434
WISCONSIN DENTIST
WORKFORCE REPORT
2001
Written by:
Gayle R. Byck
Hollis Russinof
Judith A. Cooksey
June 2002
Table of Contents
Executive Summary
-3-
Background
-5-
Methods
-7-
Findings
1. Characteristics of Wisconsin Dentists
2. Supply and Distribution of Dentists
3. Race and Ethnicity of Wisconsin Primary Care Dentists
4. Dental School Attended
5. Dentist Participation in Medicaid
6. Volunteer and Charity Care
7. Retirement Plans
-9-10-12-16-18-20-26-28-
Analysis – Projected Dentist Capacity Required to Serve Medicaid Enrollees -30Discussion
-33-
Appendices
-37-
Appendix A – Dental Advisory Committee
Appendix B – Survey Methodology and Instrument
Appendix C – Counties by Wisconsin Region
Appendix D – Counties by Rural/Urban Status
Appendix E – Data Tables
This report was written by Gayle R. Byck, PhD, Hollis J. Russinof, MUPP and
Judith A. Cooksey, MD, MPH at the University of Illinois at Chicago, Illinois
Regional Health Workforce Center.
Funding for this study was provided by the Wisconsin Primary Health Care
Association in collaboration with the Health Resources and Services
Administration, Bureau of Health Professions and Bureau of Primary Health Care.
Executive Summary
In early 2001, the State of Wisconsin conducted a survey of licensed dentists to learn more about
their dental workforce. This survey was required by state statute. The Wisconsin Primary Health
Care Association contracted with the Illinois Regional Health Workforce Center to analyze and
assess the survey data in terms of the supply, distribution, and characteristics of Wisconsin
dentists as well as their participation in Medicaid, volunteer work, and retirement plans. Major
findings are presented below.
Characteristics of Wisconsin Dentists
Ninety-four percent of licensed dentists responded to the survey. Of those, 66% (2,842) reported
that they were currently practicing in Wisconsin. The majority of dentists practicing in
Wisconsin were:
• in general practice (81%),
• white (95%),
• graduates of an in-state dental school (67%),
• in practice more than 20 years (57%),
• solo practitioners (53%).
Supply and Distribution of Dentists
• Statewide, there were 53 dentists per population, or 1,887 people per dentist.
• The Southern and Western regions and the rural categories had the lowest dentist supply.
• There was a great deal of variation in dentist supply by county.
• The most common specialists were orthodontists (5%) and oral surgeons (4%).
• Rural areas had proportionately fewer specialists than metropolitan areas.
• Only 17 counties had a pediatric dentist.
• Pediatric dentists were concentrated in the metropolitan areas and in the Southeastern region.
• Primary care dentist supply varied by region and urban/rural status based on dental school
attended, with most dentists in the Southeastern region and the metro-central category being
in-state graduates.
Race and Ethnicity of Wisconsin Primary Care Dentists
• There were proportionately fewer non-white primary care dentists than minorities in the state
population, except for Asian/Pacific Islanders.
• Proportionately fewer non-white than white dentists attended an in-state dental school and
more attended a dental school in other states.
• Non-white dentists had been in practice fewer years than white dentists.
Dental School Attended by Wisconsin Dentists
• 70% of primary care dentists attended an in-state dental school.
• Half of in-state graduates practiced in the Southeastern region (which includes Milwaukee),
and over 70% practiced in metropolitan areas.
• Graduates from border state dental schools were more evenly distributed by region and were
most likely to practice in rural areas.
• The proportion of graduates who were non-white was much higher from other states than
from in-state or border state dental schools.
• Dentists who attended an in-state dental school had been in practice longer than dentists from
out-of-state dental schools.
3
Dentist Participation in Medicaid
• While 93% of dentists accepted new patients in their practice, only 1 in 5 (20%) dentists
reported accepting new Medicaid patients.
• 42% of dentists reported treating Medicaid patients.
• Dentists in the two rural categories had the highest rates of Medicaid participation (53% and
60%).
• Medicaid participation was lowest in the Southeastern region (30%).
• Medicaid participation varied by: specialty (higher for pediatric dentists), dental school
attended (lowest for in-state), and race/ethnicity (higher for non-white); it did not vary based
on years in practice.
• 15 counties had no primary care dentists willing to accept new Medicaid patients.
Volunteer and Charity Care
• 58% of all dentists provided some form of volunteer or charity care.
• Almost half of all dentists provided some pro bono (free) care.
• Few dentists volunteered at a clinic serving uninsured or underinsured patients or participated
in the WDA/State Donated Dental Services Program.
Retirement Plans
• Almost 1 in 7 (433) dentists planned to retire or leave practice in the next 5 years.
• About 1 of 3 (996) planned to retire or leave practice in the next 10 years.
• An even higher percentage of prosthodontists, periodontists, and oral surgeons planned to
retire or leave practice in the next 10 years.
• In the next 5 and 10 years, 46% and 74% of dentists, respectively, with more than 30 years of
experience planned to retire or leave practice.
• 14% and 35% of dentists who participated in Medicaid planned to retire or leave practice in
the next 5 and 10 years, respectively.
Conclusions. There are a number of findings that should be addressed by dentists, policy makers
and planners in Wisconsin. Dentist supply was low in certain regions of the state, specifically the
rural areas and the Southern and Western regions. The majority of dentists graduated from an instate dental school and these dentists tended to be concentrated in the Southeastern region, were
less racially diverse, and had lower rates of Medicaid participation. Dentists who attended dental
school in Minnesota, Illinois, or Iowa were more geographically dispersed throughout the state.
With a growing Medicaid enrollment and few dentists reporting a willingness to accept new
Medicaid patients, access to dental care for Medicaid patients is of concern. An analysis of
dentist capacity needed to serve the Medicaid population shows that dentist participation in
Medicaid will need to increase dramatically in order for large percentages of Medicaid enrollees
to receive dental care. Finally, the large number of dentists planning to retire or leave practice in
the next 5 and 10 years requires further study and attention.
4
Background
A Wisconsin statute required a survey of all Wisconsin dentists in 2001. The Wisconsin Primary
Health Care Association (WPHCA) contracted with the University of Illinois at Chicago Illinois
Regional Health Workforce Center (IRHWC) to examine the primary care dental workforce in
Wisconsin. One reason for the survey was to better understand the supply and distribution of
dentists, as well as to examine issues related to access to care. This assessment can assist
policymakers and oral health professionals in their discussions about both workforce planning
and improving access to dental care for underserved popula tions.
This report provides the following information:
1. The characteristics of dentists currently practicing in Wisconsin in 2001.
2. The supply and distribution of primary care (general and pediatric) dentists in the state.
3. The extent to which primary care dentists reflected the racial and ethnic diversity of the
state population and the impact of in-state and border state dental schools on the
racial/ethnic diversity of the primary care dental workforce.
4. The impact of location of dental school attended on the overall number and statewide
distribution of primary care dentists in the State and participation in Medicaid or volunteer
activities and provision of charity care.
5. The characteristics of dentists who did and did not bill for Medicaid services
6. The characteristics of dentists who did and did not participate in volunteer activities or
provide charity care.
7. Projected short-term changes in dentist supply based on reported plans to reduce workload
or retire within the next year or five years.
8. Projected dentist capacity required to serve Medicaid enrollees.
Preliminary findings were presented to a group of stakeholders in March 2002 in Madison,
Wisconsin for comment and review. A list of these stakeholders can be found in Appendix A.
5
6
Methods
Data Sources
2001 Dentist Workforce Survey. The primary data source for this study was the 2001 Dentist
Workforce Survey, 1 which was developed and administered by the Wisconsin Bureau of Health
Information (BHI). The survey, required by state statute, was mailed in spring 2001 to all 4,563
dentists licensed in Wisconsin as of November 7, 2000. Appendix B contains the questionnaire
and a description of BHI's methodology.
Census data. Data from the 2000 census were used to provide population figures for each of the
counties. These data were publicly available via the Internet. 2
Wisconsin Medicaid data. The State of Wisconsin's web site provides monthly enrollment data
on the number of Medicaid, BadgerCare, and Medical Assistance enrollees by county. 3 These
numbers were used for participating dentist-per-Medicaid-population ratios.
Variables and Definitions
Wisconsin regions. Much of the data in this report are presented for the entire state and/or by the
following five regions, defined by the BHI as: Northeastern, Northern, Southeastern, Southern,
and Western. A map and a list of counties in each region are provided in Appendix C.
Urban/rural status. The Wisconsin counties were categorized as:
• Central metropolitan (“metro-central”; 3 counties, all in the Milwaukee area, which is where
the state’s dental school is located).
• Other metropolitan (“metro-other”; 17 counties, which include cities such as Madison, Green
Bay, La Crosse, Racine, Eau Claire, Sheboygan, Oshkosh, and Appleton).
• Rural counties adjacent to metropolitan counties (“rural-adjacent”; 26 counties, scattered
throughout the state).
• Rural counties nonadjacent to metropolitan counties (“rural- nonadjacent”; 26 counties, 14 of
which are in the northern part of the state, the remaining are scattered throughout).
A map showing the urban/rural categories and a list of the counties in each category are provided
in Appendix D.
These urban/rural classifications were based on the 1993 rural- urban continuum codes (RUCC).4
The RUCC classify metropolitan counties based on size. Non- metropolitan counties were
grouped according to degree of urbanization and proximity to metropolitan areas. The RUCC
includes 10 urban-rural categories (4 metropolitan and 6 non-metropolitan). We combined these
categories to form the four major categories described above.
1
2001 Dentist Workforce Survey, [Electronic Data File]. (September 2001). Bureau of Health Information, Division
of Health Care Financing, Wisconsin Department of Health and Family Services.
2
GCT-P5. Age and Sex: 2000. Data Set: Census 2000 Summary File 1 (SF 1) 100-Percent Data. Geographic Area:
Wisconsin -- County Source: U.S. Census Bureau, Census 2000 Summary File 1, Matrices PCT12 and P13.
http://factfinder.census.gov
3
Wisconsin Department of Health & Family Services. See http://www.dhfs.state.wi.us/Medicaid1/caseload/481caseload.htm
4
Economic Research Service, U.S. Department of Agriculture. (2000). Measuring rurality: rural-urban continuum
codes. http://www.ers.usda.gov/briefing/rurality/RuralUrbCon/
7
Years in Practice. The survey did not ask the dentist to provide his/her age. However, it did ask
for the year that the dentist received his/her dental degree. Therefore, as a proxy for age, years in
practice is discussed. (Note that this variable had a large number, 876, of non-responses.)
Race/Ethnicity. There were 5 race/ethnicity categories on the survey: American Indian/Alaskan
Native, Asian/Pacific Islander, Black, Hispanic, and White. For all analyses using race/ethnicity,
we combined the first four categories as "non-white" and the latter category remained "white".
Hours worked. Dentists were asked to indicate the number of hours per week that they spent at
each practice location.
Dental school attended. The survey questionnaire listed 21 dental schools and provided space
for the respondent to fill in a school not listed. These schools were organized by state into three
categories:
• In-state (the only dental school in Wisconsin is located at Marquette University in
Milwaukee).
• Border or neighboring states - Minnesota, Illinois, and Iowa (University of Minnesota in
Minneapolis, University of Iowa in Iowa City, University of Illinois at Chicago and Southern
Illinois University in Edwardsville, as well as other schools in these states that are now
closed).
• Other states – This category included all other states. While Michigan also borders
Wisconsin, there were very few dentists practicing in Wisconsin who graduated from a
Michigan dental school.
Medicaid participation. Dentists were asked two questions regarding Medicaid participation:
(1) Do you serve Wisconsin Medical Assistance (MA, Medicaid) or BadgerCare patients? and
(2) Do you accept new Wisconsin Medical Assistance (MA, Medicaid) or BadgerCare patients?
Respondents were also asked to estimate the number of Medicaid Assistance and BadgerCare
patients treated in year 2000; however, BHI did not publicly release these data because the data
were found to be inconsistent with actual figures obtained from the Medicaid program. 5
5
Wisconsin Bureau of Health Information. Public Use Data File Documentation. 2001 Dentist Workforce Survey.
8
Findings
The 2001 Wisconsin Dental Workforce Survey had a 94% response rate (4,301 of the 4,563
licensed dentists). Of the 4,301 respondents, 2,842 dentists (66%) indicated that they were
currently practicing in Wisconsin, while 1,459 were not currently practicing in Wisconsin. Of
those who were not currently practicing in Wisconsin, 84% did not indicate their status (e.g.,
practicing outside of Wisconsin, retired, etc.). The American Dental Association reports 2,890
professionally active dentists in Wisconsin in 1998. 6
The remainder of this analysis describes the 2,842 dentists practicing in Wisconsin.
The following pages provide detailed findings on:
1. Characteristics of Wisconsin dentists,
2. Supply and distribution of Wisconsin dentists,
3. Race and ethnicity of Wisconsin primary care dentists,
4. Dental school attended,
5. Dentist participation in Medicaid,
6. Volunteer and charity care,
7. Retirement plans, and
8. Projected dentist capacity required to treat Medicaid enrollees.
6
American Dental Association, Survey Center, 1998. Distribution of Dentists in the United States by Region and
State. Chicago, Illinois. January 2000.
9
1. Findings: Characteristics of Wisconsin Dentists
•
Almost 84% of the respondents who listed a specialty were primary care dentists - either
general practice dentists (2,272; 81%) or pediatric dentists (71; 2.5%). Thirty-one
respondents did not list a specialty (Appendix E, Table E1).
•
There were 461 dental specialists with the largest numbers being in orthodontics (152) and
oral surgery (122); regardless of region or urban/rural status, oral surgeons and orthodontists
were the most common specialists (Appendix E, Tables E1 and E2).
•
There was minimal variation by region in the proportion of dentists who were general
practitioners. However, rural areas had proportionately more general practitioners and fewer
specialists (Appendix E, Table E2. See also Tables E3 and E4 for characteristics of dentists
by region and urban/rural status).
•
Over 95% of Wisconsin dentists were white, 3% were Asian-American, 1 % were Hispanic,
0.5% were Black, and 0.2% were American Indian/Alaskan Native. The proportions were
similar for all dentists and for primary care dentists only.
•
In their primary practice, more than half (57%) of all Wisconsin dentists were individual
proprietors, 39% were in group practice, and less than 2% worked for the government (Table
1). Primary care dentists were more likely to be solo practitioners (60%) than dentists in
other specialties (42%).
•
Two-thirds of Wisconsin dentists attended an in-state dental school. Almost one-fourth
attended a dental school in MN, IL, or IA (Figure 1). Looking just at primary care dentists:
70% attended an in-state dental school; 23% attended a school in MN, IL, or IA; and 7%
attended an out-of-state school not in MN, IL, or IA.
•
Over half (57%) of Wisconsin dentists had been in practice more than 20 years (Figure 2).
The proportions were similar for primary care dentists.
•
The median number of hours worked in the primary practice was the same for all dentists and
for primary care dentists – 35 hours. Median hours worked was 35 or 36 hours per week
regardless of region, urban/rural status, dental school attended, race/ethnicity, solo or group
practice, accepting new patients, or participating in Medicaid. Dentists who had been in
practice more than 30 years had a slightly lower median number of hours worked – 32 hours.
Twenty-eight percent of dentists reported working fewer than 32 hours per week and 7%
reported working more than 42 hours per week.
10
Findings: Characteristics of Wisconsin Dentists
Table 1. Practice Setting of Dentists
Practice Setting*
All Dentists
Primary Care Only
Other Specialties
(%)
(%)
(%)
Individual proprietor
57
60
42
Group practice
39
37
49
Employed
17
16
20
Partner
13
12
16
Shareholder
10
9
14
Government
2
1
3
Other
3
2
5
* 532 respondents did not answer the question, 439 of which were primary care dentists.
Figure 1. Location of Dental School
Attended, All Dentists
Figure 2. Years in Practice,
All Dentists
>30 yrs.
(20%)
Other
(9%)
MN/IL/IA
(24%)
In-state
(67%)
21-30 yrs.
(37%)
<10 yrs.
(13%)
10-20 yrs.
(30%)
11
2. Findings: Supply and Distribution of Wisconsin Dentists
•
For all dentists, the statewide ratio of dentists per 100,000 population was 53 (Table 2). For
comparison, the ADA reported 55 professionally active dentists per 100,000 people in
Wisconsin in 1998, 7 and the national ratio was 59 in 1999. 8 We can also reverse this ratio to
discuss the population per dentist. The statewide ratio for all residents was 1,887 persons to
one dentist.
o
By region, the Southern and Western regions had the lowest dentists per population ratio
- 45 and 46 dentists, respectively. In contrast, the Southeastern region had the highest
ratio at 58 dentists (Table 2).
o
Differences were also apparent by urban/rural status, with a ratio of dentists per
population of 64 in the metro-central category compared to ratios of 42 and 41 dentists in
the two rural categories (Table 3).
•
Similar distribution gaps were found among primary care dentists. Statewide, the ratio of
primary care dentists per 100,000 population was 44. The distribution of primary care
dentists by region and urban/rural status was similar to all dentists.
•
Primary care dentist supply varied by region and urban/rural status based on dental school
attended:
o
Region: Most (86%) dentists in the Southeastern were graduates from the in-state dental
school. Only the Western region had a greater proportion of out-of-state graduates than
in-state graduates (Figure 3).
o
Urban/Rural Status: About 9 out of 10 dentists in the metro-central category graduated
from the in-state dental school, compared to about 6 of 10 dentists in the metro-other,
rural-adjacent, and rural- nonadjacent categories (Figure 4).
7
American Dental Association, Survey Center, 1998. Distribution of Dentists in the United States by Region and
State. Chicago, Illinois. January 2000.
8
American Dental Association, Health Policy Resource Center, 2001. Future of Dentistry. Chicago, Illinois.
12
Findings: Supply and Distribution of Wisconsin Dentists
Table 2. Dentist Supply by Region
Wisconsin Northeastern
Total population
5,363,675
1,160,186
All dentists
2,842
606
Dentists per
53
52
100,000 population
Population per dentist
1,887
1,914
Primary care dentists
2,343
504
Dentist per
100,000 population
44
43
Population per dentist
2,289
2,302
Northern Southeastern Southern
482,311
2,006,929
972,710
255
1,171
433
53
58
45
Western
741,539
341
46
1,891
216
1,714
954
2,246
351
2,175
283
45
2,233
48
2,104
36
2,771
38
2,620
Table 3. Dentist Supply by Urban/Rural Status
Total population
All dentists
Dentists per
100,000 population
Population per dentist
Primary care dentists
Dentist per
100,000 population
Population per dentist
Wisconsin
5,363,675
2842
53
Metro-central Metro-other Rural-adjacent
1,383,248
2,257,060
1,230,485
885
1204
514
64
53
42
1,887
2,343
1,563
722
1,875
961
2,394
446
2,428
179
44
2,289
52
1,916
43
2,349
36
2,759
36
2,754
Figure 3. Region Practicing by Dental School
Attended
Figure 4. Urban/Rural Status by Dental
School Attended
80%
60%
60%
40%
40%
20%
20%
0%
0%
Metro-central
W
est
ern
So
uth
ern
80%
So
uth
eas
ter
n
100%
No
rth
ern
100%
No
rth
ea
ste
rn
Ruralnonadjacent
492,882
203
41
Metro-other
Rural-adjacent
Ruralnonadjacent
Legend
In-state
MN/IL/IA
Other State
13
Findings: Supply and Distribution of Wisconsin Dentists (continued)
•
There was a great deal of variation by county in terms of total dentists and dentist per
100,000 population. All counties had at least one dentist.
•
Among the three smallest counties:
o
Menominee county had 3 dentists (2 in general practice) and 4,562 people (46 dentists
/100,000 population)
o Iron county had 2 dentists (both in general practice) and 6,861 people (29/100,000)
o Florence county had 1 general practice dentist and 5,088 people (20/100,000)
•
Among the three largest counties:
o
Milwaukee county had 563 dentists (461 in primary care) and 940,164 people
(60/100,000)
o
Dane county had 229 dentists (179 in primary care) and 426,526 people (54/100,000)
o
Waukesha county had 260 dentists (213 in primary care) and 360,767 people
(72/100,000)
•
Figure 5 shows the number of primary care dentists in each county adjusted to the
population.
•
Only 17 counties had a pediatric dentist. Figure 6 shows counties in Wisconsin that had at
least one pediatric dentist. Pediatric dentists were concentrated in the Southeastern region (36
pediatric dentists) along with a few counties in the middle of the state. Pediatric dentists also
tended to practice in metropolitan areas. There were 13 metropolitan and 4 rural (all ruraladjacent, 5 pediatric dentists total) counties with at least one pediatric dentist.
14
Findings: Supply and Distribution of Wisconsin Dentists
15
3. Findings: Race and Ethnicity of Wisconsin Primary Care Dentists9
•
The population of Wisconsin was predominantly white (90%) with relatively small numbers
of racial/ethnic minorities. The percentage of the primary care dentist workforce that was
white was higher than the general population (95%). Other than Asian-Americans, nonwhites were underrepresented among primary care dentists (Table 4).
•
Characteristics of non-white dentists included:
9
o
Proportionately more practiced in the Southeastern region, while few practiced in the
Northern and Western regions, as well as in rural areas (Appendix E, Table E5).
o
A larger proportion (27%) attended an out-of-state dental school in a non-neighboring
state than white dentists (7%) (Figure 7).
o
They were in practice fewer years than white dentists. About 12% of white dentists had
been in practice fewer than 10 years and 22% had 30 or more years of experience,
compared to 42% and 11% of non-white dentists, respectively (Figure 8).
There were no racial/ethnic data for 606 primary care dentists.
16
Findings: Race and Ethnicity of Wisconsin Primary Care Dentists
Table 4. Wisconsin Population and Primary Care Dental Workforce by Race/Ethnicity
Race/Ethnicity
White
Black
Asian/Pacific Islander
Am. Indian/Al. Native
Other
Hispanic
State Population
(%)
90
6
2
1
2
Primary Care Dentists
(%)
95
0.6
2
0.3
--
4
1
*Data were missing for 606 dentists. State population data are from the U.S. Census
Bureau, 2000 Census. Hispanic was a separate category from race in the census, but not
in the WI dental workforce survey.
Figure 7. Race/Ethnicity by Dental School
Attended
Figure 8. Race/Ethnicity by Years in
Practice
100%
100%
80%
80%
>10 years
In-state
60%
MN/IL/IA
40%
Other
60%
10-20 years
21-30 years
40%
>30 years
20%
20%
0%
0%
White
Non-white
White
Non-white
17
4. Findings: Dental School Attended
•
67% of all dentists attended an in-state dental school, 24% attended a dental school in a
border state, and 9% attended a dental school in another state (see Appendix E, Table E6).
o
Specialty: A greater proportion (85%) of in-state graduates were general practitioners
than out-of-state graduates (border states 77%, other states 60%). The highest proportion
of specialists by dental school attended was from dental schools in other states (5%
pediatric dentists, 35% other specialists) (Figure 9).
The findings below apply to primary care dentists only (see Appendix E, Table E7).
• Region: Half of in-state dental school graduates practiced in the Southeastern region
(which includes Milwaukee). Graduates from dental schools in MN, IL, and IA were
more evenly distributed by region than graduates from in-state or other state dental
schools (Figure 10).
• Of graduates from the border state dental schools (Appendix E, Figures E1 and E2):
o
Almost half (46%) of Wisconsin dentists from a Minnesota dental school
practiced in the Western region.
o
Wisconsin dentists from an Iowa dental school primarily practiced in the Southern
(39%) and Northeastern (25%) regions.
o
Illinois graduates who practiced in Wisconsin were located throughout the state.
• Urban/rural status : Graduates from MN, IL, and IA schools were more likely to
practice in rural areas than graduates from in-state or other state dental schools. Most instate graduates (75%) practiced in metropolitan areas (Figure 11).
• Race/ethnicity: The proportion of graduates from other states (16%) who were nonwhite was considerably higher than from border state (5%) and in-state (3%) dental
schools (Figure 12).
• Years in Practice: Dentists from out-of-state dental schools had been in practice fewer
years than dentists from the in-state dental school. Almost one- fourth of in-state
graduates had been in practice more than 30 years (Figure 13).
18
Findings: Dental School Attended
Figure 9. Specialty by Dental School Attended
Figure 10. Region Practicing by Dental School
Attended
100%
100%
80%
General
80%
60%
Pediatric
60%
40%
Other
Specialists
40%
20%
Northeastern
Northern
Southeastern
Southern
Western
20%
0%
0%
In-state
MN/IL/IA Other states
In-state
Figure 11. Urban/Rural Status by Dental School
Attended
MN/IL/IA Other states
Figure 12. Race/Ethnicity by Dental School
Attended
100%
100%
Metro-central
80%
80%
60%
Metro-other
40%
Rural-adjacent
40%
20%
Ruralnonadjacent
20%
0%
White
60%
Non-white
0%
In-state
MN/IL/IA
Other states
In-state
MN/IL/IA
Other states
Figure 13. Years in Practice by Dental School
Attended
100%
80%
<10 years
60%
10-20 years
40%
21-30 years
>30 years
20%
0%
In-state
MN/IL/IA
Other states
19
5. Findings: Dentist Participation in Medicaid
The State of Wisconsin provides dental services to enrollees in Medicaid, BadgerCare, and
Medical Assistance programs (referred to from now on as "Medicaid"). Enrollment in these
programs has been steadily increasing from 493,821 in January 2001, to 507,595 in July 2001, to
554,262 in January 2002. 10 Table 5 shows the distribution of Medicaid enrollees by region and
urban/rural status for July 2001. Almost half of enrollees (46%) were in the Southeastern region
and 69% were in the metro categories. The Northeastern and Western regions had the lowest
proportion of their population enrolled in Medicaid, as did the metro-other and rural-adjacent
categories.
•
Although an overwhelming majority (94%) of dentists accepted any new patients (although
this proportion was lower in rural areas), their willingness to participate in Medicaid was
much lower:
o
When asked about their participation in Medicaid, 42% (1,143) of all dentists reported
treating Medicaid patients (Figure 14). In comparison to these self- reported data,
Medicaid claims show that 1,421 dentists submitted claims for dental services in FY
2000.11
o
Only 20% (539) of dentists reported accepting new Medicaid patients (Figure 15).
o
Pediatric dentists were significantly more likely to report treating Medicaid patients
(73%), and accepting new Medicaid patients (64%), than both general practitioners (41%,
16%) and other specialists (39%, 34%). Other specialists were significantly more likely
than general practitioners to accept new Medicaid patients (Figure 16).
10
Wisconsin Department of Health & Family Services. See http://www.dhfs.state.wi.us/Medicaid1/caseload/481caseload.htm
11
Wisconsin Department of Health and Family Services. (August 2000). Wisconsin Medicaid Dental Facts FY
2000.
20
Findings: Dentist Participation in Medicaid
Table 5. Medicaid Enrollees by Region and Urban/Rural Status, July 2001
Category
Medicaid
% of state
% of population
Enrollees
enrollees
enrolled
Region
Northeastern
77,867
15
7
Northern
48,960
10
10
Southeastern
235,480
46
12
Southern
71,051
14
7
Western
71,390
14
10
Tribes
2,847
1
-TOTAL
507,595
100
9
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
Tribes
TOTAL
188,326
163,794
95,054
57,574
2,847
507,595
37
32
19
11
1
100
14
7
8
12
-9
Figure 15. Percentage of Wisconsin
Dentists Who Reported Accepting New
Medicaid Patients
Figure 14. Percentage of Wisconsin
Dentists Who Reported Treating
Medicaid Patients
Treats
42%
Does Not
Treat
58%
Does Not
Accept
New
80%
Accepts
New
20%
Figure 16. Medicaid Participation by
Specialty
100%
80%
60%
Treats
40%
Accepts New
20%
0%
General
Practice
Pediatric
Dentistry
Other
Specialty
21
Findings: Dentist Participation in Medicaid (continued)
•
Among primary care dentists, there were differences in Medicaid participation based on
dentist and practice characteristics (also see Appendix E, Table E8):
o
Region: The Medicaid participation rate was highest in the Western region (60%). The
Southeastern region had the lowest proportion (30%, 165 dentists) of dentists treating
Medicaid patients, but the highest total number of participating dentists (280). In terms
of accepting new Medicaid patients, the highest proportions were in the Northern (23%,
108 dentists) and Southern (21%, 164 dentists) regions (Figure 17).
o
Urban/Rural Status: A higher proportion of dentists in rural areas (53% in ruraladjacent, 235 dentists, and 60% in rural- nonadjacent, 105 dentists) reported treating
Medicaid patients compared to dentists in metropolitan areas (45% in metro-other, 424
dentists, and 26% in metro-central, 182 dentists). The two rural categories also had
proportionately more dentists accepting new Medicaid patients than the metropolitan
categories, although the differences were smaller (Figure 18).
o
Dental school attended: Primary care dentists who attended an out-of-state dental
school, particularly in MN/IL/IA, were more likely to treat Medicaid patients than
dentists who attended an in-state school. Dentists who attended an out-of-state dental
school were also more likely to accept new Medicaid patients than dentists who attended
an in-state school (Figure 19). Even when examining participation of graduates by the
region in which they are practicing, in-state graduates in the Southeastern region had the
lowest participation of in-state graduates practicing in any region (Appendix E, Figure
E3).
o
Race/ethnicity: Non-white primary care dentists were significantly more likely than
white dentists to treat Medicaid patients (53% vs. 42%) and accept new Medicaid patients
(37% vs. 17%) (Figure 20).
o
Practice Setting: Private practice dentists who were individual proprietors or in group
practice had similar Medicaid participation, which was lower than dentists in other types
of practice (e.g., government) (Figure 21).
22
Findings: Dentist Participation in Medicaid
Figure 17. Medicaid Participation by Region
Legend:
100%
Treats Medicaid Patients
80%
Accepts New Medicaid Patients
60%
40%
20%
W
est
ern
So
uth
ern
So
uth
eas
ter
n
Figure 19. Medicaid Participation by Dental
School Attended
Figure 18. Medicaid Participation by
Urban/Rural Status
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
No
rth
ern
No
rth
eas
ter
n
0%
0%
Metrocentral
Metro-other
Ruraladjacent
Ruralnonadjacent
In-state
Figure 20. Medicaid Participation by
Race/Ethnicity
Other State
Figure 21. Medicaid Participation by Ownership
Status
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
MN/IL/IA
0%
White
Non-white
Individual
Proprietor
Group Practice
Other
23
Findings: Dentist Participation in Medicaid
•
Medicaid participation varied by county. One way to compare counties is to examine the
number of Medicaid enrollees per participating dentist:
o
The range of Medicaid enrollees per primary care dentist currently treating Medicaid
patients was 145:1 (145 Medicaid enrollees to 1 participating dentist) to 2,035:1 (Figure
22).
o
Only one county did not have a primary care dentist who reported treating Medicaid
patients.
o
The range of Medicaid enrollees per primary care dentist accepting new Medicaid
patients was 339:1 to 5,888:1 (Figure 23).
o
Fifteen counties were without a primary care dentist who accepted new Medicaid
patients; these counties had a total of 32,744 Medicaid enrollees as of July 2001.
24
Findings: Dentist Participation in Medicaid
25
6. Findings: Volunteer and Charity Care
•
When asked about whether they provided any pro bono (free) care, volunteered at a clinic
serving uninsured or underinsured patients, or participated in the Wisconsin Dental
Association Donated Dental Services Program12 (WDA/DDSP), participation among all
dentists varied: (Appendix E, Table E9). :
o 58% (1,654) provided some form of volunteer or charity care
o 48% (1,269) provided pro bono (free) care,
o 16% (436) volunteered at a clinic serving uninsured or underinsured patients,
o 21% (566) participated in the WDA/DDSP.
•
Overall, there were no consistent differences in volunteer and charity care by region and
urban/rural status (Appendix E, Table E9). Regarding volunteering at a clinic, there were
differences by specialty and years in practice:
o
Pediatric dentists were significantly more likely to report having volunteered at a clinic
serving uninsured and underinsured patients (29%) than both general practitioners (15%)
and other specialists (18%) (Figure 24).
o
Higher proportions of dentists with less than 20 years experience volunteered at a clinic
serving uninsured or underinsured patients than did dentists with more than 20 years of
experience. (Figure 25).
•
Volunteering at a clinic was likely affected by the number and location of safety net dental
clinics:
o
Only 20 Wisconsin counties had a safety net dental clinic 13 (Figure 26).
o
Sixty-one percent (1,424) of general and pediatric dentists resided in a county with a
safety net dental clinic.
o
About the same proportion (15%) of dentists reported volunteering at a clinic serving
uninsured or underinsured patients, regardless of whether their primary practice was in a
county with or without a safety net dental clinic.
12
"The Donated Dental Services(DDS) is a program directed at those people who are unable to afford needed dental
care because of a limited income which is clearly linked to a permanent disability, chronic illness or advanced age
(65 or over)." Since 1998, about 375 people have received treatment through this program. See
http://www.wda.org/Public/community/donated_services.htm
13
Children's Health Alliance of Wisconsin. Dental Care Access Programs for Uninsured and Underinsured in
Wisconsin. Updated April 2001.
26
Findings: Volunteer and Charity Care
Figure 24. Volunteer and Charity Care by
Specialty
Figure 25. Volunteer and Charity Care by
Years of Experience
100%
100%
80%
80%
60%
60%
40%
40%
20%
20%
0%
General Practice
Pediatric
Dentisty
Other Specialty
0%
<10 years 10-20 years 21-30 years >30 years
Legend
Any Volunteer Charity Care
Any Free Care
Clinic Volunteer
WDA/DDSP Participant
27
7. Findings: Retirement Plans
•
Almost 1 in 7 (433) dentists planned to retire or leave practice in the next 5 years. About 1 in
3 (996) were expected to retire/leave within the next 10 years. The ratios were similar for
primary care dentists as well. (Table 6)
•
Among dental specialists, almost half of prosthodontists (49%) and periodontists (47%) were
expected to retire/leave within the next 10 years, as were 40% of oral surgeons (Table 7).
•
There was little variation in retirement plans in the next 5 or 10 years based on region. While
plans were similar over the next 5 years for urban and rural dentists, the rural-adjacent
category was expected to lose slightly more dentists (41%) over the next 10 years than
metropolitan areas (34% for both). (Appendix E, Table E10).
•
Other notable findings included (Appendix E, Table E10):
o
Of dentists with more than 30 years experience, 46% and 74% planned to retire or leave
practice in the next 5 and 10 years, respectively.
o
A higher percentage of graduates from in-state and other state dental schools (each 37%)
were planning to retire/leave practice in the next 10 years than graduates from border
state dental schools (29%).
o
About 1 in 7 (14%) and 1 in 3 (35%) dentists who participated in Medicaid planned to
retire or leave practice in the next 5 and 10 years, respectively.
•
At the county level, 9 counties were projected to lose more than 25% of their dentists to
retirement/leaving practice (Figure 27). In the next 6-10 years, 61 counties were projected to
lose more than 25% of their dentists to retirement/leaving practice (Figure 28).
•
An estimated 56 new dentists will enter practice in Wisconsin each year between 2000 and
2010. (This number is based on a recent study by the Wisconsin Dental Association, which
also noted that Wisconsin's population is expected to increase 4.25% during this same time
period. 14 ) But significantly more dentists planned to leave Wisconsin during this same period
of time:
o
Within five years, there will be 153 fewer dentists in Wisconsin (433 dentists
retiring/leaving minus 280 new dentists).
o
Within ten years, there will be 436 fewer dentists in Wisconsin (996 dentists
retiring/leaving minus 560 new dentists).
14
Beazoglou, T, Bailit, H & Heffley, D. (2001). Analysis of Workforce, Population Needs, and Policy Options in
Wisconsin for the Next 10 Years. Wisconsin Dental Association.
28
Findings: Retirement Plans
Table 6. Retirement Plans, by Number of Dentists
Retirement Plans
All Dentists (#)
Within the next 12 months:
Retire
32
Move outside WI
52
Reduce patient hours
199
Retire/leave WI in next 2 to 5 years
349
Primary Care Only (#)
Other Specialties (#)
25
46
169
286
6
6
28
58
Total retiring or leaving Wisconsin in
next 5 years
433 (15%)
357 (15%)
70 (15%)
Retire/leave WI in next 6 to 10 years
563
451
109
Total retiring or leaving Wisconsin in
next 10 years
996 (35%)
808 (34%)
179 (39%)
2,842
2,343
461
Total dentists in practice
Table 7. Retirement Plans of Specialty Dentists, by Number of Dentists
Retirement Plans
Orthodontists
Prosthodontists Periodontists
(#)
(#)
(#)
Within the next 12 months:
Retire
0
0
1
Move outside WI
2
1
1
Reduce patient hours
4
6
4
Retire/leave WI in next 2 to 5
22
9
2
years
Total retiring or leaving
Wisconsin in next 5 years
Oral Surgeons
(#)
1
1
4
4
4
0
9
18
24 (16%)
10 (21%)
4 (8%)
6 (10%)
22 (18%)
29
13
21
15
27
53 (35%)
23 (49%)
25 (47%)
21 (36%)
49 (40%)
152
47
53
59
122
Retire/leave WI in next 6 to 10
years
Total retiring or leaving
Wisconsin in next 10 years
Endodontists
(#)
Total dentists in practice
Figure 27. Dentists Retiring/Leaving Practice
in <5 Years by County
Figure 28. Dentists Retiring/Leaving Practice
in <10 Years by County
60
50
50
# counties
# counties
40
30
20
10
40
30
20
10
0
0
0%
1-25%
26-50%
51-75%
% of all dentists retiring/leaving
76-100%
0%
1-25%
26-50%
51-75%
76-100%
% of all dentists retiring/leaving
29
Analysis: Projected Dentist Capacity Required to Serve Medicaid Enrollees
The scenarios in Table 8 present one approach for analyzing the required dentist capacity to treat
larger volumes of Medicaid enrollees (see Appendix E, Tables E11 and E12 for these scenarios
by region and urban/rural status). The output from this ana lysis is the number of Medicaid
enrollees that would have to be treated by a single dentist under these scenarios. In reality,
Medicaid patients are not evenly distributed among dentist, rather, a small number of dentists
generally treat a large number of Medicaid enrollees.
The assumptions for all scenarios are as follows:
1) the number of Medicaid enrollees was held constant at the July 2001 count (507,595
Medicaid enrollees); and
2) the total number of Wisconsin primary care dentists was held constant for each
scenario
(a) accepting new Medicaid patients (372 dentists statewide),
(b) treating Medicaid patients (946 dentists statewide), and
(c) accepting any new patients (2,139 dentists statewide).
The scenarios vary by the number of adult and children Medicaid enrollees targeted to receive at
least one dental visit per year at the following utilization levels:
1) 23% of Wisconsin Medicaid enrollees, which is the FY 2000 level of enrollees who
received at least one dental service (116,747 enrollees) 15 ;
2) 57% of all Medicaid enrollees, based on the Healthy People 2010 objective of lowincome children receiving preventive dental care (289,329); and
3) 83% of Medicaid enrollees, based on the Healthy People 2010 target of children and
adults using the oral health care system each year (421,304) 16 .
One way to examine required capacity is to keep the supply of dentists constant, while increasing
utilization. Focusing on the number of dentists who reported treating Medicaid patients:
a) To maintain current Medicaid utilization for dental services (23% in FY '00), each dentist
treating Medicaid patients would need to treat 123 Medicaid enrollees. At two visits per year
per enrollee, this would total 246 Medicaid visits. Nationally, in 1999, the average annual
number of visits provided by a general practitioner in private practice was 2,621 (not
including dental hygienist visits) and 3,883 (including dental hygienist visits). 17 Thus, these
Medicaid enrollees' visits would take up between 9% and 6% of the dentist’s total scheduled
visits.
b) To meet the Healthy People 2010 57% objective (applying the objective to both children and
adults), then each dentist treating Medicaid patients would need to treat 306 Medicaid
enrollees (612 annual visits), accounting for between 23% and 16% of all scheduled visits.
Another way to examine how dentist participation affects utilization by Medicaid enrollees is to
increase the supply of available dentists and keep utilization constant. Using the 57% objective,
if all primary care dentists who accepted any new patients were to participate in Medicaid (2,139
15
Wisconsin Medicaid Dental Facts FY 2000; see www.legis.state.wi.us/lc/studies/DCA/facts_dhfs.pdf
U.S. Department of Health and Human Services (2000). Healthy People 2010. 2nd ed. With Understanding and
Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office.
17
American Dental Association. The 1999 Survey of Dental Practice. Chicago. 2001.
16
30
dentists), each dentist would need to treat 135 Medicaid enrollees (270 annual visits). This
accounts for between 10% and 7% of all scheduled visits, a marked decrease from b) above.
Table 8. Number of Medicaid Enrollees Per Primary Care Dentist, Statewide, Using
Different Scenarios of Utilization and Dentist Participation
Number of
Medicaid
Enrollees per
Primary Care
Dentist:
Accepting New
Medicaid Patients
(n=372)
Treating Medicaid
Patients (n=946)
Accepting Any
New Patients
(n=2,139)
% of Medicaid enrollees with at least one dental visit:
23% (FY 2000 rate)1
57% (Healthy
83% (Healthy
People 2010
People 2010
objective)2
objective)3
314
778
1,133
123
306
445
55
135
197
1
23% of Wisconsin Medicaid enrollees, which is the FY 2000 level of enrollees who received at least one dental service (equals 116,747
enrollees, based on July 2001 enrollment);
2
57% of all Medicaid enrollees, based on the Healthy People 2010 object ive of low-income children receiving preventive dental care
(289,329 enrollees); and
3
83% of Medicaid enrollees, based on the Healthy People 2010 target of children and adults using the oral health care system each year
(421,304 enrollees).
31
32
Discussion
This report describes the many attributes of Wisconsin dentists based on self-reported survey
data collected in Spring 2001. The survey count of active dentists in Wisconsin (2,842) was very
close to estimates by the ADA (2,890 in 1998); thus, the survey captured most Wisconsin
dentists. The information collected from this survey may be used by a wide audience to better
understand the Wisconsin dental workforce. Major findings are described below.
The Supply of Dentists in Wisconsin
State Supply. Overall, Wisconsin ranks about 15th highest among all states in total dentist
supply, and about 19th highest when the dentist supply is adjusted to the state’s population. 18 In
Wisconsin, there were 53 dentists per 100,000 people, or one dentist per almost 1,900 people.
The national average was 59 dentists per 100,000 people. Thus, the Wisconsin supply ranks
fairly well among states, but is below the national average.
Dentist Distribution Across Wisconsin. The supply of dentists varied across regions of
the state. The greater Milwaukee area and other metropolitan areas had a substantially higher
supply than rural areas (all of these data adjust for population differences). Most (81%)
Wisconsin dentists are general dentists, 3% are pediatric dentists, and the remainder are other
dental specialists (16%). In addition to an overall low dentist supply, rural areas also had a much
lower supply of specialists.
Pediatric Dentists. Of specific concern for children's access to oral health care was the
low number of pediatric dentists 19 and their concentration in metropolitan areas, particularly the
Southeastern region. While there is no ideal standard for the number of pediatric dentists to
100,000 children, in 1995 there were 5.4 pediatric dentists per 100,000 children nationally. For
comparison, there were 5.1 in Wisconsin; the ratio ranged from 2.8 in Idaho, North Dakota and
South Dakota to 10.3 in Connecticut. 20
Characteristics of Wisconsin Dentists
Dental School Attended. A majority (70%) of Wisconsin dentists attended the only dental
school in Wisconsin (Marquette University School of Dentistry in Milwaukee). Substantial
numbers graduated from schools in neighboring states: Minnesota, 11%; Illinois, 7%; and Iowa,
5%. There were differences in the demographics and practice characteristics of in-state dental
graduates compared to graduates from neighboring and other states. The out-of-state dentists
were more likely to be more recent graduates, practice as specialists, and participate in Medicaid.
The practice locations of graduates from neighboring states were more often in rural areas and
showed some proximity to the state where they graduated (e.g., Minnesota graduates practicing
in the Western region of Wisconsin). The graduates from other states were more diverse by race
18
Bureau of Health Professions, National Center for Health Workforce Information & Analysis, Health Resources &
Services Administration, U.S. Department of Health and Human Services. HRSA State Health Workforce Profiles:
Wisconsin. Rockville, MD: December 2000.
19
Pediatric dentists provide both specialty dental care to children with complex medical, dental and psychosocial
needs, and basic dental care to all children. There are limited data on the portion of children’s dental care that is
provided by pediatric dentists, however due to their numbers, general dentists are considered to be the major
provider of dental care for children. Because of the reluctance of some general dentists to treat the very young or
preschool aged child, pediatric dentists may provide care to a larger number of the very young children.
20
Waldman HB. Are we maintaining the ratio of private practicing pediatric dentists to the number of children?
Journal of Dentistry for Children July-August 1998:264-267.
33
and ethnicity (overall 95% of all dentists were white). Thus, Wisconsin depends upon these
graduates to fill key dental care needs throughout the state. What is not known from this study is
whether there are differences among the dental schools (e.g., curriculum, scholarships) that
attract different types of students or what influences dentists from out-of-state dental schools to
choose to practice in Wisconsin.
Race/Ethnicity. Non-white dentists tended to have been in practice fewer years, attended
out-of-state dental schools, and had higher Medicaid participation than white dentists. Research
supports the importance of non-white health professionals in providing access to poor and nonwhite patients. One study found that non-white dentists were 2.7 times more likely to participate
in Medicaid than white dentists. 21 This finding is consistent with studies of physician’s
behavior. 22
Rural Issues. As stated above, overall dentist supply, as well as the supply of dental
specialists, was low in rural areas. Access to dental care is likely difficult for rural residents
regardless of insurance status. Interestingly, despite being fewer in number and accepting fewer
new patients, more rural dentists reported treating Medicaid patients than metro-central and
metro-other dentists. This finding coincides with those from an Illinois study, where 51% and
45% of dentists in the rural-adjacent and rural- nonadjacent categories participated in Medicaid
compared to 22% and 32% of dentists in the metro-central and metro-other categories. 23
Dentist Medicaid Participation
Findings from this study showed important differences in Medicaid participation based on dentist
characteristics and practice location, both of which impact current and future access to dental
care for Medicaid enrollees. While 42% of dentists reported treating Medicaid patients, only
20% dentists reported that they would accept new Medicaid patients. Participation was highest in
the rural areas (similar to what was found in the Illinois study, described above). Participation
was also high in the Southern and Western regions, where dentist supply was lowest. In the
Southeastern region, where 86% of dentists were in-state graduates, Medicaid participation was
lowest. In fact, by region, participation was lowest for in-state graduates practicing in the
Southeastern region (29%) compared to in-state graduates practicing in other regions. Also,
pediatric dentists were most likely to participate in Medicaid, although there were few of them.
Non-white dentists also had higher Medicaid participation.
Our current aggregate estimate is that the 946 primary care dentists who reported treating
Medicaid patients would each have to treat 123 Medicaid patients to maintain the 23% utilization
reported in FY 2000 by the State. Projections of the number of Medicaid enrollees each dentist
would need to treat, based on varying utilization levels, indicate that the current dentist
workforce is insufficient to care for the Medicaid population. For example, to meet the Healthy
21
Mayer ML, Stearns SC, Norton EC, Rozier RG. The effects of Medicaid expansions and reimbursement increases
on dentists’ participation. Inquiry. Spring 2000;37:33-44.
22
Brotherton SE, Stoddard JJ, Tang SS. Minority and Non-minority pediatricians’ care of minority and poor
children. Arch Pediatr Adolesc Med. 2000;154:912-917. Also, Xu G, Fields SK, Laine C, Veloski JJ, Barzansky B
& Martini CJM. The relationship between the race/ethnicity of generalist physicians and their care for under-served
populations. Am J Public Health. 1997;87:817-822.
23
Byck GR, Walton SM, Cooksey, JA. Access to dental care services for Medicaid children: Variations by
urban/rural categories in Illinois. Journal of Rural Health. Forthcoming, Fall 2002.
34
People 2010 objective of 57% of low- income children receiving preventive dental care 24 , each
currently participating primary care dentist would need to treat 306 Medicaid enrollees annually
(6/week). At 2 visits per enrollee per year, this constitutes between 16% and 23% of all annual
patient visits. Historically, dentists have not participated at these levels. Given the trend in
increased Medicaid enrollment, the current level of dentist participation in Medicaid is
insufficient to maintain current utilization levels (23% in FY 2000) much less increase utilization
rates for Medicaid enrollees.
Dentist Retirement Plans
Wisconsin dentists reported on their plans for retiring or leaving practice and indicated
substantial attrition in the next 5 to 10 years. Almost 1 in 7 (433) dentists planned to retire or
leave practice in the next 5 years, and about 1 in 3 (996) reported the same in the next 10 years.
Based on estimates of new dentists from the WDA study, this represents a net loss of 153
dentists in 5 years and 436 dentists in 10 years. In addition, Medicaid participation will be
affected by dentists' retirement plans.
Study Limitations
In contrast to many studies of health care professionals, this study had a very high response rate.
However, there were some limitations to this study which should be noted. First, the data were
all self- reported, however, when compared to other published data, there were similarities. The
number of currently practicing dentists from the survey (2,842) closely matched numbers
published by the ADA (2,890). Also, the number of dentists who reported treating Medicaid
patients (1,143) was similar to the number reported by the Wisconsin Department of Health and
Family Services for FY 2000 (1,421), although the reported volume of Medicaid services
reported by dentists responding to the survey did not match actual Medicaid claims data
maintained by the State of Wisconsin.
Among the issues that could not be studied here, but could be explored in future studies:
•
estimates of productivity, such as volume of services provided (to either all patients or
Medicaid patients, specifically) and the effect on dentist supply estimates.
•
the hometown or home state of dentists, in order to further examine differences in practice
location (region, urban/rural) based on dental school attended (for example, did dentists
who attended dental school in Minnesota settle in Wisconsin's Western region because
they were originally from that area, or was there something that attracted them there?).
•
information on where dentists did their dental residencies and whether that influenced their
decision to stay in the area or relocate.
•
whether there were any differences in practice characteristics by dentists' gender.
24
U.S. Department of Health and Human Services (2000b). Healthy People 2010. 2nd ed. With Understanding and
Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office.
35
36
Appendix A: Dental Stakeholders Committee
Sandy Breitborde, Director
Bureau of Health Information
Department of Health and Family Services
PO Box 309
Madison, WI 53701
Michael W Donohoo, DDS
Wisconsin Dental Association
7623 West Burleigh St
Milwaukee, WI 53222-5001
Anne Dopp, Chief Clinical Officer
Department of Health and Family Services
1 West Wilson Street, Room 218
Madison, WI 53707-7850
Tammy Filipiak, RDH
Wisconsin Dental Hygienists Association
Northcentral Technical College
473 Locker Road
Mosinee, WI 54455-9541
Dr. Richard Gartner
Department of Health and Family Services
PO Box 7850
Madison, WI 53707-7850
Steven Geiermann, DDS
Regional Dental Consultant
HRSA Midwest Field Office
233 North Michigan Avenue, Suite 200
Chicago, IL 60601-5519
Robert Jecklin, Executive Director
Scenic Bluffs Community Health Center
238 Front Street, PO Box 39
Cashton, WI 54619
Sarah V. Lewis, JD, Executive Director
Mari Freiberg, Associate Director
Wisconsin Primary Health Care
Association
5721 Odana Road, Suite 105
Madison, WI 53719
William K Lobb, DDS
Dean, Marquette University School of
Dentistry
PO Box 1881
Milwaukee, WI 53201-1881
Doug Long, Dental Policy Analyst
Division of Health Care Financing, DHFS
1 West Wilson Street, PO Box 309
Madison, WI 53701-0309
Darryl D Pendleton, DDS
Executive Director
Milwaukee AHEC
2220 East North Avenue
Milwaukee, WI 53202
Midge Pfeffer, RDH
Program Coordinator, Eastern Wisconsin
AHEC
2220 East North Avenue
Milwaukee, WI 53202
Dr. Martin Venneman
Executive Director, La Crosse Medical
Health Science Consortium
1300 Badger Street
La Crosse, WI 00005-4601
Warren LeMay, DDS
Chief Dental Officer
Division of Public Health
Department of Health and Family Services
PO Box 2659
Madison, WI 53701-2659
37
38
Appendix B: Survey Instrument and BHI Methodology
WISCONSIN BUREAU OF HEALTH INFORMATION
PUBLIC USE DATA FILE DOCUMENTATION
2001 DENTIST WORKFORCE SURVEY
I. General Description (Included herein)
II. Methodology (Included herein)
III. Data Specifications – Shaded items are not included herein.
A. Explanation of Data Elements and Limitations
B. Selected Frequencies
C. Wisconsin County Codes
D. Dataset Layout
E. Survey Instrument (Included herein)
I. General Description
The data contained in the public use file for the 2001 Dentist Workforce Survey were
reported by dentists to the Bureau of Health Information (BHI) under requirements
created by Chapter 153, Wis. Stats., and HFS 120.40, Wis. Admin. Code. This file
contains data on approximately 94% of the 4563 dentists who were licensed in
Wisconsin as of November 7, 20001.
A previous survey of Wisconsin dentists was conducted in 1993. Public use files for
that survey are available for purchase from BHI.
Neither the original source nor BHI bears any responsibility for the analysis or
interpretations that users may make. Data purchasers are strongly urged to inform BHI
of any errors and discrepancies they discover when using these data. Please contact
BHI at ASKBHI@DHFS.STATE.WI.US
To assist others in acquiring our data and to assure that data analysis can be
replicated, we request that the source of these data, regardless of medium (including
data summaries, data tables, and/or subsets of the data), be cited as stated below2.
1. A list of licensed dentists was obtained on November 7,2000 from the Wisconsin
Department of Regulation and Licensing.
2. Source: 2001 Dentist Workforce Survey, [Electronic data file]. (September 2001).
Bureau of Health Information, Division of Health Care Financing, Wisconsin
Department of Health and Family Services.
39
WISCONSIN BUREAU OF HEALTH INFORMATION
PUBLIC USE DATA FILE DOCUMENTATION
II. Methodology
Preparation for the 2001 Dentist Workforce Survey began in November 2000. The
survey instrument relied on previous surveys and was revised after receiving
comments from various data users, including the Wisconsin Dental Association3, the
Wisconsin Division of Health Care Financing4 the Division of Public Health5, the
Center for Health Systems Research and Analysis 6, Department of Regulation and
Licensing7 Southwest Wisconsin AHEC8, EDS9 Wisconsin Primary Care
Association10, MATC Health Occupations Program 11 and Marquette Dental School1 2.
Dentist mailing addresses were obtained from the Department of Regulation and
Licensing. The first surveys were mailed on March 23, 2001. A follow-up mailing
was sent on May 15 2001. The final response rate was 94%, with 4301 of 4563
licensed dentists returning the survey.
survey forms for quality control purposes.
Records were cleaned prior to data set completion. Names of educational
institutions activity descriptions and other text information were standardized where
possible.
3.
4.
5.
Maryann T Dillon, CAE, Director; Dr. Kathy Roth, Past President; Dr Thomas Hughes
Mary Laughlin
Warren LeMay DDS, MPH; Denise Carty MS, RN; Char White; Anne Dopp, Chief Clinical Officer Primary
Care
6. Bridget Booske, Ph.D.
7. Patrick Braatz
8. Joel Davidson, Executive Director
9. Stan Henkel Dental Consultant
10. Sarah Lewis
11. A. Sido
12. Bill Lobb
40
41
42
Appendix C: Counties by Wisconsin Region
Northeastern
Northern
Southeastern
Southern
Western
Brown
Calumet
Door
Fond du Lac
Green Lake
Kewaunee
Manitowoc
Marinette
Marquette
Menominee
Oconto
Outagamie
Shawano
Sheboygan
Waupaca
Waushara
Winnebago
Ashland
Bayfield
Florence
Forest
Iron
Langlade
Lincoln
Marathon
Oneida
Portage
Price
Sawyer
Taylor
Vilas
Wood
Jefferson
Kenosha
Milwaukee
Ozaukee
Racine
Walworth
Washington
Waukesha
Adams
Columbia
Crawford
Dane
Dodge
Grant
Green
Iowa
Juneau
Lafayette
Richland
Rock
Sauk
Barron
Buffalo
Burnett
Chippewa
Clark
Douglas
Dunn
Eau Claire
Jackson
La Crosse
Monroe
Pepin
Pierce
Polk
Rusk
St Croix
Trempealeau
Vernon
Washburn
43
Appendix D: Counties by Urban/Rural Status -
Metro-central
Milwaukee
Ozaukee
Waukesha
Metr o-other
Brown
Calumet
Chippewa
Dane
Douglas
Eau Claire
Kenosha
La Crosse
Marathon
Outagamie
Pierce
Racine
Rock
Sheboygan
St Croix
Washington
Winnebago
Rural adjacent
Clark
Columbia
Dodge
Dunn
Fond du Lac
Grant
Green
Green Lake
Iowa
Jackson
Jefferson
Kewaunee
Langlade
Lincoln
Manitowoc
Monroe
Oconto
Polk
Portage
Sauk
Shawano
Taylor
Vernon
Walworth
Waupaca
Wood
Rural nonadjacent
Adams
Ashland
Barron
Bayfield
Buffalo
Burnett
Crawford
Door
Florence
Forest
Iron
Juneau
Lafayette
Marinette
Marquette
Menominee
Oneida
Pepin
Price
Richland
Rusk
Sawyer
Trempealeau
Vilas
Washburn
Waushara
44
Appendix E: Data Tables
Table E1. Specialty Distribution by Region
Wisconsin
Northeastern
(%)
(%)
General Practice
81
82
Pediatric
3
3
dentistry
Oral surgery
4
4
Endodontics
2
2
Orthodontics
5
6
Periodontics
2
2
Prosthodontics
2
1
Oral pathology,
1
1
dental public
health, and other
Total
100
100
Total all dentists
2,842
601
Total primary
2,343
507
care dentists
Northern
(%)
83
2
Southeastern
(%)
80
3
Southern
(%)
82
2
Western
(%)
82
2
5
1
6
1
1
1
4
3
5
2
3
1
4
2
7
1
1
1
7
2
5
2
0.3
0.3
100
254
216
100
1,157
960
100
424
353
100
337
283
*Thirty-one dentists did not have location information and thirty-eight did not have specialty information.
Table E2. Specialty Distribution by Urban/Rural Status
Wisconsin
Metro-central
Metro-other
(%)
(%)
(%)
General Practice
81
80
78
Pediatric dentistry
3
3
3
Oral surgery
4
4
6
Endodontics
2
3
3
Orthodontics
5
5
6
Periodontics
2
3
2
Prosthodontics
2
3
2
Oral pathology,
1
0.2
0.1
dental public health,
and other
Total
100
100
100
Total all dentists
2,842
877
1,186
Total primary care
2,343
724
966
dentists
Rural-adjacent
(%)
87
1
4
0.4
5
1
1
0.2
Ruralnonadjacent (%)
91
0
3
0.5
5
0.5
0.5
0
100
510
448
100
200
181
*Thirty-one dentists did not have location information and thirty-eight did not have specialty information.
45
Table E3. Dentist Characteristics by Region
Dentist Characteris tics
Wisconsin
Northeastern
(%)
(%)
Specialty
General practice
81
82
Pediatric dentistry
3
3
Other specialty
16
16
Northern
(%)
Southeastern
(%)
Southern
(%)
Western
(%)
83
2
15
80
3
17
82
2
17
82
2
17
General and Pediatric Only
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
31
42
19
8
0
65
27
8
0
25
45
31
75
18
6
0
0
66
27
7
0
61
22
17
Dental School Attended
In-state
MN/IL/IA
Other state
70
23
7
69
21
10
61
33
6
86
9
6
60
33
8
41
52
7
Race/Ethnicity
White
Non-white
95
5
97
3
96
4
93
7
96
4
99
1
Years in Practice
<10
10-20
21-30
>30
13
30
37
20
14
28
37
20
10
31
42
16
13
31
36
20
12
28
37
22
15
30
36
19
46
Table E4. Dentist Characteristics by Urban/Rural Status
Dentist Characteristics
Wisconsin
MetroMetro(%)
central
other
(%)
(%)
Specialty
General practice
81
80
78
Pediatric dentistry
3
3
3
Other specialty
16
17
19
Ruraladjacent
(%)
Ruralnonadjacent
(%)
87
1
12
91
0
10
General and Pediatric Only
Region
Northeastern
Northern
Southeastern
Southern
Western
22
9
41
15
12
0
0
100
0
0
34
5
18
24
18
31
22
13
21
14
23
36
0
14
27
Dental School Attended
In-state
MN/IL/IA
Other state
70
23
7
89
6
6
61
30
9
64
30
6
60
36
4
Race/Ethnicity
White
Non-white
95
5
93
7
96
4
97
3
99
1
Years in Practice
<10
10-20
21-30
>30
13
30
37
20
15
29
35
21
13
33
35
19
10
27
42
20
13
26
41
20
47
Table E5. Dentist Characteristics and Practice Location by Race/Ethnicity
Dentist Characteristics
White
Non-white
(%)
(%)
Specialty
General practice
82
73
Pediatric dentistry
2
10
Other specialty
15
18
General and Pediatric Only
Region
Northeastern
Northern
Southeastern
Southern
Western
23
10
40
16
12
16
8
62
13
1
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
29
43
19
8
50
37
12
1
Dental School Attended
In-state
M N/IL/IA
Other state
72
22
7
52
22
27
Years in Practice
<10
10-20
21-30
>30
12
29
38
22
42
27
20
11
Table E6. State of Dental School Attended, All Dentists
State
%, (#)
Wisconsin
67 (1,882)
Neighboring States*
24 (672)
Minnesota
11 (301)
Illinois
8 (234)
Iowa
5 (137)
Nebraska
2 (49)
Michigan
1 (27)
Ohio
1 (27)
Missouri
1 (22)
Indiana
1 (21)
Other State
4 (119)
Total
100 (2,819)
*Currently, the dental schools in the neighboring states are
University of Minnesota, University of Iowa, University of
Illinois at Chicago, and Southern Illinois University.
48
Table E7. Dentist Characteristics and Practice Location by Dental School Attended
Dentist Characteristics
In-State
Border State
Other State
(%)
(%)
(%)
All dentists
67
24
9
Specialty
General practice
Pediatric dentistry
Other specialty
85
2
13
77
3
21
60
5
35
Region
Northeastern
Northern
Southeastern
Southern
Western
21
8
50
13
7
21
14
16
22
28
29
8
34
17
12
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
39
36
18
7
8
54
25
12
25
54
17
5
Race/Ethnicity
White
Non-white
97
3
95
5
84
16
Years in Practice
<10
10-20
21-30
>30
10
28
39
23
20
36
31
13
20
28
38
14
General and Pediatric Only
Figure E1. Distribution of Border State
Graduates by Region
100%
Figure E2. Distribution of Border State
Graduates by Urban/Rural Status
100%
80%
Northeastern
80%
60%
Northern
60%
Metro-other
40%
Rural-adj.
Metro-central
Southeastern
40%
Southern
20%
Western
Rural-nonadj.
20%
0%
0%
Minnesota
Illinois
Iowa
Minnesota
Illinois
Iowa
49
Table E8. Medicaid Participation by Dentist Characteristics and Practice Location
Dentist Characteristics
Treats Medicaid Patients Accepts New Medicaid Patients
(%)
(%)
All dentists
42
20
Specialty
General practice
Pediatric dentistry
Other specialty
41
73
39
16
64
34
Region
Northeastern
Northern
Southeastern
Southern
Western
46
50
30
48
60
12
23
16
21
16
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
26
45
53
60
15
15
23
18
Dental School Attended
In-state
MN/IL/IA
Other state
38
53
45
15
20
22
Race/Ethnicity
White
Non-white
42
53
17
37
Years in Practice
<10
10-20
21-30
>30
38
43
44
38
19
16
19
17
Practice Setting
Individual Proprietor
Partner in group practice
Employed in group practice
Shareholder in group practice
Other
42
49
39
37
62
15
16
17
14
47
General and Pediatric Only
100%
Figure E3. Medicaid Participation by Region
and Dental School Attended
80%
In-state
60%
Border state
40%
Other state
20%
W
est
ern
So
uth
ern
No
rth
ern
So
uth
eas
ter
n
No
rth
eas
ter
n
0%
50
Table E9. Volunteer and Charity Care by Dentist Characteristics and Practice Location
Dentist Characteristics
Participate in
Any Volunteer/ Any Pro Bono
Volunteer at WDA Donated
Charity Care
(Free) Care
Clinic (%)
Dental Services
(%)
(%)
Program (%)
All Dentists
58
48
16
21
Specialty
General practice
Pediatric dentistry
Other specialty
59
63
58
47
56
50
15
29
18
20
26
25
Region
Northeastern
Northern
Southeastern
Southern
Western
67
57
52
67
59
56
47
42
52
51
23
7
12
22
11
27
17
16
25
18
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
51
65
64
48
40
53
52
43
12
22
12
6
15
23
24
16
Dental School Attended
In-state
MN/IL/IA
Other state
59
60
56
48
51
41
15
15
17
21
19
25
Race/Ethnicity
White
Non-white
61
54
49
31
16
21
22
17
Years in Practice
<10
10-20
21-30
>30
55
61
59
52
38
49
49
44
19
19
13
11
15
21
20
17
General and Pediatric Only
51
Table E10. Retirement Plans by Dentist Characteristics and Practice Location
Dentist Characteristics
Retire/Leave in Retire/Leave in
<5 Years (%)
<10 Years (%)
All dentists
15
35
Specialty
General practice
Pediatric dentistry
Other specialty
15
17
15
34
42
39
Region
Northeastern
Northern
Southeastern
Southern
Western
15
17
15
16
13
36
39
34
37
33
Urban/Rural Status
Metro-central
Metro-other
Rural-adjacent
Rural-nonadjacent
16
15
14
17
34
34
37
41
Dental School Attended
In-state
Border state
Other state
16
11
16
37
29
37
Race/Ethnicity
White
Non-white
16
20
37
32
Years in Practice
<10
10-20
21-30
>30
11
4
10
46
12
14
42
74
14
14
35
36
General and Pediatric Only
Participation
Treats Medicaid patients
Accepts new Medicaid patients
52
Table E11. Number of Medicaid Enrollees Per Primary Care Dentist, by Region, Using
Different Scenarios of Utilization and Dentist Participation
Number of Medicaid
Enrollees per Primary
Care Dentist:
Northeastern Region
Accepting New
Medicaid Patients
(n=59)
Treating Medicaid
Patients (n=229)
Accepting Any New
Patients (n=473)
Northern Region
Accepting New
Medicaid Patients
(n=48)
Treating Medicaid
Patients (n=108)
Accepting Any New
Patients (n=196)
Southeastern Region
Accepting New
Medicaid Patients
(n=148)
Treating Medicaid
Patients (n=280)
Accepting Any New
Patients (n=902)
Southern Region
Accepting New
Medicaid Patients
(n=72)
Treating Medicaid
Patients (n=164)
Accepting Any New
Patients (n=318)
Western Region
Accepting New
Medicaid Patients
(n=45)
Treating Medicaid
Patients (n=165)
Accepting Any New
Patients (n=250)
% of Medicaid enrollees with at least one dental visit:
23% (FY 2000 rate)1
57% (Healthy People
83% (Healthy People
2010 objective)2
2010 objective)3
304
752
1,095
78
194
282
38
94
137
235
581
847
104
258
376
57
142
207
366
907
1,321
193
479
698
60
149
217
227
562
819
100
247
360
51
127
185
365
904
1,317
100
247
359
66
163
237
1
23% of Wisconsin Medicaid enrollees, which is the FY 2000 level of enrollees who received at least one dental service (equals
116,747 enrollees, based on July 2001 enrollment);
2
57% of all Medicaid enrollees, based on the Healthy People 2010 objective of low-income children receiving preventive dental care
(289,329 enrollees); and
3
83% of Medicaid enrollees, based on the Healthy People 2010 target of children and adults using the oral health care system each
year (421,304 enrollees).
53
Table E12. Number of Medicaid Enrollees Per Primary Care Dentist, by Urban/Rural
Status, Using Different Scenarios of Utilization and Dentist Participation
Number of Medicaid
Enrollees per Primary
Care Dentist:
Metro-Central
Accepting New
Medicaid Patients
(n=103)
Treating Medicaid
Patients (n=182)
Accepting Any New
Patients (n=679)
Metro-Other
Accepting New
Medicaid Patients
(n=139)
Treating Medicaid
Patients (n=424)
Accepting Any New
Patients (n=908)
Rural-Adjacent
Accepting New
Medicaid Patients
(n=98)
Treating Medicaid
Patients (n=235)
Accepting Any New
Patients (n=401)
Rural-Nonadjacent
Accepting New
Medicaid Patients
(n=32)
Treating Medicaid
Patients (n=105)
Accepting Any New
Patients (n=151)
% of Medicaid enrollees with at least one dental visit:
23% (FY 2000 rate)1
57% (Healthy People
83% (Healthy People
2010 objective)2
2010 objective)3
421
1,042
1,518
238
590
859
64
158
230
271
672
978
89
220
321
41
103
150
223
553
805
93
231
336
55
135
197
414
1,026
1,493
126
313
455
88
217
316
1
23% of Wisconsin Medicaid enrollees, which is the FY 2000 level of enrollees who received at least one dental service (equals
116,747 enrollees, based on July 2001 enrollment);
2
57% of all Medicaid enrollees, based on the Healthy People 2010 objective of low-income children receiving preventive dental care
(289,329 enrollees); and
3
83% of Medicaid enrollees, based on the Healthy People 2010 target of children and adults using the oral health care system each
year (421,304 enrollees).
54