NGA Policy Academy for State Officials Improving Oral Health Care for Children WORKFORCE 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: $ $31.6 $ % * 4.7% * $699.4 * Dental Expenditures as a Percent of Total Health Expenditures In Billions of Dollars ©ADEA 2001

Dentists per 100,000 U.S. Population ActualProjected Source: Bureau of Health Professions, HRSA, DHHS. Data from the Eighth Report to Congress 1991 and unpublished reports ©ADEA 2001

Percentage Distribution of the Employment Status for All U.S. Dentists in Private Practice: 1998 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. ©ADEA 2001

Percent of Professionally Active Dentists by Gender and Race/Ethnicity Male85.9% Female14.1% Native American0.1% Asian/Pacific Islander6.9% Black/African American3.4% Hispanic/Latino3.3% White/Caucasian86.3% Source: American Dental Association Bureau of Health Professions, HRSA ©ADEA 2001

Percent Distribution of Professionally Active Dental Specialists: % of professionally active dentists are generalists79.4% of professionally active dentists are 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 PUBLIC PRIVATE PRIVATE/STATE-RELATED Source: American Dental Education Association ©ADEA 2001

Dental School ©ADEA 2001

U.S. Dental School Graduates Source: American Dental Association 5,756 4,095 3,181 ©ADEA 2001

U.S. Dental Schools: Trend of Applicants and First Year Enrollees , Source: Applicants- American Dental Education Association Enrollment- American Dental Association ©ADEA 2001

Estimated Additions of Dentists to the Dental Workforce: Years 1995 to 2040 Assumptions: number of graduates remains at 4050 retirement age of 65 year 2014 year year 1995 year 2040 year 2031 Source: American Association of Dental Schools ©ADEA 2001

Percent of Dental Practitioners Employing Allied Dental Personnel: 1998 Source: American Dental Association 7% 11% 36% 90% 63% 94% ©ADEA 2001

First-Year Enrollment in U.S. Allied Dental Programs: Source: American Dental Association DENTAL ASSISTING DENTAL HYGIENE DENTAL LABORATORY TECHNOLOGY ©ADEA 2001

Number and Type of U.S. Allied Dental Programs: Source: American Dental Association DENTAL ASSISTING DENTAL HYGIENE DENTAL LABORATORY TECHNOLOGY ©ADEA 2001

Total and Women First-Year U.S. Dental School Enrollment women 4314 total Source: American Dental Association TOTAL FIRST-YEAR ENROLLMENT WOMEN ENROLLMENT 37.6% of first-year enrollment is women ©ADEA 2001

Percent U.S. Dental School First-Year Enrollment by Race/Ethnicity: % 0.5% 4.6% 5.1% Source: American Dental Association ©ADEA 2001

First-Time, First-Year Minority Enrollees in U.S. Dental Schools: 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, ,600 DMD:Pop1:1700 1:6000 1:5400 1:860 1:1450 ©ADEA 2001

Dentists & patients by race/ethnicity Patients> WhiteHispanicBlack Asian Dentists\/ White76.6% 8.5% 10.5% 3.2% Hispanic43.6%45.4% 9.8% 3.0% Black27.0% 7.9%61.8% 2.3% Asian47.5%14.5%11.5% 25.1% (ADA, 2000) ©ADEA 2001

Average First-Year Resident Tuition and Fees by Type of U.S. School: Source: American Dental Association $28,688 $20,590 $14,504 $8,983 ©ADEA 2001

Graduating Debt by Type of U.S. Dental School: Source: American Dental Education Association PRIVATE PRIVATE-STATE RELATED PUBLIC ALL SCHOOLS ©ADEA 2001

Mean Educational Debt of Indebted Medical and Dental Graduates $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 Percent of population enrolled in a benefit plan 56.1% Percent of enrolled population by type of plan 17.9%HMO PPO31.2% OTHER7.5% INDEMNITY43.0% %%%% Patient insurance coverage among all dentists (1997) PRIVATE BENEFIT PLAN63.0% NO PLAN: SELF PAY30.7% PUBLIC ASSISTANCE5.4% Source: -National Association of Dental Plans American Dental Association Survey Center TOTAL ©ADEA 2001

Dentists’ Participation in Capitation and Preferred Provider Dental Plans: % 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: 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: Source: ADA Survey Center, 1999 Survey of Dental Practice. 65% Increase: $155,750 $94,220 ©ADEA 2001

U.S. Postdoctoral Dental Education First-Year Enrollment: GPR Source: American Dental Association SPECIALTY AEGD Total ©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