Averting a Post-Millennial “Bust”

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.


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