Study to dental schools: Serve patients, make money

If dental schools want to survive the coming recession and beyond, dental school clinics need to become revenue sources, not expense centers. That means a major rethinking of clinics' purpose and organization. That's one of the key recommendations from the three-year Macy Study "New Models of Dental Education".

The study, funded by the Josiah H. Macy, Jr. Foundation, examines the academic, research, service, and especially, financial challenges facing dental schools, and offers up a variety of solutions. The study was prompted by concern that dental schools are confronted with high operating costs and shrinking revenues. Not only does this lower the standard of education at the schools, but also jeopardizes their place in research universities.

One big cost center is the dental school clinic. As one paper in the Macy study points out, a clinic might cost $50,000 annually to operate, but student dentists working at the clinic might only generate $12,000 in billings. "National data show a gap between revenues and expenses of at least 25 percent; we think this gap is understated," says Allan J. Formicola, D.D.S., M.S., who edited the Macy Study.

One of the most intriguing recommendations? Instead of primarily being teaching venues, dental school clinics should be patient-centered, providing dental services to a range of patients with a range of complex, real world problems. That would mean faculty -- primarily general dentists -- would come to the fore, treating patients while students were part of the team, gaining experience based on their level of training. The end result, says the study? More billings, better and more efficient patient care, and students that gain deeper experience in serving patients. Another benefit? A model that would "generate the resources schools need to invest in their teaching, research, and service programs."

Can this paradigm shift pay off? The Macy Study authors seem to think so. For example, the study notes how the University of Louisville reorganized its dental clinics to focus on general dentistry, led by general dentists. Just like a commercial, private dental practice, the school brought in dental assistants and front office staff. The result? The clinics were more efficient, and billings jumped 21 percent annually for seven years.

The toughest nut to crack: Changing the current culture in dental school clinics. "Faculty do not see themselves as active practitioners for clinic patients" notes one paper. Clinics also tend to be heavy on specialists, when in fact, more general dentists need to be involved to make the shift work. And the way schools manage programs is at odds with the way an efficient, revenue-generating clinic needs to run. Still, "dental school clinics are one of the few sources of income left...for schools" says the study. But getting there requires a mighty paradigm shift.

Can dental schools make that shift and embrace new models of dental education? The Macy Study delves into this and many other proposals aimed at revitalizing dental education.

The American Dental Education Association (ADEA) has released the results of the study in a special supplement to the February 2008 issue of the Journal of Dental Education (JDE). The supplement contains papers and discussions from the April 2007 meeting at Emory University where 50 national leaders from dental education, research, and private practice debated the results and recommendations of the Macy Study. ADEA members can get a copy of the supplement here.

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