Environmental Scan for Strategic Planning Efforts at the University of the Pacific Arthur A. Dugoni School of Dentistry

Transcription

1 Strategic Planning Efforts at the University of the Pacific Arthur A. Dugoni School of Dentistry Dental Workforce, Access to Care, and Dental and Allied Dental Education November 18, 2016

2 Page 2 A. Dental Workforce in the U.S. and in California 1. Dentist Workforce Dentistry is currently ranked the second best job in the United States according to the U.S. News and World Report. The job of a dental specialist, Orthodontist, is rated first. 1 According to survey data from the American Dental Association (ADA), there were 195,722 professionally active dentists in the United States as of Seventynine percent (79.05%) of all the active dentists were general practice dentists, 2 and approximately 91.7% were engaged in private practice. 3 Based on the regional distribution in 2009, about 20.3% of all the dentists in the U.S. are practicing in the Pacific region (California, Oregon, Washington, Alaska) (Fig. 1). The state of California alone has 30,180 active dentists, or 15.42% of the national total. 2,3 Fig. 1: Distribution of All Professionally Active Dentists and New Professionally Active Dentists by Region, 2009 The number of dentists per 100,000 population in the United States was 60.9 in 2015 and varied across states (Fig. 2). California (77.1) has one of the highest dentist-topopulation ratios in the nation, after the District of Columbia (89.9), New Jersey (81.5), Alaska (80.8), and Massachusetts (78.3). 4 Between 2005 and 2015, dentists-to-pollution ratios increased for most states, and California saw an increase of 3.4%. 4 Furthermore,

3 Page 3 per capita supply of dentists in the United States, adjusted for hours worked and patient visits, is projected to increase through 2035 (Fig. 3). 5 Fig. 2: Dentist Per 100,000 Population Across Different States, 2015 Source: American Dental Education, Health Policy Institute, 2016

4 Page 4 Fig. 3: Historical and Projected Dentists per 100,000 Population in the U.S. However, according to the Health Workforce Simulation Model (HWSM) used by the Health Resources and Services Administration (HRSA), in the decade to come, increases in supply will not meet the increases in demand for dentists nationally. California is among the states projected to experience the greatest shortfalls in the number of dentists in 2025, with 1,234 fewer dentists than needed. 6 About one in 18 dentists (5.5%) moved to a different state between 2011 and 2016; dentists who were 40 years or younger were much more likely to move, with about one in eight (12.6%) migrating across state lines. 7 Between January 2011 and January 2016, the overall dentist workforce in California stayed even, dentists under the age of 40 increased by 0.3%. 7 Dentists have one of the highest median ages of healthcare practitioners, substantially exceeding nearly all others. According to the U.S. Department of Labor, the median age of dentists in 2013 was 48.7 years; the median age for dental hygienists was 43.9; and the median age for all health practitioners was Furthermore, the average age of dentists has been increasing in the past decade from 48.5 in 2005 to 50 in partially due to the delayed retirement of many older dentists. While dentists average age Error! Bookmark not at retirement in 2005 was 66.1, average age increased to 68.8 in defined. The five states with the highest shares of dentists younger than 50 are on or west of the Rockies (Idaho, Nevada, Utah, Arizona, Montana). 9 The dentist workforce in California is slightly older than the national average, with close to half (49.3%) of practicing dentists in the state are 50 and younger. 9

5 Page 5 The percentage of female dentists in the workforce has increased from 20% to 29% between 2005 and 2015, and is expected to continue growing as is evident in the growth of the proportion of female dental school graduates. In terms of race and ethnicity, white and Asian dentists are proportionally more represented in the profession whereas Hispanic and black dentists are proportionally less represented when compared to Error! Bookmark not defined. the U.S. population. 2. Allied Dental Workforce Dental hygienists work in a host of settings to deliver clinical care and work under varying levels of supervision, depending on the state practice act. Currently, 39 states have policies that allow dental hygienists to work in community-based settings (like public health clinics, schools, and nursing homes) to provide preventive oral health services without the presence or direct supervision of a dentist. 10 Dental hygiene is one of the fastest growing professions in the country, with a projected growth of 28 percent from 2012 to Ongoing research linking oral health to general health may continue to spur demand for preventive dental services, which are provided by dental hygienists. According to the U.S. Department of Labor, in 2015 there were estimated 200,550 dental hygienists employed in the country, and California had the highest employment level of dental hygienist (20,560) of all the states (Fig. 4). 11 When it comes to wage level, California has the second highest mean wages for dental hygienist ($45.18/hour, $93,970/year), and San Francisco is the top paying metropolitan area for dental hygienist ($52.30/hour, $108,790/year).

6 Page 6 Fig. 4: Employment of Dental Hygienist, by State, May 2015 Source: U.S. Department of Labor, Bureau of Labor Statistics, 2015 Several states are considering a variety of proposals which would facilitate licensed dental hygienists pursing additional education to administer an advanced clinical scope of services, including restorative care. In Minnesota, an advanced dental therapists (ADT) may be dually licensed as an ADT and registered dental hygienist (RDH). In Vermont a dually licensed dental therapist will provide oral health care services under the general supervision of a dentist within the parameters of a written collaborative agreement. These models are designed to extend the reach of the existing oral health care system to underserved populations. 10 Furthermore, HRSA is providing support to the states for developing innovative programs and the training of advanced dental hygienists to address oral health workforce needs in health professional shortage areas. 6 A 2014 report entitled California s Health Workforce Needs: Training Allied Workers described the importance and need in training allied health workforce, including dental hygienists, to meet the healthcare demand of the state: Over the next decade, California s health workforce is expected to require almost 450,000 new workers mostly due to population growth and aging, but also to expanded coverage under the Affordable Care Act. While physicians and other highly trained clinicians are critical to health care delivery, the majority of health care jobs are technical and support positions referred to in this report as the allied health workforce that tend to require associate

7 Page 7 degrees or vocational certificates. Overall, about 40 percent of all health care jobs that need to be filled over the next decade will require some college but less than a bachelor s degree Trends in the Dental Sector and Public Oral Health The 2013 ADA report on the trends in the U.S. dental sector indicated several important structural changes in recent years. 13 Utilization of dental care has declined among working age adults, particularly the young and the poor, as dental benefits coverage for adults has steadily eroded the past decade, again particularly for young and poor adults. On the other hand, dental care utilization among children has increased steadily the past decade, a trend driven entirely by gains among poor and near-poor children. The percent of children who lack dental benefits has declined, driven by the expansion of public programs. Total dental spending in the U.S. slowed considerably in the early 2000s and has been flat since 2008, with public financing accounting for an increasing share. It is projected that dental spending will remain flat in the coming decades. Older Americans are expected to account for a growing share of dental expenditures. Seniors ages will account for about 32% of all dental expenditures by 2040, followed by children with about 24%. The largest growth will be in adults ages whose proportion of total expenditures is expected to double between 2010 and The growing racial and ethnic diversity of the population will likely have an effect on dental utilization trends. Racial and ethnic minorities are less likely to use dental care than whites. From 2000 to 2050, the percentage of the white population is projected to drop from 81% to 74%. The percentage of the population identifying themselves as Hispanic is expected to grow from 12.6% in 2000 to just over 30% in Hispanics are less likely than the general population to visit the dentist regularly and more likely to view regular dental care as unimportant. Hispanics are also more likely to be uninsured for dental benefits than whites. The shifting patterns of dental care utilization and spending have had a major impact on dentists. Average net incomes of dentists declined considerably beginning in the mid-2000s, and held steady since 2009 but have not rebounded. Two out of five dentists indicate they are not busy enough and can see more patients, a significant increase over past years. Dentists will increasingly encounter patients who proactively shop for value and quality. Compared with health care, more patients pay out-of-pocket for dental care, increasing the importance of savvy shopping. Young adults are the least likely to have dental insurance and most likely to use information technology to gather information, find providers, and compare prices. This will intensify as advances in health information technology make it easier for patients to access information on specific providers.

8 Page 8 With the increased demand for value in dental care spending, practices will need to become more efficient. The trend towards larger, multi-site practices will continue, driven by dental plan pressures for smaller provider networks, practice patterns of new dentists and increased competition for patients. Health care reform and Medicaid expansions with an increasing emphasis on outcomes and costeffectiveness will encourage alternative models of dental care. According to the most recent ADA data on Oral Health Care System in different states, California is above the national average in many public oral health care categories while lacking in others (Fig. 5). 14 In 2013, 45% of children with Medicaid coverage in California had a dental visit, compared to the national average of 48%. In 2013, 67% of children with private dental benefits coverage in California had a dental visit, compared to the national average of 64%. In 2013, 62% of adults with private dental benefits coverage in California had a dental visit, compared to the national average of 59%. In 2013,15% of Medicaid children in California received a sealant on a permanent molar, compared to the national average of 14%. In California, the average oral health status rating was 6.8 for high-income adults and 7.7 for low-income adults in 2015, compared to the national average of 8.2 for high-income adults and 7.2 for low-income adults. 44% of high-income Californian adults and 45% of low-income California adults answered all the questions on the Oral Health Knowledge survey correctly, compared to 52% of high-income and 44% of low-income U.S. adults. In 2012, 64% of California population was on community water systems with fluoridated water, compared to the national average of 75%.

9 Page 9 Fig. 5: Oral Health Care System: California Source: American Dental Education, Health Policy Institute, 2016

10 Page Dental Health Professional Shortage Areas The two-thirds of the U.S. population served by current oral healthcare delivery system are ambulatory, not economically disadvantaged, generally healthy and not living in remote or institutionalized settings. The other one-third of the population not receiving adequate services is typically poor, institutionalized or homebound, beset with multiple comorbidities, or living in remote areas. 15 As of October 14, 2016, HRSA designated a total of 5,403 Health Professional Shortage Areas (HPSA) for dental health in the nation, which encompasses 50.8 million people. 16 Of the 5,401 shortage areas, 3,108 (57.5%) were in rural areas. It is predicted that an additional 7,934 dental practitioners are needed to achieve a population-to-practitioner ratio below the minimum threshold of 5000:1 (Table 1). 16 Fig. 6: Dental Health Professional Shortage Areas (HPSA) U.S. Source: HRSA, Data Warehouse, 2016

11 Page 11 Table 1: Dental Health Professional Shortage Areas (HPSA) in Western Region Source: HRSA, Data Warehouse, 2016 In California, there are a total of 394 dental HPSAs, the highest among all the states (Fig. 6). Only 35.7% of dental needs were met in California, while 229 practitioners are needed to achieve HRSA s target population-to-practitioner ratio. As defined by HRSA, each HPSA is assigned a score on the basis of specific criteria that ranks its shortage of health providers or need. HPSA scores are developed to assist in determining those areas or facilities that have the greatest need for health professionals. HPSA scores range from 1 to 26 for dental, and the higher the HPSA score is, the greater the need for health professionals in that region. In California, there are 37 dental HPSAs with scores of 20 and higher, and the areas with the highest score and greatest needs are: Mercy Mt. Shasta Community Clinic (25), Shasta Community Health Center (24), Shingletown Medical Center (24), Stanislaus County (24), San Juaquin Prime Care Medical Corporation-Reedley (23), Redwood Family Practice, Inc. (23), and Ridgecrest Regional Rural Health Clinic (23). 17

12 Page 12 B. Dental Education 1. Pre-doctoral Dental Education During the period of 1982 to 2000, seven U.S. private, or private and state related dental schools closed. The remaining U.S. dental institutions reduced their class sizes. However, since that time, driven by access to care, a growing applicant pool, and the attractiveness of dental careers, a number of new dental schools have been started (Table 2). Table 2: New U.S. Dental Schools, Opening University Location 1997 Nova Southeastern University College of Dental Davie, FL Medicine 2002 University of Nevada, Las Vegas, School of Dental Las Vegas, NV Medicine 2003 Arizona School of Dentistry and Oral Health Mesa, AZ 2008 Midwestern University College of Dental Medicine - Glendale, AZ Arizona 2009 Western University of Health Sciences College of Pomona, CA Dental Medicine 2011 Midwestern University College of Dental Medicine - Downers Grove, IL Illinois 2011 East Carolina University School of Dental Medicine Greenville, NC 2011 Roseman University of Health Sciences College of South Jordan, UT Dental Medicine 2012 Lake Erie College of Osteopathic Medicine School of Bradenton, FL Dental Medicine 2013 University of New England College of Dental Biddeford, ME Medicine 2013 Missouri School of Dentistry and Oral Health Kirksville, MO 2013 University of Utah School of Dentistry Salt Lake City, UT 2015 Touro College of Dental Medicine at New York Medical College Valhalla, NY Currently, there are 66 public and private dental schools in the United States accredited by CODA. All 66 schools will have at least one class of dental students enrolled in As reflected in Figure 7, 16 states have more than one dental school, and 12 states do not currently have a dental school.

13 Page 13 Fig. 7: Distribution of Dental Schools in North America Source: American Dental Education Association (ADEA), 2016 Fig. 8: Number of U.S. Dental School Examined Applications, Applicants, and First Year Enrollment, to Source: American Dental Association, 2015

14 Page 14 Table 3: First-Year U.S. Dental School Enrollment by Gender, to Source: American Dental Association, 2015 Between 2004 and 2014, the number of dental school applicants in the United States increased from 9,433 to 11,745 (Fig. 8). During the same period, first-year enrollment increased from 4,612 to 5,967, with the number of male students increasing by 876 (44%) and female students increasing by 479 (18%) (Table 3). 18 Fig. 9: Region of Residence of First-Year United States Dental Students, Source: American Dental Association, 2015

15 Page 15 In , 973 or 16.3% of the first-year dental students were from the Pacific region (California, Oregon, Washington, Alaska), the second highest in the nation after South Atlantic (18.5%) (Fig. 9). According to the American Dental Education Association (ADEA) Survey of Dental School Seniors, 72% of the 2013 dental senior respondents from California planned to practice in California after graduation. 19 The state of California currently has six dental schools, two public institutions and four private institutions (Table 4). In , these six dental schools had a combined total of 4,659 applications and 635 first-year enrollees 18. Of the 635 first-year dental students in California in 2014, 296 (46.6%) were female, 274 (43.1%) were Asian, 220 (34.6%) were White, and 60 (9.4%) were Hispanic. In the same year, a total of 739 California residents enrolled as first-year dental students at a U.S. dental school, and 473 (64%) of them chose a dental school in their home state. Table 4 also lists the current first-year tuitions and fees for the dental schools in California. 20 Table 4: First-year Dental School Tuition and Fees in California ( ) Institution Funding Type In-state Out-of-State University of the Pacific Private $98,917 $98,917 University of California, San Francisco Public $40,016 $52,261 University of California, Los Angeles Public $39,797 $48,998 University of Southern California Private $83,826 $83,826 Loma Linda University Private $65,966 $65,966 Western University of Health Medicine Private $64,910 $64,910 Source: American Dental Association, 2015 In 2015, the average student debt of dental school graduates in the U.S. was $223,984. More than a third (34%) of these new dentists had an educational debt of $300,000 or more, and only 12% were debt free. Close to half (49.4%) of the graduating class intended to go straight into private practice, and 34.3% intended to pursue advanced dental education after graduation. 21

16 Page Advanced Dental Education There are currently 769 CODA-accredited advanced dental programs in the U.S., in which 468 are dental specialty programs and 301 are postdoctoral general dentistry programs (Table 5). 22 In the most recent school year ( ), the advanced dental programs in the U.S. received a total of 58,336 applications, enrolled 3,677 firstyear residents, and graduated 3,611 dentists with advanced dental training. Of the 7,059 individuals who were enrolled in an advanced dental program in , 43.7% were female, 57.2% were White, 8.4% were Hispanic, and 5.4% were non-u.s. resident. Type of Program Table 5: Advanced Dental Programs in the U.S. Number of Program Specialty 468 Clinical Fellowship, Oral and Maxillofacial Surgery 10 Clinical Fellowship in Orthodontics 5 Combined Prosthodontics-Maxillofacial Prosthetics 2 Combined Specialty 1 Dental Public Health 15 Endodontics 56 Maxillofacial Prosthetics 7 Orthodontics 68 Pediatric Dentistry 79 Periodontics 58 Prosthodontics 48 Oral and Maxillofacial Pathology 16 Oral and Maxillofacial Radiology 8 Oral and Maxillofacial Surgery 102 Postdoctoral General Dentistry 301 Advanced Education in General Dentistry (AEGD) 91 Dental Anesthesiology 9 General Practice Residency 184 Oral Medicine 7 Orofacial Pain 10 TOTAL 769 Source: American Dental Association, 2016

17 Page 17 The enrollment and graduates of U.S. advanced dental programs have been increasing each year for the past 11 years (Fig. 10). 22 In 2015, US dental schools graduated 5,771 predoctoral students, and in the same year 3,677 dentists enrolled in an advanced dental education program. Table 6 indicates the trends in average applications per program and first-year enrollment in U.S. dental advanced programs between and , in which the vast majority of all the dental disciplines have seen an increase in numbers. 21 Fig. 10: Enrollment and Graduates of Advanced Dental Education Programs, to Source: American Dental Association, 2016 Table 6: Applications per Program* and First-Year Enrollment in US Advanced Dental Programs in vs Discipline Applications per Program First-year Enrollment Applications per Program Dental Public Health Endodontics Oral and Maxillofacial Pathology Oral Maxillofacial Radiology Oral and Maxillofacial Surgery Clinical Fellowships in Oral and Maxillofacial Surgery Orthodontics and Dentofacial Orthopedics First-year Enrollment

18 Page 18 Clinical Fellowships in Craniofacial and Special Care Orthodontics Pediatric Dentistry Periodontics Prosthodontics General Practice Residency Advanced Education in General Dentistry Dental Anesthesiology Oral Medicine Orofacial Pain / / Source: American Dental Association, 2016 [NOTE: Applications refer to the number of individuals whose credentials were complete and reviewed for admission. This figure represents the total number of applications examined by all programs, and counts an applicant more than once if he or she applied to multiple programs. Applications per program ratio excludes programs that did not receive applications and programs for which no applicant data were available.] California currently has 71 advanced dental programs, second only to the state of New York which has 139 programs. The majority of advanced dental programs in California are housed in the six dental schools or their affiliated clinical sites. Arthur A. Dugoni School of Dentistry currently has four (4) advanced dental programs in AEGD, Endodontics, Orthodontics, and Oral and Maxillofacial Surgery, compared to UCLA (14), USF (12), USC (9), and Loma Linda (7). 3. Allied Dental Education There are currently 611 CODA accredited Allied Dental Education programs in the U.S., which includes 263 Dental Assisting programs, 332 Dental Hygiene programs, and 16 Dental Laboratory Technology programs. Table 7 shows the change in enrollment numbers in U.S. Allied Dental Education programs between 2005 and Table 6: First-Year Enrollment in Allied Dental Education Programs, to Dental Hygiene 7,323 7,420 7,525 7,690 7,784 8,007 8,110 8,258 8,287 8,472 8,279 Percent Change Dental Assisting 8,160 8,279 8,413 8,633 10,054 10,390 9,620 8,198 7,397 7,601 6,875 Percent Change Dental Laboratory Technology Percent Change Source: American Dental Association, Health Policy Institute, Surveys of Dental Hygiene Education Programs, Surveys of Dental Assisting Education Programs, and Surveys of Dental Laboratory Technology Education Programs American Dental Association

19 Page 19 U.S. Dental Hygiene Education programs have been growing fairly consistently both in first-year capacity and first-year enrollment in the last decade, although the enrollment numbers declined slightly between 2014 and 2015 (Fig. 11). 23 The average cost for tuition and fees to obtain a degree in dental hygiene was $39,391 for outof-state students in The cost has almost doubled in the last decade (Fig. 12). 23 Of the 335 institutions currently awarding degrees in dental hygiene, 83% are public, 5.7% are private non-profit, and 10.7% are private for-profit. The majority of the U.S. dental hygiene programs offer either an Associate Degree (277 or 82.7%), or a Baccalaureate Degree in Dental Hygiene (44 or 13.1%). The acceptance rate of dental hygiene programs in was 31.1%, and the 61.4% of the schools require applicants to have some college education. There are 27 dental hygiene programs in the state of California. 23 The majority of the most recent dental hygiene program graduates (92.7%) are women; 71.6% of all the graduates are White, and 13% are Hispanic; 35.7% are 23 years or younger, and 73.9% are 30 years and younger. Two-thirds (67%) of the dental hygiene program graduates are employed in private practice, while 4.6% are unemployed. 23 In 2015, there were a total number of 5,094 faculty members in U.S. dental hygiene programs. Of the 5,095 dental hygiene faculty members, 29.6% are full-time faculty and 70.4% are part-time; 83.1% are female, 85.5% are White, and 4.3% are Hispanic; 20.2% are 60 years and older, and 5.3% are under 30; 20.1% have a DDS/DMD degree, 30.9% have a Master s degree, and 35.6% have a Bachelor s Degree as their highest academic degree. 23 Fig 11: First-Year Student Capacity Versus Enrollment by Number of Dental Hygiene Programs, to

20 Page 20 Fig 12: Average Total Costs for Tuition and Fees in Accredited Dental Hygiene Programs, to Source: American Dental Association, Surveys of Dental Hygiene Education Programs, 2016 Dental Assisting Education programs in the nation experienced a peak in first-year capacity and first-year enrollment around 2010 and 2011, and the numbers have been declining consistently for the past five years (Fig. 13). Furthermore, student capacity has exceeded enrollment by a large amount in dental assisting programs, albeit the gap is closing as the number of programs has decreased since The average cost for tuition and fees to obtain a degree in dental assisting was $14,123 for out-of-state students in The cost has increased significantly between 2005 and 2014, and decreased slightly in 2015 (Fig. 14). 24 Of the 264 institutions currently awarding degrees in dental assisting, 90.5% are public, 2.3% are private non-profit, and 6.8% are private for-profit. The majority of U.S. dental assisting programs offer either a Certificate (162 or 61.4%), or a Diploma (87 or 32.9%). The acceptance rate of dental assisting programs in was 62.6%, and the 80.3% of the schools require applicants to have at least a GED/high school diploma. There are 20 dental assisting programs in the state of California. 24 In 2014, 4,986 (78.7%) of the 6,312 originally enrolled dental assisting students completed the program, and of those who completed the program, 4,252 (85.6%) found dental-related employment. The vast majority of the most recent dental assisting program graduates (98.5%) are women; 58.2% of all the graduates are White, 10.5% are Black, and 15.7% are Hispanic. 54.9% are 23 years or younger, and 79.6% are 30 years and younger. 24 There are a total number of 1,296 faculty members in U.S. dental assisting programs: 41.7% are full-time faculty and 58.3% are part-time; 89.9% are female, 81.1% are White, and 6.2% are Hispanic; 16.7% are 60 years and older, and 5.5% are under 30; 13.8%

21 Page 21 have a DDS/DMD degree, 21.4% have a Master s degree, and 37.6% have a Bachelor s Degree as their highest academic degree. 24 Fig 13: First-Year Student Capacity Versus Enrollment by Number of Dental Assisting Fig 14: Average Total Costs for Tuition and Fees in Accredited Dental Assisting Programs, to Source: American Dental Association, Surveys of Dental Assisting Education Programs, 2016 There are only 17 Dental Laboratory Technology Education programs currently in the nation. Student capacity and enrollment for dental laboratory technology has fluctuated moderately in the past decade, with the general trend being on the decline (Fig. 15). The average cost for tuition and fees to obtain a degree in dental laboratory technology

22 Page 22 was $23,729 for out-of-state students in 2015, and the cost has increased moderately between 2005 and 2014, and decreased slightly in 2015 (Fig. 16). 25 Of the 17 institutions currently awarding degrees in dental laboratory technology,94.1% are public and 5.9% are federally funded. 10 of the 17 programs offer an Associate Degree, and 6 offer a Certificate. The acceptance rate of dental laboratory technology programs in was 85.5%, and the 82.4% of the schools require applicants to have at least a GED/high school diploma. There are two dental laboratory technology programs being offered in the state of California. 25 In 2014, only 171 (67.6%) of the 253 originally enrolled dental laboratory technology students completed the program, and of those who completed the program, only 118 (69%) found dental-related employment. Unlike the other two allied dental education programs, only 139 of the 245 (56.7%) of the most recent dental assisting program graduates are women, and only 31.8% of all the graduates are White. Compared to dental hygiene and dental assisting graduates, a higher percentage of the dental laboratory technology graduates are Black (11.8%) and Hispanic (17.1%), and the average age is older with only 26.3% under 23 and 50.6% under 30 years. 25 There are a total number of 120 faculty members in U.S. dental laboratory technology programs: 55.8% are full-time faculty and 44.2% are part-time; 35% are female, 55.8% are White, and 9.2 % are Hispanic; 15.8% are 60 years and older, and 10% are under 30; 4.2% have a DDS/DMD degree, 17.5% have a Master s degree, and 34.2% have a Bachelor s Degree as their highest academic degree. 25 Fig. 15: First-Year Student Capacity Versus Enrollment by Number of Dental Laboratory Technology Education Programs, to

23 Page 23 Fig 16: Average Total Costs for Tuition and Fees in Accredited Dental Laboratory Technology Programs, to Source: American Dental Association, Surveys of Dental Laboratory Technology Education Programs, 2016

24 Page 24 References 1 The 100 Best Jobs. U.S. News. Accessed on October 11, American Dental Association. Supply of Dentists in the U.S.: Accessed on September 30, American Dental Association. Distribution of Dentists in the United States by Region and State, American Dental Association. The Dentist Workforce Key Facts (July, 2016). Accessed on October 11, Munson, B., & Vujici, M. Number of Practicing Dentists per Capita in the United States Will Grow Steadily. American Dental Association, revised June Accessed on October 11, U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. National and State-Level Projections of Dentists and Dental Hygienists in the U.S., Rockville, Maryland, Accessed on October 14, American Dental Association. Dentists Migration Across State Lines (2016). Accessed on October 11, U.S. Department of Labor. Bureau of Labor Statistics. Labor Force Statistics from the Current Population Survey. Employed persons by detailed occupation, sex, race, and Hispanic or Latino ethnicity. Accessed on February 9, American Dental Association. U.S. Dentist Workforce by Age Group (2015). Accessed on October 11, American Dental Hygienists Association, Facts about the Dental Hygiene Workforce in the United States, revised August Accessed on October 14, United States Department of Labor. Bureau of Labor Statistics. May 2015 National Occupational Employment and Wage Estimates: Dental Hygienists. Accessed on October 14, Public Policy Institute of California. California s Health Workforce Needs: Training Allied Workers. Accessed on October 14, American Dental Association. A Profession in Transition: Key Forces Reshaping the Dental Landscape, Accessed on October 11, American Dental Association, Health Policy Institute. The Oral Health Care System: A State-by-State Analysis. Accessed on October 12, Brown LJ. Adequacy of current and future dental workforce: theory and analysis. Chicago: American Dental Association; U.S. Department of Health and Human Services. Health Resources and Services Administration (HRSA). Designated Health Professional Shortage Areas Statistics Toolbar=false Accessed on October 12, Department of Health and Human Services. Health Resources and Services Administration HRSA, Data House, HPSA Find. Accessed on October 14, American Dental Association, Survey of Dental Education, Enrollment, Volume 1. American Dental Association: Chicago, IL, 2015.

25 Page American Dental Education Association, ADEA Survey of Dental School Seniors, 2011 Graduating Class, Table 18, Washington, DC, American Dental Association, Survey of Dental Education, Tuition, Admission and Attrition, Volume 2. American Dental Association: Chicago, IL, American Dental Education Association, ADEA Snapshot of Dental Education, , Accessed on October 18, American Dental Association, Survey of Advanced Dental Education. American Dental Association: Chicago, IL, American Dental Association, Survey of Dental Hygiene Education Program. American Dental Association: Chicago, IL, American Dental Association, Survey of Dental Assisting Education Program. American Dental Association: Chicago, IL, American Dental Association, Survey of Dental Laboratory Technology Education Program. American Dental Association: Chicago, IL, 2016.