In August, the latest installment in North Carolina’s ongoing experiment in social engineering through health care education officially will be underway. East Carolina University’s new dental school will admit its first class of students.
The school will cost nearly $100 million to build, with an additional $11.5 million in recurring funds every year from state taxpayers. This rather large investment is supposed to enable North Carolinians in some of the state’s more remote areas — the “underserved” — to see a dentist more easily. Taking a closer look, however, one wonders if the need to improve “access” is really so urgent.
At first glance, the proposal for the new dental school seems reasonable enough. Some people in our state have to travel further to see a dentist than others; dentists are not distributed evenly on a county-by-county per capita basis; as the map shows, four counties don’t even have a dentist.
The trouble is that these “underserved” citizens are somewhat difficult to find in reality. For instance, Trenton is at the center of dentist-free Jones County, one of four such counties used to justify the new school.
A quick Google Maps search for a “dentist near Trenton, NC” reveals 10 dentists within 30 minutes of driving time. Put another way, the maximum possible benefit that the 200 or so citizens of Trenton, one of the most underserved areas in the state, could get from ECU’s new dental school is less than a half hour of driving time. If Jones County citizens’ teeth are rotten, it’s not from want of nearby dentists.
True, some remote areas are a bit farther from a dentist, but the longest travel time to a dentist in North Carolina I was able to find was in the aptly named town of Last Chance. According to Google Maps, it takes 54 minutes to reach the dental offices of David H. Elliott II from Last Chance.
Rhett White, city manager of Columbia, in dentist-free Tyrrell County, told me that the problem of distance, which doesn’t seem that considerable, sometimes is compounded by the lack of dentists willing to accept Medicaid patients. This means that poor people have to travel farther to see a dentist. This is indeed a problem, but one resulting primarily from the problems inherent in Medicaid and not from a lack of dentists.
Furthermore, there is significant reason to doubt that efforts at placing dentists in remote areas will be successful — in any case, not on a large scale.
To produce dentists who will locate voluntarily in lesser-served areas, East Carolina’s new dental school will use several methods. It will recruit selectively students from rural areas, train dentists to rely less heavily on specialists, and put students through an “extended immersion” experience in several rural areas of the state.
The plans eventually may have some impact, but, as at ECU’s Brody School of Medicine (which tries something similar), they will be limited by the huge incentives against working in remote areas. Because dentists typically serve constituencies of several thousand people, it is difficult to imagine a dentist moving to Trenton (population ~200) when he or she could stay in New Bern and serve patients from both New Bern and Trenton. Besides, a new dental school won’t fix problems with Medicaid.
Finally, even if North Carolina needs more dentists, a new dental school is not the best way to increase the supply. According to the American Dental Association, it would be more efficient to simply increase enrollment at the dental school we already have. In a 2005 report, the ADA calculated that dental schools tend to increase their economic efficiency as enrollment rises to around 1,300 students. But ECU’s new dental school is expected to enroll 50 students per class (200 students total when at capacity) and UNC-Chapel Hill’s dental school is planning to increase enrollment to 100 students per class (400 total). If the ADA is correct, we are wasting millions by building a new low-capacity school when it would be prudent to increase the capacity of the existing one.
It appears too late for the incoming class of Republican legislators to stop the dental school from being built — there’s already a big hole in the ground for the school — but the legislature and UNC system should consider more carefully next time the rationale behind massive spending programs. No dentist shortage has been demonstrated, and yet we’re trying to solve the alleged shortage in a very inefficient way. This shouldn’t happen twice.
Duke Cheston is a reporter and writer for the John W. Pope Center for Higher Education Policy (popcenter.org).