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Dental Boards
Through its Washington lobbyist firm, the AGD attended the Health Resources and Services Administration (HRSA) Health Care Workforce Summit held in Washington, D.C. from Aug. 10–12, 2009. The summit assembled health care workforce experts from government, industry, and academia to explore the challenges facing the health delivery system due to current and impending workforce shortages in primary care, rural communities, and among underrepresented minority populations, and to identify potential solutions utilizing the National Health Service Corps (NHSC) and other HRSA health professions and nursing training programs authorized by Title VII and Title VIII of the Public Health Service Act, respectively.
Dentistry and dental training programs were not highlighted directly by any of the presenters, but they were implicit in several presentations about the maldistribution of dentists and the critical role that the NHSC and the Title VII health professions programs can be expected to play in rectifying the problem. In the few instances when dentistry was discussed directly, particular attention was paid to the lack of access to dental care in rural communities.
In general, the overall dialogue of the summit was deeply impacted by the ongoing debate in Congress about reforming the overall health care system. Most presenters discussed their views within the context of broader reform to the manner in which health care is delivered to the American public.
HRSA Administrator Mary K. Wakefield, PhD, RN, gave an overview of HRSA, which is a $7.2 billion agency, one of the largest in the federal Department of Health and Human Services (HHS). The 2009 stimulus package appropriated $2.5 billion to HRSA, one of the largest investments in health care, with approximately 20 percent of those funds allotted specifically to the Title VII and Title VIII health care workforce training programs, including the NHSC. The goal of HRSA is to build and sustain a primary care workforce, which is essential to health care reform. HRSA runs more than 80 programs that provide financial and technical support for health care workforce training and fund and oversee some 7,500 health care sites.
The current health care system cannot be sustained by the existing primary health care workforce training programs under Title VII and Title VIII; an increased investment in these programs is necessary if the supply of health care professionals is to meet demand. There are specific trouble spots that require particular attention; for example, dental and mental health care is especially lacking in rural areas. To help meet this goal, Congress appropriated $200 million to HRSA to double the size of the NHSC. The success of the stimulus in this area is already evident, as the NSHC cited an additional 28 physicians hired only last week; though this may seem to be a small number, adding 28 new physicians means that 29,400 additional rural patients will have access to care. President Obama has proposed a further increase for HRSA’s budget for FY2010.
Edward O’Neil, PhD, MPA, FAAN, spoke on “The Fierce Urgency of Now” and characterized the health care debate in terms of an “inflection point.” He explained that the current system is at the point where we either invent a new paradigm, or ride the current one—the one we understand and are comfortable with—into failure.” Dr. O’Neil explained that the current system is in dire need of reinvention, and that even loads of cash—which he theorized leads only to overtreatment and overdiagnosis—can lead to failure. Health care currently comprises approximately 18 percent of the United States gross domestic product, and the Congressional Budget Office estimates that this figure will rise to 30 percent by 2035. Clearly, said Dr. O’Neil, the cost of our current system is unsustainable. He theorized that in 10 to 15 years, health care will—or should—exhibit:
· Chronic prevention and management of disease.
· Price competition.
· Consumer responsiveness.
· Evidence-based practices.
· An information technology network.
· A focus around the home and community, rather than the ambulance.
In Dr. O’Neil’s view, the road to transition must be driven by regulation. His successful practice model was influenced by increased regulation, technology, consumer participation, and facilities; the practice model did not rely upon finance, insurance prerogatives, debt, or tradition.
Edward Salsberg, MPA, and Bernadette Melnyk, PhD, RN, spoke on “Trends in the Primary Care Workforce: Will There Be Enough for Health Care Reform?” Both Mr. Salsberg and Dr. Melnyk agreed that, while the percentage of doctors going into primary care has remained fairly constant, there are a number of problems facing adult primary care that must be addressed:
1. Rapid population growth equals increased demand.
2. Aging of population.
3. Growth in chronic illness.
4. Medical advances, while generally beneficiary, mean that there is more to cover in each visit to a primary care physician (PCP).
5. Importance of physicians’ lifestyles:
a. Age: In 2007, 13,000 primary care physicians retired; by 2017, that number may increase to 24,000.
b. Gender: Few women are going into primary care.
c. PCPs report dissatisfaction, as compared to specialty doctors.
d. U.S. graduates are showing less and less interest in primary care.
Mr. Salsberg also addressed the problem of maldistribution: PCP shortages are felt most intently in rural and poor communities. Additionally, female doctors are less willing to go into rural areas, as are younger doctors, who seem to prefer urban lifestyles. Mr. Salsberg proposed the following solutions:
1. Education: Emphasize primary care to medical students.
2. Supportive reimbursement policies that benefit non-physician clinicians.
3. The expansion of the NHSC, admission policies, and diversity.
4. Redesigning the delivery system.
Secretary JudyAnn Bigby, the head of HHS for the Commonwealth of Massachusetts, addressed the national health care debate using Massachusetts as a model. Elements of the Massachusetts experience include:
1. Government support to low-income individuals.
2. Insurance reform: Merger of individual and small-group markets.
3. Fair employer contributions.
4. Individual mandate to purchase insurance for those who can afford it.
5. Connector authority:
a. Sets floor for coverage.
b. Sets standard for affordability.
c. State-subsidized product is not available from the Exchange.
Secretary Bigby noted that Massachusetts has shown that system-wide reform requires an integrated structure of governance and oversight in order to be effective. She also pointed out that health care reform in Massachusetts is saving the state money:
Costs in FY2006 (pre-reform): $1.4 billion
Costs in FY2007 (post-reform): $1.3 billion
Costs in FY2008: $1.687 billion
The public option in Massachusetts is administered outside of the health care exchange, which allows for better administration.
For parties interested in viewing the materials that accompanied the presentations highlighted above, please visit http://www.team-psa.com/workforcesummit2009/agenda.asp. The AGD recognizes that two of the biggest challenges in achieving optimal health for all are underutilization of available oral health care and maldistribution in areas of greatest need. The AGD believes that the role of the general dentist, in conjunction with the dental team, is of paramount importance in improving both access to and utilization of oral health care services. The AGD will embrace opportunities to work with other communities of interest to address and solve disparities in access to and utilization of care across the nation. All parties should work together to make sure that all Americans receive the very best comprehensive dental care that will give them optimal dental health and overall health.
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