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MyView: What can we do for dental education?

June 17, 2019

By Robert N. Bitter, D.M.D.

Photo of Dr. Bitter
Robert N. Bitter, D.M.D.
It has been my pleasure the last five years to again be a full-time dental educator at one of our dental schools. I first started my dental career in dental education, joining the faculty at Northwestern University Dental School after completing my specialty training at that institution. Between these two times, I spent 33 years as a specialty private practitioner. Having now returned to academia, I have found that dental education today is very different from what many of us experienced during the years we spent in dental school earning the three initials that follow our names.

I had the good fortune to be educated in an era when the federal government was very generous to dentistry — considerable funding had been available, along with some coercion, for dental schools to double the enrollment size of many, if not most, of the dental programs in this country.

At that time, too, dental school tuition had been very reasonable — at many of the private institutions, and certainly at the public institutions.

My first year's tuition at a private institution in a three-year dental program was just a little over $4,000, and prorated so that my three years of tuition included the expenses that before this had included four years of tuition.

Mind you, not everything was rosy — the economy during and after the Carter years saw interest rates over 20%.

Still, I consider myself lucky.

What has changed? Well, simply put, dental education is a lot more complicated today. As a faculty, we have considerably more governmental regulations and accreditation guidelines than previously — things like Health Insurance Portability and Accountability Act, OSHA, Title IX, and strict institutional regulations regarding human research, to name a few.
What we teach is so much more complicated as well. Science has made great strides, and the subjects taught have grown as our profession has grown.

These changes have necessitated technologically sophisticated and expensive equipment — CAD/CAM, CBCT and guided implant planning and surgery, lasers, digital X-rays and computer software and equipment and electric handpieces come quickly to mind.

Even simple supplies, like composite resin systems, require multiple kits to accomplish the many ways this material is now used today in restorative dentistry.

And of course, dental school tuition has risen considerably, in most instances in an attempt to compensate for funding that had previously been a part of federal and state funding for higher education.

Today the cost to a dental school institution to train a dentist during their four years of dental education is approximately $400,000. The strain to dental schools to accomplish what they do today is enormous. Being the dean at a dental school was once the pinnacle of success in our profession.

Now these individuals find themselves struggling to keep their programs properly funded in today's chaotic times.

What needs to change? The ADA has long been concerned about rising dental student debt. As doctors, though, we need to appreciate the difference between a symptom and a cause of disease. I would argue that student debt is a symptom; the cause being the lack of federal and state funding for our institutions. If we want to train the best clinicians in the world, we have to be prepared to pay the price for excellence. In addition, our federal and state governments are now making more demands of dentistry to provide care for many segments of our population that have historically lacked good access to care: the poor, the disabled or handicapped, rural communities, and perhaps soon, even the aged Medicare population.

My parents always impressed on me that you never get something for nothing. If dentistry is to provide the type of care for the American population that government seems to expect, it will come at a cost.

What can we do? The ADA has historically lobbied government most strongly for the private practicing dentist. Recently though, at our ADA Dentist and Student Lobby Day in Washington, D.C., we began to include dental students and dental student debt in our lobbying efforts. But, as I mentioned, dental student debt is the smoke. The fire that drives this is the loss of higher education funding for our dental school institutions. The ADA and many of our state dental associations have political action committees. These organizations have the appropriate corporate designation that allows them the opportunity to speak on behalf of our members and our profession to our legislators, at both the federal and state levels.

Other organizations, including our various dental foundations and even the American Dental Education Association, do not have this corporate designation and are thus unable to lobby government as effectively. In addition, even dental school deans are in many instances hampered in their effort to voice their concerns in their institutions. Large educational institutions have many deans within a university, a dental school dean being just one of many that request monies for their programs. And the chancellors and presidents of private and state institutions oftentimes do not look favorably on a dean that seems to function outside the normal operating channels, especially as regards to seeking funding from government officials and legislators.

So, who can speak for our dental school programs and their young graduates who will be the future of our profession?  For the future of dentistry in this country, I would argue that it is time for the ADA and our state dental associations to put our dental school programs and their funding needs in our legislative advocacy agenda.

We have too much to lose if we do not step forward and give a voice through our lobbying efforts to the concerns for our dental education programs and the young professionals they train. If our profession and its educational programs are to meet tomorrow's challenges, we need to advocate for this change, and the ADA and organized dentistry is best capable of being that voice.

How can this happen? I will mention but one option that comes to mind is to increase revenue — there certainly are more that could be listed. The federal government has a program in medicine, the graduate medical education program, to compensate teaching institutions for training post-grad medical residents where an institution provides Medicaid and Medicare services. Medical students do not receive these monies, as they generally do not directly provide care in this regard during their training — but dental students at most of our dental schools do directly provide patient care to the Medicaid population in their communities. At my school, 52% of our clinic population are Medicaid patients. If dental pre-doc students treat these patients, should they not receive the same benefit that exists more generally in medicine for its care providers?

Please note that some dental post-grad programs, (general practice residencies, advanced education in general dentistry and many pediatric dentistry programs), already receive this type of government funding. These monies can be substantial and could benefit our dental school institutions and at the same time help bring dental school tuition to a more reasonable cost for our young dental professionals.     
 
Please know that I do not expect this change to occur overnight given the current political environment. The effort to bring about this change for our dental schools, and for our dental students as well, is going to be a long, hard fight. But if we don't step forward and bring our concerns to those who govern, not only will our profession suffer, but the patients we serve as well.

Dr. Bitter is a clinical assistant professor at Southern Illinois University School of Dental Medicine. He is a past president of the Illinois State Dental Society and the former ADA 8th District trustee from 2014-2018. He can be reached at rbitter@siue.edu.