The short answer is no. There may be people in Maine not getting the dental care they need but it is not because there is a shortage of dentists. I have done some extensive research on the subject and found that the widely held belief that there is a shortage of dentists in Maine is based on a rather arbitrary and poorly designed formula to designate areas as Health Professional Shortage Areas (HPSA). As a result, over 90% of some states are designated health professional shortage areas. Please read the below summary of my investigation into the subject which specifically addresses an HPSA in Maine.
Health Professional Shortage Areas
The determination that there is a shortage of dentists in America has been based largely on the preponderance of Dental Health Professional Shortage Areas.1 HPSAs are designations assigned by the Department of Health and Human Services.2 Formulas have been developed to uniformly evaluate areas for the HPSA designation. However, little information is available regarding the methods used to develop these formulas. Given that some states are almost entirely designated as HPSAs, it is reasonable to question the validity of these calculations. There are so many HPSAs in the United States that an access to care crisis has been declared. This is despite an all-time high dentist to population ratio in the country.3,4,5 Because of this and the changes to the dental profession that have resulted, it is of extreme importance that dentists and advocates for the profession understand the HPSA designation.
Generally, a population to dentist ratio of 5,000:1 or greater warrants an HPSA designation.2 There are a multitude of factors that can lower the population to dentist ratio threshold to 4,000:1.6,7 There is no published information divulging how either of these ratios was determined. There are three categories of HPSA. A Geographic HPSA is an indication that there are not enough dentists within a reasonable distance of the area. A Population Group HPSA signifies areas that have access barriers that prevent the population group from use of the area’s dental providers. A Facilities HPSA refers to federal and/or state correctional institutions or public and/or non-profit medical facilities.
In addition to population to dentist ratio, DHHS considers other factors like populations with incomes below poverty level, travel distance/time to access dental care, fluoridation, and hours per week dentists see patients.7 Complex formulas are used to evaluate these factors regarding assignment of HPSA status. Ultimately, a lot of work has gone into creating a complicated method of delivering a rather arbitrary answer.
The Department of Health and Human Services has set a goal population to dentist ratio of 3,000:1.8 Again, it is not clear how this ratio was determined. If this ratio is accepted as truly ideal, the country has nearly twice as many dentists as the country needs.3,6 However, it is claimed that there is an uneven distribution of dentists in America that is contributing to the crisis in dental care.1
Dallas Plantation, Maine is one of thousands of HPSAs in America.9 It has a population of about 309.10 This is not a typo. There are just 309 people there. It is a ski resort area in a mountainous region of the state. And, there are no dentists there. However, a quick search of the ADA website reveals there are 27 dentists within 50 miles. The nearest dentist is a mere 6.3 miles from Dallas Plantation.11 I called this dental practice to find that it would take no longer than one week to be seen for an exam. If there was an emergency, I could be seen that day. Is this unreasonable? Does this sound like a crisis? Is this really too far to travel for dental care? It is reasonable to think anyone living in this area must travel for many necessities. Is it not reasonable to expect residents of Dallas Plantation to travel 6.3 miles for their dental needs?
HPSAs are the foundation for the house of cards called the “Access to Care Crisis”. Are there people in need of dental care that aren’t receiving it? The answer is yes. Is it because there are 10,000 too few dentists like the Pew report states? With more dentists than ever in the history of the United States and an all-time high dentist-to-population ratio, there is no possibility this could be true.
1. The Pew Charitable Trusts, In Search of Dental Care, June 2013,
http://www.pewstates.org/uploadedFiles/PCS_Assets/2013/In_search_of_dental_care.pdf
2. U.S. Department of Health and Human Services, Health Resources and Services Administration,
http://www.hrsa.gov/shortage/
3. Dentist supply in the United States: 1993-2011. American Dental Association (2013). Retrieved September 6, 2013, from
http://www.ada.org/1443.aspx
4. Historical national population estimates: July 1, 1900 to July 1 1999. Population Estimates Program, Population Division, U.S. Census Bureau. Internet Release date: April 11, 2000. Revised date: June 28, 2000. Retrieved September 7, 2013, from
http://www.census.gov/population/estimates/nation/popclockest.txt
5. The number of dentists in the United States, 1900-2000. American Dental Association, Survey Center. 2002.
6. U.S. Department of Health and Human Services, Health Resources and Services Administration, Dental HPSA Designation Overview.
http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/dentalhpsaoverview.html
7. U.S. Department of Health and Human Services, Health Resources and Services Administration, Dental HPSA Designation Criteria.
http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/dentalhpsacriteria.html
8. HRSA Data Warehouse, Designated Health Professional Shortage Areas as of January 8, 2013.
http://www.dentistryiq.com/content/dam/diq/online-articles/documents/2013/01/HPSA Stats.pdf
9. U.S. Department of Health and Human Services, HRSA Data Warehouse.
http://datawarehouse.hrsa.gov/hpsadetail.aspx
10.
http://en.wikipedia.org/wiki/Dallas_Plantation,_Maine
11.
http://www.rangeleydental.com/Welcome.html