Providing a diverse high-quality dental workforce to address our changing needs

One thing all dentists in New Mexico have in common is that they received their dental education somewhere else. There is no dental school in New Mexico, adding a barrier to New Mexico state residents wishing to attend dental school, and an additional barrier as dental school graduates must relocate if they wish to practice in New Mexico.

All New Mexicans deserve to receive quality dental care from a competent highly-trained dentist. However, as New Mexico residents migrate to urban and suburban centers, new dentists find it difficult to set up practices in rural areas, leaving these areas underserved. That is why NMDA supports incentive programs, such as school loan repayment, to increase the number of dentists available to residents in these underserved areas.

Action Plan Initiatives:

  1. Make incremental progress to opening a dental school in New Mexico. NMDA believes that we must provide an educational opportunity to qualified New Mexico students to ensure the diversity of New Mexico’s cultures and geography are represented in the dental profession. Incremental progress toward opening a dental school can achieve the goal and the state will realize many of the benefits with each step taken. These would include an enlarged and more diverse pipeline of students, accessible and more comprehensive services for high needs populations, and educational and research resources for our state’s professionals. Costs will not be unsubstantial, but the return on investment will be even greater.

Increment I – Invest in current student opportunities. Fund grants for all students accepted into dental schools through programs like the Western Interstate Commission for Higher Education (WICHE). Making the commitment to dental education needs to begin by fully funding all WICHE-eligible students that are accepted into dental school. WICHE funded students are required to return to the state. It is truly the minimum the state can do to show a commitment to our students and to expanding dental education. The more adequately the state funds our current students, the less difficult it will be to transition to the necessary subsidies for a dental school. Funding WICHE ensures a steady flow of dentists until the school opens and improves the commitment of those graduates to return. It requires a modest increase in investment, but takes a step toward increasing the annual funding levels to that needed for a school.

Increment II – Expand the pipeline of students to insure an adequate class size by establishing a BA/DDS program to recruit, nurture and support New Mexico students through dental school and encourage diversity. UNM has a successful program that recruits students out of high school, nurtures them throughout their undergraduate education and assures them of a place in the medical school, if they remain qualified. It gives students from underserved communities and underrepresented cultures a chance for success in the medical profession. The undergraduate component of a program would be identical to a program for pre-dental students, so creating a program that allows dental students to graduate to a dental school is not difficult. Simply expanding the relationships to our existing contract schools or contracting with a new school or schools to accommodate these students is very doable. Although they would still be attending dental school out-of-state, ideally some components of the clinical education would be completed back in the state. Most schools include substantial clinical externship experiences and for New Mexico students that could be done at a number of locations, either in conjunction with UNM’s residency or any of many Federally Qualified Health Centers in the state. Ultimately, the goal would be to utilize these students along with the WICHE subsidized students to create the critical mass required to begin classes at our dental school.

Increment III –. Construct public health infrastructure to recruit faculty and support clinical externships during transition from out-of-state to in-state dental school. The dental school feasibility study conducted in 2011 outlined a unique model that maximizes clinical experiences in five newly constructed Federally Qualified Health Centers. Four would be in the quadrants of the state providing services to rural communities and underserved populations. The fifth would function as a multi-specialty referral hub and serve a more urban population in the central part of the state. These facilities will serve as both a revenue source to support the school and faculty practice and become the clinical facilities for a school. They will also serve as externship facilities for our students at out-of-state schools allowing us to begin educating dentists in our state even before we have a school. These new facilities may be staffed with a combination of new practitioners and current practitioners from the area working part-time under contract. Completing this step puts us in a position where it will require very little time and a modest additional investment to start a school.

  1. Initiate or expand existing loan repayment scholarship programs for up to the entire cost of dental school in exchange for practice in highly underserved areas. It is not unusual for the state or local communities to provide lucrative incentives to attract big industries to their areas, but for relatively modest investment they could realize even greater relative returns by attracting a dental practice. Incentives for larger business often include tax relief or credits, low interest loans or grants. While the scale of a dental practice is relatively small, the benefits to the community in terms jobs, additional revenue and direct services are large.
  2. Utilize projects in cooperation with underserved New Mexico communities to investigate the use of expanded function dental “mid-levels” of various models to facilitate care. Everyone agrees, including dentists, that there are services that can be reasonably provided by non-dentists working under the supervision of a dentist. Most of the discussion then focuses on what those services are and what level of supervision is necessary. In the last few years there has been considerable discussion about the utilization of so-called dental “mid-levels” to provide services to underserved populations.

While some type of new mid-level may have a role in addressing access issues, there are currently more questions than answers. Is there a model that can function in a market-driven commercial environment? What level of supervision is appropriate? What educational model is viable? Will insurance cover services provided by mid-levels? Who bears liability for adverse outcomes? Every eventuality cannot be anticipated, but those that can, need to be considered. New Mexico should explore the idea more thoroughly, but cautiously and methodically.