School of Dentistry

Executive Summary – Advancing Dental Education in the 21st Century

by nljohnson

In preparation for the VCU School of Dentistry’s strategic planning process, Dean David C. Sarrett, DMD, MS, provides an executive summary representing an analysis of Advancing Dental Education in the 21st Century

This summary provides a “snapshot” of the challenges, trends and issues in today’s dental education.

Areas of Challenge

Finances

  1. In past 20 years, public support decreased from 57% to 18%
  2. 2004 to 2011 tuition at public schools increased 67%

Student Debt

  1. In 2014, average is $247K
  2. 20% of grads exceed $350K
  3. 44% of students from families with $100K to $200K income
  4. 15% of students from those with less than $50K
  5. 54% of 1996 grads had paid off their debt 17 years after graduation

Number of Graduates

  • 1980s and 90s school closure reasons:
  1. Budget
  2. Relevance to university
  3. Decline in applicants
  4. Perception that caries is no longer a national problem
  5. Dentists report lack of business
  • 1970s and 80s grads climbed to 6300 per year
  • 1994 dropped to 3744
  • Current: 6000 per year

Dental Schools and the University

  1. 42 of 66 schools are in research intensive universities
  2. New schools are not in research intensive institutions

Pre- and Post-Doctoral Education

  1. Broader integration of biomedical and clinical sciences happening
  2. Number of basic science faculty reduced by 47% in last decade
  3. Community-based experience growing
  4. IPE
  5. Poor preparation of students to treat children
  6. Is goal of “practice ready” still realistic?
  7. Majority of clinical experience in school clinics that lose money
  8. Pre- and post-doctoral and DH clinic income only 13% of average budget
  9. 50% variability in clinical time for students – lack of agreement on amount needed
  10. In 2015, 47% of grads attended post-doc program
  11. Positions have increased to 3616 from 2836 in 2004
  12. 15% of post-doc students are international graduates
  13. Specialist income 67% higher than GPs
  14. School-based advanced education programs have high tuitions

Enrollment of AA and HIS Students

  1. DDS AA 4.7%
  2. DDS HIS 7.7%
  3. One-third of schools enrolled 1 or no AA
  4. Similar percentages for advanced education enrollment

Dental Schools as Safety Nets

  • 1.2M treated by schools

Faculty

  1. 2005 to 2014 at 3% in full-time to part-time clinical faculty
  2. Basic science faculty decreased 50%
  3. Students rose 30% but faculty only 3.8%
  4. Student-to-faculty ratio increased from 7.3% to 8.7% from 2005 to 2014
  5. These are cost cutting measures
  6. Average faculty associate professor income $146,875 while private practitioner is $179,900
  7. 2014 39% of full-time faculty were 60 years or older

Bailit: How Many Dentists Are Needed in 2014?

  1. In 2013, there were 195K active dentists
  2. With current graduation rates the number of dentists is expected to increase from 62 per 100K people to 63
  3. 35% to 40% of dentists report they are not busy enough
  4. Estimate based on trends
  • Oral Health Trends
  1. 188% decline in DMFT
  2. Prevalence of periodontal disease 46% with 9% severe
  3. Severe mainly in people older than 50 and smokers
  4. Prevelance or perio disease expected to decline but number of people with disease increases
  5. Edentulism 5% in 2012, by 2050 at 30% decline
  6. 2012 only 8% had one or more missing teeth
  • Utilization of Dental Services
  1. Restorations and crowns have declined 30% to 35% in past 21 years
  2. Extractions and root canals declined 20% to 30%
  3. Bridges and partial dentures have declined 50%
  4. Future services: botox, sleep apnea?
  • New Technologies
  1. No clear trend on how this may affect demand for services
  • Trends in Practice Organization
  1. By 2040, 25% of care may be provided by large corporate dentistry companies
  2. The data supporting this is not robust
  • Trends in Demand for Dental Care
  1. US population expected to grow to 340M by 2040
  2. Per capita dental visits are expected to grow very slowly, less than 1% by 2040
  • Number of dentists needed in 2040
  1. Surplus estimated to be 32% to 110%
  2. HRSA estimates shortage of 15,600 by 2025 based on disease to be treated, not demand and payment for dental services

Manski and Meyerhoefer: Projecting the Demand for Dental Care in 2040

  • US Population expected to grow to 380M in 2040
  • Age Trends
  1. Under 18 flat
  2. 18-65 lower
  3. Over 65 increased
  • Demographic Trends
  1. Growth of blacks and whites steady but a lower rate
  2. Growth of Hispanics at higher rate
  • Income Estimates
  1. Percent of households with income $35K to $75K are declining
  2. Percent of households with income over $100K are increasing
  3. Other income ranges remained mostly flat
  • Dental visits have declined 7% from 2006 to 2012
  1. 316M in 2004
  2. 278M in 2011
  3. 308M in 2013
  4. Adult visits have declined
  5. Children visits have increased
  • Dental Expenditures
  1. $85B in 2012 compared with $1.3T total health expenditures
  2. Dental expenditures have steadily increased between 1960 and 2012 except for several short decline periods
  • Dental Insurance
  1. 64% of population had some type in 2014
  2. $85B spent in 2012
    1. $35B private
    2. $4.7B Medicaid
    3. $789M Medicare
    4. $41B cash
  • Projections
  1. Visits rise from 294M in 2017 to 319M in 2040
  2. This 8.5% increase is less than the 19% population growth
  3. Visits per person drop from 0.92 in 2017 to 0.84 in 2040
  4. Percent of population with a dental visit per year increase from 42% in 2015 to 44% in 2040

Ecklund and Bailit: Estimating the Number of Dentists Needed by 2040

In 2040, the US population is projected to be 380,000,000.28. If 42% of the population use dental care annually, 160 million Americans would have at least one dental visit that year. Assuming that den­tists average 2,000 patients per year in 2040, 80,000 FTE dentists would be needed to provide care to this population. If 67% of the population seek care in 2040, 255 million people would require 127,000 FTE dentists.

Based on ADA estimates, there would be about 240,000 dentists in 2040 if current trends continue with no further growth in the number of graduates. Some 70% (168,000 dentists) would be in full-time practice. This suggests that the surplus of dentists would likely be between 32% and 110%.

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