The Promise of InnovationA Case for the Future

OurChallenge

Our Challenge | 1

To ensure a vigorous and respected future for dentistry.Dentists have to be brave enough to explore new ideas and tough enough to discard outdated ones. The alternative is for dentistry to move from a healthcare profession to a trade.

Great schools, great dentists. It’s just that simple … and that complicated.

Back To The Future

Dental schools not only train and inspire educators, researchers and practitioners, but they are also a safety net for people in underserved communities. They are the laboratories for research and discovery, the cocoons for treatment advances. They are the very foundation of the profession.

Most schools have dramatically expanded fund raising efforts over the past decade to cope with a worsening financial picture. Professors, administrators, alumnus – even students – are pitching in.

But they are in critical need of help.

“ The importance of science, research and scholarship in guiding change in dental education cannot be minimized. Otherwise, the profession risks its own de-evolution to a vocational school program, losing its hallmark as a learned profession.”

— Journal of Dental EducationSeptember 2006

2 | ADA Foundation

Our Challenge | 3

Status Quo Is Not An Option

America’s dental schools grapple with outdated infrastructure and parent universities that, in some cases, have been unable to upgrade programs and facilities. This is not news. Since an ADA monograph sounded the alarm twenty-five years ago, seven dental schools have been squeezed out of existence. Dozens more teeter on the brink.

Most new dental schools and those planning to open in the next five or so years are not based in research universities and are unlikely to invest in research programs. If these trends continue, by 2015 only 75 percent of dental schools will be based in research universities, compared to 85 percent in 1985. “For dentistry to remain a learned, self-regulating profession, the majority of dental schools must be in flagship research universities,” warned a Macy Foundation study.

Important faculty positions are going begging all across the country as the disparity grows between compensation for dental school clinical faculty and community practitioners. Meanwhile, the average dental school student graduates with crushing loan obligations, as schools struggle to make up shortfalls with tuition increases.

“The curriculum at most dental schools is based on a model of educational delivery that is at least 50 years old,” lamented a report in 2006 by The American Dental Education Association’s Commission on Change and Innovation.

Add to that a lack of diversity of dental school faculty and students.

Dentistry needs urgent care, beginning with its schools.

4 | ADA Foundation

Outside the university walls, the public is woefully undereducated about oral health. Although research continues to strengthen the link between oral health and a person’s overall wellbeing, dentistry often is perceived in a medical vacuum. Heart disease, premature births and high blood pressure have been tied to periodontal disease. Diabetes, osteoporosis and cardiovascular disease have symptoms observable in the mouth.

The epidemic of obesity is clearly associated with nutrition. But when the public thinks of dental implants, people are more likely to picture Paris Hilton than a child who can’t bite into an apple. A New York Times report found correlation between success for job applicants and a healthy smile. And a Cincinnati implant pioneer likes to talk about one of his first patients – a middle-aged woman who had not been out of her house for a decade because of her ill-fitting dentures.

Boomers are not only outliving their teeth, but the National Institutes of Health just announced a $1.3 million grant to study the relationship between poor dental health and cognitive decline. One of the physicians participating in the new study notes, “It’s becoming increasingly clear that to have good general health, you need to have good oral health.”

Yet, right now there’s no provision for a dentist to serve on the Congressional Health Benefits Advisory Committee, Medicaid is shamefully underfunded and state support for dental education has declined over the past 15 years from an estimated 60 percent to between 20 and 25 percent of total school revenues. Likewise, private schools are faced with a significant decline in federal support. In the past decade, schools have experienced large reductions in Graduate Medical Education funding for dental residents, in the recruitment of underrepresented minority students and in biomedical research.

A Public Disconnect

Our Challenge | 5

A Bold Response

6 | ADA Foundation

It’s time for a powerful response to a formidable issue. The American Dental Association Foundation is launching a campaign to raise $100 million aimed at dramatic change in dental education.

Our Challenge | 7

Led by Dr. Greg Chadwick, former President of the ADA and current chair of the National Campaign for Dental Education Task Force, the ADA Foundation is calling upon dentists, dental researchers and educators and local and regional dental organizations to support the profession and each other.

This campaign comes with an unusual structure, which puts the strategy and flow of funding directly into the hands of donors.

More than five years of study and advice from literally hundreds of leaders in dental education, the dental profession, the dental industry, organized dentistry and philanthropy resulted in what is now called Dental Education: Our Legacy – Our Future. Born from a single fundamental

belief that dental education is the key to creating and sustaining a professional legacy, the objective is to raise awareness of the need for philanthropic support of dental education and to create greater visibility for the fund-raising campaigns of dentistry’s many partner organizations.

While, dental schools already are sharpening business practices, implementing new clinic operations and juggling resources to meet the immediate needs of students, the Foundation was urged to seize the opportunity to support dental education institutions for the next generation of dentists.

8 | ADA Foundation

In the summer of 2006, ADAF brought a diverse group of leaders together to identify the issues most in need of overhaul. They considered a wide variety of existing research, as well as their shared experience.

At that time, approximately 280 dental school faculty positions were vacant. An estimated 50 percent of current faculty was slated to retire during the next decade. Dental school students graduated with an average student loan debt of $122,000. It has only gotten worse.

Skyrocketing tuition, not surprisingly, has had an adverse effect on minority enrollment. African-Americans, Hispanics and Native Americans comprised only 4.7 percent, 6.3 percent and 0.4 percent respectively of the total dental school graduate population. Federal authorities have designated 1,480 areas in the United States as suffering from a dentist shortage. That number has nearly doubled since 1990, and most of the nation’s problem areas have large minority populations.

The ADAF task force targeted the following strategic areas:

> Recruiting and sustaining high quality dental school faculty

> Developing more financially efficient dental education delivery models

> Influencing curriculum change

> Increasing student and faculty diversity.

From the pool of advisors, Dr. Chadwick has formed an Innovation Advisory Committee to identify and prioritize projects that can transform dental education and build a more secure future for the profession.

First Line Of Attack

Minority Enrollment

African-Americans

Hispanics Native Americans

4.7%

Total Minority Enrollment

11.4% 6.3% 0.4%

Our Challenge | 9

A guiding principle is to keep control of dentistry in the hands of dentists. Dentists are independent and evaluative. “That is how we are trained. That is how we practice,” was one piece of advice at the ADAF conference.

ADA research and interviews with stakeholders have suggested two approaches: venture-philanthropy and portfolio. Both methods allow donors to choose in advance how their gift will be used. The choices they make – and the choices they decline

– will help guide the course of dental education, compatible with the entrepreneurial spirit of people who have chosen the profession of dentistry. As investors, they can expect regular progress reports and an opportunity to see the life of their gift.

Although every dollar spent will be subjected to the litmus test of the four imperatives identified by the dental community, there’s enormous flexibility in the avenues of giving.

A Two-Pronged Strategy

STrATEgy

10 | ADA Foundation

Venture-PhilanthropyDonors invest in specific major programs among the four essential areas. They have significant input.

The Challenge | 11

Here’s how it might work:

A prospective donor, such as a foundation, corporation or individual philanthropist comes forward with a $2.5 million pilot program to deliver education to rural dental students. The donor pledges to fund the entire project. Or, the donor might agree instead to a lead gift of $1.5 million toward the project and commit to assist the ADA Foundation in securing the balance from within his network of influence.

Once financing is secured, the ADA Foundation would broker the idea, circulating details of the proposal to the dental education community. Working closely with the donor(s), the Foundation would mount a competitive grant application process.

Obviously, a major donor might also be attracted to a project originated by the Innovation Advisory Committee or by a university or researcher.

12 | ADA Foundation

> Onsite courses, distance education or on-the-job training to recruit educators from the ranks of practitioners. Components might include financial incentives and loan repayment programs.

> A dental educator track created in dental schools, recruiting dental students who want to be teachers rather than practitioners. These candidates might be drawn from the schools of education and biological sciences.

> A study to revamp the basic clinic. Increase efficiency and revenue in the clinical delivery system by with more hours of clinic, serving a greater number of patients per clinic period. Explore the roles and relationships among faculty, students and patients. Compile data on cost/effect of clinician educators providing care while mentoring students. Streamline billing and collection for clinical services, explore technology infrastructure, patient and payer mix and related patient satisfaction issues.

PortfolioA portfolio of projects and programs will be available for scrutiny by donors. Each project will be consistent with the four strategic areas and each will be detailed, unambiguous and come with a price tag.

Sample program areas might include:

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> A major national research effort to address educational outcomes, such as student performance on regional licensing examinations or, more important, on the performance of graduates in practice could be the first step toward significant curricula redesign. Just as clinicians are moving to evidence-based practice, so academicians need to move to evidence-based education.

> Provide inter-disciplinary collaborative teaching with nursing, family medicine, pediatrics, public health, biomedical science. Work on a model to replace the traditional lecture format with newer educational methods to learn complex material and promote critical thinking.

> Regionalize an underrepresented minority program. Create a model to address the health care needs of a low-income region which lacks access to health care. Leverage educational dollars and health care dollars to educate dental students and deliver care in a community-based setting. Partner with a Federally Qualified Health Center.

“ We need to embrace innovation and exhibit the courage and wisdom to implement changes that will define our profession for the next decades.”

– Michael Glick, DMD editor

Journal of the American Dental Association

14 | ADA Foundation

Invest in the FutureThere are fault lines beneath the surface of the practice of dentistry. And dental education is at the epicenter. Experts agree that unless action is taken – and soon – the system will be unable to meet its traditional educational, research and service missions. And the profession is at serious risk of being shunted to the sidelines of health care.

Solutions will be neither quick nor inexpensive.

Individual dental schools struggle mightily to cope with the escalating costs, declining revenues and student indebtedness, but they need help. These are national problems that call for a nationwide solution. The ADA Foundation can collectively bolster the dental schools around the country and assist in integrating the academic, research and clinical programs into the university. Grants, endowment funds and research collaboration will send a message to universities that their dental schools are an important and vital component of the educational community. Money is a convincing handshake for dentistry’s allies and partners.

The ADA Foundation is asking those who best understand what’s at stake to not only invest in the future of the profession but to shape its course. Projects available for consideration by donors will have clear purpose, a detailed plan and a price tag. Choice of projects for support will have a genuine effect on the nature of reform, ensuring that the dentistry of tomorrow reflects the intentions and ideals of today’s professionals.

FUTUrE Our Challenge | 15

16 | ADA Foundation

“ The practitioner of the future will be using technology and materials beyond what most of us can imagine today. We have to prepare the way for those changes, and that starts with dental schools. The ADA Foundation’s Innovation Fund will provide dental schools and other dental organizations the financial resources to make serious and significant change.”

— Dr. Kathy Roth president

American Dental Association

16 | ADA Foundation

Nearly ten years ago, the Surgeon General’s Report on Oral Health said flatly, “Ignoring oral health problems can devastate well-being, diminish quality of life and burden American society.” The same can be said for ignoring the problems in dental education. As this country continues the enormous task of re-working the future of health care, the dental community must have a strong voice and a convincing strategy. The charitable arm of the largest dental professional organization in the U.S., the American Dental Association Foundation, is uniquely positioned to carry out this mission.

Your support can be a potent force for change.

Copyright 2009 American Dental Association.Reproduction or republication strictly prohibited without prior written permission.

American Dental Association211 East Chicago AvenueChicago, IL 60611-2678312.440.2500