The above links will take you to the Center for the Health Professions site.

Revising Dental Health Professional Shortage Area Methodology

A Dental Health Professional Shortage Area (DHPSA) is a federal designation that may be applied for by communities which suspect they have a shortage of dental professionals. DHPSA designation is a prerequisite for participating in a variety of state and federal funding programs designed to increase access to services, in particular National Health Service Corps placements. These programs represent the federal government’s primary attempt to address the distribution, and to a lesser extent, the diversity, of dental health professionals.

Instituted in their current form in 1978, the DHPSA designation criteria have been criticized since their inception principally because they are based upon dentist to population ratios. These ratios, it has been argued, are unable to account for the significant distinctions between the oral health needs of different areas/populations. They are also seen as insensitive to access barriers outside of physical proximity to a dentist.

Current criteria therefore have limited diagnostic potential when applied to areas – such as cities – where underservice to the poor and/or to minority populations is characterized not simply by a lack of dentists, but rather by financial and attitudinal barriers to accessing those resources. Given these and other deficiencies, it is unclear whether current DHPSA designation criteria can appropriately target communities in need of federal and state aid.

In response to similar criticisms, Primary Care Health Professional Shortage Area criteria were updated in 1978 and are on the verge of second revision, in order assure the inclusion of indicators that speak directly to issues of need. The designation criteria for Dental Health Professional Shortage Areas, however, have remained essentially unchanged since the 1965 legislation in which they were introduced. This is true despite the 1976 addition of section 332 to the Public Health Service Act requiring health professional shortage criteria to “include indicators of need such as infant mortality, access to health services, and health status.”

This pilot project will lay the theoretical groundwork for the process of revising the designation methodology and explore what data are available to operationalize the model.

Project Scope:

The pilot project will entail the following activities:

• A review of the literature on shortage designations and indicators of workforce shortages.
• A review of existing methods and explore weaknesses of current system
• Identification key indicators of shortage areas, including provider presence, community characteristics, and health indicators.
• Consultation with national advisors and experts as well as community representatives to elicit their input on important factors for developing a new methodology
• Identification of what information is desired, and what is nationally available
• Propose other data collection methods if necessary
• Revise “ideal” model with existing information

The final product will be a concept paper on the factors to consider when developing a new methodology. This will include a discussion of which variables should be included vs. which variables are actually available. The ultimate goal of the project is to assist in the development of more comprehensive designation criteria, sensitive to unmet need resulting from a variety of physical, financial, and attitudinal barriers.

Project Staff:
Kevin Grumbach, MD, Principal Investigator
Beth Mertz, MA, Project Director
Joshua Orlans, Research Associate

Funding:
National Center for Health Workforce Information and Analysis, Bureau of the Health Professions, Health Resources and Services Administration (Grant # 1 U79 HP 00004-010) and National Institute of Dental and Craniofacial Research, National Institutes of Health (Grant # NIH U54 DE 142501).