Who will be teaching? The future of dental hygiene education threatened as a shortage looms

The future of dental hygiene education threatened as a shortage looms

By Diana J. Lamoreux, RDH, BS, MEd

The profession of dental hygiene experienced 20 years of growth during the 1960s and 1970s. During that period of time, an adequate number of hygienists entered dental hygiene education after earning an advanced degree and gaining experience in a clinical setting. These individuals have remained in their roles and are now approaching retirement. The same can be said about dental school faculty. A limited number of dental hygienists (and dentists) have entered the academic arena since. This decades-long trend has far-reaching ramifications for the future of dental hygiene and dental education, survival of the professions, and the provision of an adequate workforce to satisfy access to care.

The need for faculty is compounded by a lack of awareness and scarcity of information about the problem. The impact of the potential loss of educational leaders and role models in hygiene and dental education is not common knowledge.

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Looming is a potential absence of leadership given the pending retirement of an entire generation of mentors. The majority of dental hygiene faculty is employed by community colleges. Only baccalaureate program faculty is expected to engage in research. As a result, it is no wonder minimal information is available. There is little incentive to conduct research and publish in the community college setting. Studies are essentially nonexistent. Quantitative and qualitative research is needed, and little is known about the shortage or how to address the issues.

The prospect of educating dental professionals is largely dependent on the continued existence of an adequate number of qualified educators who possess content knowledge, commitment, educational theory, and practice expertise. This is a daunting challenge given the anticipated deficiencies.

Reasons for the shortage

Any attempt to understand how the dental field faculty pool has come to this crossroads requires looking at the reasons people enter and leave postsecondary settings.

It is obvious, but worth noting, that the rewards and challenges inherent in faculty culture differ significantly from those found in private practice culture. Given that, practitioners choose to enter academia for the following reasons

  • Altruism and intrinsic reward
  • The status associated with teaching at the college level
  • The stimulating intellectual environment and the camaraderie among colleagues
  • An inherent passion for teaching, to create a positive learning environment (if they experienced the opposite)
  • Attractive retirement plans and medical insurance, as well as extensive time off and a stable income
  • An optimistic view toward the character of the work environment
  • Opportunities for professional development

Regardless of perceived advantages by many, fewer clinicians are entering and remaining in the educational arena. The fact that private practice is substantially more lucrative usually overrides the enticement of an academic life. College-level faculty remuneration cannot compete with the private marketplace for hygienists or dentists. Research has demonstrated that most dentists can earn double in private practice; hygienists have the potential to make 25% more. This harsh reality certainly discourages recruiting efforts.

Faculty retention rates were good in the 20th century. Job satisfaction was apparently acceptable for decades. Dental hygiene and dental faculty today leave their positions for various reasons:

  • Unreasonable expectations and academic demands due to faculty vacancies
  • Distaste for the political climate in competitive postsecondary institutions
  • Financial concerns, educational debt, better salaries at other programs, spousal relocation, retirement, illness, or death

With few exceptions, it is obvious that the only individuals who persevere in academia find teaching is a labor of love. Unfortunately, for all affected, these educators are few and far between.

The few existing studies that have attempted to explain faculty shortages have been anecdotal yet reasons can be identified or at least theorized. In addition to retiring faculty and higher income from clinical practice, here are some other probable explanations for the scarcity of dental hygiene and dental faculty:

  • Debts incurred during the pursuit of higher education (This and higher salaries are the most fundamental impediments to individuals inclined to consider academia as a vocation.)
  • A deficiency of qualified applicants
  • A lack of response to position announcements (Inconvenient geographic locations in rural settings are not conducive to attracting applicants.)
  • Shrinking college and university budgets (Monetary limitations make it difficult for institutions to recruit and retain faculty of the caliber necessary to maintain program quality.)
  • A lack of awareness among all dental professionals; students are not familiar with academic opportunities
  • The disproportionate workload demands due to unfilled vacancies (Demands are not attractive to prospective faculty and have exhausted existing faculty, driving them back to the private sector.)
  • The limited access to advanced-degree programs in dental hygiene (Only about 25% of the dental hygiene programs offer accredited degree completion; approximately 60% of the dental hygiene programs in the United States are located in community college settings and award only associate's degrees.)
  • Undesirable work schedule inflexibility
  • Disillusionment and/or frustration with academic life
  • Negligible orientation and mentoring
  • Historically, dental hygiene and dental school academic culture has not exposed students to the world of academe.
  • The minimal interest in teaching exhibited by generations (Polls have shown that approximately 65% of dental hygiene students express an interest in becoming an educator during dental hygiene education but very few pursue.)

The pressures for reduced-cost education and attention to changing market demands have encouraged community colleges to favor hiring adjunct over full-time tenure track faculty. Given that development in tandem with the unprecedented need for faculty, dental hygiene and dental programs have had to make adjustments to continue to provide instruction to students. The programs redistribute workload to existing full-time faculty. In addition, they utilize inexperienced professionals with less than desirable credentials (either minimal years of clinical experience and/or individuals without advanced degrees) to teach didactic courses and supervise students in the clinical setting. As a result, the lack of a qualified applicant pool has resulted in hiring adjunct faculty not formally prepared to educate students. The educational value is being threatened while existing faculty struggle to maintain quality instruction.

Survey results from program directors have reinforced the fact that committed, competent full-time faculty is essential to maintaining dental hygiene program standards. Compromising weakens the academic rigor of dental hygiene and dental programs, potentially lowers standards, with a consequential impact on the oral health of the general public. It is sobering to realize that people with credentials less than those teaching kindergarten students are teaching future dental professionals whose education will impact caring for the health, safety, and well-being of dental patients.

Addressing the problem

To continue to educate individuals to adequately serve the public, dental hygiene and dental students should be enthusiastically encouraged to pursue further education and enter the world of academe. Creative yet practical solutions need to be developed to reverse the current trend. Here are some suggestions to attract, mentor, and retain faculty in the future:

  • Increase awareness at the collegiate, local, and national level (A collective effort by professional organizations and dental hygiene and dental programs will be required.)
  • Develop more degree-completion opportunities

This will enable more dental hygienists to complete a baccalaureate degree to qualify for faculty positions. Baccalaureate programs need to take into consideration all the barriers to accomplishing this. Flexible schedules and venue choices (distance vs. hybrid vs. face-to-face) will allow for the largest number of hygienists to pursue an advanced degree. Approximately 30% of dental hygiene and assisting programs offer courses via technology-based distance education with the numbers of programs adding other venues increasing.

  • Focus on sound recruitment strategies with current students (This should include regular, active recruiting of the best and brightest students, development and offering of incentives, and the sharing of best practices.)

Studies have demonstrated few examples of faculty making academic life appear attractive. Other research has shown that students' perception about dental hygiene faculty becomes their belief. It will be even more important in the future for faculty to incorporate positive role modeling into teaching practices. By openly discussing the advantages of faculty life on a regular basis, academia will hopefully be placed in a consistent, positive light for students. Faculty should also be encouraged to tout the rewards of witnessing former students become successful, dedicated, ethical clinicians or better yet, educators.

  • Foster an interest in technology, communication, leadership, and educational principles (All are necessary skills to thrive in the academic environment today.)
  • Develop high caliber mentoring programs to attract and retain individuals capable of sustaining teaching excellence (P. J. Desjardins is a renowned physician who aptly defines mentoring as an extended trusting, confidential relationship between two individuals who have mutual personal growth and academic progress as common goals. Current faculty say inadequate time is allotted in their schedules to commit to mentoring junior faculty; only one third of current faculty report being mentored.)
  • Expand federal, state, and ADEA loan forgiveness and grant programs as an impetus to balance the salary differential
  • Create alternative ways to reward faculty
  • Develop a database to monitor recruitment, mentoring, and retention methods to mitigate the challenge in the future

What is being done

For obvious reasons, not much has been accomplished thus far. Faculty has waged complaints and some educators have tried to prioritize the crisis, but little research has been conducted and few individuals are currently committed to addressing the multitude of issues. What has been cultivated, however, has been quite imaginative.

The provision of teaching opportunities has been identified as the primary vehicle for educating students about academic rewards. Adding education philosophy and fundamentals, peer tutoring, and teaching assistant prospects to dental hygiene and dental program curriculum would reveal this world to students. The following such programs are in place:

  • ADEA Fellowship Program (emphasizes the benefits of an academic life)
  • "Growing Our Own Dentist" (Developed by Delta Dental of Kansas, this is an attempt to exacerbate the "dental deserts" in the state.)
  • Faculty Extender Program at Baylor College of Dentistry
  • Teaching Training at the University of Texas
  • Dental educator program at Harvard School of Dental Medicine
  • University of Pittsburgh employs dental hygiene students as teaching assistants

Additional efforts to attract and retain dental hygiene and dental school teachers include:

  • The University of Michigan's dental school established a comprehensive mentoring program for faculty eight years ago to maintain capable faculty; good retention rates have been reported.
  • Supplemental institutional support for faculty development
  • Adding credentialed part-time faculty to ease full-time faculty workloads
  • Redefining full-time as four days a week (Faculty could feasibly earn extra income a fifth day a week in private practice.)

If vacancies in dental hygiene and dental programs are not filled with well-qualified individuals who are capable of meeting students' needs and possessing current technological education soon, there is potential for a profound negative impact on the profession and the delivery of dental care.

Over the past 20-plus years, educators across the country have expressed grave concern because few students or clinicians have exhibited an interest in or have pursued careers in dental hygiene or dental education. This foreboding challenge is nothing new to existing faculty. What has often been uttered among dental hygiene and dental faculty over the past few decades is: "There is no new blood on the horizon."

It has become apparent from the faculty vacancies that go unsatisfied for months and years and the numbers of faculty that will be retiring in the near future that replacements are vital. With the labor-intensive nature of developing effective faculty, and the imminent retirement of many learned educators who have served as mentors, the quantity and quality of leadership for the future of dental education will become a precious commodity.

It does not appear there is an end in sight. Awareness must be raised among professionals, and practical yet creative solutions need to be implemented and nurtured. A broad-based commitment is necessary to guarantee the integrity of professional programs, graduating competent hygienists and dentists, enlisting educators, and placating access to care. We need to somehow prepare the next generation to become our replacements -- dedicated educators, leaders, mentors.

The statistics about faculty shortages

In 2000, for the first time in history, the U.S. Surgeon General, David Satcher, addressed oral health as a priority in this country. His commentary, "Oral Health in America: A Report of the Surgeon General," identified oral health as essential to general health and noted that there is a "worrisome shortfall in the numbers of men and women choosing careers in oral health education and research." Since then, these related statistics have been released:

  • As of 2009, there were 4,230 dental health professional shortage areas (HPSAs). More than 49 million people live in dental HPSAs today.
  • The U.S. Bureau of Labor Statistics projected that the demand for dental hygienists would increase 36% by 2010 and that the distribution of the dental workforce would be inequitable.
  • Studies predicted that half of full-time dental hygiene faculty will retire and there will be approximately 900 faculty vacancies in dental schools in the 2010-2020 decade.
  • In 2013, the U.S. Bureau of Labor Statistics determined that employment for hygienists will grow 33.3% by 2022.
  • As of 2014, the number of retiring dentists will exceed the number of graduating dentists.
  • The American Dental Education Association (ADEA) believes dental educators should promote and ensure access to effective oral health care. Without sufficient numbers of educators in coming years, the impact on access to care could be dramatic.
  • Surveys that polled dental hygiene program directors quantified three core concerns related to the faculty shortage: 1. current lack of qualified faculty and sustaining quality programs without, 2. projected faculty departures, and 3. future demand for additional qualified dental hygiene educators to adequately prepare students to satisfy impending demands to abate access to care.


DIANA J. LAMOREUX, RDH, BS, MEd, graduated from Ohio State University in 1972, practiced dental hygiene for over 30 years, was a part-time clinical instructor in the Cleveland area since 1981, and retired in December 2011.

References

1. National Health Policy Forum. "Oral Health Update: Ten Years After the Surgeon General's Report." Available at: http://www.nhpf.org. Accessed January 11, 2014.
2. Bagramian RA, Taichman RS, McCauley L. "Mentoring of Dental and Dental Hygiene Faculty: A Case Study," J Dent Educ 2011: 75: 291-99.
3. Monson AL, Engeswick LM. "ADHA's Focus on Advancing the Profession: Minnesota's Dental Hygiene Educators' Response," J Dent Hyg 2007: 81: 1-11.
4. Livingston HM, Dellinger TM, Hyde JC. "The Aging and Diminishing Faculty," J Dent Educ 2004: 68: 345-53.
5. Nunn PJ, Gadbury-Amyot CC, Battrell A. "The current status of allied dental faculty: a survey report," J Dent Educ 2004: 68: 329-44.
6. Coplen AE. "The Need for New Qualified Dental Hygiene Educators," ADHA Publications/access Sept-Oct 2010: 4-5.
7. Carr E, Ennis R, Baus L. "The Dental Hygiene Faculty Shortage: Causes, Solutions and Recruitment Tactics," J Dent Hyg 2010: 84: 165-68.
8. Vanchit J, Papageorge M, Jahangiri L. "Recruitment, Development, and Retention of Dental Faculty in a Changing Environment," J Dent Educ 2011: 75: 82-89.
9. Shepherd KR, Nihill P, Botto RW. "Factors Influencing Pursuit and Satisfaction of Academic Dentistry Careers: Perceptions of New Dental Educators," J Dent Educ 2001: 65: 841-47.

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