The ADA Health Policy Institute (HPI) has predicted that, despite fears of a looming dentist supply cliff, the dentist workforce in the United States will actually increase through 2037 due to an influx of younger and more diverse dentists. But how will this play out at the state level? Will some states experience a greater dentist supply increase than others? HPI offers projections for ten select states, particularly those with some of the highest population concentrations.
To me, the best evidence suggests that, in aggregate, there is significant unused capacity in the dental care system,9 and under the proper policy conditions, the existing dental workforce can absorb a lot more demand for dental care.10 However, moving beyond the aggregate to assess the adequacy of the level of provider coverage in certain geographic areas (for example, rural areas) or for certain populations (for example, those covered by Medicaid) is much more complex. Factors such as rising debt from loans used to pay for education could make new dentists less inclined to accept patients whose care is covered by Medicaid programs. At the same time, the “feminization” of the dentist workforce might have the opposite effect, because female dentists are more likely to treat patients who have low incomes than are their male counterparts.11 Some of the newer dental schools also aim to train dentists specifically to work in rural and underserved areas. Zooming out to get the “30,000-feet level” perspective, policymakers need to ask themselves, “Is training more dentists the best way to address our access-to-dental-care challenges?” Finding the answer to this question will require a much more sophisticated analysis than I am able to provide in this article. My PhD advisor and famous Canadian health care economist Robert Evans often spoke of “health care zombies,” which he described as ideas that simply will not die even when data and research convincingly refute them.12 The conventional wisdom of a looming retirement cliff, which will lead to a sharp decline in the supply of dentists and an aging dentist workforce, is one of these health care zombies. Hopefully, this one can now be put to rest. n http://dx.doi.org/10.1016/j.adaj.2016.06.016
In “Just the Facts,” the ADA News (11/21) reports that “over three-fourths of U.S. adults report that they plan to go to the dentist within the next year.” However, “only 37 percent of adults report having gone to the dentist within the last year,” according to the ADA Health Policy Institute. Additional information on the ADA Health Policy Institute is available online.
The Daytona Beach (FL) News-Journal (7/1, Meyer) reported the reason why nearly 60 percent of Americans have not visited a dentist in the past year is cost, “according to a Harris poll conducted among 15,000 adults last summer on behalf of the American Dental Association Health Policy Institute and Families USA.” This coincides with the nearly 30 percent of Americans “across all income levels” who say claim “dental problems affect the quality of their life, with low-income adults most affected.” Dr. Drew Agnini of Lakeland, Florida, president of the Polk County Dental Association, said, “People delay treatment because of finances. We see it with low-income patients because the funds are not there but high-income patients may not want to spend discretionary funds because of teeth.” The News-Journal mentions Medicare does not cover dental benefits and Medicaid coverage varies by state.
In its “Snapshots of American Dentistry,” the ADA News (10/3) reports that “U.S. adults without a dental visit in the last 12 months cite cost as the top reason why they do not visit the dentist more often,” according to the ADA Health Policy Institute “Oral Health and Well-Being in the United States” report. The report is available at ADA.org/statefacts.
I read with great interest the article "Health Policy Institute: Dentists' Earnings Remaining Stagnant" in the Jan. 18 issue of the ADA News. How astounding! Let us dissect and analyze the uncomfortable reasons for this. I thank Marko Vujicic, Ph.D., for his honesty. If the schools keep producing and flooding the market with new dentists, even the blind can see that incomes will not rise. Supply and demand, remember?
Dr Bicuspid (4/18, Pablos) reports that an April 8 discussion at the recent 2016 American Association of Endodontists annual session in San Francisco focused on the future of dentistry, featuring Marko Vujicic, PhD, chief economist and vice president of the ADA Health Policy Institute, and Gerald Glickman, DDS, JD, chair of the department of endodontics at the Texas A&M University Baylor College of Dentistry. The pair discussed how the following four different trends may affect the future of dentistry: rising supply of dentists and falling demand for dental care, increasing demand for preventive work and less demand for restorative work, changes in higher education, and an upcoming data revolution.
10/31/2015 Solving Dentistry's ‘busyness’ problem
Dentistry has a busyness problem. As numerous analyses from the ADA Health Policy Institute show, the percentage of dentists who report they are not busy enough and can see more patients has been rising steadily for approximately a decade.1 Nationally, approximately 1 of 3 dentists say they are not busy enough. This varies widely by state (1 of 2 in Florida compared with 1 of 20 in North Dakota2) and by practice characteristics—dentists who accept Medicaid tend to be much busier than those who do not.3 Confirming this trend, appointment wait times have decreased steadily and dentist earnings are stagnating.4 Marko Vujicic, PhD
Research Examines How Student Debt Influences Career Decisions.
The ADA News November 02, 2015 reports that “high education debt levels” influenced “some career decisions for dentists,” according to research published in the November issue of The Journal of the American Dental Association. According to the article, researchers found that dentists “with higher initial debt were less likely to specialize and were more likely to enter private practice over other primary occupations.” Article co-author Marko Vujicic, Ph.D., chief economist and vice president of the ADA Health Policy Institute, said, “Contrary to what we hear a lot from the field, the research found no relationship between educational debt levels and the likelihood of owning a practice,” adding, “More significantly, in my view, we found that factors such as gender, race and whether your parent is a dentist had much more significant impact on career choices than debt.” ADA News points out that education debt balances among students graduating in 2011 from dental school were $203,000.
HEALTH POLICY PERSPECTIVES Rethinking dentist shortages Marko Vujicic, PhD JADA 146(5) http://jada.ada.org May 2015 page 347
"The fact that there is significant unused capacity within the dental care system and that the most important barriers to dental care are financial leads to an important policy implication. In the current situation, adding additional dental care providers to the market is unlikely to address the most critical issues concerning access to dental care. Rather, the evidence strongly suggests that policy makers ought to focus on solutions that address the demand-side constraints the US population faces—especially low income Americans—in accessing dental care"
How then should HRSA’s analysis be interpreted? Zooming out to the big picture, analyses like HRSA’s and HPI’s dentist workforce projections, through a strong micro-data empirical approach, shed important light on how the supply of dentists will evolve in the coming years. HRSA’s analysis attempts to go one step further and models the future demand for dentists, concluding that demand will grow faster than supply. In my view, neither HPI’s nor HRSA’s analyses are appropriate methodologies for assessing provider adequacy – even at the national level. In HPI’s workforce projection model as well as other HPI studies we explicitly state this and caution against the “overinterpretation” of our findings. HRSA’s analysis suggests that more dentists or other types of dental care providers are needed to meet the future demand for dental care. However, as noted above, the most important barriers to dental care are not supply related. Specific to one important population – Medicaid beneficiaries –access to dental care is unlikely to improve without comprehensive reforms to state Medicaid programs. Simply increasing the number of dentists in the market is not the solution. Future research should focus on analyzing the dental market in smaller geographic areas and on better understanding the drivers of demand for dental care. The ADA Health Policy Institute is currently engaged in several research initiatives in partnership with other academic and government agencies to help contribute to this effort.
Supply of Dentists in the United States is Likely to Grow from ADA Health Policy Institute Authors: Bradley Munson, B.A.; Marko Vujicic, Ph.D. October 2014.
The future demand for dentists, in turn, will depend on the future demand for dental care among the population, the future evolution of productivity and efficiency of dentists, and potential changes in the workforce mix within dental care delivery models. While further work is needed, our results suggest that, at the aggregate level, the United States could be entering a period of expanding supply of dentists and flattening demand for dental care.