Table of Contents

Periodontics
Restorative

Inside Dentistry

October 2005, Volume 1, Issue 1
Published by AEGIS Communications

At the Head of the Class

Allison M. DiMatteo, BA, MPS

Your Profession, Your Role, Your Future

Beyond the rhetoric and redundancy, dental education is facing what some call a crisis that encompasses myriad challenges and threatens to have long-term implications to the foundation of oral healthcare itself, as well as to the abilities of dentists already in practice to achieve their own personal and professional goals. Vacant faculty positions are taking longer to fill. There’s an exodus of experienced educators from the academic arena. Curricula are often overburdened with coursework that would be better emphasized as prerequisites or that is lacking in modern day relevancy. Financial constraints are strangling the schools themselves, as well as the students.

Photography ©2005 Cie Stroud.

It’s not a dramatic, alarmist overstatement, and it does matter...on many levels. The fact of the matter is that dental schools are faced with having to—within the next decade—fill an estimated 3,400 anticipated vacant teaching positions that will result from faculty retirements alone. Now, considering that collectively the 56 U.S. dental schools graduate an average of a little more than 4,000 students per year and, of that figure, less than 1% pursues careers in academic dentistry, the fate of dental schools is questionable, at best.

What’s more, some have noted that the overall change in the climate of dental school demographics can affect the way practitioners practice dentistry, manage their practices, and perceive their practice businesses as investments for their future. So, note some educators, considering that dental schools are challenged by recruiting and retaining faculty, that there is a threat of needing to reduce class sizes, and that the demographics of dental school graduates is changing, the implications of what’s taking place in dental education to those already in practice may need to be clarified. Fewer students could graduate, so there would be fewer new dentists entering the profession who are ready, willing, or able to meet the growing needs of a demanding dental patient population. And if there are fewer dentists coming into the profession, what does that mean for the future of the practices of those professionals who are ready to retire out of it?

Howard E. Strassler, DMD, Professor and Director of Operative Dentistry at the University of Maryland Dental School in Baltimore, can see the potential implications. Whereas 25 or 30 years ago there were few women attending dental schools, today approximately 50% of all dental students are women, he said. That fact alone begs questions regarding how these graduates will move their careers, whether they would participate in ownerships of practices or be employees, and the amount of time they will spend practicing.

“If you decrease the class sizes at dental schools because of faculty shortages or dental schools have to close because they can’t have viable faculty,” Strassler explained, “this, combined with the changing demographics, can have implications to whether or not dental practices are sellable.”

Fewer graduates—and/or fewer graduates with an interest in purchasing a practice—means that those dentists with a solo dental practice who view that practice as part of their retirement “nest egg” may have longer to wait to realize a return on their investment, he implied. And that investment could translate to hundreds of thousands of dollars.

“They don’t stand to profit as much, and their return on investment may be lower than their expectations,” Strassler said. “Someone may need to practice more years until they can find the right buyer.”

So, if you were looking to retire at age 62 or 65, you may be waiting until you’re 68 or 70, Strassler suggests.

However, it might not be all doom-and-gloom. Many have suggested that the reputed crisis is really an era of opportunity, a time for practicing dentists with the inclination—and the academic skills—to give back to the profession by teaching the next generation and helping to shape the present and future of dental education. With the advent of progressive, on-going changes in the manner in which dental schools assemble their faculties, the doors are opening wide for those who’ve pondered a professorial role. If you’ve contemplated a career in academic dentistry, now may be the time to make your move, or at least broaden your horizons. Here’s an Inside look at why and how.

Now Hiring...Still Hiring...and Still Going to be Hiring

Based on the 2003/2004 academic year, there are now 291 vacant budgeted faculty positions spanning 55 of the nation’s 56 dental schools, according to this year’s report by the American Dental Education Association (ADEA).a Of those, 237 are full-time positions, and 54 are part-time positions. However, while the average number of vacancies reported to be usual and normal at any one time was 3.6 per school, it’s taking longer to fill those vacant positions. Only 43% of the vacancies have been vacant less than 7 months, a decline of 55% from the previous year, suggesting an increase in the number of positions that are remaining vacant longer than 6 months.

And, while in previous years the factors cited as most influencing a dental school’s ability to fill a position were salary/budget limitations and lack of response to position announcements, this year it’s a question of finding the people who can meet the position requirements.

“The challenge is obtaining individuals who can fulfill the scholarship and research requirements of the position as set by the parent university,” explains Richard G. Weaver, DDS, the Associate Director of ADEA’s Center for Educational Policy and Research. “It’s a matter of obtaining faculty that have the educational backgrounds, as well as the clinical, didactic skills.”

As a result, he said, it’s taking longer to fill some of the positions. Further, according to Michael C. Alfano, DDS, PhD, Dean of New York University College of Dentistry, there are some areas that are typically harder to recruit for, such as orthodontics and radiology.

Currently there is an estimated average of 5.3 vacant faculty positions per dental school, with some schools having more and others less. However, 50% of the deans surveyed feel that faculty recruitment and retention is a problem at their school, with more than 55% saying that they anticipate it will become more difficult over the next 5 years to fill vacant positions.a

“In a total pool of several thousand faculty members,” said Alfano, “there is a concern that we don’t have enough young people expressing an interest in full-time academics, and that’s something that we, as a profession, have to be concerned about.” Based on 2003 statistics, the total number of dental school faculty is 11,348.a

It’s About the Bottom Line

But while the applicant pool for vacant dental school faculty positions may not be up-to-par, what’s holding back those who can make the grade from pursuing academic dentistry? Well, at least in the dental discipline of endodontics, a report published in 2002 found that the 392 first and second year residents enrolled in the U.S. who responded to a survey most frequently indicated low salaries of teachers (70%) as the reason for not being interested in an academic career. Fifty-one percent cited educational debt as the reason, while 31% claimed their reason was a desire to be their own boss or a lack of interest in research.b

And who wouldn’t want to unload that debt quickly? The average educational debt of all dental school seniors (i.e., from both public and private dental schools) in 2002, according to the American Dental Association, was $107,503. That represents an increase in dept of 93.5% from 1992.c

“People in private practice are doing very well financially right now,” observes Edward J. Swift, Jr., DMD, Chairman of Operative Dentistry at the University of North Carolina School of Dentistry. “There is a real financial imbalance between academic dentistry and private practice, and it’s hard to overcome.”

And so it is. According to ADA information, there was an estimated 57% gap between a dental school faculty salary and the net income from private practice reported in 1999. At that time, the average faculty salary was reported as $77,300, compared to a net private practice income of $134,590.c The numbers have increased proportionally over the years, but the gap is still a pretty fair estimate according to those interviewed.

“At our school, and probably a lot of others, in certain departments we’ve lost faculty strictly for economic reasons,” Swift has observed. “They know they can get into private practice, maybe not even work as hard, yet make a significantly greater amount of money. A lot of it comes down to finances, unfortunately.”

Swift isn’t alone in his assessment. Despite the multitude of opportunities that today’s dentistry presents—such as improving oral care benefits and outcomes, further exploring the regeneration of tooth structure, and helping people enjoy their teeth for a lifetime—a challenge or obstacle to the pursuit of a career in dental education is the cost of that education and the significant amount of debt it generates, according to Harold Slavkin, Dean of the University of Southern California School of Dentistry.

According to the ADA, the average annual cost to dental schools to train and educate students in fiscal year 2002 was $78,763.c Explained Roger Levin, DDS, CEO of Levin Group, many forget that unlike other schools, dental schools are expensive to run and operate. Compounding matters—including dental schools’ abilities to pay faculty salaries competitive with those in private practice—is the fact that state legislators are allocating more money to Homeland Security, so there is less money for other areas, including education.

“Dentistry is an enormously lucrative field, with a fabulous return on your investment if you’re going into it for economic reasons and pursuing private practice,” Slavkin commented. “People have to come together and figure out how to make dental education cheaper. It’s objectively the most expensive major professional school in any university in the U.S.”

Filling the Void with Corporate Connections

To alleviate some of the burdens of presenting an ever-expanding curriculum when dental school faculty are over-extended because of still-unfilled vacancies, some schools are turning to outside experts. Scientists and researchers from industry represent a very possible, and sensible, means to satisfy teaching needs if the content and the lectures are thoroughly and conscientiously reviewed.

“Bringing in credible PhDs from industry to talk about materials—whether ceramics or glass ionomers or impression materials—can help to supply dental schools with some expertise in certain areas when it comes to teaching,” notes Gerard Kugel, DMD, MS, PhD, Associate Dean for Research at Tufts University School of Dental Medicine. “We’ve done it at our school, but we’ve not done it with one manufacturer; we’ve done it with multiple companies.”

Remaining objective and non-exclusive, he asserts, is the only way to keep a corporate-dental school relationship above board and ensure that instructional content is just that—instructional, not promotional. But while assistance in certain material science areas may help fill some voids in terms of teaching components of the curricula, it’s not sufficient to eliminate the problems caused by vacant positions that remain unfilled. For this reason, dental schools are looking for ways—and finding them—to make academic dentistry more rewarding for those who wish to make such endeavors a part of their overall professional portfolio.

There Is a Place for You
If you think there isn’t a place for you in dental education, think again. Of new faculty hires, only 20% are immediate graduates of advanced dental education programs, and 11% are immediate graduates of dental schools. Other sources of new hires include those from another dental school (15%) and the uniformed services (2%). The majority of new faculty hires—at 52%—are individuals from private practice.a

What’s making it possible for those that have been in private practice to enter the academic arena is a fundamental paradigm shift in terms of what it means to be an academic dentist. By abandoning old ways of looking at faculty positions, dental schools have opened up new avenues by which to offer the brightest minds in the profession the opportunity to experience the best of both worlds: intellectual fulfillment and financial security.

It’s a Whole New Venue

For example, Tufts has been successful at incorporating more flexibility into the schedules for and expectations of its various faculty members. In the past, someone in an academic career would be sent on a tenure track, be expected to conduct research and publish, and be accountable for teaching. It was a 4- or 5-day-a-week commitment. To be promoted meant publishing, securing research funding, and teaching. If clinical instruction was all that was being done—and it didn’t fit into the university’s overall criteria for advancement—then there wasn’t any.

“It’s just not practical anymore to expect faculty to be able to do it all,” says Kugel. Today, rather, Tufts implements faculty career tracks that meet the various educational requirements of the dental school, without the need for any one individual to be a jack of all trades: research tracks dedicated to laboratory work; clinical tracks focused on working with students to develop their skills; teaching tracks that emphasize the interpretation to the students of everything else that’s going on.

What’s more, explains Lonnie H. Norris, DMD, MPH, Dean of the Tufts dental school, being considered a valuable asset to their institution is not reserved for only full-time educators. Those working 1 or 2 and half days a week are equally respected for their contributions.

“I think that dental schools have to be a little more open to accepting different views of what it means to be an academic dentist,” Kugel believes. “At Tufts, you can focus on your track and still be brought up to a full professor level.”

In addition, notes Strassler, as some schools embrace distance type learning programs—where faculty are brought in to give lectures that are electronically recorded—the potential to teach at more than one location may also present itself.

“The future may be that there will be faculty who have expertise in a given subject who will go from dental school to dental school to provide information because that expertise does not exist within any one dental school alone,” Strassler said.

Simultaneously, dental schools are looking for ways to maintain the energy and enthusiasm that their faculty—veteran and new alike—feel toward their academic careers. At NYU College of Dentistry, Alfano has found that it boils down to creating an exciting environment, one in which the faculty feel fulfilled, appreciated, and intellectually stimulated in areas other than dentistry. There, “Liberal Arts at Lunch” sessions invite the foremost scholars in history, literature, philosophy, and/or mathematics to visit the dental school and enlighten its faculty, while a new university commons area with a faculty lounge resonates with “We appreciate you; we respect you; you are valuable.” All of this, Alfano says, is designed to help retain faculty by focusing on helping them evolve and feel fulfilled as scholars.

And What About the Money Matters?

According to Levin, an ongoing critical issue facing dental schools is funding faculty salaries—including chairs—in such a way that the salary gap between academia and private practice is closed. Alumni support is essential to this endeavor, he says.

“We are going to absolutely need alumni increasing their contributions to help fund the schools and maintain a strong future for academics,” he urges.

Now, more than ever, Swift says, dental schools depend upon private support from alumni and friends in order to stay in the black. “Sure, it would be nice to see the State and Federal governments increase their level of funding to enhance faculty salaries,” commented Swift, “but I’m pretty much a realist, and I’m sure it’s not going to happen.”

Regardless, Norris asserts that leaders of academia must ensure that if they cannot receive all of the funding for their budgets to support faculty salaries that are equal to private practice, then they must develop programs or schedules that enable faculty to flexibly and freely supplement their incomes. By doing so, dental schools will help facilitate the realization of an overall compensation package that is more competitive.

“When you look to get a little bit more creative, you can make career paths in academia that allow people to have at least one full day for private practice when they don’t have to stay in the classroom or school environment,” Norris emphasizes. “You can make schedules so that individuals can supplement their salaries by working outside the facility in private practice, or provide an incentive to researchers to bring in grants so that those monies can supplement their salaries.”

Going Back and Giving Back

“Dentistry has been good to almost all of us,” reflects Levin. “When a dentist hits a point in his or her career where they can spare a half a day a week or a day every other week to help students—especially in the clinical setting—I think that it’s wonderful. It’s up to every generation to do its part to maintain the strength of the profession, or truly the next generation will pay the price.”

Along those lines, Levin echoes the sentiments of others who feel strongly that enabling practicing dentists to dedicate 1 or 2 days a week to student education is paramount to strengthening dental school infrastructures.

And now, more than ever before, it’s possible for those practicing in the field to make their contributions to academia and the profession-at-large in a variety of ways that can accommodate their needs. Where and how vacancies are filled—and how supporting research is conducted—at dental schools are changing, and there’s more room to explore the benefits and fulfillment that a career in education has to offer. Whereas in the past scientists conducting research at dental schools were probably more narrowly focused than they ought to have been, today’s educational leaders are looking to collaborate with colleagues in the medical school, material science, applied science, and other areas. In this century, notes Slavkin, the well-rounded dental school faculty includes registered nurses, pharmacists, physicians, and others, not necessarily because there aren’t dentists for the positions, but because it’s the right thing to do in order to provide students with an enriched education.

Conclusion—Crisis or Opportunity?

It’s been suggested that without more talented young people pursuing a career in academic dentistry, the worst case scenario would be that some schools would close. Considering that there is already a cross-country shortage of dentists—which is likely to get worse in the future—the situation wouldn’t be helped if any schools had to close or reduce their class sizes simply because there weren’t enough people to teach them, explains Swift.

Underserved areas would continue to be disadvantaged and out of reach of the benefits that preventive and restorative treatments can offer. And the profession, as a whole, would suffer. Manpower initiatives similar to those imposed in the 1980s would come back into play, explains Levin, and then everything from reimbursement to allocation would be under government regulation.

“I do think there are some very serious challenges that could result from a shortage of faculty,” Levin emphasized. “Number one, there could be school closings. Number two, there could be cut-backs in terms of the number of students that can be handled. And number three, which possibly is the most important and should be number one, is that the quality of education will suffer.”

And when education suffers, so do all other aspects of the profession. Consider that the tremendous success so many practicing dentists are experiencing right now is due in large part to innovative material science and product engineering efforts, all of which have at their core the research undertaken at universities and dental schools. Would those magnificent—and lucrative—smile makeovers be possible without them? A pool of dental researchers is needed to keep the momentum going.

“If we don’t attract some of the better people into education, then obviously there beckon the questions, ‘Who’s educating our students and, frankly, who’s educating the educators?” ponders Kugel. “Not only do we have to teach people to be dentists, but we must also teach people to be teachers.”

So, when you look at it that way, it’s safe to say that the future of dentistry lies where it first began: with dental education. Secure that foundation—with a dedicated effort to recruit, develop and retain qualified faculty according to an innovative new concept of what it means to be an academic dentist—and you ensure the future of the dental industry—and oral healthcare—overall. For those currently enjoying the rewards of private practice but who’ve considered an academic agenda—only to shy away from the thought because of yesterday’s institutional limitations—maybe it’s not a crisis, but an opportunity, after all, to consider going—and giving—back to school.


a Weaver RG, Chmar JE, Haden NK, Valachovic RW. Dental school vacant budgeted faculty positions: academic year 2003-2004. J Dent Educ. 2005;69(2):296-305.

b McNally MA, Dunning DG, Lange BM, Gound TG. A survey of endodontic residents’ attitudes about a career in dental education. Journal of Endodontics. 2002;28(8):592-94.

c Brown LJ, Meskin LH, eds. The Economics of Dental Education. Chicago: American Dental Association, Health Policy Resources Center; 2004.

The Inside Look FROM...

The staff and publishers of Inside Dentistry gratefully acknowledge the time, insight, and candid comments shared by our interviewees, without which this inside look at dental education would not have been possible. The following individuals, all well-respected throughout the dental industry and the academic arena, made invaluable contributions to this presentation.

Michael C. Alfano, DDS, PhD
Dean
New York University College of Dentistry
mca1@nyu.edu

Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine
gerard.kugel@tufts.edu

Roger Levin, DDS
CEO
Levin Group
rlevin@levingroup.com

Linda Niessen, DMD
Vice President for Clinical Education
Dentsply International
Clinical Professor, Department of Restorative Sciences
Baylor College of Dentistry
lniessen@dentsply.com

Lonnie H. Norris, DMD, MPH
Dean
Tufts University School of Dental Medicine
lonnie.norris@tufts.edu

Harold Slavkin, DDS
Dean
University of Southern California School of Dentistry
slavkin@usc.edu

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
University of Maryland Dental School
hstrassler@umaryland.edu

Edward J. Swift, Jr., DMD
Chairman of Operative Dentistry
University of North Carolina School of Dentistry
ed_swift@dentistry.unc.edu

Richard G. Weaver, DDS
Associate Director
Center for Educational Policy and Research
American Dental Education Association
WeaverR@adea.org

 

Get Them While They’re Hot: How Dental Schools Are Trying to Recruit A Younger Generation of Educators

One of the worsening problems in dental education that is begging for attention is the average age of dental school faculty and the fact that it’s older than people think. According to a recent report by the American Dental Education Association (ADEA), 55% of dental faculty is 50 years of age or older, and 24% is over the age of 60. Therefore, as more senior faculty retire and leave more vacancies to be filled, the shortage of young, interested professionals willing to pursue a career on the academic side of dentistry warrants attention, and action. Specifically, ADEA predicts that over the next 10 years, an estimated 30% of current faculty will retire, leaving more than 3,400 vacant faculty positions to be filled.

Some say the answer, then, is to get them while they’re hot—potential dental educators, that is. A 2002 survey published in the Journal of Endodontics suggests that those dental students with an affinity toward an academic career enjoy clinical teaching, working with others in the field, and/or the university atmosphere. It would seem, then, that it is incumbent upon dental schools to target potential educators the minute they walk through the doors as first year students. And there are efforts underway to do just that.

Intervening Involvement
According to Lonnie H. Norris, DMD, MPH, Dean of Tufts University School of Dental Medicine, although the shortage of qualified individuals to fill vacant faculty positions represents an entire professional problem deserving collective attention, it is up to the individual schools themselves to be more proactive in talking to students and making them aware of the benefits and advantages of academic careers. That means letting students work as assistant teachers, getting them involved in national projects and committees, and working on collaborative research initiatives within the dental school itself, as well as with other schools or other departments within the university.

So, from early on in students’ dental education experiences, Norris promotes their involvement in teaching. In conversations with his faculty, he reinforces the importance of conveying a positive attitude about the school’s educators, the academic life, and the rewards of teaching. Further, he encourages students to look at the multiple employment benefits (i.e., retirement plans, health insurance, vacation pay, etc.) that accompany a career in education.

“We have bright, talented young people coming to us as first year students who are really excited about entering dentistry,” affirms Linda Niessen, DMD, Vice President for Clinical Education for DENTSPLY International and a Clinical Professor in the Department of Restorative Sciences at Baylor College of Dentistry. “We need to harness and maintain that enthusiasm and encourage them to consider entering the dental education arena.”

Posturing the Passion Over Education
In fact, in the realm of research, the Student Clinician Program, sponsored by DENTSPLY and held in conjunction with the American Dental Association annual session, enables one student from each of the 56 U.S. dental schools each year to conduct research—in addition to fulfilling their dental school curriculum requirements. These are students, explains Niessen, with a demonstrated interest in research and whom dental schools should be recruiting for positions in dental education.

According to Harold Slavkin, Dean of the University of Southern California School of Dentistry, recruiting future dental educators should begin when recruiting prospective dental students. To do so, he says, means sharing the passion about discovery, science, technology, and eliminating health disparities.

“Dental education is about passion, commitment, and a love of learning,” Slavkin believes. “If you don’t recruit for those sorts of students and nurture and mentor them once you have them, then at the time of graduation, you won’t have any takers of academic dentistry.”

To this end, requirements for dental school scholarships may hold some promise for enticing students with the interests and intellect associated with academic dentistry. At Tufts, 5 research track scholarships are available to students entering the dental school so that they can conduct research, work with a mentor, present their research findings, and complete their degree requirements. According to Gerard Kugel, DMD, MS, PhD, Associate Dean for Research at the Tufts dental school, this, along with research and clinical teaching assistantships, have done wonders to get students excited about teaching.

Maintaining the Motivation
But beyond the recruitment of dental school students themselves into the academic arena lies the challenge of then keeping them, too, enticed to remain there. According to ADEA, 73% of new dental school hires are those entering into positions with lower academic ranks, while 43% of reported separations from dental education are individuals leaving lower academic ranks and entering private practice. Older faculty with academic ranks of professor or associate professor have been leaving for retirement, but younger faculty—assistant professors and instructors with an average age of 46 or 40, respectively—are leaving dental education for private practice.

“There’s a great emphasis now on whiteness and brightness and esthetic dentistry, and the economy is such that private dental practice is in a boom era,” Norris explained. “The salaries people can get in private practice are usually higher than what you can get from an academic career, so private practice is academia’s biggest competition.”

In response, the face of academic dentistry is changing in terms of what’s permissible for a faculty member. The days of full-day, 4- or 5-day-a-week teaching, research, and clinical schedules are long gone. The time has come when dental schools are making way for part-time faculty members—whether clinical instructors, assistant or associate professors, or researchers—and enabling them to pursue other endeavors that could enhance their professional, personal, and financial satisfaction. And, along the way, they’re finding ways to ensure that tomorrow’s dental school educators are taught how to teach, and that if they’re to practice outside of the education environment, that they receive the support and guidance necessary to balance both worlds.

 

The Curriculum Conundrum

There’s a sense among dental school educators, administrators, and industry organizations that more time is needed in dental school to fully focus on those evolving and emerging disciplines that require attention and training. Proposed solutions include not only updating the curricula to add those subjects with modern day relevancy and remove those without it, but to also determine what can be made a prerequisite. After all, in the last 50 years, so many more techniques and materials have been added that need to be pieced in, but there just isn’t enough time, educators say.

“We have a real chore trying to teach the dental curricula,” admits Gerard Kugel, DMD, MS, PhD, Associate Dean for Research at Tufts University School of Dental Medicine. “Dental schools are slow to change the curriculum because doing so requires people to change, and people just don’t want to change.”

But, before anything can change, recognition of where problems in the curricula are—as well as the fact that they’re universal—must be recognized first. And perhaps nobody knows that better than those dentists just a few years out of dental school and embarking on their careers as practicing professionals.

“There is a whole curricula review process that has been initiated that is taking a look at updating the competency requirements for new dentists, as well as delineating the essential knowledge foundation for each of those competencies,” explained Richard G. Weaver, DDS, the Associate Director of the American Dental Education Association’s (ADEA) Center for Educational Policy and Research. “From there, a reassessment of the scope and content of the curriculum can be determined, so there is a process going on at this time to really make an in-depth review of the dental school curricula.”

However, advocates for changes in dental education don’t view what’s happening as simply a need for curriculum reform, but of total reform. According to Michael C. Alfano, DDS, PhD, Dean of New York University College of Dentistry, “Dental schools have been doing a reasonable job of creating new curricula since the Geis Report was published in 1926.”

The problem, however, is that dental education has reached the stage where it can’t be tweaked anymore. In viewing dental schools and dental education as a collective enterprise, what’s needed is a consideration of what can be moved into a pre-doctoral program, and this is much more easily accomplished if dental schools agree en masse as to what courses will become prerequisites, Alfano recommends.

For example, let’s say that School A was to start requiring biochemistry as a prerequisite, but Schools B and C didn’t. You’d expect to see a fall-off in applications to School A. Alfano explained that it becomes more difficult for an individual school to modify requirements than for either clusters of schools or, nationally, for all schools to agree that 3 to 5 years from now they will all begin to require biochemistry as a prerequisite.

“The first thing is to get ADEA, the ADA [American Dental Association] and other major stakeholders to come to grips with the fact that we need a major revision in dental education; somebody has to make that call,” asserted Dr. Harold Slavkin, Dean of the University of Southern California School of Dentistry. “Then, we need to ask ourselves critically if the dental program is something you can understand and become confident at in terms of skill level in 4 years, or do we need an additional fifth year for an internship to do a better job at building skills?”

And there are other areas in need of assessment. For example, molecular genetics is arguably the future of medicine and dentistry. But instead, dental schools continue to present traditional biochemistry or intermediate metabolism, courses that have been argued as not as relevant to today’s practice as some other topics, such as pharmacology. Further, the manner in which subjects—such as anatomy—are taught also requires scrutiny. Although it’s been taught the same way for 300 years, Alfano questions the efficiency of tying up large laboratories for the conventional dissection of cadavers when technological advancements (e.g., plastination, simulation, 3-dimensional modeling) can benefit students and educators alike.

The board examinations themselves-and the way they’re constructed-also need modification. Rather than query students about minutia details that won’t be retained in the course of day-to-day practice (i.e., the specifics of any one of the 350 biologic mediators of inflammation), what Alfano advocates are general concept questions that demonstrate a graduate’s thorough understanding of the correlations between clinical and basic sciences and their implications for treating patients.

“When we have 1 part of the boards that the average, very good general dentist 10 years out of dental school and in practice can’t pass, then we probably have a problem with it,” Alfano says. “The boards are supposed to be designed to test content that is important for the general practitioner.”

For this reason, in addition to the fact that so many required subjects are now crammed into the dental curriculum, most educators—although not all—support the concept of a post-graduate year 1 (PGY1). The PGY1 effort acknowledges that there is nothing better to top off a primary education in dentistry than a 1-year experience in either advanced education in general dentistry or a general practice residency in a hospital. In collaboration with a mentor, students undertake “these wonderful educational experiences that perfectly guide them into managing more difficult cases than they would typically see in dental school, allowing them a period of time to develop their own diagnostic acumen and therapeutic skills,” Alfano detailed. In New York State, PGY1 eliminates the clinical board exam as a requirement for licensure in New York.

 

Funding the Future
Without question, today’s dental school deans are searching for and implementing innovative ways to ensure their abilities to meet the cumulative salary requirements for those seeking to pursue a career in academic dentistry. However, guaranteed salary positions have historically been protected through endowments, and many in education today believe fund-raising and donations are still paramount to ensuring their long-term viability. To this end, dental schools are going to be more aggressive at fund-raising efforts targeted toward alumni, notes Howard E. Strassler, DMD, Professor and Director of Operative Dentistry at the University of Maryland Dental School in Baltimore.

The time has come, he and others agree, for practicing dentists to decide if they have an emotional investment in their alma mater and, if so, to give back to their dental school so that programs can be enhanced and knowledgeable, prestigious faculty can be brought on-board. Endowments for such positions that are supported by alumni giving, Strassler explains, help offset what a dental school must pay for someone’s salary and help make it more competitive with private practice.

Overall, he said, alumni support is a way to sustain dental schools so that class sizes can be maintained, graduates can continue to enter the practicing world, and the profession can continue to thrive.

The irony of the situation today, notes Harold Slavkin, Dean of the University of Southern California School of Dentistry, is that dentists are making more money than ever before in private practice, but dental education is endangered.

“At this time in history, dental schools do not have an entitlement,” he explained. “They must earn their place in the university.”

Explains Strassler, the dental education itself that is provided at our nation’s dental schools is not enough to allow them to survive. Therefore, in terms of identifying suitable faculty, there is a focus being placed on finding individuals who can bring in research dollars and other money to help with dental schools’ bottom lines.

The unfortunate fact is that there have been dental schools that have closed within the past 15 years because they weren’t producing an income level consistent with what they should in terms of research or other sources. Therefore, Strassler and others have said, it is very critical that dental schools maintain a level of status in dental and basic science research, and that there’s money to help support such educational programming.

And there are efforts underway—in addition to alumni giving campaigns—to secure such support. According to Slavkin, individual organizations—whether they be the American Dental Association or associations dedicated to different dental specialties—have all created foundations to encourage people to contribute money to help solve the funding problems being faced by dental schools. As an example, the ADA Foundation has launched the National Campaign for Dental Education, noted Roger Levin, CEO of Levin Group. Ambitious indeed, its goal is to raise several hundred million dollars for dental education—to conduct research on the many aspects of dental education, support the development of new models of the education process, and support promising new educational initiatives.

 

Foreign Affairs: Filling the Void for the Short and Long Term

Some dental schools—such as Tufts University School of Dental Medicine, the University of North Carolina at Chapel Hill, and others—have done well for themselves in recruiting for vacant positions by reaching outside the borders to cultivate and nurture a pool of eager, talented, and educated graduates from foreign countries. Highly qualified—but not licensed to practice in the U.S. without a U.S. degree and completion of national boards—they’ve expressed a demonstrated long-term interest in academic careers.

In fact, the American Association of Dental Schools (AADS) asserts that in order to expand their pool of potential faculty, dental schools should remove restrictions that inhibit qualified foreign faculty from accepting appointments in U.S. dental schools.a Further, the AADS holds that foreign dental graduates should have all of the prerogatives regarding an academic career as their U.S. trained counterparts.

At Tufts, the Faculty International Program allows dental school graduates from other countries to come to the dental school, teach for a couple of years, and then enter a 2-year program—tuition free (i.e., a value of between $35 to $45 thousand per year)—all the while maintaining their teaching faculty position and their original salary. Once they’ve completed their program, the faculty-students then agree to stay at least 2 or 3 years.

According to Lonnie H. Norris, DMD, MPH, Dean of the Tufts dental school, the total time for which an international student could be teaching at the dental school could be at least 5 or 6 years. This, he says, affords them an opportunity to complete their DMD degree to practice in the U.S., and it provides the dental school with much needed faculty support.


a Kennedy JE, Hunt RJ. Meeting the demand for future dental faculty. American Association of Dental Schools 75th Anniversary Summit Conference.