Dental groups in Wisconsin are clashing over the recently approved $10 million in state money intended to support the construction of a new dental school -- a proposition that the Wisconsin Dental Association (WDA) calls "ill-advised" and a "lame-duck decision."
Marquette University, home to the state's only dental school, is also vigorously opposed to the proposition, and its position recently led to a tense exchange between university representatives and state Sen. Bob Jauch (D-Poplar).
The disagreement stems from a bill passed in April by Jauch that offered a $10 million grant for the construction of a rural dental education outreach facility at the Marshfield Clinic if the clinic secured matching funding of at least $10 million in nonstate funds.
— Gene Shoemaker, DDS, president, Wisconsin Dental Association
The Marshfield Clinic, established in 1916, provides dental access for the rural and economically impoverished communities of Wisconsin through a combination of state and federal grants. Marshfield currently operates five federally qualified dental health clinics in northwest Wisconsin.
Marshfield was awarded the grant in December after Security Health Plan of Wisconsin, a nonprofit health insurance company affiliate of the clinic, matched the amount.
The dispute arose when Marshfield's intention to start a new dental school was discovered by Marquette, which had been in favor of the bill earlier this year.
"We were told that the proposal was for postbaccalaureate and residency programs that would be complementary to Marquette's program," William Lobb, DDS, dean of Marquette University School of Dentistry, told DrBicuspid.com.
Marquette officials initially supported the idea, but had they known that the final proposal would include a new dental school, they would have opposed it, Dr. Lobb said.
"If the state is investing money, it should be in the existing dental school," he added.
Different student-patient populations
In a list of questions sent to the State Building Commission after it approved the project earlier this month, the WDA asked why Marshfield is now building a dental school when it was "vaguely sold as a 'dental educational outreach facility' when the bill originally passed the Legislature in the waning days of session."
Greg Nycz, director of health policy at the Marshfield Clinic and executive director of the Family Health Center of Marshfield, said he was open about his desire to set up a dental program from the start and that there was an article about it in the local paper as far back as April.
The new school is intended to serve a different purpose than the existing school at Marquette, he emphasized. It will have a rural focus and will try to attract students who can go to underserved areas, with clinical training provided in the rural dental clinics.
"Most of the students in the existing school tend to come from higher income families, and we will try to select students from the underserved populations and areas so they can serve in those areas," explained Nycz.
The program will be ideal for students seeking to benefit from expanded National Health Services Corps under the healthcare reform, which will make students servicing underserved areas or in a community health center eligible for federal loan repayment, he added.
Wisconsin has one of the poorest percentages of getting dental care to BadgerCare (the state's Medicaid program) and Medicare patients, and hundreds of thousands are not getting care, according to Nycz.
"The dentists that we do have are not evenly distributed," he said. "We want to help the state find solutions. If we continue to train dentists like we always have in the past, we will get the same results. The aim is to address the problem of undersupply in the rural communities."
Underserved needs being met?
Marquette feels that rural needs are already being met by its current graduates, and any additional state money would be best spent bolstering the existing dental school, according to Dr. Lobb.
"There are 80 graduates in our program, and most of them stay within Wisconsin and are well distributed," he said. "We service 64 of the 72 counties in Wisconsin, and we feel we are meeting the needs of people."
Marquette's dental school also draws students from underserved communities, and there is no guarantee that the students in this new program will stay in the underserved communities, he contended.
Dr. Lobb had asked the building commission to postpone the allocation of these funds because he felt they were handed out without much public debate, an objection echoed by Gene Shoemaker, DDS, president of the WDA.
Also, the school and the WDA have pointed out that the state's own study on the need for rural dental education that was completed in March 2010 does not support a new dental school.
According to the WDA, the study found that "while lack of dentists is an issue in selected counties, the core problem is Medicaid fees are low and do not provide Medicaid members adequate financial access to care, and that the establishment of a new dental school at the Marshfield Clinic, as currently proposed, does not appear feasible."
There are other ways to increase access to care besides spending $10 million on this project, said Dr. Shoemaker.
"Wisconsin, like many other states, has very low Medicaid reimbursement, and one solution is raising these rates, not creating more dentists," he said.
Dentists want to serve this population, he added, "but if from a small business standpoint it does not make sense and you cannot even meet your overhead, they will eventually move to more affluent areas."
Dr. Shoemaker also feels that the state money would be better used on the existing dental school. Marquette currently has a proposal to add 20 more dental students to its school and could use the funds to do more research and add more faculty, he said.
"The state already says there is no money, but this $10 million was spent without much debate," concluded Dr. Shoemaker.
"State funding is tight," wrote Dr. Lobb in a December 17, 2010, letter submitted to the Milwaukee Journal Sentinel. "Funding should be directed to entities with a proven record of meeting the needs of the state and its citizens."
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