Evaluation of Strategies to Recruit Oral Health Care Providers to Underserved Areas in California by sammyc2007


									Evaluation of Strategies to Recruit
  Oral Health Care Providers to
 Underserved Areas in California
            Beth Mertz, MPA
     Center for the Health Professions
               June 6, 2004
     AcademyHealth Annual Meeting

 Funded by the California Program on Access to Care
          Research Questions
1. What are the federal, state and private programs
   in CA that impact the number of oral health care
   providers working in underserved communities?
2. What impact do the programs have in relation to
   existing need
3. Do the programs, policies, and legislation work
   in tandem towards addressing the distribution of
4. In what way could existing programs be
   improved or expanded upon so they better
   articulate with one another?
           Pipeline Framework
• Practice Environment Strategies:
   – Short term solutions to influence a providers location
     and patient base
• Dental Education Strategies:
   – Increase students awareness of barriers to access and
     sensitize them to working with underserved populations
     through coursework, clinical rotations and residencies
• Applicant Pool Strategies:
   – Influence the pool of available providers, particularly
     by mentoring and admitting minority or disadvantaged
     students or those students having an interest in working
     with underserved populations
• Literature Review             • Expert Interviews
   – Framework                     – Phone Interview with
   – Underserved                     Programs Admins
     population estimates          – Program details from
      • (3 million)                  websites & literature
• Inclusion                     • Estimates
   – Any program or policy         – Number of providers,
     with direct or indirect         percent of practice
     goal of recruiting oral         underserved, duration of
     health care providers to        service, calculated
     work in underserved             patient visits and
     areas                           individual patients
   Practice Environment Strategies
• Loan Repayment                    • Professional Licensure
  Programs (7)                        Scope of Practice
• Scholarship Programs (4)          • Licensure by
  – Key Common Features               Credential
     • Graduates agree to
       practice in an approved      • Mexico Pilot Program
       “underserved” site for a     • Foreign Dentists
       specific amount of time in
       return for loan repayment
     • 2-4 year terms, $25,000-
       $35,000 annual loan
         Impact of Practice
       Environment Strategies
• Loan Repayment & Scholarship:
  – 51 providers annually = aprox. 130,000 patient visits
    for 40,000 persons. Cost = $10 per visit or less
    depending on retention of provider
• Licensure:
  – RDHAP: 17 graduates a year = 34,000 patient visits,
    compounded annually
     • Shift in care provision from RDH to RDHAP, not adding new
  – Licensure by credential: unknown
  – Foreign Dentists: unknown
  – Mexico Pilot: unlikely to happen
    Dental Education Strategies
• Pipeline Profession and Practice: Community
  Based Dental Education
      • Expand off-site community clinic training sites
      • Expand number of days in clinic rotations
      • Curriculum reform
      • Fund post-bac program
      • Recruit underrepresented minority and disadvantaged
• Residency (AEGD or GPR)
   – 50% of graduates currently do general or specialized
     advanced training
• PGY-1 Mandatory Year (Proposed)
   – Required year of residency, could replace clinical
     licensing exam
          Impact of Dental
         Education Strategies
• Pipeline Profession & Practice:
  – Potential to provide an additional 46,000
    patient visits in community rotation sites from
    existing dental students
• Residency Programs:
  – 88 residents provide 60,000 patient visits for
    18,000 underserved persons annually
• Mandatory PGY-1 Year
  – Residents could provide an additional 280,000
    patient visits for over 85,000 persons
      Applicant Pool Strategies
• Recruitment and      • Impact of Applicant
  training of            Pool Strategies:
  underrepresented       – Difficult to measure,
                           long term affects
  minority students
                         – Can measure program
• High School              success (i.e. how many
  Recruitment and          students participate)
  Mentoring                but not so much access
                           to care impact
• Post-Baccalaureate
                  Current Programs’ Impact
                                                                                    Annual         Percent of
                                                        Program                   Underserved     underserved
                                                      Participants                  Persons     (based on 3 million
                                                                   Patient Visits
                                                                                    Served           estimate)

Current Programs with Data to Estimate
Loan and Scholarship                                      51         130,050        39,409            1.3%
RDHAP (pilot project participants)                        21             0            0               0.0%
Foreign Dentists (Bench Exam)                            300        unknown       unknown           unknown
Foreign Dentists (Mexico Pilot)                          n/a           n/a           n/a               n/a
ID Program Dentists                                       94        unknown       unknown           unknown
Welcome Back Center                                      400        unknown       unknown           unknown
Pipeline Program                                         n/a           n/a           n/a               n/a
Advanced General Dentistry Residency (Non-Military)       88          59,160        17,927            0.6%
Advanced General Dentistry Residency (Military)           73           n/a           n/a               n/a
Post Bac Programs                                          5           n/a           n/a               n/a
Dental School Outreach                                    50           n/a           n/a               n/a
                                           Subtotal     1,082       189,210        57,336            1.9%
              Projected Programs’ Impact
                                                     Annual                       Percent of
                                       Program                   Underserved
                                                  Underserved                underserved (based on
                                     Participants                  Persons
                                                  Patient Visits               3 million estimate)
Potential Increase in Programs with Data to Estimate
Loan and Scholarship                        60        153,000     46,364             1.5%
RDHAP                                       17        34,000      10,303             0.3%
Foreign Dentists (Bench Exam)               n/a         n/a         na                n/a
Foreign Dentists (Mexico Pilot)             30        76,500      23,182             0.8%
ID Program Dentists                         n/a         n/a        n/a                n/a
Welcome Back Center                         n/a         n/a        n/a                n/a
Pipeline Program                           635        40,640      12,315             0.4%
Residency Programs (PGY1)                  352        281,600     85,333             2.8%
Post Bac Programs                           16          n/a        n/a                n/a
Dental School Outreach                  unknown      unknown     unknown           unknown
                                Total     1,110      585,740     177,497            5.9%
The programs evaluated have a strong impact on
the communities they serve. However, so great is
the gulf between what these efforts are able to
produce and the growing need for care, that a
new, expanded model of addressing this growing
public health crisis needs to be considered. Such
a strategy should be an amalgam of educational,
loan repayment, practice reform, and finance of
Center for the Health Professions
   University of California,
          San Francisco
3333 California Street, Suite 410
   San Francisco, CA 94118

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