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In 1998, at the First PFA International Continuing Education Symposium in London on 22 June (Dental World, Sept/Oct 1998 issue), then U.S. National Institute of Dental Research Director, now USC School of Dentistry Dean, Harold Slavkin warned the dental profession that with the increasing population and the closing of many dental schools, we were going to be facing a severe shortage of dentists by 2005. Several dentists heralded this as reduced competition, but Dr. Slavkin noted that they may celebrate now, but when it came time to pass their dental office on to newer hands, those hands would not be there. Practicing dentists had better not consider their office as a retirement package for their old age.
Newer, expensive dental technology coming into the marketplace will also age the functioning dentists’ practices of today. Outfitting an older office with the newer technology would not be cost-effective over the remaining productive life span of the older dentist. Yet not to would make the office less attractive to a new graduate for purchase.
In Dental World, May/June 2002 issue, we reported on an article from The Academy of General Dentistry entitled “Rethinking Licensure,” which noted the rural shortage of dentists and what some states were doing about it.
Now we have received an article from Oral Health America, which is a fully independent organization dedicated to improving oral health in the United States, titled “Dentist Shortage Goes Beyond Rural Regions.” Their research resulted in noting that 25 states, many in the Midwest, had a shortage of dentists. The shortage in the Midwest should come as no surprise after the closings of dental schools at Loyola, Northwestern, Washington University of St. Louis, and Oral Roberts. The dental school at Marquette University (Milwaukee) needs to be subsidized by Wisconsin to stay open.
Oral Health America used the criteria of one dentist for every 2000 people. And Nevada’s ratio was one dentist for every 3100 residents. But Nevada is addressing the problem by “rethinking licensure” and opening a new dental school.
Other states above this 1:2000 ratio are Alabama, Arizona, Arkansas, Delaware, Florida, Georgia (where the Emory Dental School closed), Idaho, Indiana, Kentucky, Maine, Maryland, Mississippi, Missouri, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wyoming. In most of these states this reflects under served rural areas. But even in the states with a 1:2000 ratio, particularly in the Midwest, many urban areas are currently underserved. Highly populated cities lack dentists serving Medicaid/public health beneficiaries and the uninsured.
ADA past President Joseph Devine addressed this in his speech at our Awards Banquet last October. When public aid programs underpay the provider, you cannot make up in volume for each patient loss in revenue and continue to stay in business.
President Robert Klaus of Oral Health America noted, “Having an adequate supply of dentists is key to ensuring that Americans can access oral health care. We cannot continue to ignore the oral health of rural America and the other underserved areas.”
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What is the answer?
The problem is more complex than simply running off a list of figures. As a result, the solutions are going to be more complex.
Figures will tell you that work time in the labor force is down mostly by dental emergencies than any other factor—even when the workers are covered by dental insurance.
Access by producing more dentists is only part of the answer. In the 1960s, new dental schools were opened, existing schools increased enrollments through government capitation programs, and there were more dentists graduated. But these new dentists stayed in already served areas where remuneration compensated them well for their work, and they lived in areas where they could make maximum use of the recreational advantages.
The Public Health Service flourished during the 1960s and 1970s as an alternative to active service in the Armed Forces. But when peace came and the draft ended, the PHS, which was serving rural areas, lacked the manpower as well.
State licensure strangles locating in another State through the fear that one state would become overpopulated with dentists wanting to live there. Nowhere is the economic factor of supply and demand calculated in. If you were a dentist in the European Union, you could practice anywhere in Europe that is a member. In many third-world countries, you do not even need a license to practice dentistry, they are so desperate for dentists. But in the United States, your license is restricted to your state. Teeth change from state to state, you know.
The bottom line is simply an economic one. Dentists will locate where they can achieve a level of living commensurate with their talents, and the years they suffered achieving dental skills, and the years of experience practicing those skills. A secondary reason is closeness to areas that they can easily travel to enjoy the benefits of their labors.
Rural areas can be attractive to raise a family in. But inner-city public aid areas are not worth the risk in placing yourself in harm’s way, after all those years to achieve a doctor’s degree, for such little compensation. Again, the bottom line is economics.
In recent years, advertising, insurance companies, government restrictions have all attempted to reduce the honored profession to that of a business that can be dealt with on a profit/loss basis. Even the general population has begun to buy into the concept that dentistry is merely a service commodity, and not an honored profession. This has also resulted in fewer individuals choosing dentistry as a profession, and many enter into it as they would a successful business opportunity.
If you want to lay this on the back of government, reread the series of articles in Dental World by Dr. Amarjit Gill of the United Kingdom describing socialized dentistry gone wrong. Again the bottom line is economics.
“Houston, we have a problem!” |
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International Committee
Chairman Ernesto Acuna discussed the financial impact on many third-world countries where many eligible members simply cannot afford membership at this time. Many existing Fellows have considered dropping their membership because of financial reasons. One of the thoughts to be considered is some form of dues reduction to these areas. The Central Office and President responded that each country’s situation is considered by the Executive Committee on a case-by-case basis. They had reviewed the FDI’s dues structure, which is a sliding scale based on that country’s GNP, but it was determined that this would cause a larger reduction in income if we implemented that. The FDI is securing the majority of their funding from their annual Congress with the dues structure being secondary. PFA has no such major funding input as a Congress and must rely exclusively on the income from the dues.
There is another consideration that PFA is an international honor organization inviting only that country’s elite dentists to become Fellows in comparison to FDI, which accepts any dentist wishing to be a member.
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Trustee Bernardo Levit reinforced Dr. Acuna’s statements that some of his area’s elite dentists, giving of themselves to help the general population or teaching in academic institutions, do not make the money to be able to accept our invitation. On the other hand, many dentists who can afford the dues and want to be members are not qualified by our standards.
The Central Office assured the Board that they are constantly examining this problem. But even in our own country, the costs of maintaining the International Office have risen, the interests of the Board in updating and modernizing our operations have stretched our means to provide these services to where it has become necessary for the Foundation to assist us in executing our programs to keep them running or to initiate them. To pare back our major source of income in collecting dues would result in a reduction of services provided and programs being run, which make PFA what it stands for globally.
These are difficult decisions that face the Board annually, and the Executive Committee quarterly, and the Central Office daily.
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