PRACTICE PERSPECTIVES Workforce Shortages Pinch Care by GUY DEYTON, DDS I
f you tried to recruit staff in the last year, you may have had difficulty filling open positions and you may have found it necessary to escalate your compensa- tion packages. You also may have discov- ered that formerly dependable temporary agencies were unable to offer replacement staff and had waiting lists for offices seek- ing help. Reports like this led the Missouri Office of Dental Health (ODH), the Missouri Dental Association, and the Missouri Dental Hygienists Association to review workforce data and distribute a workforce survey to care providers.
This article will describe what we learned about Missouri’s Oral Healthcare Workforce and what we intend to do to help make things better. There were 843 total responses to the ODH Workforce Survey distributed in March 2022. Here are the main takeaways from our deep dive into the survey and data. Explanations follow.
The current workforce shortage cuts across all roles in the dental office: doctor, hygienist, dental assistant and administrators.
• The pre-pandemic workforce already was strained. The pandemic resulted in an estimated exit of 1-10 percent of our oral healthcare workforce, depending on the workforce role.
• Staff left offices for many reasons. Some exit reasons, like perceived health risks or need to stay home with children, were directly related to the COVID-19 pandemic. Other reasons, like cumula- tive stress and burnout, were indirectly related to the pandemic. Some reasons were personal.
• Our surveys and others indicate some may return to the oral healthcare work- force, but many may not return, opting for more flexible work options with less perceived risk.
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• The result is short-staffed oral health- care facilities that are not only strug- gling to see all patients in need of care, but also stressed and frustrated about where they can find the staff they need.
PRE-PANDEMIC WORKFORCE: DENTISTS
To understand our current workforce is- sues, one has to look backwards. From 1960 through 1984, three dental schools (Wash- ington University, St. Louis University and UMKC School of Dentistry) produced an av- erage of approximately 240 dentists per year. Between 1979 and 1989, Washington Uni- versity and St. Louis University closed their undergraduate dental schools. In the mid- 1980s UMKC cut its class size from 160 to 80. By 1990 many more dentists in Missouri started retiring than were being replaced by graduating dentists. In the 12 years between 1990 and 2002, Missouri lost approximately 642 dentists practicing in Missouri. In the 19 years since, we have recovered only about half of the dentists we lost. In that same pe- riod the population in Missouri has increased by more than 1 million people. The result was a 35 percent increase in the average workload on each Missouri Dentist.
PRE-PANDEMIC WORKFORCE: ASSISTANTS & HYGIENISTS
Between 1990 and 2020, the saving grace for the oral healthcare workforce was the growth of dental hygienists and Expanded Function Dental Assistants (EFDA). The number of hy- gienists grew by more than 2,000. Between 2000 and 2020, there were approximately 6,766 EFDA permits issued to approximately 3,000 assistants and hygienists. The increase in the number of dental hygienists and EFDAs didn’t keep pace with the population growth, but it did let the oral healthcare workforce cope with increasing demand.
THE EFFECTS OF THE COVID-19 PANDEMIC ON WORKFORCE
The COVID-19 pandemic was hard on all healthcare workforce sectors including dentistry. Fifty-eight percent (58%) of re- spondents to the ODH Survey reported staff left their employ due to COVID-19 related concerns during the pandemic. While it is difficult to exactly determine the attrition rate by role, combining the results of the ODH Survey with other published surveys leads ODH to the following estimates on the impact of the pandemic on the oral health- care workforce in Missouri.
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