DISTRICT PRESIDENTS SPOTLIGHT
TENTH DISTRICT
Dr . John E . Pawlowicz
The four-year dental education model of didactic and clinical education with no residency requirement is an outdated model . We cannot prepare new dentists to competently provide a level of care consistent with modern advancements in dental procedures , technologies and dental materials , as well as proper training in aspects of the profession , such as sleep , orofacial pain , implant placement and restoration that they are legally licensed to perform in just the four years of a dental school curriculum . It is time to adopt the medical model and require a post-doc residency of at least one year . This can be facilitated in many ways : AEGD programs in dental schools , GPR programs at schools and hospitals and FQHC community clinics affiliated with dental and medical schools . This will also help address the growing need to provide care to underserved populations .
Care gaps – socio-economic disparities in care exist to a large degree . This is attributed to exceptionally low state-funded insurance reimbursements , falling numbers of dental graduates ( replacement rates for retiring dentists does not meet the demand ). Rural and inner-city access to care is far inferior to suburban and upper / upper middle class urban areas . Specialty access is even worse .
Reimbursement rates for both state-funded programs and commercial insurance . Non-covered services , co-pays , UCRs and yearly maximums are not commensurate with the advances in procedures , techniques and costs of standard-ofcare modern dentistry . These three go together with the other challenging issue of the profession : the cost of a dental education .
The cost of a dental education is also challenging to the profession . The average total in-state tuition and fees , not including living expenses , for the Pennsylvania dental schools ( Pitt , Penn , Temple , and LECOM - even though three of the years occur in Florida ) is $ 400,000 . The average salary in Pennsylvania for a general dentist is $ 185,000 .
Over 15 years at 6 %, with a monthly payment of $ 3,300 ( 30 % per month of that 185K average salary after taxes ), borrowing this amount will accrue an additional $ 200,000 in interest , ballooning the cost of a four-year dental school education to $ 600,000 without factoring living expenses .
Imaginative state and federal policy makers could solve these issues if they looked at them as a whole and began to treat dental education and dentistry as a profession similarly to medical training and the medical profession .
Showing value to membership is the most challenging issue facing organized dentistry . Common issues new dentists raise and discuss is organized dentistry has not done enough to advocate for dentists with insurance companies regarding reimbursement COLAs ; Continuing Education that is easy to get without the added cost of membership . In effect , the DSOs offer support for new dentists regarding the above-mentioned and there is no need for ADA membership . Additionally , the ADA has been slow to drive universal licensure / licensure by credentials to facilitate the movement across state lines . Limited to no involvement in addressing the cumbersome and months-long credentialing process for insurance billing . Discounts on health insurance and malpractice are not enticing to dentists who have access through a spouse or other buying cooperative . Established dentists are also turning away from organized dentistry as their historic CE source . Other less expensive , easily accessible avenues for accredited CE are now more widely available and accepted . Many look to the ADA as an accrediting body , not one to whom membership is necessary or an advantage .
Organized dentistry has stood by and watched as DSOs have grown , taking advantage of the excessive cost of a dental education and promising new and young dentists guaranteed salaries . Young dentists are not able to purchase / finance / buy into solo or independent group practices due to crushing educational debt . DSOs buy and consolidate formerly privately owned practices who cannot find individual buyers . What DSOs also provide is non-dentist oversight and management . Care decisions and practice protocols designed to manage costs supersede the dentists ’ independent decision making and treatment planning . This creates a model where dentists are working for non-dentists and often third-party payer .
18 MAY / JUNE 2024 | PENNSYLVANIA DENTAL JOURNAL