC, CASLR, IHS, Local/Private </li></ul></ul><ul><li>Post-Bac Program </li></ul><ul><ul><li>Additional help for those without resources - financial and educational </li></ul></ul><ul><li>Education Partnership Programs </li></ul><ul><ul><li>Track interested students from primary on up </li></ul></ul><ul><li>Service Learning </li></ul><ul><ul><li>Educational Partnership Agreement Dental Pilot Initiative (USC, UCLA, UOP)/RWJ pipeline program </li></ul></ul><ul><li>ABCD Program </li></ul><ul><ul><li>Training component teaches new skills for practicing dental professionals </li></ul></ul>
  12. 14. Dental HPSA Designations <ul><li>Requirements </li></ul><ul><li>Must be rational service area (MSSA) </li></ul><ul><li>Requires 5000:1 pop/ FTE dentist ratio </li></ul><ul><li>Or 4000:1 pop/FTE ratio with high needs </li></ul><ul><li>Contiguous area analysis required </li></ul><ul><li>Benefits Include </li></ul><ul><li>National Health Service Corps Placement </li></ul><ul><li>NHSC scholarships (select areas) </li></ul><ul><li>Funding preference for residency training programs in GPR for those who place graduates in shortage areas </li></ul>
  13. 16. Policy and Research: DHPSAs <ul><li>AB 668: California Dental Loan Forgiveness Program </li></ul><ul><ul><li>Currently being evaluated by OHSPD </li></ul></ul><ul><ul><li>2 key differences – matching funds can be from any source, HPSA criteria may not apply </li></ul></ul><ul><li>HRSA Evaluation of HPSA process at national level, found lack of articulation between process and goals of program </li></ul><ul><li>Center for Health Professions Study of Methdology in process </li></ul>
  14. 17. Facts and Figures: Demand <ul><li>Dentists have enjoyed and increase in net income indicating adequate demand for current services </li></ul><ul><li>Large portions of CA’s population does not receive care </li></ul><ul><li>Underserved populations suffer a disproportionate share of dental disease, but are least likely to attain services </li></ul><ul><li>Need and demand for services </li></ul><ul><li>are not the same </li></ul>
  15. 18. Supply vs. Demand Consumers need perception location costs Providers cultural comp supply prevention costs BIG GAP System Issues: Reimbursement, Safety Net, Public Health There is a disconnect between the professional agenda and practice realities of dental professionals and the public health goal of equity in access and optimally healthy communities. Access Barriers : Financial, Process, Attitudinal, Physical
  16. 19. Demand by Underserved Populations <ul><li>Demand vs. Need </li></ul><ul><ul><li>Demand = function (quantity, price) </li></ul></ul><ul><ul><li>Quantity of Services is Low, Price is High = Demand is Low </li></ul></ul><ul><ul><li>Then why the overcrowded clinics, long wait lists, complaints about lack of Medicaid providers, and ER Incidents? </li></ul></ul><ul><ul><li>NEED is high </li></ul></ul><ul><ul><li>Difference between met and unmet demand is UNMET NEED </li></ul></ul>
  17. 20. Barriers to Access <ul><li>Physical </li></ul><ul><ul><li>no services available in clinics, or for underserved populations </li></ul></ul><ul><li>Financial </li></ul><ul><ul><li>Capital costs, inability to attract providers, lack of reimbursement for preventive only </li></ul></ul><ul><li>Attitudinal </li></ul><ul><ul><li>beliefs or perceptions that impede delivering or obtaining care – latent demand </li></ul></ul><ul><li>Process </li></ul><ul><ul><li>navigational barriers - knowledge about eligibility, how to get dental care outside of ER </li></ul></ul>
  18. 21. Unmet Need and Latent Demand <ul><li>Increasing quantity of services and decreasing price will decrease unmet need. </li></ul><ul><li>Demand for restorative services is activated with pain, no need to increase this demand! </li></ul><ul><li>Demand for preventive services (which may be latent) can be activated, through outreach and education, referrals, or exposure in other settings </li></ul>Preventive Care Restorative Care
  19. 22. Differentiate Markets for Preventive and Restorative Services <ul><li>Quantity of services is diminishing in overall market </li></ul><ul><ul><li>Shortage of Dentists, particularly in public market </li></ul></ul><ul><ul><li>Hygienist and Assistant ranks growing, but linked to dentists </li></ul></ul><ul><li>Market for preventive and restorative services is link through practice acts </li></ul><ul><li>Strategies vary for increasing access to preventive and restorative care: different costs, different financing, and different providers </li></ul>
  20. 23. Redefining the Oral Health Care Workforce <ul><li>Interdisciplinary models for </li></ul><ul><li>care delivery exist </li></ul><ul><li>Expand roles of non-oral health professionals to assist in prevention, referrals and oral health education </li></ul><ul><li>Easiest to reach underserved populations in existing settings (primary care clinics, WIC offices, schools) </li></ul><ul><li>Many barriers as professional boundaries and traditional modes of practice are change averse </li></ul>
  21. 24. Challenge for Primary Care <ul><li>Can primary care systems help increase access to oral health care for underserved, and reduce levels of disease, particularly in the most vulnerable, poor, children, elderly, and disabled? </li></ul><ul><li>Is there a way to integrate both preventive and restorative oral health services into primary care? </li></ul><ul><li>Can you entice the next generation of oral health providers to work in primary care settings? </li></ul><ul><li>Will oral health and primary health care be able to bridge professional gaps and confront legal, educational and practice barriers that currently stand in the way of integrating care? </li></ul>
  22. 25. <ul><li>3333 California Street, Suite 410 </li></ul><ul><li>San Francisco, CA 94118 </li></ul><ul><li>415-476-8181 phone </li></ul><ul><li>415-476-4113 fax </li></ul><ul><li>http://futurehealth.ucsf.edu </li></ul><ul><li>Presentation Available at </li></ul><ul><li>http://futurehealth.ucsf.edu/resources/roadshow.html </li></ul>

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