NGA Policy Academy forNGA Policy Academy for State Officials Improving State Officials Improving

Oral Health Care for ChildrenOral Health Care for Children

WORKFORCE ISSUESWORKFORCE ISSUES

Richard W. Valachovic, D.M.D., M.P.H.Executive Director

American Dental Education Association

May 7, 2001

©ADEA 2001

National Health and Dental Service Expenditures: 1980 - 1998

1990 1992 1993 1994 1995 1996 1997 1998

National Health Expenditures Dental Service Expenditures

$1149.1

$31.6 $53.8

4.5%* 4.7%*

$699.4

* Dental Expenditures as a Percent of Total Health Expenditures

In B

illi

ons

of D

olla

rs

©ADEA 2001

Dentists per 100,000 U.S. Population1950 - 2020

51.5

52.7

59.5

49.0

45

47

49

51

53

55

57

59

61

Actual Projected

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 Data from the Eighth Report to Congress 1991 and unpublished reports.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

©ADEA 2001

Percentage Distribution of the Employment Status for All U.S. Dentists in Private Practice: 1998

Sole Proprietors Partners

Non-owner Dentists Independant Contractors

Sole Proprietors

76.6%

Partners 15.5%

Non-owner Dentists 5.4%

Independent Contractors 2.5%

Source: American Dental Association 1999 Survey of Dental Practice.

92.7% of professionally active dentists are in private practice.

92.7% of professionally active dentists are in private practice.

©ADEA 2001

Percent of Professionally Active Dentists by Gender and Race/Ethnicity

Male 85.9%

Female 14.1%

Native American 0.1%

Asian/Pacific Islander 6.9%

Black/African American 3.4%

Hispanic/Latino 3.3%

White/Caucasian 86.3%

Source: American Dental Association Bureau of Health Professions, HRSA

©ADEA 2001

Percent Distribution of Professionally Active Dental Specialists: 1998

0 5 10 15 20 25 30

Orthodontists

Oral & Maxillofacial Surgeons

Pediatric Dentist

Periodontics

Endodontists

Prosthodontists

Public Health Dentists

Oral Pathologists•79.4% of professionally 79.4% of professionally active dentists are active dentists are generalists generalists

•20.6% are specialists20.6% are specialists

Source: American Dental Association

0.8%

5.7%

8.2%

11.9%

14.1%

16.3%

16.4%

26.6%

©ADEA 2001

U.S. Dental Schools: Number by Type 1950 - 2001

0

10

20

30

40

50

60

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Public Private Private/State-Related

6054

PUBLIC

PRIVATE

PRIVATE/STATE-RELATED

Source: American Dental Education Association©ADEA 2001

Dental School

©ADEA 2001

U.S. Dental School Graduates1955 - 1999

0

1,000

2,000

3,000

4,000

5,000

6,000

1955 1960 1965 1970 1975 1980 1985 1990 1995

Source: American Dental Association

5,756

4,095

3,181

©ADEA 2001

U.S. Dental Schools: Trend of Applicants and First Year Enrollees

1950-1999

0

3,000

6,000

9,000

12,000

15,000

18,000

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995

Applicants First-Year Enrollment

15,734

6301 4996

9829

Source: Applicants- American Dental Education Association Enrollment- American Dental Association

9010

43143979

4644

3573

©ADEA 2001

Estimated Additions of Dentists to theDental Workforce: Years 1995 to 2040

-2000 -1500 -1000 -500 0 500 1000 1500

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©ADEA 2001

Percent of Dental Practitioners Employing Allied Dental Personnel: 1998

0 20 40 60 80 100

Dental Assistant

Dental Hygienist

Receptionist

Business Personnel

Sterilization Asst.

Lab Technician

Source: American Dental Association

7%

11%

36%

90%

63%

94%

©ADEA 2001

First-Year Enrollment in U.S. Allied Dental Programs: 1970 - 1998

0

3,000

6,000

9,000

1970 1975 1980 1985 1990 1995

Dental Hygiene Dental Assisting Dental Laboratory Technology

Source: American Dental Association

DENTAL ASSISTING

DENTAL HYGIENE

DENTAL LABORATORY TECHNOLOGY

6162

6087

487

©ADEA 2001

Number and Type of U.S. Allied Dental Programs: 1970 - 1998

0

50

100

150

200

250

300

350

1970 1975 1980 1985 1990 1995

Dental Hygiene Dental Assisting Dental Laboratory Technology

Source: American Dental Association

248

237

34

DENTAL ASSISTING

DENTAL HYGIENE

DENTAL LABORATORY TECHNOLOGY

©ADEA 2001

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

First-Year Enrollment Women's Enrollment

Total and Women First-Year U.S. Dental School Enrollment

1970 - 1999

1624 women

4314 total

Source: American Dental Association

TOTAL FIRST-YEAR ENROLLMENT

WOMEN ENROLLMENT

37.6% of first-year enrollment is women.

1970 1975 1980 1985 1990 1995

©ADEA 2001

Percent U.S. Dental School First-Year Enrollment by Race/Ethnicity: 1980 - 1999

0%

5%

10%

15%

20%

25%

30%

35%

40%

1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Native American or Alaska Native Asian or Pacific IslanderBlack or African-American Hispanic

23.8%

0.5%

4.6%

5.1%

Source: American Dental Association©ADEA 2001

First-Time, First-Year Minority Enrollees in U.S. Dental Schools: 1990-1999

0

200

400

600

800

1000

1200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Asian/Pacific Islander Black/African-AmericanHispanic/Latino Native American/Alaska Native

971

576

205245

17421515 25

Source: American Dental Education Association©ADEA 2001

U.S. dentist-population ratio by race/ethnicity(BHPr, HRSA, 1996)

Total Black Hispanic Asian White Dentists 154,900 5,200 5,200 10,700 133,600

DMD:Pop 1:1700 1:6000 1:5400 1:860 1:1450

©ADEA 2001

Dentists & patients by race/ethnicity

Patients> White Hispanic Black Asian

Dentists\/

White 76.6% 8.5% 10.5% 3.2%

Hispanic 43.6% 45.4% 9.8% 3.0%

Black 27.0% 7.9% 61.8% 2.3%

Asian 47.5% 14.5% 11.5% 25.1%(ADA, 2000)

©ADEA 2001

Average First-Year Resident Tuition andFees by Type of U.S. School: 1970-1998

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

1970 1975 1980 1985 1990 1995 1996 1997 1998

Public Average of All Schools State Related Private

Source: American Dental Association

$28,688

$20,590

$14,504

$8,983

©ADEA 2001

Graduating Debt by Type ofU.S. Dental School: 1979 - 2000

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Average of All Schools Public State-related Private

Source: American Dental Education Association

PRIVATE

PRIVATE-STATE RELATED

PUBLIC

ALL SCHOOLS

©ADEA 2001

Mean Educational Debt of Indebted Medical and Dental Graduates

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

1996 1997 1998 1999 2000

Dental Students Medical Students

$106,000

$94,900

Medical School information provided by Association of American Medical Colleges, AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals, 1999 (51)

©ADEA 2001

Dental Benefit Plans: 1999

0 10 20 30 40 50 60 70

Percent of population enrolled in a benefit plan

56.1%

Percent ofenrolled populationby type of plan

17.9%HMO

PPO 31.2%

OTHER 7.5%

INDEMNITY 43.0%

% % % % % % % %

Patient insurancecoverage amongall dentists (1997) PRIVATE BENEFIT PLAN 63.0%

NO PLAN: SELF PAY 30.7%

PUBLIC ASSISTANCE 5.4%

Source: -National Association of Dental Plans 2000 -American Dental Association Survey Center

TOTAL

©ADEA 2001

Dentists’ Participation in Capitation and Preferred Provider Dental Plans: 1999

34.8% PPO only

2.4% Capitation only

12.8% PPO & Capitation

50.0% Neither Plan

Source: American Dental Association

©ADEA 2001

U.S. Dental School Graduates’Immediate Practice Plans: 1980-2000

0%

5%

10%

15%

20%

25%

30%

35%

40%

1980 1985 1990 1995 1996 1997 1998 1999 2000

Government UndecidedTeaching Solo Practice Partner-Group EmployedPostdoctoral Education

Source: American Dental Education Association

POSTDOCTORAL EDUCATION

EMPLOYED

PARTNER-GROUP

SOLO

36.5%

9.5%

5.5%

34.1%

©ADEA 2001

Average Net Income of Full Time, Solo, Private Practice U.S. Dentists: 1990 - 1998

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

Source: ADA Survey Center, 1999 Survey of Dental Practice.

65% Increase: 1990-1998

1990 1991 1992 1993 1994 1995 1996 1997 1998

$155,750

$94,220

©ADEA 2001

U.S. Postdoctoral Dental EducationFirst-Year Enrollment: 1971 - 1999

0

500

1,000

1,500

2,000

2,500

3,000

1971 1974 1977 1980 1983 1986 1989 1992 1995 1998

Total Advanced Total Specialty GPR AEGD

GPR

Source: American Dental Association

SPECIALTY

AEGD

Total 2601

1202

879

520

©ADEA 2001

Examples of State Efforts

• Improve dentist participation in Medicaid

• Loan forgiveness programs

• Scholarships• New dental schools• Tax incentives

• Expand allied programs

• Change licensure requirements

• Primary school-based clinical care

• NHSC models• Hospital-based

programs

©ADEA 2001