Michigan Department of Community Health Bureau of Health Professions  Prevention  Regulatory  Disciplinary  Workforce Excellence

Health Licensing Division 26 Licensed Health Professions Over 400,000 Health Care Professionals 19,713 Dentistry Licenses Granted (7,637 Dentists; 9,623 Dental Hygienists; 1,263 Dental Assistants

Health Regulatory Division Receives Allegations of Misconduct from the public or health professionals 3,121 Allegations of Misconduct in FY ,859 Allegations 1994 through 2006

Top Five in FY 2006: Negligence/Incompetence: 1080 (35%) Criminal Conviction: 345 (11%) Substance Abuse: 291 (9%) Drug Diversion: 157 (5%) Continuing Education: 111 (4%)

Top Four Professions: Nursing: 1,002/157,193 (.6%) Medicine: 828/33,528 (2.5%) Dentistry: 254/19,713 (1.3%) Osteopathic: 239/7,001 (3.4%)

Health Investigation Division Investigates factual allegations that represent true violations 832 investigations authorized from 3,121 allegations in FY 2006 (27%) 519 disciplined health professionals (from 832 investigations) in FY 2006

Top Four Disciplinary Actions in FY 2006: Probation: 238 (46%) Suspended License: 205 (39%) Fine Imposed: 52 (10%) Voluntary Surrender: 27 (5%)

Workforce Development, Research, & Evaluation Section (WDRE) WDRE Section formed in August 2006 WDRE staffs the Michigan Healthcare Workforce Center MHWC major functions: Serves as a clearinghouse for workforce data Administers surveys to licensed health professionals Convenes and/or participates with groups to address workforce issues Conducts research and publishes papers on workforce related issues

(WDRE) Section (cont’d) MDCH/MDE/MDLEG/MDHS/MHC/OCNE Serve as Advisory Body to MHWC Professional Licensee Workforce Surveys (Phys/Dental/Nurs/Pharm/PA) Professional Scope of Practice/Corporate Structure for Professional Practice

Healthcare Information for Professionals and Health Consumers Two Newsletters Two Newsletters Six Websites Six Websites Board Support: Over 1,600 Professional Practice Inquiries from Professionals or the public responded to annually Board Support: Over 1,600 Professional Practice Inquiries from Professionals or the public responded to annually

Professional Practice Issues Currently Being Investigated Continuous Professional Development Continuous Professional Development E-Health E-Health Pain & Symptom Management Pain & Symptom Management Sexual Boundary Violations Sexual Boundary Violations Patient Safety Patient Safety

FY 2007 Dental Survey Findings Two-page (21-22 questions) survey available online and through mail Collects demographic, employment, practice, and patient information One-third of all Michigan dentists and hygienists received the survey 697/2,777 renewing dentists (25%) and 2,062/3,433 renewing DYHGs (60%) completed the survey

FY 2007 Dental Survey Findings (cont’d) 43% Dentists and 38% DHYGs plan to work only one to ten more years (compared to nurses and physicians at 33% and 34% respectively) 7% of dentists plan to reduce patient care hours within three years

FY 2007 Dental Survey Findings (cont’d) 7% of dentists plan to retire in the next three years 80% of dentists who plan to retire or reduce patient hours cite age as a factor in their decision. 37% of dentists are 55 years of age or older 81% of dentists are male; 99% of DHYGs are female

FY 2007 Dental Survey Findings (cont’d) 85% of dentists and 95% of DHYGs are white 64% of dentists report seeing no Medicaid or MIChild children in a typical month. Only 1% of dentists report seeing an average of 250 or more of these patients each month. 86% of dentists report that none of their patients in a typical month are covered by Medicaid. Only 1% report seeing an average of 60 or more of these patients each month.

FY 2007 Dental Survey Findings (cont’d) 75% of dentists report seeing 20 or fewer uninsured children in a typical month. Only 1% report seeing an average of 300 or more of these patients each month. 75% of dentists report 30 or fewer uninsured adults each month. Only 1% report seeing an average of 500 or more of these patients each month. 82% of dentists renewing their license in Michigan attended a Michigan Dental School.

Findings of the FY 2007 Dental Surveys Reflect National Findings: The aging healthcare workforce is likely to result in a worsening shortage of dental health care in Michigan. Few Michigan dentist are seeing low income, uninsured or underinsured children and adults. Ethnic minorities are underrepresented among dental health professionals. There is a gender bias toward male dentists and female dental hygienists. The greatest predictor of what state a dentist practices in is where s/he attended dental school.

Michigan’s Shortage of Dental Care Compared to other Midwest States* StateTotal PopUnderserved Pop% Pop UnderservedFTEs Needed MI10,120,8601,120, %238.5 OH11,464,042741,6586.5%169.3 IL12,763,3711,419, %349.2 IN6,271,973134,6512.1%36.9 WI5,536,201398,0607.2%104.0 Target Ratio for Dental Care is:  1 FTE for every 5,000 people located in a geographic shortage area  1 FTE for every 4,000 low income population area (30% are at or below 250% Poverty)

Michigan Dental HPSA Severity Among 83 Counties 2 Full County Geographic HPSAs (2%) 54 Full County Population Group HPSAs (66%) 9 Partial County Population Group HPSAs (11%) 65 Michigan HPSA Counties (79%) 18 Non-HPSA Counties (21%)

Recruitment and Retention Tools in Midwest States StateSchool/Students in 2007Current NHSC PlacementsSLRP Placements MI2 (184)3653 (total = 89) OH2 (190)1533 (total = 48) IL2 (118)2026 (total = 46) IN1 (101)613 (total = 19) WI1 (80)936 (total = 45)

Dental Recruitment & Retention Challenges/Opportunities Weakness/Challenges: Low number of dentists serving uninsured/Medicaid population Low number of dentists serving uninsured/Medicaid population High percentage of at risk (uninsured and Medicaid enrolled) population High percentage of at risk (uninsured and Medicaid enrolled) population Michigan = 11% and 15.1% Ohio = 11.7% and 16.7% Illinois = 14% and 16.3% Indiana = 12.9% and 14.5% Wisconsin = 9.5% and 15.9%

Dental Recruitment & Retention Challenges/Opportunities (cont’d) Aging dental workforce Aging dental workforce Poor Michigan economy (lure of states with better weather & better economies) Poor Michigan economy (lure of states with better weather & better economies) Increased demand for dentists in other Midwest states due to closure of 2 Chicago dental schools Increased demand for dentists in other Midwest states due to closure of 2 Chicago dental schools Low Medicaid reimbursement rates Low Medicaid reimbursement rates Michigan’s State Loan Repayment Program (SLRP) places relatively few dentists in southeast Michigan. Michigan’s State Loan Repayment Program (SLRP) places relatively few dentists in southeast Michigan. There are only 3-6 dentist applicants to SLRP each year. There are only 3-6 dentist applicants to SLRP each year.

Dental Recruitment & Retention Challenges/Opportunities (cont’d) Strengths/Opportunities Michigan’s beauty and low-cost housing Michigan’s beauty and low-cost housing High percentage of underserved provides opportunity for new dentists High percentage of underserved provides opportunity for new dentists High percentage of underserved provides opportunity for federal & state loan repayment reimbursement and scholarship opportunity High percentage of underserved provides opportunity for federal & state loan repayment reimbursement and scholarship opportunity Michigan has the largest State Loan Repayment Program in the nation Michigan has the largest State Loan Repayment Program in the nation Michigan has a disproportionately larger share of federal (NHSC) loan repayment recipients Michigan has a disproportionately larger share of federal (NHSC) loan repayment recipients

Dental Recruitment & Retention Challenges/Opportunities (cont’d) Michigan SLRP and NHSC could target Detroit and other metro areas for dental placements Michigan SLRP and NHSC could target Detroit and other metro areas for dental placements The SLRP and NHSC could be marketed to Michigan dental schools The SLRP and NHSC could be marketed to Michigan dental schools Establish another Michigan dental school and increase admissions to current schools Establish another Michigan dental school and increase admissions to current schools Legislation for increased Medicaid reimbursement for practicing in a dental HPSA Legislation for increased Medicaid reimbursement for practicing in a dental HPSA Develop and national Practice in Michigan campaign that targets or includes dental professionals Develop and national Practice in Michigan campaign that targets or includes dental professionals Increase Medicaid reimbursement rates and reduce reimbursement processing time Increase Medicaid reimbursement rates and reduce reimbursement processing time

Healthcare Workforce Websites Michigan Healthcare Workforce Center Michigan Health Careers Michigan Center for Health Professions Michigan Center for Nursing Pain and Symptom Management Patient Safety

Bureau of Health Professions Steven Creamer, Manager Workforce Development, Research, and Evaluation Section