Time to Face the Strange

Scott Hudimac, DDS, MAGD

As my year as PAGD president is quickly passing, I find myself reflecting on the state of our profession, both on a personal level and as someone involved in the leadership of organized dentistry. In addition, this year I attended the 30-year reunion of my dental class graduation from West Virginia University School of Dentistry and I find myself reflecting on how dentistry was at that time. Since we are turning our attention to the changing demographics of the dental workforce in this issue of Keystone Explorer, I thought that a comparison of these two eras would be interesting.

The composition of my dental class was significantly different than what I think would be found in most dental schools today. First there was a male/female split of about 80/20, whereas the ratio in most dental school classes today is much closer to 50/50. Also, the proportion of foreign students enrolled in dental schools was much smaller than it is today. Another difference came from not the make-up of the class itself, but from the career paths chosen after dental school. While some of my classmates did go on to obtain advanced degrees in one of the dental specialties, there is a much larger section of dental school classes that pursues a specialty degree today than ever before. These three changes have had a significant effect on the make-up of today’s dental care workforce, and we need to respond to these changes both as a profession and as an organization.

“Instead of looking to expand the number of positions and people in the dental care workforce, we must try to make sure that those positions already in place receive quality education and are used efficiently…”

Another huge change in dental workforce demographics involves the positions that exist in order to meet the oral health care needs of the public. When I graduated in 1989 there were two professionals that provided the direct patient care—dentists and dental hygienists—and their support staffs of dental assistants. Today there is a greatly expanded set of positions in the dental care workforce. Sure, there are still dentists and dental hygienists, but there are now many more support staff that can also provide direct patient care. Expanded function dental assistants have a scope of practice that can help the dentist treat more patients. In some states, there are midlevel providers such as dental therapists and dental hygienists with expanded scope of practices that allow for restorative and even surgical care that can also increase access to care for the public. There are even positions in many states, including Pennsylvania, that allow for the independent practice of dental hygiene in settings with no direct supervision from a dentist, again in an attempt to increase public access to dental care.

All of these differences present both challenges and opportunities to us as both a profession and as an organization. First, we must realize that there are less general dentists coming out of dental schools, and thus less potential members for PAGD. In addition, as an organization known for providing great continuing education, we must be aware that there is a great deal of competition in dental CE, and that people may be seeking to get that CE in different ways. The PAGD Board of Directors and Education Committee are working on ways to diversify our CE offerings to meet this challenge. Because only by offering true value to our members will we be able to both keep our current members satisfied and coming back while also being valuable and relevant to new dentists in order to attract new members.

As an organization, we must also be involved in advocacy efforts that will allow our collective voice to be heard as legislators, the Pennsylvania State Board of Dentistry, and organizations such as the PEW Foundation, The Kellogg Foundation, and the American Dental Hygiene Association look to make changes to the way that dental care is provided in our state and country. Much of the focus seems to be on expanding the dental workforce with nontraditional new positions to increase access to care for underserved populations.

While always well-meaning, some of these efforts are misdirected in that simply increasing the sheer numbers of dental care workforce providers may not be able to rectify the access to care issue. There is still the challenge of getting dentists to practice in the health care provider shortage areas since most of these expanded function positions still require direct supervision by a dentist. In addition, the access to care issue will always involve provision of dental care through the Medicaid system, which also requires participation by general dentists and will not be significantly improved just by adding more non-dentists.

Instead of looking to expand the number of positions and people in the dental care workforce, we must make sure that those positions already in place receive quality education and are used efficiently, and that we somehow find a way to get dentists to practice in those areas most in need of access to dental care. In recognition of the need for our organization to be involved in advocacy efforts in Harrisburg, the PAGD Board of Directors has approved a budget that allows us to hire a full-time lobbying firm. This will ensure that we are well informed of the issues affecting us and that our ideas and concerns are made known and taken into account by those who can make the decisions that will affect our profession, the dental care workforce in general, and the overall dental health of the people of Pennsylvania.

So stay tuned for future information and alerts as to what is going on that could affect our profession and our organization. But we need your help. When you are asked to be involved in our advocacy efforts, please take action and write a letter, make a phone call, attend a meeting, do whatever it takes. Because there is strength in numbers, and only when our members get involved can we be truly successful as an organization.

I hope to see everyone at Bedford Springs in April for another great PAGD Annual Meeting and another session of great continuing education programs. You know that Rick and Joey will be setting up something great for us once again.

Have a great day.