Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic describes a new ADEA initiative that takes the long view—engaging today’s students to eventually fill the faculty pipeline.

In 2016, the ADEA Board of Directors approved an initiative to encourage and expand the establishment of ADEA Chapters for Students, Residents and Fellows. At last count, 30 U.S. dental schools had chapters, and eight more schools had plans to create one. Most chapters are quite young, with the majority established in the last five years. As of yet, there are no formal chapters in Canada, but ADEA has set a goal of establishing a chapter at every North American dental school, and the ADEA Council of Deans has created a working group to help ensure that this happens.

What do we hope these chapters will accomplish? Their primary purpose is to promote student interest in academic careers, or as one chapter founder put it, become “the group at every dental school that tells the story of how great a career in academic dentistry is and how accessible that career can be for anyone who wants to pursue it.” That is the vision of Tim Treat, D.D.S., who started an ADEA chapter at the Indiana University School of Dentistry (IUSD) in 2014.

Tim graduated last year and currently serves as the ADEA Board Director for Students, Residents and Fellows. He likes to tell the story of what started him down the path toward academic dentistry. In 2013, the IUSD Dean of Students reached out to the school’s class presidents to see if any were interested in attending the ADEA Annual Session & Exhibition. Unlike his peers, Tim said, “Yes.”

“So I’m this first-year dental student, on my own, flying to Seattle, and a couple days later I’m at the ADEA Gies Awards sitting next to the Dean of the dental school and seeing the celebration of amazing things people were doing all over the country to make dental education better,” he recalls. That interaction with faculty and administrators in that environment hooked Tim on the idea of an academic career, and his exposure to the ADEA Council of Students, Residents and Fellows (ADEA COSRF) helped him see how an ADEA chapter might help make that possible. He returned to Indiana, enlisted the support of classmate Mackenzie Kelley, and together they worked to create an ADEA student chapter at IUSD.

Today, that chapter is going strong. It hosts the school’s annual Dental Day for prospective students, and its Last Lecture series, where retiring faculty members tell their stories, is among the best-attended events at the dental school.

“Tim has really been able to bring ADEA to life for our students,” says John Williams, D.M.D., M.B.A., the Dean at IUSD. “The students have now gone on to become involved in additional aspects of ADEA. In fact, the current COSRF chair is an Indiana third-year student, Allison Williams.”

IUSD faculty and administrators also report that students have begun approaching them to learn about academic careers since the school formed its chapter two years ago. Tim is not surprised. During his tenure as an ADEA Board Director, Tim has learned about the great need for dental educators in the face of pending retirements. He sees this as an opportunity for his generation to “get into faculty positions and make a difference,” and he believes the timing couldn’t be better.

“More and more students each year will never own their own practices. Academic dentistry is an alternative with many benefits,” Tim says. He is clearly convinced of that. He is currently in a general practice residency at the Veterans Administration hospital in Indianapolis. Once completed, he intends to return to his alma mater to teach, and thanks to John Williams, a wonderful new transitional appointment awaits him.

“A year ago I created a clinical fellowship program for prospective faculty who had recently graduated,” John told me. The two-year fellowship will allow students who have completed a general practice residency or AEGD program to continue to develop their clinical skills and an academic portfolio. They’ll learn about teaching, assessment, curriculum management, accreditation—even the finances of dental education. “It will be a robust exposure to what it means to be an academic,” John says.

Recent events at IUSD represent exactly the types of developments we need in order to ensure that the next generation is ready to step into our shoes. It is estimated that only 4% of students need to go into academia to solve the future faculty problem. In other words, if two or three graduates from each dental school were to follow Tim’s path, those projected faculty vacancies that keep us up at night would disappear. The first step is to make sure that students know about ADEA and are aware that academic careers are an option.

“Every academic institution has an opportunity, if not a responsibility, to engage their students in this option,” John believes. “The more we can talk to students early on and get them good role models, the more I think you’ll have a significant improvement in faculty recruitment and retention.”

One of those role models is Jennifer Perkins, D.D.S., M.D., Assistant Professor in the Department of Oral and Maxillofacial Surgery at the University of California, San Francisco, School of Dentistry (UCSF SOD). She is also the winner of this year’s ADEA/ADEA Council of Students, Residents and Fellows/Colgate-Palmolive Co. Junior Faculty Award.

Jennifer is nothing if not approachable. She remembers that as a resident, she was always the one that people would come to with questions. As one of the newer full-time faculty members at UCSF SOD, she’s developed a similar reputation.

“It didn’t take very long after my getting here in 2014 for word to get out that I was someone students could come to,” she says. Today, Jennifer’s reputation as an oral surgeon, academic, parent of four, and go-to person for advice on dental career decision-making even draws occasional calls from students on other campuses.

“I’m not a guru who knows the answers to everything,” she says, “but you know, being willing to put time in with students, that makes an impression.”

Many faculty take the time to mentor students, but junior faculty, perhaps by virtue of their relative youth, tend to be especially effective role models. Jennifer had a mentor of her own who provided the support and reassurance that she would be a good candidate for oral surgery. Her decision to pursue an academic career came later.

“I didn’t know that was going to be my career necessarily until another faculty member here in my training program told me on multiple occasions—just out of nowhere—‘You’re really meant to do academics and be a teacher.’”

When she did start teaching part time, she says it became “obvious” to her as well that she needed to become an educator. “I get equally, or more, excited about teaching as about all the other parts of my job. So I think if I was in private practice, I would really be missing out on one of the things that kind of gives life to my career: getting to interact with the next generation.”

The students in UCSF SOD’s ADEA Student Chapter nominated Jennifer for the ADEA Junior Faculty Award. ADEA at UCSF SOD is one of the largest and most active ADEA chapters. In existence for more than 10 years, it hosts outreach events for high school and college students, two lunch and learn series and tutorial sessions for dental students, and faculty/student mentorship programs—one for first-year students, and another through the ADEA Academic Dental Careers Fellowship Program (ADEA ADCFP). Not surprisingly, UCSF SOD has now received an ADEA Distinguished Chapter Award five years in a row!

This month, ADEA will unveil the ADEA Chapter Toolkit for Students, Residents and Fellows at the first-ever ADEA COSRF Leadership Orientation to be held here in Washington, DC. The toolkit is a dynamic resource intended to help ADEA Student Chapters cultivate interest in academic dental careers. It includes information and resources to guide chapter creation, member recruitment, fundraising and planning events that will raise awareness of academic dental careers.

“It’s a matter of putting this on the radar screen and letting students make their own decisions,” John Williams believes, “but it’s far easier to do it when you have a strong ADEA Student Chapter and people know why it’s there.”

I couldn’t agree more.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic reviews the abundance of diverse programming—and programming related to diversity and inclusion—at the 2017 ADEA Annual Session & Exhibition in Long Beach, CA.

Last month saw another ADEA Annual Session & Exhibition come and go, and while I’m always impressed by what each ADEA Annual Session Program Committee (ADEA ASPC) can pull off, this year’s meeting was exceptional. The waterside venue in Long Beach, the California sun, and—most importantly—the programming, were all superb, and the presence of a record-breaking number of members made the atmosphere electric.

Blasting Off!

Many attendees joined us for the first time, and with over 400 separate events to choose from, I’m sure the process of getting oriented was daunting for some of our new participants! Fortunately, ADEA member Nisha Ganesh from East Carolina University organized an event to help first-time attendees navigate the meeting. Saturday’s first-ever Find Your Tribe session offered 100 newcomers lunch, icebreaker activities and the support of an “Army of Connectors.” These conference veterans, including most members of the ADEA ASPC, answered questions and brought people with similar interests together.

This year’s theme was Beyond Boundaries, and the Opening Plenary with physician/astronaut Mae Jemison set the stage for sessions designed to take us out of our comfort zones and into less familiar territory. She inspired us with her quest to support interstellar travel and her conviction that humankind can progress in striving for such goals. Her jokes about Star Trek (she once made a cameo appearance on the show) also pleased many in the audience who were clearly fans—then-Chair of the ADEA Board of Directors Cecile Feldman among them. Who knew that Cecile once dreamed of going into space?

I should also note two other highlights of this particular plenary. First, there was hardly a dry eye in the house when Cecile bestowed this year’s Distinguished Service Award on ADEA Senior Scholar in Residence Leo Rouse, D.D.S., who has served as a mentor to hundreds, if not thousands, during his career. I was also personally touched by her surprise acknowledgment of my 20 years of service as ADEA CEO. Hard to believe it has been that long. The time has really flown!

Politics as [Un]usual

This year’s Political Spotlight was also a big hit, and provocative from the word go. As luck would have it, the House of Representatives was just starting its hearings on President Trump’s wiretapping allegations as the session began, so the discussion couldn’t have been more timely.

Well-known political commentators Ana Navarro and Hilary Rosen entertained attendees with their pointed comments on the flurry of activity that has been roiling the federal government these past few months. To judge from the informal conversations occurring throughout the convention center and beyond, the uncertainty in Washington is creating a lot of anxiety for all of us. Despite their wide range of political views, our members (and the country as a whole) are used to a certain tempo and restraint in the nation’s political discourse. Both have been absent of late, leaving everyone feeling unsettled.

“The scope of federal decisions that could affect us—everything from Medicaid to GME to HRSA to CDC to accreditation to student loan programs—it goes on and on and on,” Cecile recently remarked. “The only thing that’s predictable right now is that the unpredictable will occur.”

One silver lining amid the turmoil may be a boost in member engagement. ADEA’s Chief Advocacy Officer, Yvonne Knight, told me that in Long Beach, she heard more members express appreciation for ADEA’s advocacy work than ever before. I urge those of you who want to join our work here in Washington to participate in our ADEA Virtual Hill Day on April 26.

Diversity and Inclusion

Like many of our previous plenary speakers, Jemison, Navarro and Rosen had star power. No doubt about it. But arguably, the brightest light at this year’s Annual Session was supplied by Anne Koch, D.M.D.—an endodontist, entrepreneur and faculty colleague of mine from our time together at the Harvard School of Dental Medicine—who spoke about the needs of transgender patients and her own experience transitioning. She addressed a packed audience at a morning seminar that officially ended at noon but unofficially continued until almost 3:00 p.m. while Anne answered questions and talked one-on-one with attendees. A few hours later, she headlined our new Sunday evening plenary, “In the Mix” Series: Inclusion, Excellence and Dental Education—a time for members to actively network with one another while exploring the many faces of diversity and inclusion.

I don’t remember the last time we had a dental educator as a plenary speaker, but having one of our own speak to these particular issues was extremely powerful. If you’ve already met Anne, you know she has an open and engaging personality. She’s also a dynamic presenter. You could hear a pin drop during her remarks, and when the discussion portion of the plenary began, everyone participated. Without a doubt, this new event on diversity and inclusion was a huge hit and highlight of Annual Session for many. Anne’s assessment? She told me, “I felt like I belonged at this meeting for the first time!”

It’s interesting to note that, although unintentional, all of this year’s plenary speakers, including the Google executive who provided pointers on innovation Tuesday morning, were women, and a racially and ethnically diverse group at that. Yet, no one seemed to notice—which says a lot about our community and about ADEA’s success in promoting diversity and inclusion at this meeting and beyond.

Although much of the programming reflected the theme of this year’s meeting, Beyond Boundaries, diversity and inclusion sessions were woven throughout the fabric of the event. Their importance was affirmed again and again—starting with a two-day preconference workshop for participants in the ADEA/W.K. Kellogg Foundation Minority Dental Faculty Development and Inclusion (MDFDI) Program, featuring former Health and Human Services Secretary Louis Sullivan, M.D., and ending with voting on resolutions at the closing of the ADEA House of Delegates.

Building a diverse oral health team is one of the four themes Dr. Leon Assael, the new Chair of the ADEA Board of Directors, plans to emphasize during his year as Chair. “Diversity is the critical issue that will affect the oral health professions in the coming decade,” he told the delegates. “If our students reflect the communities they serve, if they feel comfortable caring for patients who reflect all facets of the human experience, we will see palpable improvement in American society.”

The diverse range of attendees also made this a year a standout.

  • Our effort to draw more Canadian members to the meeting was a big success, and we were able to move forward with the discussions we began in Montréal related to AADSAS® and ADEA’s survey work.
  • Several of our European colleagues were also in attendance, including the President, President-Elect and Director of the Association of Dental Educators in Europe (ADEE), whom we’ll be seeing again at our joint meeting in London next month.
  • More than 600 students and a few parents and health professions advisors attended this year’s ADEA GoDental Recruitment Event. They met with representatives from 47 dental schools and 11 organizations, including three branches of the U.S. Armed Services, participating for the first time.

Looking Ahead

When the world appears to be chaotic, it’s easy to be discouraged, but to judge from the ADEA members in Long Beach, dental educators are excited about the opportunity to face the future. They believe, as do I, that we have the resources and the talent to take on the challenges before us.

What are those challenges and opportunities? Three Chair of the Board symposia and a fourth session on the future of allied dental education answered this question, each in its own way. A presentation by Kaiser Permanente’s Nirav Shah, M.D., M.P.H., on health care transformation had a lot people talking, as did two presentations on the future of dental education in the 21st century. Some of the views expressed were highly controversial, but the opportunity to engage in stimulating debate was well received.

A series of short TED Talks-style presentations on educational innovation and the unveiling of a newly reconstituted ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) 2.0 also contributed to the mix of programming. I heard a lot of praise for these sessions, which challenged ADEA members to rethink their assumptions and join the ongoing effort to shape the future of dental education. Especially in the area of licensure, a topic I’ll be covering later this year, attendees welcomed the opportunity for dialogue.

All in all, the depth and scope of this year’s programming was exceptional, reflecting the elevated level of engagement within ADEA sections and councils, the membership’s willingness to freely share ideas and resources, and the generosity of our Corporate Members. As ADEA’s Chief Policy Officer, Denice Stewart, D.D.S., M.H.S.A., remarked when we spoke last week, those who say that face-to-face meetings will go away in the era of global communications are missing something fundamental. The opportunity to meet and mix with colleagues from all over the world adds what she called “an extra layer of richness,” and reinforces the sense that we are all pursuing a common goal.

That sense is all the more palpable when the opportunities for interaction are diverse and the attendees bring an array of backgrounds and experiences. I have no doubt these qualities will be on display when we meet next March in Orlando. Please consider submitting a program, poster or TechExpo presentation for the 2018 ADEA Annual Session & Exhibition, Vision 2030, and help us continue to shape the future of dental education.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic describes a renewed ADEA initiative to strengthen the Association’s relationship with its Canadian members.

It’s no secret that ADEA aspires to play a greater role on the global stage. In 1992, we cofounded the International Federation of Dental Education Associations (IFDEA). In 2007, our Association met with colleagues from 66 nations at an IFDEA summit in Ireland, and IFDEA was subsequently reborn as the International Federation of Dental Educators and Associations. We’ve hosted five ADEA International Women’s Leadership Conferences in France, Canada, Sweden, Brazil and Spain. This April, the ADEA Board of Directors will be leading an oral health delegation to Cuba, and, in May, ADEA and the Association for Dental Education in Europe will be offering their members a two-day collaborative meeting in London. (I’ll be reporting on both events this summer.)

But closer to home, we have also come to realize there is more we can do to forge closer ties with those ADEA members who live north of the U.S.-Canada border—and there are many reasons for engaging them more fully in ADEA’s work and us in theirs.

Monty MacNeil, D.D.S., M.Dent.Sc., Dean of the University of Connecticut School of Dental Medicine and ADEA Board Director for Deans, recently shared these thoughts with me: “Subtle differences can be powerful tools for learning from each other. It’s important to look at how we do things—how we are alike and how we differ and what we can borrow from each other to create the most effective strategies for advancing dental education.”

Monty should know. He has spent half his life in the United States and half in Canada. When the Dalhousie University Faculty of Dentistry graduate came to the States for advanced dental education in the 1980s, he was struck by the fact that some U.S.-based dental schools had not yet adopted the competency-based teaching and assessment approaches he was familiar with at home. On the other hand, he discovered a robust and captivating research environment that ultimately led him to pursue a career in the United States.

Finding adequate research dollars is a challenge most everywhere, but U.S. dental educators are relatively fortunate in this regard compared with our Canadian counterparts. (For more on the ways our Canadian colleagues are bolstering their research enterprise, see my earlier post, Re-imagining Dental Education in Canada.) In addition to federal and private dollars that support academic research, U.S. dental educators benefit from ADEA’s in-house research arm, which generates data about our educational endeavors.

Dan Haas, D.D.S., B.Sc.D., Ph.D., Dean of the University of Toronto Faculty of Dentistry (U of T FOD), is eager to tap into that ability. “In Canada, we have not had the capacity to do national exit surveys of our graduates or even incoming surveys to get a snapshot of who our students are,” Dan told me. He would like access to ADEA’s expertise to form a national picture of how Canadian students are doing, where they are going professionally and whether Canada’s predoctoral education programs are achieving their goals. He’s also interested in learning more about the faculty experience—all achievable goals if ADEA expanded its surveys to include Canadian schools.

This possibility was one of several topics raised during a Montréal meeting last November with Dr. Monty MacNeil, several senior members of the ADEA staff, the deans or associate deans of nine of the 10 Canadian dental schools, and representatives of the Association of Canadian Faculties of Dentistry (ACFD), ADEA’s sister association in Canada.

Canadian schools first joined the ADEA fold decades ago, but their priorities and challenges remain uniquely Canadian. A desire to bridge that divide to better engage and serve our Canadian members inspired Monty and ADEA’s Senior Scholar in Residence, Leo Rouse, D.D.S., to propose the November meeting. Including Canadian schools in ADEA’s surveys was just one of several ideas floated by the meeting participants. We also discussed bringing Canadian schools into ADEA AADSAS® (ADEA Associated American Dental Schools Application Service) for predoctoral students.

Currently, only the University of Dalhousie Faculty of Dentistry participates in ADEA AADSAS. Including all Canadian dental schools would require making the application available in French for French-speaking students applying to the three dental schools in Québec. We are already exploring this possibility with Liaison International, our application services partner.

Paul Allison, B.D.S., Ph.D., Dean of McGill University Faculty of Dentistry and President of ACFD, is also enthusiastic about Canadian schools working more closely with ADEA. In addition to having Canadian dental schools participate in ADEA surveys and ADEA AADSAS, Paul would like to find ways to engage more Canadian faculty in ADEA’s professional development programming.

“There are some fantastic opportunities for learning and networking at these big ADEA meetings,” Paul told me, but he says making Canadian participation a reality can be challenging. “Speaking for McGill, when we send someone away to a conference in the middle of the academic year, it affects the teaching. We just don’t have the spare capacity.”

Funding can also be an issue for small schools with tight budgets. This year, ADEA took steps to ensure that all Canadian faculty were aware of our policy that any dental faculty member who had not previously attended an ADEA Annual Session could apply for free registration for the 2017 ADEA Annual Session & Exhibition.

“We have three new hires who started in July,” Dan told me, “and all three jumped on this because they want to learn how to teach, so I was quite thrilled.” This will be U of T FOD’s largest turnout at any annual meeting in memory, in part because Dan is also supporting the attendance of several of his academic administrators. Paul also mentioned that a number of Canadian deans will be attending this year.

As the current President of the ACFD, Paul sees other ways that ADEA could help Canadian schools over the long term. ACFD provides a forum where Canadians can network and help one another on issues that pertain to dental education in Canada. The association also represents the Canadian dental education community in interactions with other organizations that influence Canadian dentistry. Nevertheless, in comparison with ADEA, ACFD is small and more limited in what it can do. Paul hopes that closer ties between the two organizations will eventually lead to a greater range of services for ACFD members while freeing up ACFD to focus exclusively on Canadian concerns.

And how would this “rapprochement” benefit ADEA members here in the United States? Our Canadian colleagues recently published a new predoctoral competency document, and they have just agreed to create a working group to explore various postgraduate education models with the idea of establishing a mandatory postgraduate year for new dentists. If history is any guide, these efforts will provide inspiration and models that also inform the evolution of dental education in the United States.

“Collaboration is how you grow,” Dan says, “not in size but in continuing to get better at our two main missions: research and education.” I heartily agree with that statement, and believe cross-border collaboration is a potent facilitator of that growth.

“At the end of the day,” Monty points out, “we do the same things. We educate students, we provide care to patients and especially the underserved, and we have a research mission within our universities that can be quite substantial. It’s just a matter of defining where we can help each other achieve the best results.”

In many ways, U.S. and Canadian dental education are already intertwined. Each year, 150 Canadians cross the border to study dentistry in the United States. The two systems have reciprocity in terms of accreditation, and three U.S. dental schools now have Canadian-born deans.

Just as importantly, the cross-border sharing of ideas plays a substantial role in advancing educational policy and practice in both nations. Consider, for example, these two practices—Objective Structured Clinical Examination, a Canadian export that has gained traction in the United States, and holistic review, which has crossed the border in the opposite direction—and the value of this international collaboration immediately becomes clear. ADEA is taking concrete steps to advance this collaboration, including sending a delegation to the ACFD annual meeting in Québec City in June. I have no doubt these and other efforts across North America will serve all ADEA members well in the years ahead.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic reflects on his own experiences as a student and looks at the ways three different schools are encouraging a new generation to engage in research.

A slight diversion: While I have you and before I address the topic of this month’s letter, I want to call your attention to exciting changes with the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI). In 2016, the ADEA Board of Directors determined there had been immense success as a result of the Commission’s work since 2005, and it was the appropriate time to renew ADEA’s commitment to change and innovation in dental education. Therefore, I am pleased to inform you that ADEA CCI 2.0 is getting underway. I encourage you to read the guest editorial that Dr. Cecile Feldman, Chair of the ADEA Board of Directors, and I wrote explaining the idea behind ADEA CCI 2.0. The guest editorial will also appear in the March issue of the Journal of Dental Education.

On to this month’s letter: Last fall I was invited to speak about research and scholarship and their roles as engines of dentistry. The occasion was the Hinman Student Research Symposium, co-sponsored by the Atlanta-based Hinman Dental Society and the University of Tennessee Health Science Center College of Dentistry (UTHSC COD). The college has made promoting a robust research program part of its mission, and my visit there gave me the opportunity to reflect on the experiences that propelled me to pursue an academic career.

When I applied to dental school, I was planning to return to my hometown and become a successful general dentist. As you might guess, that’s not what happened. While at the University of Connecticut School of Dental Medicine, the school’s research requirement and my faculty mentors nudged me in a different direction. I found myself exploring Strep mutans, taking part in a table clinic program sponsored by SCADA (a joint venture between ADEA Corporate Member Dentsply Sirona and the American Dental Association), and eventually completing a pediatric dental residency at Children’s Hospital Medical Center in Boston. By the end of that experience, I was hooked on research and had set my sights on a career in dental education. I secured a position on the faculty at Harvard School of Dental Medicine, and I haven’t looked back.

Tim Hottel, D.D.S., M.S., M.B.A., Dean at UTHSC COD, also pursued research as both a predoctoral and graduate student, and appreciates the benefits of engaging in this pursuit early on. Since arriving in Memphis seven years ago, he has been encouraging both faculty and students at his institution to take the plunge.

“You never know when one of these young people will come onto something that changes the face of dentistry,” Tim told me. “But you have to introduce them to research if you want them to do it.”

Making that introduction comes fairly easily at UTHSC COD since the Hinman Student Research Symposium, now in its 23rd year, brings student researchers from dental schools across North America to Memphis every October. Tim’s success in engaging students in research also comes through another channel: the college’s faculty. Tim began encouraging them to develop projects when he first became dean, and along with Franklin Garcia-Godoy, D.D.S., M.S., Ph.D., his dean of research, has been successful in bringing in alumni dollars to support that effort. As a result, the college—while not a research-intensive dental school—now boasts more than 100 publications in peer-reviewed journals each year.

“This is what drives student interest,” Tim told me. “The faculty talk about their research with the students, and then the students get excited and away they go!”

Indeed, student research appears to be thriving on a number of dental school campuses that are relatively new to the research game. One of those schools is Roseman University College of Dental Medicine (Roseman CODM), founded in 1999. Perhaps best known for its mastery-learning pedagogy, this private, not-for-profit dental school is well on its way to developing a strong culture of scholarship and research. Roseman boasts an active cohort of student researchers, including a two-time winner of a prestigious SCADA student research award.

According to Roseman Dean Frank Licari, D.D.S., M.P.H., M.B.A., cultivating the next generation of dental researchers starts with the school’s holistic admissions process. Roseman has welcomed a number of candidates with Master’s and Ph.D. degrees (including the aforementioned award winner) who are interested in continuing their research while they are in dental school. “And in turn, those students serve as role models to some of our other students who have never done research,” Frank says.

All Roseman dental students have the option of taking part in research beginning in their first year. Those who show an interest are paired with faculty to get a better sense of what a research career would be like. In talking with Frank, it became clear that there’s a lot of one-on-one mentoring going on at Roseman.

“When you identify students who have that level of knowledge and ability and excitement and curiosity,” Frank says, “it’s important that we encourage them to look at academic and research careers.”

It is no secret that these can be a tough sell at many schools, but Frank says the Roseman faculty set a positive example. “Students see that people love to come here to work, that they want to be part of the college, so that encourages students to consider academic careers.”

Clark Stanford, D.D.S., Ph.D., Cert. Prosthodontics, Dean at the University of Illinois at Chicago College of Dentistry (UIC COD), is also eager to cultivate a cohort of budding scholars. Nine years ago, Luisa DiPietro, Ph.D., D.D.S., started UIC’s Multidisciplinary Oral Science Training (MOST) Program, which provides research-training opportunities for students along the higher education continuum. (The program is currently run by Anna Bedran Russo, D.D.S., Ph.D., along with Dr. Lyndon Cooper, D.D.S., Ph.D.)

A select group of UIC COD predoctoral students participate in MOST’s joint Ph.D./D.M.D. program. This predoctoral immersion in research takes “dedicated mentors and carefully selected students, and you have to work with them intensively,” Clark says of the seven-year, dual-degree program. It also takes money. Some financing comes from National Institutes of Health T32 training grants to the college and individual fellowship awards received by the students, and the College of Dentistry also contributes by waiving tuition for students who pursue the dual degree.

“We see the program as a strategic investment in the profession,” Clark told me. “We’ve also invested in physical renovations and in recruiting talented faculty, but the dual-degree program helps to change the culture in dentistry, to break down the wall of separation between research and clinical faculty. By having a cadre of junior scientists, we bridge that gap.”

One day, Clark’s “bridge builders,” and the student researchers at Roseman CODM, UTHSC COD and elsewhere will fill the faculty ranks and even shake the world with their discoveries, but they are already serving an important function. Their deeper appreciation of the value of scientific investigation to inform clinical practice is rubbing off on their peers. Everyone I spoke with agreed that all students need to understand scientific principles in order to make sound clinical decisions, and they believe exposure to research at the predoctoral level is crucial to achieving this goal.

Ultimately, patients benefit from these activities and so does the profession. Knowledge and technology are doubling every 12 to 15 years, and that rate will only accelerate as time moves forward. To remain a learned profession and retain the trust of those we serve, we must continue to investigate the dental and craniofacial complex, develop the evidence base for what we do, and make ongoing scholarly contributions that support human health.

We are fortunate as a profession. Our understanding of the oral cavity gives us an advantage in this endeavor. Not only is the mouth a mirror of the body, it is also easily accessible from a research perspective. By studying saliva and tissues in the mouth, dental researchers can shed light on cancer, pain, infectious diseases, glandular function, genetics, biomimetics and tissue engineering, not to mention oral health and well-being.

Cultivating the next generation of researchers may be relatively easy. Researchers are persistent, curious, motivated, focused, even aggressive. They possess a raw intelligence, a love of science, and a desire to improve the status quo. They find the balance between skepticism and receptivity. They are also hard working. As Thomas Edison famously said, “genius is 1% inspiration and 99% perspiration.”

Many of today’s predoctoral students possess these qualities in spades. We owe it to them—and to our profession—to nurture their interest in science and provide clear career paths that lead to scholarship and research.

 

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic explains how ADEA and other associations are priming the applicant pipeline for schools of the health professions in anticipation of the demographic challenges that lie ahead.

“What keeps you awake at night?”

That was the question posed at a retreat of the Federation of Associations of Schools of the Health Professions (FASHP), which I attended last month with the heads of 12 of our sister associations. As we went around the room, the answer most frequently voiced was: “The future applicant pipeline.”

Across the health professions, we’ve seen a general flattening or decline in program applicants as the “echo boom” of the millennial generation ebbs and Generation Z takes its place. Although this rising cohort of young people is large enough to sustain the health care workforce for some time to come, if we don’t prepare now to compete for new entrants to our professions, we could experience a post-millennial bust.

According to the National Student Clearinghouse Research Center, U.S. college enrollments have been declining since 2012, and high school graduation rates have begun to stagnate. The impact of these trends on health professions programs is inevitable, and it is already visible today. Just ask Lucinda Maine, Ph.D., RPh, my counterpart at the American Association of Colleges of Pharmacy (AACP), who calls herself “the canary in the coal mine.” In 2015, a couple of AACP member institutions failed to fill every seat in their incoming classes, and in 2016 it became clear that this was not an anomaly but the start of a trend.

It’s easy to see why pharmacy has been the first profession to bear the brunt of coming demographic changes, especially given recent economic shifts. As our community witnessed the opening of 13 dental schools since 1997, pharmacy saw far greater expansion—from 82 schools in 2002 to 139 schools today—and a lot of existing schools opened branch campuses. The dramatic growth seemed to make sense when the media was buzzing with stories of a national pharmacist shortage, but the recession changed those calculations.

“You had people who had been working part time who increased to full time in order to retain benefits,” Lucinda says. “You had people who had stepped out of the workplace who came back in. We’re not looking at a law school or an MBA situation by any stretch of the imagination. Our graduates are still getting pretty darn good jobs. They just may not be able to stay in some of the metropolitan areas that are attractive to young professionals.”

The contraction of opportunities in pharmacy, combined with the addition of thousands of first-year slots and a decline in the population of young adults seeking professional education, have added up to a significant challenge—one many of us could face in the years ahead.

In the early 2000s, veterinary medicine experienced shortages across all sectors, and schools increased capacity to meet that shortage. While rural shortages persist, there has been an excess capacity of veterinarians since the recession, especially in companion animal services in the suburbs. Despite these trends, veterinary medicine has been fortunate.

“Our applicant pool has been steady for the last five years, and we’ve seen an increase of 5% in the most recent cycle,” Andrew Maccabe, D.V.M., Chief Executive Officer of the Association of American Veterinary Medical Colleges, told me when we spoke recently.

Nevertheless, Andy is concerned about what the future holds. Veterinary medicine grads have a debt-to-income ratio of 2:1, the highest among all the health professions. Although veterinarians maintain very low default rates, financial advisors recommend a debt-to-income ratio no higher than 1.4:1 for graduates of professional programs. Both Lucinda and Andy expressed concern that the need for this level of borrowing might discourage applications from the minority and low-income students our communities already struggle to recruit.

“We’re in significant danger of exhausting the diversity in the application pool pipeline,” Andy says. In response, his association is working with a consultant to develop a national recruitment strategy that will have a strong emphasis on recruiting under-represented students.

Turning to our world, the volume of applications to dental schools and dental hygiene programs has held steady in recent years despite significant growth in our educational capacity. Dental schools and dental hygiene programs have enjoyed a robust applicant pool in part thanks to ADEA’s investment in recruitment to the dental professions. Starting with our decision in 2006 to host ExploreHealthCareers.org (EHC), the number one online destination for people seeking information on careers in the health professions, we have used the Internet to full advantage. Our GoDental® website inspires, informs and guides those interested in a dental or dental hygiene career, and since 2012 we have hosted virtual fairs for dental predoctoral students to extend the reach of our annual in-person gatherings.

Keeping these web-based efforts up-to-date is essential but can be technically challenging. With this in mind, we decided last year to transfer ownership of EHC to Liaison International, a leader in the higher education application service industry with a deep commitment to building the pipeline for the health professions. Liaison has relaunched the site and will make it more responsive to the millions of people who look to it for advice about careers in the health professions.

Our efforts to broaden the applicant pool also continue to pay off as evidenced by a 2014 report from Urban Universities for HEALTH. Dental schools showed an outstanding commitment to diversity, with 93% of them reporting that their admissions committees used holistic review.

We also continue to feed the pipeline for predoctoral programs through our stewardship of the Summer Health Professions Education Program (SHPEP), which thrives thanks to generous support from the Robert Wood Johnson Foundation. Designed to ensure that people from educationally disadvantaged backgrounds can prepare for the rigor of health professions programs, SHPEP broke new ground last year with the inclusion of six additional health professions alongside dentistry and medicine.

While celebrating these successes, we should not rest on our laurels. Applications to dental school have been flat in recent years, and demographic trends tell us we are heading for a potential downturn unless we take preventive action. Centralized application services (CASs) play a critical role in supporting ADEA’s institutional members and the long-term sustainability of the Association. That’s why ADEA took part in a CAS summit to discuss pipeline issues and established an ADEA CAS Working Group last fall to analyze trends.

To start, the group is establishing a platform for data-informed decision-making related to ADEA’s four application services. This should give us a better handle on who is applying to our programs, who is matriculating, and how this may have changed over time. The group will also look at demographic and higher education trends that can inform our recruitment and marketing efforts.

Historically, the trends in other health professions have been leading indicators for dentistry, signs we ignore at our peril. A decline in the applicant pool has consequences for our institutional members and implications for our Association as well. Students are the lifeblood of the educational enterprise, and while we strive mightily to keep educational costs in check (see the November 2016 Charting Progress), we cannot thrive if our class sizes shrink precipitously.

“As an organization, you just have to watch for that and be glad that you grew your reserves when the times were really good,” Lucinda says. She told me AACP is a “rock-solid” organization, both operationally and financially, but emphasized that every once in a while, organizations have to stop and recalibrate.

I couldn’t agree more. As members of Generation Z begin entering our halls, the time is right to reflect on how we are recruiting to the dental professions and what more needs to be done. I’m glad we have a team in place that is doing just that.

 

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic talks with others in the dental community about how the new Congress and the Trump Administration might “repeal and replace” the Affordable Care Act. 

Like most Americans who woke on Nov. 9 ill-prepared for the political earthquake that rocked the nation, health policy observers have been scrambling to determine how a Trump Administration will affect health policy in general and oral health specifically. The situation remains extremely fluid, but it’s undeniable that the health policy landscape is about to shift dramatically.

As Julie Frantsve-Hawley, RDH, Ph.D., Executive Director of the American Association of Public Health Dentistry (AAPHD), put it, “It’s sort of a wait and see.”

Three weeks after the election, the President-elect made two appointments that offered some clues as to what may lie ahead. While the ACA—considered by many to be President Obama’s signature achievement—may not be dismantled entirely, it is sure to be shaken up and stripped down in the years ahead, and ultimately rewritten to reflect a more limited government role.

Mr. Trump’s nominee to head the Department of Health and Human Services is Representative Tom Price (R-GA), who currently chairs the House Budget Committee. Rep. Price has been trying to repeal the ACA since 2009 and will be the driving force behind renewed efforts. Does that mean that the more than 20 million people now insured thanks to the ACA are about to lose their coverage? Not necessarily.

“I don’t think any administration would be interested in leaving consumers hanging,” Marko Vujicic, Ph.D., Chief Economist and Vice President of the American Dental Association Health Policy Institute, replied when I asked him about the potential consequences of an ACA repeal.

Marko is one of the people at some of our partner organizations with whom I spoke last month. I was pleased to learn that, despite some very real concerns about what the future may hold, these colleagues do not ascribe to the doom-and-gloom scenarios many pundits have put forth in recent weeks.

“The health care positions articulated by the Trump campaign are likely to lead to consumers paying more of the cost of their medical care, which could crowd out dental spending,” Marko told me. On the other hand, he pointed out that the ACA also “missed the boat” in many ways when it came to dental care.

“In whatever form repeal and replace happens,” Marko believes, “it might create an opening—an opportunity to reexamine some of the law’s dental provisions.”

What might a Republican health plan look like? The Empowering Patients First Act, authored by Rep. Price, provides a detailed description of one vision for repealing and replacing the current health care law. The Price plan would repeal Medicaid expansion, which has extended coverage to 15.7 million people and delivered an infusion of federal dollars—$47 billion in the first year alone—to participating states. Despite initial reluctance among many Republican governors to accept the new Medicaid funding, 31 states and the District of Columbia eventually chose to take part, and several more states were on the cusp of applying for waivers to design their own Medicaid expansion programs before the election.

Now those efforts are on hold as everyone waits to see whether the new Congress will repeal the expansion or modify the program in other ways. House Speaker Paul Ryan’s proposal, A Better Way, would cut federal funding to states that have already expanded Medicaid rather than eliminate the expansion all together. A third plan, authored by Sen. Ted Cruz (R-TX), is mute on Medicaid expansion.

President-elect Trump’s nominee to head the Centers for Medicare & Medicaid Services (CMS), Seema Verma, M.P.H., will also play a central role in shaping the new administration’s health policy. The Indiana-based consultant is well acquainted with the ACA, having worked with several states participating in the Medicaid expansion to redesign their programs.

Assuming Medicaid continues to play a part in whatever ACA replacement plan emerges, Seema Verma’s work in the past with Indiana governors Mike Pence and Mitch Daniels may provide clues to what lies in store for Medicaid beneficiaries. The Indiana expansion plan required new participants to pay a greater share of their medical costs and mandated the use of health savings accounts. Of special interest to our community, the Indiana plan included adult dental benefits and used access to these benefits as an incentive for Medicaid recipients to make regular contributions to their accounts.

As for Mr. Trump’s views on these matters, more flexible health savings accounts figured prominently in his campaign’s health care platform, so these might well have a place in a redesigned Medicaid program. During the campaign, he also made clear his desire to turn Medicaid as a whole into a block grant program, which would give states more discretion in how they spend federal Medicaid dollars. Some lawmakers have proposed an alternative—a per-capita funding formula. Interestingly, this per-member-per-month strategy would align with some of the accountable care models that are currently being tested by the Center for Medicare & Medicaid Innovation, a creation of the ACA.

Like Marko, Scott Litch, Esq., CAE, Chief Operating Officer and General Counsel at the American Academy of Pediatric Dentistry, also sees room for improvement in how the federal government supports oral health, particularly when it comes to children. When we spoke, he mentioned the perennial problems (high administrative burden and low reimbursement) dentists encounter with Medicaid, and he pointed out that although children’s dental care is a covered benefit under the ACA, many insurance plans offered through the marketplaces include high deductibles. As a result, families end up paying out-of-pocket for their children’s dental care or don’t seek care at all. Scott is also concerned about another ACA “glitch”—the fact that consumers who purchase a children’s medical plan that lacks dental coverage are not required to purchase a stand-alone dental plan for their children.

“In dentistry, the whole idea is to get people into preventive care,” Scott says, noting that the need for out-of-pocket spending discourages such behavior. After the new administration takes office, Scott will be keeping an eye on the future of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefit, which provides comprehensive and preventive health care services for children, as well as on the future of the Children’s Health Insurance Program (CHIP). CHIP, which is set to expire at the end of September 2017, covers children whose parents lack private insurance but earn too much to qualify for Medicaid. Our community will need to make a strong case on behalf of these federal programs if we want them to remain intact in the years ahead.

Children’s dental care is one of the 10 essential health benefits that the ACA specifies must be covered by Medicaid, CHIP and private insurance plans sold through the federal and state health insurance marketplaces. Maternity and newborn care, mental health services and addiction treatment are among the other mandated benefits that make current plans costly. In an effort to make insurance coverage less expensive and more attractive to healthy young consumers, the Price plan would allow insurers to sell plans that lack these essential benefits despite their value to other consumers.

Despite all the talk of wholesale change, repeal of the ACA may prove more of a challenge than the Trump team envisioned. In fact, lawmakers appear to be looking for ways to retain two facets of the ACA that have proven extremely popular: the provision that allows young people to stay on their parents’ policies until age 26, and the provision that prevents insurers from refusing to cover people with pre-existing health conditions. That said, ACA replacement plans could deviate from these provisions in significant ways. Some Republican proposals would allow insurers to charge sick people more if they allow their health coverage to lapse (if, for example, they are too sick to work and can’t afford insurance between jobs). These proposals also rely on high-risk pools to cover people whose health conditions make them unattractive to insure. Rep. Price proposes funding for these pools at $1 billion per year for three years; Speaker Ryan’s plan allocates $2.5 billion per year in perpetuity.

When I spoke with Julie Frantsve-Hawley, she was still digesting the impact the election might have on her association’s agenda. She told me AAPHD members had identified three advocacy priorities for the coming year: Increasing federal funding for oral health, community water fluoridation, and the creation of an adult oral health benefit in Medicare.

“We may need to divert attention from that to maintain ground on some of these other things,” she told me. She plans to engage in conversations with her members and reach out to other oral health stakeholders to evaluate how best to proceed. “I think anything we do needs to be done collectively,” she concluded.

The American Association for Dental Research (AADR) is also focused on federal oral health funding, with an emphasis, not surprisingly, on research dollars. Although President-elect Trump has not made research funding a focus of his first 100 days in office, AADR Executive Director Christopher Fox, D.M.D., D.M.Sc., sees some reasons for optimism on this front. First, candidate Trump mentioned the importance of medical research and innovation during his campaign and also talked about investing in infrastructure.

“We hope that his infrastructure investment includes infrastructure as it relates to the scientific enterprise,” Chris told me.

Second, Chris rightly points out that biomedical research has enjoyed bipartisan support in the past—for its economic value as well as for its impact on the nation’s health. Finally, a fourth dentist, Drew Ferguson (R-GA), was just elected to Congress. Chris believes Dr. Ferguson will help inform his colleagues on Capitol Hill and the new HHS secretary about issues related to dentistry and oral health.

During this time of uncertainty, it’s easy to be fearful. The foundation on which we’ve built our advocacy efforts over the last decade is now riven with cracks, and what will rise in its place is largely unknown. Yet, as Chris put it, “We cannot put our heads in the sand. We need to stay optimistic and treat this as an opportunity.”

I agree. Repealing and replacing the ACA will be a monumental and time-consuming task, as Senate Republicans have acknowledged. The pace of legislative change gives us plenty of opportunities to reach out to the Trump Administration and our Members of Congress to educate them about the value of what we do and the critical role dental care plays in supporting overall health. Members of the dental education community must rally the same energy that propelled us to support health care reform eight years ago if we want a hand in shaping its continued evolution.

Note: The ADEA advocacy website has news, information and advocacy resources to support our members in this critical pursuit. For breaking news throughout the day, follow our Advocacy and Government Relations team on Twitter at @ADEAAGR.

 

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic shares the results of a recent study and strategies that schools are employing to keep dental education costs in check.

Last month, the American Dental Association (ADA) House of Delegates received the results of a study that should be of particular interest to the dental education community. It hasn’t received much fanfare, but the report—which classifies dental education models, examines revenues and expenses, and evaluates the community’s preparedness to engage in research—stands apart as the first research-based effort to get a handle on what is driving the cost of dental education.

At the request of the ADA House of Delegates, Cavanaugh Hagan Pierson & Mintz, a management consulting firm with a strong focus on the health professions, teamed with ADEA to analyze which factors contribute to the cost of dental education and to see if there might be steps that dental schools could take to keep costs in check.

The ADA Study on Approaches to and Implications of Alternative Dental Education Models found that many of the variables that predict dental school expenditures mirror those that predict expenditures in higher education generally: the size of the faculty, the number of students and the cost of living in any particular school’s locale. But to the disappointment of some, the analysis found no “magic bullet” that all schools could seize to improve their efficiency. In other words, it found no correlation between curricular models and costs.

“The unique design and delivery of predoctoral education at every school means that each has to figure out how to deal with cost on its own,” said ADA Trustee Robert Bitter when we spoke last month.

Bob represented the ADA on the joint ADA-ADEA Study Group that helped to inform the research effort. As a periodontist who joined the faculty at Southern Illinois University School of Dental Medicine two years ago, and as the father of a recent medical school graduate, Bob is concerned about the cost of professional education. But the study convinced him that there are no simple solutions to the cost conundrum.

“What will work for each school depends on its mission, its location and how it chooses to engage in research,” Bob said.

Nader Nadershahi agrees. You may know him as the Dean of the University of the Pacific, Arthur A. Dugoni School of Dentistry. He is also a member of the ADA House of Delegates, and in that capacity, he represented that association on the ADA-ADEA Study Group.

“I was hoping if we looked, there would be one or two models of efficiency that stood out,” Nader told me, “but the cost of delivering care in an educational setting is very high and very inefficient.”

Few would argue that point, but just because dental education is inherently expensive, it doesn’t mean individual schools can’t take steps to reduce costs and increase revenues.

At Rutgers, The State University of New Jersey, School of Dental Medicine (RSDM), the Dean and Chair of the ADEA Board of Directors, Cecile Feldman, has focused on keeping her school fiscally sound through revenue diversification. She also served on the ADA-ADEA Study Group, and before that, on the 2012–2013 ADEA Presidential Task Force that looked at the cost of higher education and student borrowing, so she is very familiar with the issues.

“Before ADEA undertook the cost and borrowing study,” she told me, “some people believed that dental schools didn’t care about cost but that’s contrary. It’s something we are extremely sensitive of. We want to do right by students. We’re constantly striving to bring in more revenue to keep costs as low as possible.”

Cecile has managed to augment and diversify her school’s income streams by keeping an eye on opportunities at the federal and state levels. She and her colleagues have also had a hand in creating some of those opportunities. For example, RSDM, ADEA and others advocated for the inclusion of dental schools as eligible entities in the federal program that subsidized the adoption of electronic health records. RSDM acquired $3 million in federal funds from that source alone, and another $26 million in state funds for capital improvements.

“If you’re not paying attention to what’s going through Congress or your state legislature,” Cecile says, “you’ll miss things you can really use and leverage to help move things forward.”

RSDM has also gotten managed care companies to improve their fee schedules and has dramatically grown its continuing education program—two other ways that schools can increase revenues.

Nader also has some bold ideas to add to that mix. He sees curriculum sharing as one way to lower costs for all dental schools. “If we were all collaborating,” he told me, “schools could shoulder a small percentage of the cost of developing high-quality content but have access to 100% of it.”

He’d also like to see government provide greater support for the safety-net care that dental schools deliver. “If all dental school clinics were identified as federally qualified health centers and had a per-encounter reimbursement rate,” he believes, “that would be a game changer.”

Bob Bitter also thinks government has a role to play, and he points to the steady disinvestment of states in higher education as one source of today’s educational-cost woes. What can the ADA do about that?

“We’ve advocated on behalf of our students for debt relief and lower interest rates on their educational loans,” Bob told me. “We need to begin advocating for our institutions as well.”

The ADA’s recent report provides an excellent basis for such efforts. By assembling data to inform a discussion that previously consisted of anecdotes and sometimes outdated assumptions, that association has already made a major contribution and given us a fresh look at the cost conundrum.