In 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.