Elizabeth Mertz, PhD, MA
University of California, San Francisco
The Center has historically been very influential in two areas of health care – research on workforce dynamics such as supply, demand, education, and policy – and leadership development for those working in health care organizations. Earlier this year, (Feb 2014 hot topic) this column focused on leveraging these assets to create new synergies and help solve the big problems in health care.1 A key opportunity for us to do just that is in oral health care. Although the Center’s work has always spanned all health professions, nursing, medicine, pharmacy and the allied professions have often predominated. The dental profession has had a very low profile in our work.
Dentistry has evolved apart from the rest of health care. The separation is not just in care delivery, financing and education; it is so systemic that the health services research community rarely investigates dental care issues, and many health professions’ leadership programs omit dental care providers. There are important historical reasons for this separation, but in today’s health care landscape the split is increasingly detrimental for the health and well-being of patients. Scientists continue to build the evidence base that documents important links between oral health and overall health status, calling into question the value of a bifurcated system of care. Health care professionals struggle to close the gap between the evolutions of dental and medical care.
Overcoming the long-standing separation between dental and medical care is a challenge not to be underestimated, yet at the Center we strive to do just this. For over 15 years, as we work to achieve our mission of transforming health care, our faculty and staff have conducted workforce research on dental professionals and health services research on dental issues, making us one of the go-to sources of expertise on the dental labor market and evolving delivery system.
Center researchers have kept a vigilant eye on dental care issues dating back to our origins with the Pew Health Professions Commission. Since then we have worked to keep the focus on dental care workforce and policy issues amid health care changes see publications list at the end of this article). Supply, demand, and distribution are all critical issues for access to dental care, as they are for other health professions. While the dental professional market place is different than that for physicians, nurses, and pharmacists, it is increasingly being shaped by the same forces that are affecting these other professions. For example, quality improvement, a nascent area of dental research, is poised to transform care delivery and payment models. Dental care is seen as the greatest unmet need by low-income and minority communities and consumers across the income continuum struggle with understanding and evaluating the quality of the services that are offered. Innovative workforce models are being tested across the country and provide evidence of the creative thinking, as well as need and value that communities place on access to oral health care services.
These significant challenges highlight the need for strong leadership from within dentistry. Historically dentists have functioned as small business owners, disconnected from the larger health care system and therefore overlooked for leadership capacity in health care reform and improvement. It is of paramount importance to cultivate and engage dental professionals in health care leadership programs where they can ensure that ‘health care’ includes oral health, and likewise learn from the advances in access and quality in medical care that dentistry has yet to adopt.
The Center boasts a number of interdisciplinary leadership programs that have produced leaders in dentistry doing great things. For example, Dr. Paul Glassman, a graduate of the CHCF fellows program, has dedicated his career to redesigning dental care delivery to address the needs of the elderly, disabled and low-income populations in the context of their existing community systems.
This work is not easy, but with leadership like that of Dr. Glassman and many other leaders committed to system change and improvement, empowered by the network and skills received in their leadership training, we are starting to impact change on a broader level. The UCSF School of Dentistry has recently embarked on leadership training for many of their faculty. The Department of Preventive and Restorative Dental Sciences has launched a quality improvement initiative to improve not only the current educational endeavor, but to enhance UCSF’s capacity to develop students who will be the dental leaders of the future. This commitment is consistent with the overall UCSF mission to advance health worldwide – and that includes advancing oral health care.
The Center’s research on the topics of dental workforce and leadership include the following publications. This does not include an extensive list of academic journal publications on this topic by Center researchers.
Leadership Development: A Critical Need in the Dental Safety Net
Shaking up the dental safety-net: elimination of optional adult dental Medicaid benefits in California
The Impact of the Elimination of Adult dental Benefits from Denti-Cal on the California dental Safety Net
Registered dental Hygienists in Alternative Practice In California, 2009 Descriptive Report
Collaborative Practice in American Dentistry: Practice and Potential
A Review of California Office of Statewide Health Planning and Development, Health Workforce Pilot Projects Program 1973-2007
Improving Access to Health Care in California: Testing New Roles for Providers
Registered dental Hygienists in California: Regional Labor Market Chart Book
Registered dental Hygienists in Alternative Practice: Increasing Access to dental Care in California
Survey of Registered dental Hygienists in California
Evaluation of Strategies to Recruit Oral Health Care Providers to Underserved Areas of California
The Distribution and Composition of Arizona’s dental Workforce and Practice Patterns: Implications for Access to Care
Dental Health Professional Shortage Area Methodology: A Critical Review
Distribution of Medicaid dental Services in California
Improving Oral Health Care Systems in California: A Report of the California dental Access Project, 2000
Geographic Distribution of Dentists in California dental Shortage Areas, 1998