MY VIEW


Workforce Issues: Present Both Challenges and Opportunities


by GUY DEYTON, DDS F


or reasons I don’t fully understand, Dr. Dean Patzman, a prosthodontist close to retirement, professionally adopted me and mentored me start-


ing at my first Greater Kansas City Dental Society meeting 38 years ago. I suspect that after listening to a still wet-behind-the ears dentist, freshly out of a residency program, he was concerned about my future and the future of my patients. As closely as I can remember, this is what he said:


“I envy the opportunities you will explore in dentistry. Your professional future will be exciting and challenging. I suspect the landscape will change more quickly than you imagine. Those with curiosity, energy and enthusiasm to explore new ways to deliver care will be successful. Of course, some things won’t change, like the value of kind- ness and respect.”


Now I pass his words on to you, especially as it relates to the challenges that lie ahead in maintaining an adequate workforce to assist you in delivering care to the increasing population that needs your services.


WHAT IS THE CURRENT STATUS OF THE ORAL HEALTHCARE WORKFORCE AND HOW DID WE GET HERE?


• Our oral healthcare workforce is cur- rently 10 to 15 percent understaffed. To give you a numerical context, Missouri is approximately 1,000 to 1,500 oral healthcare workers short of what is necessary to adequately provide access to care.


• Our workforce was short and stressed before the COVID-19 Pandemic, due to closure of dental schools at St. Louis University and Washington University. Then it got much worse quickly during the Pandemic.


• Understaffing cuts across all roles: doc- tors, hygienists, EFDAs and assistants, leaving many providers overworked, stressed and hovering dangerously close to burnout.


• Workforce surveys conducted in 2022 by the Missouri Office of Dental Health indicate that slightly more than 20 percent of our workforce is considering retirement in the next five years. To give you context, that is an additional 2,000 oral healthcare workers who may exit soon.


• The need for new doctors, hygienists, EFDAs and assistants far outstrips the capacity of our existing educational infrastructure to prepare replacements. Given our current educational capac- ity, it will take two to three decades to restore a provider-to-population ratio to provide adequate access to care to Mis- souri’s population.


• The workforce shortage disproportion- ately affects clinics serving rural and Medicaid populations. Considering workforce solutions for these popula- tions must be a priority.


WHAT OPTIONS AND OPPORTUNITIES LIE AHEAD?


1. Listen to Dr. Patzman’s advice. Our professional landscape is changing more rapidly than we imagined and more


26 focus | FALL 2023 | ISSUE 3


rapidly than we like. We are going to be forced to creatively search for new ways to educate a workforce and new ways to deliver care.


2. Expand the use of EFDAs. This should be job No. 1! EFDAs are a proven way to increase access to care in times of workforce shortages. In the early 1990s, when Missouri began to feel the impact of the dental school closures, we devel- oped the Missouri Expanded Function Dental Assistant program. It has been a resounding success, increasing the pro- ductive capacity of clinics that employ EFDAs by 15 to 20 percent. EFDAs have helped to preserve access to care even during the period of 1990-2022 when the population-to-dentist ratio in Mis- souri increased each dentist’s workload by 33 percent.


3. Create and promote accessible entry level opportunities in dentistry. We are 1,000 to 1,500 oral healthcare workers short now with the prospect of greater workforce shortages in the future. The Missouri Office of Dental Health’s bril- liant pilot project (see update on page 25) identifying partners for dental assis- tant training programs in high schools and in rural areas is a great start. If we hope to replenish our future workforce, we need to add promotion of dental ca- reer opportunities to our strategic plan on every level: national, state, local and especially chairside.


4. Employ distance learning educational modalities to keep prospective health- care providers in rural areas in place, rather than uprooting them to metro-


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