Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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7 Dental Schools and the University
7 Dental Schools and the University
Pages 199-227
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From page 199... ...
In times of relative financial strain, the incentives for such reexamination and redesign are markedly more intense, as dental educators can attest. Between 1984 and 1994, six private dental schools closed.
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From page 200... ...
Although the situation varies significantly from school to school and from state to state, the pressures on the university and the academic health center have generally intensified in the last decade. These pressures include federal policies that have added or shifted responsibilities to other units, including states and academic health centers.
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From page 201... ...
Within this environment, academic health centers have a unique Universities are, in fact, scaling back programs In a widely publicized example of retrenchment related to state economic problems, the University of California at Los Angeles has attempted to eliminate, consolidate, and restructure several of its major professional programs. It proposed to focus resources and cut administrative expenses by eliminating schools of public health, library science, architecture, and urban planning and by consolidating some of their curriculum, students, and faculty in other programs.
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From page 202... ...
On average, current-year expenditures for the average dental school are about $1 million more than current revenues. Uncompetitive patient care programs may become an increasing liability in the future.
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From page 203... ...
The above recitation lists factors that are, to varying degrees, both within and beyond the control of any dental school. Earlier chapters have discussed steps- including faculty practice plans, collaborative research, community health programs, and minority recruitment strategies-that should reduce the isolation of the dental school and serve other goals as well.
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From page 204... ...
Table 7.1 presents trend data showing changes in the proportion of dental school revenues from different sources from 1973 to 1991. The cutbacks in federal share and the increases in the state share of funding show up for both public and private schools.
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From page 205... ...
One explanation for the differences between public and private schools is that public schools are generally smaller, averaging just under 300 students per school, whereas private schools average just over 400 students. This means that fixed and semi-fixed costs are spread across a smaller student base.
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From page 206... ...
. clinic revenue Private Schools Total expenditures per DDSE Average resident 17,417 23,238 34,827 45,705 47,595 48,352 48,837 85.3% 85.0% 83.4% 84.0% 83.4% 81.6% 80.9% 13,617 18,937 28,972 34,876 36,663 37,833 39,157 tuition and fees 4,808 8,702 13,297 15,962 16,990 18,090 19,443 Clinic revenue per DDSE Remaining cost per student Percentage of total cost not recovered in tuition, fees, or .
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From page 207... ...
Variations in the cost of dental education are replicated in costs for dental hygiene education. The average cost in dental hygiene tuition and fees is approximately $4,500 at community colleges, $5,800 at technical institutes, $7,000 for four-year colleges, and $10,000 for dental school and university-based programs Solomon et al., 1992~.
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From page 208... ...
, and two others are being phased out {ADHA, personal communication, May 23, 1994~. ISSUES AND STRATEGIES Dental education, like medical education, is distinguished from professional fields such as law and business by the costs incurred in providing students with extensive clinical experience.
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From page 209... ...
In Chapter 1, the committee stated as one its guiding principles that "a qualified dental work force is a valuable national resource, arid support for the education of this work force has come and must continue to come from both public and private sources." That principle, unfortunately, does not translate easily into practice. Financial survival requires that dental schools demonstrate their contributions to their parent institutions and to the public.
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From page 210... ...
When asked about the usefulness of various strategies for increasing funding, dental school deans showed commonalities as well as variations in their responses. A substantial majority of deans believed that increased state funding, expanded enrollment, and increased tuition were unlikely sources of additional revenues.
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From page 211... ...
These could be built upon the example of past strategic development projects in dental schools, notably, those supported by the Pew National Dental Education Program {Barker and O'Neil, 1992~. Information Base and Cost Analyses The foundation for a sound financial strategy is a formal cost analysis of programs and services.
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From page 212... ...
and Canadian dental schools revealed that 25 out of 32 responding schools with faculty practice plans used practice income to supplement faculty salaries, and 12 schools said that they used the income to provide or supplement faculty insurance or other benefits {Shnorkian and Zullo, 1993~. Typically, about 10 percent of gross practice plan revenues was distributed to the dental school (i.e., the dean's office and the participating departments)
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From page 213... ...
Faculty practice plans can bring dental schools into conflict with community practitioners, especially in smaller towns and cities. In the survey cited above, half the responding schools with faculty practice plans said it was their perception that local practitioners viewed such plans as competitors jShnorkian and Zullo, 1993~.
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From page 214... ...
of dental education is expensive, partly because payments for patient care do not include the educational subsidy that Medicare provides to teaching hospitals. The existing model of dental education is also relatively unchanged from that of the 1930s and 1940s.
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From page 215... ...
In addition, research involvement tends to add more to dental school stature than any other faculty activity. On the negative side, faculty research involvement has in common with faculty practice been criticized as diverting attention from the education of students.
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From page 216... ...
. Three institutions with dental schools the University of Texas Health Science Center at San Antonio, the University of Missouri at Kansas City, and Virginia Commonwealth University have followed this model, but the last institution has recently dropped it.
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From page 217... ...
The major financial objective of regionalization is to achieve educational economies of scale. Dental education, research, and patient care involve relatively high fixed costs for clinic facilities and equipment, laboratories, and specialized staff.
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From page 218... ...
Accreditation standards should be flexible enough to recognize this kind of experimentation and cooperation. UNIVERSITY AND STATE POLICIES AND PRIORITIES The financial strategies considered and adopted by an individual dental school {or imposed on it)
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From page 219... ...
concluded that the most cost-effective way for the state to recruit an adequate supply of dentists overall was to contract with out-of-state schools to educate a defined number of Wisconsin residents rather than to continue to subsidize the existing private school in the state or to establish a new public school. The analysis, nonetheless, concluded that the contracting strategy was not desirable because the closure of the only dental school in the state would leave a major shortfall in services for the disadvantaged, especially in Milwaukee.
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From page 220... ...
Although not in the form of direct state appropriations for dental education, these funds may, to some degree, stem from a recognition of the value of private schools. STRENGTHENING THE DENTAL SCHOOL WITHIN THE UNIVERSITY Strengthening the position of dental schools within the university on an individual and a collective basis will require commitment from many sources.
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From page 221... ...
They include improving the competitiveness of patient care programs in the community and building educational and research linkages with other parts of the university and academic health center. The middle section of this chapter considers financial strategies for improving the dental school's position.
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From page 222... ...
These roles include educating university, community, and state leaders about the continued seriousness of oral health problems, the disparities in oral health status, the projected downturn in the dentist-population ratio, and the challenges of oral health research. Dental school leaders can point to improvements in dental school applicants, as well as student and faculty contributions to the community in the form of patient care and other activities, and they can participate in the governance of the larger institution.
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From page 223... ...
These included a "transition team" modeled on others used by the university in similar situations; interim positions for most of the school's administrators; recruitment of new leadership from outside; a more flexible budgeting structure with incentives for income generation by faculty and for early retirement for other faculty; pressure and direction for the reorganization of 18 departments into 6; and redefinition of appointment, promotion, and tenure policies. In several schools visited by the committee, the academic health center, the university, or a state body had initiated intensive reviews of the dental school.
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From page 224... ...
5 8.5 12 2 4 3 11 7 0 a. University administration University governing board Academic health centers (AHC)
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From page 225... ...
Universities and academic health centers vary in their involvement in the community, so opportunities for dental schools to support university service in the community or even initiate their own programs will also vary. Two opportunities mentioned elsewhere in this report include patient care {Chapter 6)
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From page 226... ...
To ensure that dental education and services are consid ered when academic institutions evaluate their role in a changing health care system, the committee recommends that dental schools coordinate their strategic planning processes with those of their academic health centers and universities. To provide a sound basis for financial management and policy decisions, each dental school should develop accurate cost and revenue data for its educational, research, and patient care programs.
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From page 227... ...
This chapter has identified risk factors that make dental schools vulnerable. Collectively and individually, dental schools should assess their strengths and weaknesses within universities or academic health centers and develop strategic plans to reduce risk factors.
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