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May 2, 2013

Pitt’s solution to dental faculty shortage

toothbrushThe national shortage of primary care physicians is well known, with the American Academy of Family Physicians projecting a shortfall of 52,000 PCPs by 2025. Perhaps less well known is that the country also is facing a shortage of dentists outside of large cities, according to the federal Health Resources and Services Administration.

The HRSA has determined that there are 48 million Americans living in what they designate as dental health professional shortage areas. And while each year about 4,800 dental students enter the profession, another 6,500 dentists retire. HRSA estimates that Pennsylvania alone needs 241 more dentists in its dental health professional shortage areas; the commonwealth has the country’s third-largest amount of rural area.

This shortage has helped trigger the recent creation of 10 new dental schools around the country, including one in Erie to add to Pitt and the state’s two other dental schools. Nationwide, the new schools are expected to help alleviate the dentist shortage but likely will exacerbate all dental schools’ serious faculty shortage.

Health-care faculty shortages are a major problem, with nursing schools presenting the most pressing need, followed by the allied health professions, pharmacy and medicine, according to an Association of Academic Health Centers survey in 2007.

But a 2009 American Dental Education Association report showed that schools of dental medicine also feel the shortage acutely, with current faculty leaving primarily to take a position at another dental school, retire or enter private practice.

Heiko Spallek, associate dean for faculty development in the School of Dental Medicine

Heiko Spallek, associate dean for faculty development in the School of Dental Medicine

Pitt’s situation is a microcosm of what dental schools face throughout the country, says Heiko Spallek, associate dean for faculty development in the School of Dental Medicine. Of the dental school’s 185 faculty, fewer than one percent has formal training in educational methodologies, he says, and half are part-time faculty with full-time dental practices.

Because the school has its own dental clinic, which functions as a teaching site, these faculty don’t have time to acquire training in classroom techniques and more general principles of education once they are here.

“In a perfect world,” says Spallek, “the best students from each year would stay on as faculty. We have several positions [open] but we are not finding the applicants we are really looking for,” he adds, “and some of the positions are open for a long time.”

Chief among the challenges of changing this situation is the differing incentives in clinical and academic dentistry. Top academic careers require faculty to publish and do federally funded research. While practicing general dentists without PhDs may provide dental students with superb clinical training, that leaves them very little time to do research and scholarship. One of the school’s assistant professors also is a department chair because he is very valuable to the school, Spallek points out, but he is still an assistant professor because promotions are geared to research.

The income disparity

Deborah Studen-Pavlovich, chair of the school’s Department of Pediatric Dentistry

Deborah Studen-Pavlovich, chair of the school’s Department of Pediatric Dentistry

Perhaps even more of a barrier is the $86,000 average yearly income difference between dental faculty members and general dentists in private practice; the difference is an average $150,000 annually between faculty and private practice dentists in specialties such as orthodontia or pediatric dentistry. Coupled with an average $200,000 student debt upon graduation, the hurdle of attracting new faculty to dental schools seems prohibitive.

Deborah Studen-Pavlovich, chair of the school’s Department of Pediatric Dentistry, knows the problem firsthand. She has been trying to fill one full-time faculty spot in her department for almost three years.

“There have been applicants,” she says. “But the majority of applicants have been foreign applicants who are looking to stay in the United States.” If hired, a dentist with a degree from a foreign institution would be given a one-time, four-year temporary license by the state, during which time he or she would have the opportunity to become licensed here.

Studen-Pavlovich has been a professor and chair for more than 25 years, but, as she points out, practicing pediatric dentists make more money in their first year than she does in her top faculty spot.

There are new incentives for faculty development and an increasing number of academic training programs within dental schools — more than 90 percent of dental schools now have such programs, by a recent Journal of Dental Education count.

Faculty development

Nationally, only 10 percent of dental students joined dental education faculty in 2007, up from a mere 4 percent the previous year.

Zsuzsa Horvath, director of faculty development

Zsuzsa Horvath, director of faculty development

At the School of Dental Medicine, Zsuzsa Horvath, director of faculty development, has been involved in devising an academic career track in the school’s pre-doctoral program to expose students to the academic opportunities available. The proposed track may consist of a one-year dental education program for dentists who wish to teach, and a two-day professional and career development retreat for all faculty.

Horvath currently is seeking approval for a proposed curriculum for this new academic track area of concentration, or ARCO. As part of the curriculum,  she instituted an elective clinical teaching practicum (CTP) for fourth-year dental students, giving them the chance to teach first- and second-year students.

This spring semester, CTP had six students. “The first-year students come to me and tell me how helpful it is to have these fourth-year students helping them and telling them what to do, in addition to the clinical faculty,” Horvath says. “And the clinical faculty appreciate the help, because we have 80 students in a course.”

The clinical practicum won’t benefit only students seeking purely academic careers, she points out, since all dental students eventually will do some teaching. “It will benefit every student who will become a dentist … in their dental practice when they mentor junior colleagues, dental hygienists and dental assistants.” But she hopes “incoming students will make a choice specifically to come here because we have this program.”

The Class of 2016 would be the first to experience the full academic track ARCO.

“A formal program,” Horvath has written, “is the best way to expose students to academia as a viable career path and equip them with the necessary skills and basic knowledge that would facilitate remaining in or returning to academia.”

Promotional videos Horvath compiled from last semester show that the program already is having an effect — and that it is needed.

Fourth-year student Cassidy Budd expressed appreciation for the teaching opportunity she received through the CTP: “I was happy I could maybe give some tips to some students who were struggling themselves,” she says. Although Budd owes several years of service to the Air Force after graduation, she says she wants to return to Pitt to pursue an academic career: “The most fun I’ve had in dental school was helping other students learn. I never knew any of the theories behind teaching. It was nice to learn to talk to students.”

Nicholas Riccio, another fourth-year CTP student, also has developed an interest in academia, but with a proviso: “I always wondered how the instructors here … learn to do what they do,” says Riccio, who plans to be an orthodontist. “I wanted to know, is there a way to get to learn that?” He would like to teach, but only on a part-time basis. “I would like to be a great clinician first,” he says.

—Marty Levine

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