DPH Training PowerPoint

NOHC, May 2-4 2005, Pittsburgh PA

Dental public health Dental public health training: training:

time for new models?time for new models?Scott L. Tomar, DMD, DrPHScott L. Tomar, DMD, DrPHUniversity of Florida College University of Florida College

of Dentistryof [email protected]@dental.ufl.edu


HistoryHistory

1950: 1950: Public health dentistry recognized as a Public health dentistry recognized as a specialty by the ADA, American Board of specialty by the ADA, American Board of Dental Public Health foundedDental Public Health founded

1951: Dr. Viron “Dief” Diefenbach becomes 1951: Dr. Viron “Dief” Diefenbach becomes first DPH resident under direction of Dr. first DPH resident under direction of Dr. George NevittGeorge Nevitt

1963: DHEW-PHS Div. of Dental Health 1963: DHEW-PHS Div. of Dental Health established 1established 1stst formal residency formal residency

mid-1960s to 1981: DHHS grants to support mid-1960s to 1981: DHHS grants to support DPH residenciesDPH residencies

1996: HRSA begins grants for DPH 1996: HRSA begins grants for DPH residenciesresidencies


Accredited DPH Residency Accredited DPH Residency Programs, 1975-2003Programs, 1975-2003

05

10152025303540

1975 1980 1985 1990 1995 2000

Year

Num

ber

1st Yr Residents Programs

Source: ADA Surveys of Advanced Dental Education


Number of Active Number of Active Diplomates of ABDPH, Diplomates of ABDPH,

1986-20051986-2005

020

406080

100120140

160180

Source: Minutes of ABDPH meetings published in J Public Health Dent; online roster of diplomates 3/30/05


How Many “Public Health How Many “Public Health Dentists” Are There?Dentists” Are There?

153

498543

0

100

200

300

400

500

600

ABDPH Diplomates

AAPHD-member Dentists

ADA DPH Specialists

Sources: ABDPH diplomate roster 3/30/05; AAPHD Online Directory 3/29/05; ADA Online Directory 3/30/05


Employment Setting of Employment Setting of Board Certified PH DentistsBoard Certified PH Dentists

20

5

6

7

14

35

35

0 5 10 15 20 25 30 35 40

Other

County/Local Govt.

School of Public Health

Private Org.

State Govt.

Federal Govt.

Dental School

Number of Diplomates

2001 Survey of Diplomates of the American Board of Dental Public Healthn=125


Diplomate Status of DPH Diplomate Status of DPH Dental Faculty and State Dental Faculty and State

Dental DirectorsDental Directors

48

3

193

51

0

50

100

150

200

250

Dental Faculty State & Territorial DentalDirectors

Diplomate

Non-Diplomate

Sources:Kaste et al. J Public Health Dent 1998;58:94-100; Kaste et al. J Public Health Dent 2001;61:114-9;ASTDD website; ABDPH website


DPH Training among non-DPH Training among non-Diplomate Dental School Diplomate Dental School

Faculty Teaching DPHFaculty Teaching DPH62%

21%

5% 5%5%10%

29%

64%

0%

10%

20%

30%

40%

50%

60%

70%

MPH DPH Residency

Completed

Currently Doing

No, But Interested

No, Not Interested

Sources:Kaste et al. J Public Health Dent 2001;61:114-9;


The Model of DPH The Model of DPH CertificationCertification

““Eligibility requirements for board Eligibility requirements for board examination are based on standards examination are based on standards that were developed in 1951-1953.”that were developed in 1951-1953.”

Source: Diefenbach VL. J Public Health Source: Diefenbach VL. J Public Health Dent 1997;57(2):89-92.Dent 1997;57(2):89-92.


Eligibility Requirements for Eligibility Requirements for ABDPH Board EligibilityABDPH Board Eligibility

1. Moral and ethical standing in dental 1. Moral and ethical standing in dental profession satisfactory to the board.profession satisfactory to the board.

2. Graduation from accredited dental 2. Graduation from accredited dental school.school.

3. Professional experience and advanced 3. Professional experience and advanced education in public health include:education in public health include: a. completion of ≥2 years of advanced a. completion of ≥2 years of advanced

educationeducation b. ≥ 2 years of full-time experience in DPH b. ≥ 2 years of full-time experience in DPH

practicepractice Adapted from ABDPH eligibility available from www.aaphd.org


Educational PreparationEducational Preparationfor ABDPH Boardsfor ABDPH Boards

The requirement of two years of advanced The requirement of two years of advanced preparation can be satisfied by:preparation can be satisfied by:

1. Completion of 1 academic year in CEPH-1. Completion of 1 academic year in CEPH-accredited program leading to a graduate degree accredited program leading to a graduate degree in public health, plus DPH residency accredited in public health, plus DPH residency accredited by the Commission on Dental Accreditation by the Commission on Dental Accreditation (CODA);(CODA);

2. Two academic years of study in CODA-2. Two academic years of study in CODA-accredited program that leads to graduate degree accredited program that leads to graduate degree in public health; in public health;

3. Completion of ≥2 years of advanced education 3. Completion of ≥2 years of advanced education in DPH from an institution outside U.S. followed in DPH from an institution outside U.S. followed by completion of CODA-accredited residency by completion of CODA-accredited residency programprogram


Median Annual Tuition, Median Annual Tuition, US Schools of Public US Schools of Public

Health*Health*2004-20052004-2005

$9,476

$20,598

$0

$5,000

$10,000

$15,000

$20,000

$25,000

In State Out of State

*Accredited by CEPH, N=36; Source: ASPH 2005 and individual schools


Average Debt of Dental Average Debt of Dental School GraduateSchool Graduate

$18,500$32,000

$39,300

$55,550

$75,750$87,600

$118,748

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

1980 1984 1988 1992 1996 2000 2003

Source: American Dental Education Assoc 2001; Weaver et al. J Dent Educ 2004; 68(9):1004-27.


Incentives for Board Incentives for Board Certification among Non-Certification among Non-Diplomate DPH FacultyDiplomate DPH Faculty

6%

10%

19%

34%

44%

52%

0% 10% 20% 30% 40% 50% 60%

Direct DPH residency

Pay increase

Promotion/tenure

Professional Status

Personal Satisfaction

None

Sources:Kaste et al. J Public Health Dent 2001;61:114-9;


Distribution of Schools of Distribution of Schools of PH by Number of Faculty PH by Number of Faculty Members with Dental or Members with Dental or Dental Hygiene DegreeDental Hygiene Degree

12%

28%

60%

0

1

2+

National Survey of Dental Public Health Activities in Schools of Public Health, 2001 (n=27; RR=77%)

Mean = 0.6

Number of Faculty


Dental Public Health Dental Public Health Training at Schools of Training at Schools of

Public HealthPublic Health

15%

85%

19%

81%

MPH in DPH concentration? Advanced training in DPH?

NoNo

Yes Yes

National Survey of Dental Public Health Activities in Schools of Public Health, 2001N=27 (RR=77%)


Preventive Medicine vs. Preventive Medicine vs. Dental Public Health Dental Public Health

TrainingTrainingDental Public HealthDental Public Health 2 Years2 Years

1 Yr. Accredited MPH 1 Yr. Accredited MPH or equiv. program or equiv. program

1 Yr. CODA-accredited 1 Yr. CODA-accredited ResidencyResidency

OROR 2-yr CODA-accredited 2-yr CODA-accredited

Program leading to Program leading to graduate PH degreegraduate PH degree

MPH generally not MPH generally not supported financiallysupported financially

Preventive MedicinePreventive Medicine 3 Years 3 Years

ClinicalClinical Most do not offerMost do not offer Prefer 1 yr in clinical Prefer 1 yr in clinical

residencyresidency AcademicAcademic

Leads to MPHLeads to MPH PracticumPracticum

Supervised Supervised experienceexperience

Support includes MPHSupport includes MPH


Deficiencies with Current Deficiencies with Current StructureStructure

Many MPH programs not CEPH-accreditedMany MPH programs not CEPH-accredited Few PH schools have DPH faculty or Few PH schools have DPH faculty or

coursescourses MPH generally at trainee’s expenseMPH generally at trainee’s expense 2-3 year F/T commitment often not feasible2-3 year F/T commitment often not feasible Educational indebtedness of dental Educational indebtedness of dental

graduatesgraduates Limited clinical practice during residencyLimited clinical practice during residency DPH separated from clinical dentistry DPH separated from clinical dentistry

during trainingduring training


Current ProblemsCurrent Problems Many barriers, few incentives for DPH Many barriers, few incentives for DPH

specialty trainingspecialty training Almost no “front-line” DPH practitioners Almost no “front-line” DPH practitioners

are board-certified specialistsare board-certified specialists Unknown what proportion of county/local Unknown what proportion of county/local

dental directors have public health trainingdental directors have public health training Unknown what proportion of county/local Unknown what proportion of county/local

dental programs provide core PH functionsdental programs provide core PH functions Currently no model for establishing minimal Currently no model for establishing minimal

DPH competency among DDSs functioning DPH competency among DDSs functioning as dental directorsas dental directors


One Potential SolutionOne Potential Solution

Link DPH training with clinical dental Link DPH training with clinical dental residencies, e.g. Pediatric Dentistry or residencies, e.g. Pediatric Dentistry or AEGDAEGD Approximates Preventive Medicine model Approximates Preventive Medicine model Creates clinicians with understanding of DPH Creates clinicians with understanding of DPH

principles and practiceprinciples and practice More marketable grads, better income More marketable grads, better income

potentialpotential Could provide graduate degree (MPH, MS) for Could provide graduate degree (MPH, MS) for

programs that currently provide just programs that currently provide just certificatecertificate


Another Potential SolutionAnother Potential Solution

Distance-learning “mini-residency” Distance-learning “mini-residency” for current DPH clinical personnelfor current DPH clinical personnel Overview of PH principlesOverview of PH principles Need for and methods of surveillanceNeed for and methods of surveillance Community-based preventionCommunity-based prevention Planning processPlanning process


Plans in the Sunshine StatePlans in the Sunshine State Hired full-time U Florida Hired full-time U Florida

College of Dentistry faculty College of Dentistry faculty member as county director member as county director for Duval Co. (Jacksonville)for Duval Co. (Jacksonville)

Pediatric and DPH residents Pediatric and DPH residents to work at county health dept.to work at county health dept.

Developing 3-year joint Developing 3-year joint Pediatric Dentistry/MPH Pediatric Dentistry/MPH programprogram

Creating new Dept. of Creating new Dept. of Community Dentistry and Community Dentistry and Behavioral Sciences to Behavioral Sciences to enhance linkages among enhance linkages among clinical service, research, and clinical service, research, and teachingteaching


ConclusionsConclusions

Few incentives and many barriers to pursuing Few incentives and many barriers to pursuing advanced DPH training with current modelsadvanced DPH training with current models

Few specialists, especially in front-line DPH Few specialists, especially in front-line DPH positionspositions

Potential need for “non-specialty” DPH Potential need for “non-specialty” DPH training of clinician/administratorstraining of clinician/administrators

Partnerships between DPH faculty, clinical Partnerships between DPH faculty, clinical programs, schools of public health, and programs, schools of public health, and health departments could be win-win-win-win health departments could be win-win-win-win situationsituation

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