Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.

I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.

Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.

The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.

The U.S. Department of Health and Human Services (HHS) this week announced more than $100 million in new grants to expand and strengthen the nation’s health care workforce. The goal of the funding is to educate and strengthen training for health care workers, and provide fellowships and traineeships.

The grants include:

- Nursing ($30.2 million): Partial loan forgiveness for students who serve as full-time nursing faculty for a designated period of time after graduating from a master’s or doctoral program; grants for schools of nursing to provide financial aid and mentoring to students from disadvantaged backgrounds underrepresented in nursing; and funding for nurse anesthetist traineeship programs for licensed registered nurses enrolled in master’s or doctoral nurse anesthesia programs.

- Dental ($3.0 million): Grants to increase oral health care education capacity for programs that train future faculty in general, pediatric, or public health dentistry, or in dental hygiene.

- Public Health ($48.0 million): Funds for 37 Public Health Training Centers to train current and future public health workers in basic health skills and key public health issues; and grants to expand public health training programs and support medical residency-type fellowships at state and local health departments.

- Interdisciplinary and Geriatric Education ($6.6 million): Grants for projects to train and educate workers to provide geriatric care for the elderly; and support for the collaboration and integration of public health curricula in medical and clinical education.

- Centers of Excellence ($18.8 million): A five-year program to support the recruitment and performance of underrepresented minority students entering health careers, and to support research and the development of curricula, training and resources related to minority health issues.

“These grants and the programs they support are vital to achieving a comprehensive and culturally competent health professions workforce capable of meeting future health care challenges,” HHS Secretary Kathleen Sebelius said in a statement announcing the funds.

Learn more about the new federal grants here and here.

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

The Affordable Care Act will allow more Americans to access dental health services, former Surgeon General and Robert Wood Johnson Foundation Clinical Scholars almnus David Satcher, MD, PhD, said recently at forum on unmet oral health needs, but there are concerns that the current dental workforce will not be able to meet the increase in demand. Satcher spoke at “Unmet Oral Health Needs, Underserved Populations, and New Workforce Models: An Urgent Dialogue,” a July 17 forum sponsored by the Morehouse School of Medicine and the Sullivan Alliance.

“We now have an opportunity to dramatically increase coverage,” he said. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.” More than five million additional children will be entitled to dental health benefits under the Affordable Care Act, according to a news release from the Morehouse School of Medicine.

“I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health care services,” Satcher said.  He was referring to mid-level dental providers, known as dental therapists.

Though improvements have been made in the 12 years since then-Surgeon General Satcher issued a report offering a framework for improving access to oral health, problems persist. Tooth decay is still common among children, he said, and many people do not have easy access to oral health providers.

Read the press release from the Morehouse School of Medicine.

Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.

The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”

He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.

Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.

A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.

By David Krol, MD, MPH, FAAP, Robert Wood Johnson Foundation Human Capital Portfolio Team Director and Senior Program Officer

For many Americans, a visit to the dentist is a rarity—not by choice, but because their health plans don’t cover dental care, they can’t afford it, or because there is no dentist anywhere near where they live or work. If you’re on Medicare, you know that dental isn’t covered. If you’re part of the VA system, you know that dental benefits are treated differently. If you’re an adult on Medicaid or serve adult patients who are on Medicaid, you know the chances are slim that there’s great coverage for dental care, unless you are lucky to be in a state that still covers it. Why does this happen and what can result?

A study recently released by the Pew Center on the States offers startling data on the scope of the problem and its consequences. In 2009, some 830,000 Americans visited an emergency department for a preventable dental condition. It should be obvious that the emergency department isn’t the best place to seek dental care. The same year, 56 percent of Medicaid-enrolled children got no dental care whatsoever, not even a routine exam. That’s no care even with insurance for it!

Those numbers are alarming for many reasons, but mostly because they reveal a significant public health challenge confronting the nation: Many Americans simply aren’t getting the oral care they need, at any age, including the basic preventive services and education that can detect oral disease in early stages. They are putting their health at risk, and increasing the strain on an already-overwhelmed health care system.

Around the country, the news media is covering the groundbreaking work of Robert Wood Johnson Foundation scholars, fellows and grantees. Here are some examples.

“Louisville [Kentucky] is going high-tech to try to figure out what’s behind the city’s problem with asthma,” the Courier-Journal reports. The city will use technology developed by Robert Wood Johnson Foundation (RWJF) Health & Society Scholars alumnus David Van Sickle, PhD, MA, that uses global-positioning technology to capture where and when asthma patients use their inhalers. Read a Human Capital Blog Q&A with Van Sickle on his work and upcoming projects.

Lisa Berkman, PhD, a Health & Society Scholars program site director at Harvard University, spoke to U.S. News & World Report about “Why Good Friends Make You Happy.”

Lucy Marion, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and dean of Georgia Health Sciences University (GHSU) College of Nursing, was recently interviewed by the Augusta Chronicle for two separate articles. She discussed the merger of the nursing programs at GHSU and Augusta State University, and the work of the Greater Augusta Healthcare Network, which she helped found.

"Just about everyone now has heard of someone they know who's done something online that they wish they hadn't done,” RWJF Clinical Scholars alumnus Ryan Greysen, MD, MA, told Health Day. Greysen is the lead author of a study that examined the pervasiveness of physician misconduct online and the repercussions of those actions. “I think the message is that medical professionals are responsible for what they put online—not only responsible for the information, but accountable,” he said.

The Pine Journal (Cloquet, Minn.) spoke to Executive Nurse Fellow Julie Myhre, MS, BA, RN, PHN, about a local initiative to provide reduced-cost dental services for underserved children. Myhre, who is part of the Northeast Minnesota Oral Health Project, said the lack of adequate dental care for children has reached an “epidemic level.”

February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.

Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?

John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.

HCB: Tell us about the school-based programs you put in place.

Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.

We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.

HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.

Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.

The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.

Here’s a sampling of recent news coverage of the work of Robert Wood Johnson Foundation Scholars and Fellows:

“As a physician, I have seen the tremendous capabilities of nurses—capabilities that are essential to meeting patient needs,” Robert Wood Johnson Foundation (RWJF) President and CEO Risa Lavizzo-Mourey, MD, MBA, writes in Medscape [free subscription]. “But to ensure that they maximize their contributions to health and health care, nurses will need advanced skills and expertise in care management, interdisciplinary teamwork, problem solving, and more. This makes higher levels of education imperative. In addition, having a larger pool of highly educated nurses will be necessary to expand the ranks of nurse faculty, addressing the shortfall that now causes nursing schools to turn away thousands of qualified applicants each year. These advanced degree nurses are also needed to help ameliorate the worsening primary care shortage.”

RWJF Clinical Scholars program alumna Raina Merchant, MD, MSHP, continues to receive media coverage for her work to map Philadelphia’s automated external defibrillators (AEDs) through the MyHeartMap Challenge. The Philadelphia CBS bureau and the Daily Pennsylvanian are among the outlets to report on the project. Read a post Merchant wrote for the RWJF Human Capital Blog about the MyHeartMap Challenge.

RWJF Executive Nurse Fellows alumna Alexia Green, RN, PhD, FAAN, spoke to Nurse.com about how the Texas Action Coalition—which she co-leads—is working to advance the recommendations of the Institute of Medicine’s Future of Nursing report. Learn more about the Action Coalitions across the country, and watch a series of videos highlighting their goals and ongoing work.

Patient outcomes are better at hospitals with higher proportions of registered nurses, RWJF Nurse Faculty Scholar Matthew McHugh, PhD, JD, MPH, RN, CRNP, told the Philadelphia Inquirer, and hospitals should “foster a culture that encourages employees to get more training, have good communication among nurses, physicians and managers, have enough people to do the work, and provide nurses with the tools they need.”