1. M AINE H EALTH W ORKFORCE S UMMIT October 18, 2011 Judith A. Feinstein, MSPH Director, Oral Health Program Maine CDC Understanding the Dental Workforce: What Does The Data Tell Us About Maine’s Needs? 1

2. O BJECTIVES  Provide an overview of Maine’s dental workforce and describe the data sources  Discuss the conclusions can be drawn and what questions are raised by the data  Review how workforce data can be used to inform strategies for addressing Maine’s dental workforce development needs  Discuss how to address Maine’s data needs  Examine recommended actions/steps that are being or could/should be taken by all interested parties 2

3. C AVEATS Remember…  “Without data, you are just an opinion.”  “You can’t fix with statistics what you bungled by design.” -- and --  “If you torture the data long enough, it will confess.” – OR – The answer you get depends on the question you ask  Source of quotes: unnamed but not to be forgotten CDC evaluators 3

4. F EDERALLY D ESIGNATED D ENTAL H EALTH P ROFESSIONAL S HORTAGE A REAS - 2011 4

5. D ENTIST TO P OPULATION R ATIO 5 ME Dept of Labor, Workforce Analysis of Maine’s Health Services Sector, issued April 2010

6. D ENTAL H YGIENISTS – P OPULATION R ATIO 6 ME Dept of Labor, Workforce Analysis of Maine’s Health Services Sector, issued April 2010

7. N EED FOR M ORE P RACTITIONERS ? 7 ME Dept of Labor, Workforce Analysis of Maine’s Health Services Sector, issued April 2010

8. A C LOSER L OOK A T THE D ATA... … and the questions we ask to get it 8

9. D ATA S OURCES  Licensure data – Maine Board of Dental Examiners  Maine Cooperative Health Manpower Resource Inventory surveys Dentist Resource Inventory Registered Dental Hygienist Resource Inventory  National Sources, e.g., HRSA 9

10. D ATA AND ITS L IMITATIONS Issues -- Survey construction and administration (methods) Voluntary or mandatory Questions (wording) Response rates Interpretations Statistical analyses Biases 10 Numerator Denominator

11. N UMBER OF L ICENSED D ENTISTS AND H YGIENISTS AS R EPORTED BY THE S TATE B OARD OF D ENTAL E XAMINERS * YearDentistsHygienistsIPDHs Licensed (Inactive) Maine Address Licensed (Inactive) Maine Address Licensed Maine Address 2011835 (7)665 (3) 1290 (36) 1194 (36) 3331 2010800 (8)653 (3) 1341 (50) 1179 (36) 1816 2009833 (8)671 (2) 1301 (54) 1175 (34) 11 200881866212381130 200783164813351146 2006n/a604n/a1082 11 * Point in time data: Numbers obtained annually in January or February in response to a query from the ME Oral Health Program to answer a survey – not an official report.

12. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 Most dentists practicing in Maine are white males over the age of 50. The typical dentist in Maine has been practicing for 24.4 years. Only 15% of those surveyed have been working for 10 years or less. As dentists get older, they cut back on hours and are more likely to work part-time. Female dentists work fewer hours and weeks/year than male dentists. There is no statistically significant difference in hours between dentists working in urban and rural settings. 12

13. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 If reaching age 65 was the only determinant of retirement-related turnover, 25% of dentists currently working will retire within 5 years, 44% within 10 years and 62% within 15 years. If rural areas are not able to recruit younger dentists the gap between retirement-related turnover in rural and urban areas becomes more severe as time passes. Intent to leave within 5 years is correlated with job satisfaction and attachment. No statistically significant differences in reported plans to leave and rural versus urban region were found. 13

14. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 Age (N = 613) Mean (min, max, st dev) 51.5 (27 to 85, st dev = 10.7) > 35 years 10. 3 % 36 – 50 33.1 51 – 64 47.5 65 + 9.1 14

15. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 Geographic Location (Labor Market) ResidenceWork Aroostook and Washington5.6% Piscataquis, Penobscot and Hancock15.9%16.0 Somerset, Franklin, Oxford, Kennebec and Androscoggin21.624.8 Waldo, Knox, Lincoln, Sagadahoc, Cumberland and York 56.853.6 Urban vs. Rural (County) Urban (Cumb, Sag, York, Andro, Penob)66.666.1 Rural (Aroostook, Franklin, Kennebec, Knox, Piscat, Somerset, Waldo, Wash, Hancock, Oxford, Lincoln) 33.433.9 15

16. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 Type of Practice Setting Self-employed (solo or group practice)80.9 % Solo practice63.8 Group practice36.2 Private practice83.0 Clinic, hospital, group plan facility11.1 Military, VA, public health, Indian Health facility 2.9 Medical Research Institute or Establishment 0.5 16

17. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – D ENTISTS, 2008 Weeks/Year and Hours/Week Mean # of weeks worked/last year in Maine (range, std dev) (N=589) 47.4 (0-52, 9.4)  Worked 35 weeks or less7.4% Mean # hrs/wk, direct patient care (N= 596)33.4 % (0-129) Mean # hrs/wk, non-clinical tasks (N=596)2.3 % (0-40, 4.9) Mean # total hours/week (N=596)35.8 (0-139, 13) Working full-time (40 hrs +/week) (N=596)40.3% (n=240) Working part-time (less than 30 hrs) (N=596)21.3% (n=127) 17

18. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – H YGIENISTS, 2008 Most Maine hygienists are white women between 35 and 54 years of age; mean age = 43.1 The typical hygienist in Maine has practiced for 18.9 years. About 26% of those surveyed had been working for 10 years or less; about 20% had been working for 30 years or more. The average number of hours worked per week is 28.1; 41% worked fewer than 30 hours weekly. As hygienists get older, they tend to work fewer hours per week. Where hygienists work is distributed fairly equally among urban core areas, suburban areas, large town areas and “small town and isolated rural areas” (27.9, 29.7, 27.6, 28.7%). 18

19. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – H YGIENISTS, 2008 Older dental hygienists were most likely to say they did not plan to still be working in their field in ME in 5 years. 82% yes, 5% no, 13% maybe (regardless of age) Largest proportions “no”: Sagadahoc & Franklin Counties; largest number: Cumberland Some differences in plans among urban core areas (14%), suburban areas (8%), large town areas (8%) and “small town and isolated rural areas” (16%). Hygienists who worked less than 30 hours/week were somewhat less likely than those working 30+ hours/week to say they would be still working in 5 years. 19

20. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – H YGIENISTS, 2008 Active Dental Hygienists by Age Group (among those who responded to the survey)* AgeNumberPercent 21 – 24243% 25 – 3414719 35 – 4422629 45 – 5422529 55 – 6411715 65 – 74132 75+2< 1 Unknown253 20 * Only responders to the survey included, N = 779; in early 2008, there were 1130 licensed hygienists with ME addresses.

21. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – H YGIENISTS, 2008 County/areaSurveyedEmployedWorkplace Aroostook and Washington322732 Piscataquis, Penobscot & Hancock136124130 Somerset, Franklin, Oxford, Kennebec & Androscoggin 146139138 Waldo, Lincoln, Knox, Sagadahoc, Cumberland & York 312280344 Urban Core229207310 Suburban11911049 Large Town106101119 Small town/rural17215265 Out of state or unknown15313158 21

22. C OOPERATIVE H EALTH M ANPOWER R ESOURCE I NVENTORY – H YGIENISTS, 2008 Primary type of Practice # of hygienists Percent General dental practice52579 Periodontal practice325 Public health305 Clinic274 Pediatric practice152 Educational institution/clinic 132 Orthodontic practice51 Prosthodontic practice42 22

23. W HAT D OES THE D ATA T ELL U S ?  Our dental professionals are getting older.  Our dental professionals live and work where most of us do. Compared to the national average, there are ~ 70% fewer dentists per capita in Maine’s six rural counties, and ~40% fewer hygienists.  The characteristics and distribution of our dental professionals impact access.  Our dental professionals don’t like to answer surveys. 23

24. W HAT D O W E N EED FROM THE D ATA ? H OW C AN W E U SE I T ?  Do we have enough dentists and hygienists? Where do they live? What do they do (focus of practice)? How much do they work (FTE)?  What would the impact of a “new” practitioner be?  ??? 24

25. R ECOMMENDED A CTIONS /S TEPS  Require more information on licensure applications  Need for meaningful questions  Need to standardize questions  Encourage participation in voluntary surveys by licensed practitioners  ????? 25

26. R ECOMMENDED A CTIONS /S TEPS  Find a home for health manpower surveys; include dental professions at same interval as medical  Support the Board of Dental Examiners in data collection efforts  Agree on standards for collection and reporting  ??? 26

27. U NDERSTANDING THE D ENTAL W ORKFORCE Questions? Comments? Judith A. Feinstein, MSPH Director, Oral Health Program judith.a.feinstein@maine.gov 207/287-3267 27