DPH Training PowerPoint

NOHC, May 2-4 2005, Pittsburgh PA

Dental public health training: Dental public health training: time for new models?time for new models?

Scott L. Tomar, DMD, DrPHScott L. Tomar, DMD, DrPHUniversity of Florida College of University of Florida College of

[email protected]@dental.ufl.edu

mailto:[email protected]


HistoryHistory

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

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

1963: DHEW-PHS Div. of Dental Health established 1963: DHEW-PHS Div. of Dental Health established 11stst formal residency formal residency

mid-1960s to 1981: DHHS grants to support DPH mid-1960s to 1981: DHHS grants to support DPH residenciesresidencies

1996: HRSA begins grants for DPH residencies1996: HRSA begins grants for DPH residencies


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 Diplomates of Number of Active Diplomates of ABDPH, 1986-2005ABDPH, 1986-2005

020406080

100120140160180

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

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


How Many “Public Health Dentists” How Many “Public Health Dentists” Are There?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 Board Employment Setting of Board Certified PH DentistsCertified 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 Dental Faculty Diplomate Status of DPH Dental Faculty and State Dental Directorsand State Dental 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 Faculty Diplomate Dental School Faculty

Teaching DPHTeaching 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 CertificationThe Model of DPH Certification

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

Source: Diefenbach VL. J Public Health Dent Source: Diefenbach VL. J Public Health Dent 1997;57(2):89-92.1997;57(2):89-92.


Eligibility Requirements for ABDPH Eligibility Requirements for ABDPH Board EligibilityBoard 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 school.2. Graduation from accredited dental 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 educationa. completion of ≥2 years of advanced education b. ≥ 2 years of full-time experience in DPH practiceb. ≥ 2 years of full-time experience in DPH practice

Adapted from ABDPH eligibility available from www.aaphd.org

http://www.aaphd.org/


Educational PreparationEducational Preparationfor ABDPH Boardsfor ABDPH Boards

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

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

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

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


Median Annual Tuition, Median Annual Tuition, US Schools of Public Health*US Schools of Public 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 School Average Debt of Dental School GraduateGraduate

$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 Certification Incentives for Board Certification among Non-Diplomate DPH Facultyamong Non-Diplomate 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 PH by Distribution of Schools of PH by Number of Faculty Members with Number of Faculty Members with Dental or Dental Hygiene DegreeDental or Dental 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 Training at Dental Public Health Training at Schools of Public HealthSchools of Public 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 TrainingDental Public Health Training

Dental 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 Prefer 1 yr in

clinical residencyclinical residency AcademicAcademic

Leads to MPHLeads to MPH PracticumPracticum

Supervised Supervised experienceexperience

Support includes Support includes MPHMPH


Deficiencies with Current StructureDeficiencies with Current Structure

Many MPH programs not CEPH-accreditedMany MPH programs not CEPH-accredited Few PH schools have DPH faculty or coursesFew PH schools have DPH faculty or courses 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 graduatesEducational indebtedness of dental graduates Limited clinical practice during residencyLimited clinical practice during residency DPH separated from clinical dentistry during DPH separated from clinical dentistry during

trainingtraining


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

trainingtraining Almost no “front-line” DPH practitioners are board-Almost no “front-line” DPH practitioners are board-

certified specialistscertified specialists Unknown what proportion of county/local dental Unknown what proportion of county/local dental

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

programs provide core PH functionsprograms provide core PH functions Currently no model for establishing minimal DPH Currently no model for establishing minimal DPH

competency among DDSs functioning as dental competency among DDSs functioning as dental directorsdirectors


One Potential SolutionOne Potential Solution

Link DPH training with clinical dental Link DPH training with clinical dental residencies, e.g. Pediatric Dentistry or AEGDresidencies, e.g. Pediatric Dentistry or AEGD 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 potentialMore marketable grads, better income potential Could provide graduate degree (MPH, MS) for Could provide graduate degree (MPH, MS) for

programs that currently provide just certificateprograms that currently provide just certificate


Another Potential SolutionAnother Potential Solution

Distance-learning “mini-residency” for current Distance-learning “mini-residency” for current DPH clinical personnelDPH 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 College Hired full-time U Florida College

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

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

Developing 3-year joint Pediatric Developing 3-year joint Pediatric Dentistry/MPH programDentistry/MPH program

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


ConclusionsConclusions

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

Few specialists, especially in front-line DPH positionsFew specialists, especially in front-line DPH positions Potential need for “non-specialty” DPH training of Potential need for “non-specialty” DPH training of

clinician/administratorsclinician/administrators Partnerships between DPH faculty, clinical programs, Partnerships between DPH faculty, clinical programs,

schools of public health, and health departments could schools of public health, and health departments could be win-win-win-win situationbe win-win-win-win situation

DPH Training PowerPoint

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