Economic impact of dental hygienists on solo dental practices.

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

Expanded function allied dental personnel and dental practice productivity and efficiency.

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices.

Impact of dental therapists on productivity and finances: I. Literature review.

This study examined the financial impact of dental therapists on Federally Qualified Health Center dental clinics (treating children) and on private general dental practices (treating children and adults). This article, the first of four on this subject, reviews the dental therapy literature and the dental access problem for low-income children. Dental therapists now practice in many developed countries, tribal areas of Alaska, and Minnesota. These allied dental professionals vary in their training and required dentist supervision, but all provide routine restorative and other related services to children and adults. The limited literature on the impact of dental therapists suggests that they work mainly in school and community clinics and some private practices, are well accepted by patients, provide restorations that are comparable in quality to those of dentists, expand the supply of services, do not increase private practices' net revenues, and in school programs decrease the number of untreated decayed teeth. Of the approximately 33.8 million children enrolled in Medicaid and the Children's Health Insurance Program (CHIP), some 40 percent now receive at least one annual dental visit. To increase utilization for all children to 60 percent--the rate seen in children from upper-income families--another 6.7 million children need to receive care; dental therapists may help to accomplish that objective.

Impact of dental therapists on productivity and finances: II. Federally Qualified Health Centers.

This article estimates the impact of dental therapists treating children on Federally Qualified Health Center (FQHC) dental clinic finances and productivity. The analysis is based on twelve months of patient visit and financial data from large FQHC dental clinics (multiple delivery sites) in Connecticut and Wisconsin. Assuming dental therapists provide restorative, extraction, and pulpal services and dental hygienists continue to deliver all hygiene services, the maximum reduction in costs is about 6 percent. The limited impact of dental therapists on FQHC dental clinic finances is because 1) dental therapists only account for 17 percent of children services and 2) dentists are responsible for only 25 percent of clinic expenses and cost reductions are related to the difference between dental therapist and dentist wage rates.

Impact of dental therapists on productivity and finances: III. FQHC-run, school-based dental care programs in Connecticut.

In many developed countries, the primary role of dental therapists is to care for children in school clinics. This article describes Federally Qualified Health Center (FQHC)-run, school-based dental programs in Connecticut and explores the theoretical financial impact of substituting dental therapists for dentists in these programs. In schools, dental hygienists screen children and provide preventive services, using portable equipment and temporary space. Children needing dentist services are referred to FQHC clinics or to FQHC-employed dentists who provide care in schools. The primary findings of this study are that school-based programs have considerable potential to reduce access disparities and the estimated reduction in per patient costs approaches 50 percent versus providing care in FQHC dental clinics. In terms of substituting dental therapists for dentists, the estimated additional financial savings was found to be about 5 percent. Nationally, FQHC-operated, school-based dental programs have the potential to increase Medicaid/CHIP utilization from the current 40 percent to 60 percent for a relatively modest increase in total expenditures.

Dental therapists in general dental practices: an economic evaluation.

Dental access disparities are well documented and have been recognized as a national problem. Their major cause is the lack of reasonable Medicaid reimbursement rates for the underserved. Specifically, Medicaid reimbursement rates for children average 40 percent below market rates. In addition, most state Medicaid programs do not cover adults. To address these issues, advocates of better oral health for the underserved are considering support for a new allied provider--a dental therapist--capable of providing services at a lower cost per service and in low-income and rural areas. Using a standard economic analysis, this study estimated the potential cost, price, utilization, and dentist's income effects of dental therapists employed in general dental practices. The analysis is based on national general dental practice data and the broadest scope of responsibility for dental therapists that their advocates have advanced, including the ability to provide restorations and extractions to adults and children, training for three years, and minimum supervision. Assuming dental therapists provide restorative, extraction, and pulpal services to patients of all ages and dental hygienists continue to deliver all hygiene services, the mean reduction in a general practice costs ranges between 1.57 and 2.36 percent. For dental therapists treating children only, the range is 0.31 to 0.47 percent. The effects on price and utilization are even smaller. In addition, the effects on most dentists' gross income, hours of work, and net income are negative. The estimated economic impact of dental therapists in the United States on private dental practice is very limited; therefore, the demand for dental therapists by private practices also would probably be very limited.

U.S. state-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

Evolution of dental school clinics as patient care delivery centers.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

Financing clinical dental education.

Many reports have documented the growing financial challenges faced by dental schools. This article examines the financial implications of two new models of dental education: 1) seniors spend 70 percent of their time in community clinics and practices, providing general dental care to underserved patients, and 2) schools develop patient-centered clinics where teams of faculty, residents, and senior students provide care to patients. We estimate that the average dental school will generate new net revenues of about $2.7 million per year from the community-based educational programs for senior students and about $14 million per year from patient-centered care clinics. These are upper boundary estimates and vary greatly by school. The organizational and financial challenges of moving to these new educational models are discussed.

Financing clinical dental education.

Many reports have documented the growing financial challenges faced by dental schools. This article examines the financial implications of two new models of dental education: 1) seniors spend 70 percent of their time in community clinics and practices, providing general dental care to underserved patients, and 2) schools develop patient-centered clinics where teams of faculty, residents, and senior students provide care to patients. We estimate that the average dental school will generate new net revenues of about $2.7 million per year from the community-based educational programs for senior students and about $14 million per year from patient-centered care clinics. These are upper boundary estimates and vary greatly by school. The organizational and financial challenges of moving to these new educational models are discussed.

U.S. State-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

State financing of dental education: impact on supply of dentists.

In 2000, the thirty-six states with public dental schools provided an average subsidy of 49,347 dollars per dental student. In contrast, nineteen states provided little or no subsidy. Since states invest in dental education, in part, to ensure an adequate supply of dentists, we examined the factors that explain dentist variation among states. We found that population size, per capita income, and the number of students from the state enrolled in dental school had a significant and positive impact. The level of state support for dental education and the presence of a dental school had a negative or nonsignificant effect, respectively. Apparently, dentists locate based primarily on the demand for their services and, to a lesser extent, on where they were raised. The states' investment in dental education had little impact on number of dentists because some states had many dentists but invested little in dental education. We identified two states that collectively account for 15 percent of enrolled students even though they provide minimal subsidy for dental education. We discuss the implications of these findings for states that do not have dental schools and need more dentists. This research was supported in part by grants from the Connecticut Health Foundation (Dental Workforce in Connecticut: Issues and Options), the Robert Wood Johnson Foundation, and the California Endowment (Pipeline, Profession, and Practice: Community-Based Dental Education).