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Final Report #130 Washington State’s Oral Health Workforce by November 2009 Susan M. Skillman, MS C. Holly A. Andrilla, MS Joseli A. Alves-Dunkerson, DDS, MPH, MBA Wendy E. Mouradian, MD, MS Melissa Comenduley Jessica Yi Mark P. Doescher, MD, MSPH UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE DEPARTMENT OF FAMILY MEDICINE CONTENTS Executive Summary ...................................................3 Discussion and Policy Options ................................34 Background ...............................................................5 References ..............................................................37 Who Provides Oral Health Services in Appendix A. Washington Department of Health Washington State? ....................................................6 Survey Questionnaires: Dentists and Dental Characteristics of the Oral Health Workforce ............9 Hygienists ................................................................39 Major Factors Affecting Future Oral Health Appendix B. Survey Findings: Dentists ...................44 Workforce Supply in Washington .............................16 Appendix C. Survey Findings: Dental Hygienists ....53 Oral Health for Underserved Populations Appendix D. Dentist and Dental Hygienist in Washington ..........................................................27 Survey Analysis Methods ........................................63 ACKNOWLEDGEMENTS ABOUT THE AUTHORS This report benefited from the information provided by SUSAN M. SKILLMAN, MS, is the Deputy Director individuals from the following organizations: of the WWAMI Center for Health Workforce Studies • American Indian Health Commission for and the WWAMI Rural Health Research Center, Washington State. Department of Family Medicine, University of Washington School of Medicine. • Directors of Dental Hygiene Education Programs in Washington. C. HOLLY A. ANDRILLA, MS, is a Biostatistician for the WWAMI Center for Health Workforce Studies • Denturist Program at Bates Technical College. and the WWAMI Rural Health Research Center, • Seattle Special Care Dentistry. Department of Family Medicine, University of • University of Washington School of Dentistry. Washington School of Medicine. • Washington Association of Community and Migrant JOSELI A. ALVES-DUNKERSON, DDS, MPH, Health Centers. MBA, is the Manager of the State Oral Health Program • Washington Dental Service Foundation. at the Washington State Department of Health, Office of Maternal and Child Health. • Washington State Dental Association. WENDY E. MOURADIAN, MD, MS, is the • Washington State Dental Hygienists Association. Associate Dean for Regional Affairs and Curriculum; • Washington State Denturist Association. Director of Regional Initiatives in Dental Education • Washington State Department of Health (Office (RIDE); and Professor of Pediatric Dentistry, Dental of Maternal and Child Health—Oral Health, Public Health Sciences, and Health Services at the Community Health Systems—Rural Health and University of Washington Schools of Dentistry, Health Professions and Facilities). Medicine, and Public Health. • Washington State Department of Social and MELISSA COMENDULEY was a Graduate Health Services. Research Assistant with the WWAMI Center for Health Workforce Studies until August 2009. • Washington State Health Care Authority. • Yakima Valley Farmworkers Clinic. JESSICA YI was a Student Assistant with the WWAMI Center for Health Workforce Studies until Martha Reeves coordinated production of the report summer 2009. at the University of Washington Center for Health Workforce Studies, and Allessandro Leveque provided MARK P. DOESCHER, MD, MSPH, is Director design assistance. of the WWAMI Center for Health Workforce Studies and the WWAMI Rural Health Research Center, Funding for this report came from the Washington and is an Associate Professor in the Department of State Department of Health (contract #N16617), in Family Medicine, University of Washington School turn funded through a grant from the U.S. Health of Medicine. Resources and Services Administration (HRSA Grant T12HP10687, CFDA 93.236). 2 Washington State’s Oral Health Workforce SUSAN M. SKILLMAN, MS C. HOLLY A. ANDRILLA, MS JOSELI A. ALVES-DUNKERSON, DDS, MPH, MBA WENDY E. MOURADIAN, MD, MS MELISSA COMENDULEY JESSICA YI MARK P. DOESCHER, MD, MSPH EXECUTIVE SUMMARY 79% of dental hygienists with Washington licenses were in practice 2007, and their average ages National attention to the growing silent epidemic were 49 and 45 years, respectively. Among the of oral diseases has increased in recent years, practicing dentists, 77% were in general practice, resulting in more focus on the importance of 4% were in pediatric practice, and less than 2% having a health workforce that can effectively specialized in public health. Three-quarters (74%) address the oral health needs of the population. of Washington’s dentists were in independent Washington State benefits from having many or solo practices. Most (96%) dental hygienists programs and initiatives to enhance the capacity, practicing in Washington were in private dental flexibility and diversity of its oral health offices/clinics. In 2007, at least 42% of the state’s workforce. This report presents comprehensive dentists and 79% of dental hygienists reported they information on that workforce, to the extent data had received their initial professional education are available, and factors that affect its future. in Washington. The current workforce of dentists Oral health disparities still persist in Washington and dental hygienists is not as diverse as the state’s State. Communities of color, non-English population. There remains an uneven distribution speaking families, low-income households, special of dental professionals across the state, with populations, and the uninsured, among others, 35 out of 39 counties having all or part of the continue to harbor higher rates of oral diseases county designated as a dental Health Professional and difficulty accessing dental care. Despite Shortage Area (HPSA). the innovative approaches used in the state to Less information is available on the characteristics overcome these gaps, further development is of dental assistants, denturists and other supporting needed to make the oral health workforce even caregivers. Expanded function dental auxiliaries more effective and efficient. are a new profession in Washington, and the first The oral health workforce in Washington includes graduates of the new education programs were dentists, dental hygienists, expanded function entering practice in 2009. Primary care providers dental auxiliaries (EFDAs), dental assistants, (including physicians, physician assistants and denturists, primary care medical providers advanced practice nurses) have been reimbursed (physicians, physician assistants, advanced by Medicaid to deliver preventive oral health practice nurses), and other supporting caregivers. services for more than a decade. All have important and complementary roles to Washington’s oral health workforce has been play in providing oral health care to Washington’s steadily increasing in absolute numbers and residents. Varying amounts of information are relative to the state’s population. The size of available to describe the number, distribution and the workforce may not keep pace, however, characteristics of these provider groups. Recent with the increasing oral health needs of the survey findings showed that 81% of dentists and 3 state’s population as it grows and ages and as educators have an array of options to affect the professionals from the baby boom generation size, characteristics and distribution of the state’s retire. A workforce is needed that can respond oral health workforce. Given the long educational to the rising rate of childhood caries through pipeline for some health professions, increases mass preventive measures as well as treatment in capacity must be planned well in advance. At of individual children. At the same time, more the same time, the current workforce must be oral health professionals will be needed to used efficiently to prevent disease and increase provide dental care for the elderly as those over access to oral health care. The following strategies 65 live longer and retain more of their own emphasize oral health prevention, education of teeth than did their predecessors. Washington’s efficient teams, and better distribution of the population is expected to grow by 24% between workforce of the future. 2009 and 2025, and by 80% for seniors. To maintain or increase the number of providers • Promote interest in oral health professions in the future will require increases in capacity among young people, especially those from at Washington’s dental education programs underrepresented populations. and/or higher rates of in-migration of dentists • Support education programs that improve and dental hygienists to the state. This projected the capacity of the workforce to care for growth in demand will also cause growth in underserved and special populations through demand for professions that increase the size training of more professionals in general and efficiency of the dental team, such as dental dentistry, pediatric dentistry, and in dental assistants, EFDAs, and possibly new types public health. In addition, support educational of professionals. There will also be growing programs with service learning and clinical attention to the use of primary care medical rotations in rural and underserved populations providers for preventive oral health services.

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