Pitt creates dental apprenticeship program to help address shortage and improve diversity
Aspandemic inconveniences go, waiting longer for a dental visit might not feel like the worst fate.
But an extended delay between hygiene appointments isn’t riskless, giving chronic conditions and other oral health issues more time to fester undetected, experts warn. Amid staff shortages, wait times for some appointments locally have swelled to nine or 10 months, according to anecdotes shared with the University of Pittsburgh School of Dental Medicine.
That’s at least three months beyond the standard interval — and “definitely not ideal,” said Kelly Wagner, director of the dental hygiene program at the school. Angling to build up the ranks, the school is starting a paid apprenticeship program with Pittsburgh Public Schools to train dental assistants.
“A big focus of those six-month appointments is prevention,” said Wagner, an assistant professor who worked more than a decade in private-practice dentistry. “I think we forget that most oral diseases are preventable. We want people at the dentist before they have a problem.”
A lack of dental assistants and hygienists contributes to delays for care, said Jim Earle, an executive dean at Pitt Dental Medicine, describing “a tremendous shortage” of assistants in Western Pennsylvania and nationally. The school itself has seen few, if any, applicants for its own assistant openings lately, he said.
Assistant duties can range from front- to back-office functions, such as sterilizing instruments, preparing exam rooms and helping with procedures that may require four hands. Over the past couple of years, assistant and hygienist openings have been the toughest dental jobs to fill, and the vacancies have depressed dental practice capacity by perhaps 10%, the Chicago-based American Dental Association found.
Those who left the jobs cited workplace culture, too much work, insufficient pay, COVID-19 concerns and a lack of benefits among their reasons for leaving, according to a June 2022 survey from the ADA Health Policy Institute. An increase in dentist retirements is probably amplifying job losses, the institute has said, although new dentists still outnumber those departing.
Some dentists have closed, and
“fewer dentists have opened or bought old practices,” said Dennis Zabelsky, a Munhall dentist and president of the Dental Society of Western Pennsylvania.
Well more than 1,000 dentists work in the region, around half of them members of his professional advocacy group, he estimated. He cast the pandemic as a tipping point — “the fulcrum on the seesaw” — that led many to leave dentistry, at times amid fears that they might take the coronavirus hometo their families.
Some clinics didn’t receive any federal COVID-19 relief during the revenuecrushing closures at the start of the pandemic, Zabelsky said. His wife, a retired teacher, covered the rent at his practice.
But other pressures on dental practices long predate COVID-19. Near-stagnant reimbursements from health insurers can make it difficult to cover the bills and pay employees, Zabelsky said.
“We need higher reimbursements to pay higher salaries,” he said. “It’s like dominos.”
In a recent survey of dental society members, 16 of 18 respondents said new dentists were not opening offices in their respective areas. Seventeen said dentists had left their areas since 2020; one said the opposite.
“Everyone has made lifechoice decisions in the pandemic. But we were aware as far back as 2016 that there was dissatisfaction with the profession,” said JoAnn Gurenlian, education and research director at the American Dental Hygienists’ Association in Chicago. “We have to be honest about things.”
The pandemic led many dental workers to evaluate their work conditions and whether to try another career, forcing the profession to pay greater attention to workplace satisfaction overall, Gurenlian said. The year before the pandemic, a survey showed 45% of hygienists
were weighing new jobs over issues of workplace respect, compensation or feeling valued, she said.
When they and dental assistants depart, patients often don’t receive adequate preventive care or medical screenings, Gurenlian said. “A dentist can’t do it all.”
She called the Pitt apprenticeship program “a great concept” that fits into broader work to strengthen the labor pool — and to advance the practice of dentistry overall. Dentists are addressing wage concerns as the profession at large collaborates on improving and promoting those hygienist and assistant jobs, she said.
“True to our core, we love serving the public,” Gurenlian said. “We have a great rapport with our patients and get to know them and [their] families. We love preventing disease and helping people be restored to a great health status.”
With a $318,720 grant from the state Department of Labor & Industry, Pitt Dental Medicine intends to recruit its first cohort of six assistant apprentices to enroll in January. The paid, 14-month program is looking to attract underrepresented minority students
from high schools in Allegheny, Beaver, Butler, Washington and Westmoreland counties.
Much of the idea is to diversify the historically white dental workforce. The school already trains hygienists and dentists, hoping some of the new apprentices will explore those career paths, too.
“Pittsburgh is a very diverse community. Those are the patients we treat,” said Wagner, the assistant professor. “Having a more diverse provider [base] definitely better prepares them to treat the population in our community.”
The one-year state grant will cover all program costs for the apprentices — except for scrubs — plus an hourly wage that will step up from $12.50 to $14.50, said Earle, the executive dean. The program also will prepare students for the certification exams that will make them credentialed assistants, and help them land jobs at the university or through its alumni network.
Organizers intend to apply for more state money and hope to extend and expand the program, which Earle identified as “pretty much a Pitt invention.” Future
cohorts should start in early summer, when enrollees would begin as new high school graduates just after commencement.
“The initial spark really came from our alumni,” many of whom reached out for staffing help during the pandemic, Earle said. Reinforcing the assistant ranks is central to making dental practices more productive and able to care for more patients, he said.
As of May 2021, dental assistants in Pennsylvania had an annual mean wage between $41,950 and $44,410, according to the federal Bureau of Labor Statistics. Nationally, the number of assistants is expected to jump 8% between 2021 and 2031, “faster than the average for all occupations,” the bureau noted.
Gurenlian urged a bigger view of the work that hygienists and assistants can take on, arguing for regulatory reform that would make it easier for them to practice in more settings.
“I’m very hopeful about addressing the workforce shortage, because I think we are all attuned to the fact that we understand the problem now,” she said. “And all of it is correctable.”