Rethinking dentist shortages

Abstract

W ith the US health care system in the midst of a major transition spurred on by the Affordable Care Act, there is renewed debate over health workforce policy issues. One key question is whether the United States will face physician, nurse, and other health care provider shortages as health insurance coverage expands and several health care occupations experience aging and other demographic transitions. Dentistry is part of this debate. Much has been written over the years— empirical research, anecdote, and commentary—on whether the United States is facing, or will face, a dentist shortage. I classify this as one of those “soap opera” topics in health policy: You can tune out for several years, and when you return you realize you have not missed much of the plot. Assessing the current and future adequacy of the dentist workforce is both conceptually and empirically challenging. It requires modeling labor market choices of dentists, dental school enrollment levels, and demand for dental care. It also requires a good understanding of barriers to dental care on the part of the population—what economists would call demand-side behavior. This brings me to a new analysis of the future supply of and future demand for dentists released by the Health Resources and Services Administration (HRSA) in March. This analysis models the future supply of and demand for dentists through 2025. The analysis predicts that, nationally, increases in dentist supply will not meet the increases in demand for dentists, leading to an exacerbation of the existing shortage. Furthermore, the analysis predicts that every state and the District of Columbia will experience a dentist shortage by 2025. HRSA needs to be commended for taking a leadership role in developing a sophisticated empirical simulation model that aims to predict demand for and supply of various types of health care professionals, including dentists. The agency is taking considerable strides to expand data availability and research efforts in this critical area of health policy. However, there are several important aspects of HRSA’s dentist workforce projections that merit discussion. The modeling of dentist supply, overall, is sound and empirically grounded. HRSA’s model predicts a rising supply of dentists. The American Dental Association Health Policy Institute recently developed a sophisticated empirical model to predict the future supply of dentists, and the analysis also predicts a rising supply of dentists. Although there is no way to make an apples-to-apples comparison between the two models, both give the same big picture conclusion: there will be more dentists in the market in the coming years. HRSA’s demand modeling is where there are some larger issues. The analysis, in my view, is based on assumptions that are inconsistent