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Education Action Campaign Case Statement

The AAP Foundation has taken up the challenge of reversing a decline in periodontal educators that threatens the future of periodontics.

Periodontal education today is at the tipping point where the decline in the number of periodontal educators threatens to become precipitous and the impact on the specialty severe. As the number of periodontal educators declines, their influence diminishes and this, coupled with a de-emphasis on specialties, may mean that periodontology will stand in danger of marginalization.

Who will educate general dentists—our primary referral sources—about periodontology during their formative years in the classroom? Who will teach them what the periodontist can do for their patients’ oral and systemic health?
Who will perform the research that clearly places our specialty at the forefront of the oral health breakthroughs, and garners respect throughout the dental community?
In an era of evidence-based medicine, who will reinforce the scientific foundations of our specialty and impart them to our future colleagues?
And finally, as clinicians transition to retirement, how does the specialty ensure a sufficient pool of periodontists to buy their practices?

The facts are on the table. The pipeline of periodontal educators faces a troubling future. All indicators point to an upsurge in vacancies in the near future as periodontal educators join other boomers in the exodus to retirement.

More than half (56 percent) of our educators are age 50 and older and nearly one in five (17 percent) is 60 and older. Periodontology will lose nearly half of its educator workforce, assuming a retirement age of 65, in the next 10-15 years. The numbers that transition from academia to private practice prior to retirement certainly will add to the pressure. Creating a pipeline of periodontists to fill these spots with individuals with the requisite research and scientific training will take more than a decade. Training educators, which takes at least 10 years beginning from the point at which undergraduate study commences, is just the beginning of the process.

During and beyond their formal education years, periodontists must be exposed to those experiences that promote their development as academics. These experiences may include exposure to seasoned academics who inspire, teaching and research experiences during postdoctoral years, and mentoring acquired under the auspices of a fellowship. The context may vary, but the exposure is critical to the formation of an educator. Clearly, it is imperative that a significant number of potential educators be in training or on their way. Waiting until the impact of boomer retirements actually hits is not an option.

The challenge we face is very clear: We must make academia an attractive and viable career path for our specialty’s best and brightest. We must do what needs to be done to ensure that our training institutions attract and retain the most gifted academicians possible so future generations of periodontists learn from and are inspired by those most deeply steeped in the skills and research-based knowledge that sets our specialty apart—other periodontists.

What was once a commonly recognized need to develop more periodontal educators and to promote the significance of periodontology is becoming an urgency and forces beyond our control demand that we take action now.

The Perfect Storm in Periodontal Education

The precariousness of periodontal education is driven by what some would call a “perfect storm,” a mix of demographic trends and economic realities that have combined with unfortunate consequences for our training institutions: as our academics join other baby boomers in retirement, their potential replacements, burdened by staggering educational debt and a lack of scientific training, are increasingly opting for private practice instead.

The numbers speak for themselves:

There are currently about 280 vacant dental school faculty positions; three-quarters are in the clinical sciences, according to the American Dental Education Association (ADEA) Institute for Public Policy and Advocacy. Furthermore, ADEA reports that retirement and faculty leaving to pursue private practice are the two greatest factors “influencing faculty separations and recruitment.”
The lure of private practice is compelling: ADEA noted that the net income of full-time dentists in private practice increased nearly 90 percent from 1990 to 2000. During the same period, guaranteed salaries for full time dental clinical faculty rose on average of 25-30 percent, according to the September 2002 issue of Journal of Dental Education. While some schools have incentive programs, the static base salaries mean that benefit packages are not increasing either.
Overall, private practice net income is more than double faculty salaries.
Rising dental school tuition leads to crushing debt. In the past 10 years dental school resident tuition and fees on average have increased 71.9 percent, from $65,067 to $111,807 in the 2004-2005 school year, according to the 2004-2005 Survey of Dental Education, Volume 2, Tuition, Admission and Attrition. The educational debt load of new dental graduates averages more than more than $120,000. Specialty training, such as periodontics, adds to the load.

The Role of the AAP Foundation: A Track Record of Success in Anticipating Needs and Addressing Challenges

The American Academy of Periodontology Foundation has the structure and the experience to meet the challenge head on. The Foundation currently has more than $10 million in invested funds. Furthermore, it has a track record of success in evaluating, establishing, and administering programs that support periodontal education. Established in 1991 as a 501 (c)(3), the American Academy of Periodontology Foundation presented its first award in 1996, the $10,000 Kramer Scholarship for Excellence. Since then, the number of awards it presents has grown to 22 annual awards totaling more than $500,000 in 2006, all supporting the educational and research components of its mission. These include:

Grants to bring outstanding periodontal lecturers to dental schools for the benefit of the entire dental professional team (Finley Visiting Scholar Grants)
Scholarships to recognize and reward achievement in postdoctoral periodontal programs (Kramer Scholarship for Excellence Award)
Fellowships to support advanced training (Lazzara Fellowship for Advanced Implant Surgery)
Fellowships to encourage entry into academic careers (Chasens Fellowships for Teaching and Research)
Fellowships to recognize and reward outstanding achievement in young educators (Tarrson Fellowship)
Awards to encourage academic careers and research (Tarrson Regeneration Scholarship, AAPF Fellowship Funded by Omni Preventive Care)

In addition to directly supporting the Foundation’s mission, these awards also reflect the AAP Foundation’s stature in the dental community. Within a relatively short time frame, the AAP Foundation has established a strong brand identity that attracts funding from corporate and individual donors, fueling its rapid growth. Whether the donor is a corporation seeking visibility within the periodontal community or an individual who wishes to create a legacy for future generations, current and potential donors see the AAP Foundation as a responsible partner in achieving their goals. At the same time, the Foundation actively seeks alliances that will support its mission, and works in partnership to develop programs and awards of benefit to the periodontal community and the public it serves. Foundation awards have played a direct role in attracting and retaining periodontal educators and, if expanded, can play a far greater role in the near future.

Seeing the Results

Tipping the scale toward an academic career path

Dr. Mark Lucas, assistant professor in the division of periodontology at the University of Colorado School of Dentistry, and a 2006 recipient of the AAP Foundation’s Abram and Sylvia Chasens Teaching and Research Fellowship, exemplifies both the extraordinary talent of those drawn to periodontal education and the financial obstacles they face.

As the son of a university president, Dr. Lucas identifies strongly with higher education and his family’s place in it. Early in his career, Dr. Lucas moved between private practice and academia, knowing that “the time would come when I would be specially equipped to assume the role of professor.” And it was a role he relished as he anticipated helping others along their career path while enhancing his own education through his interaction with students and fellow faculty.

Yet the needs of a young family combined with the burden of a high educational debt load, nearly derailed his vision. Dr. Lucas addresses the problem directly: “If I had not received the Chasens Fellowship, there is a good chance I would not have pursued an academic career path. It helped offset some debt acquired during my three years of residency so the money fit a need. I was making a decision economically and the money tipped me over into academia.”

It’s impossible to calculate the number of other potential educators who made a similar calculation and decided not to pursue an academic career, but it is likely high and points to a direction we can take to meet the coming challenge.

Providing debt relief to young faculty and future faculty

Debt relief plays a major role in attracting and retaining periodontal educators. Responding to a growing sense of urgency around the issue, and supported by a $1 million commitment from the AAP, the Foundation in 2005 created the AAP Educator Scholarships for periodontists intending to teach and AAP Teaching Fellowships for young academics. The awards provide debt relief and in return require a teaching commitment of one year for each year the recipients receive the awards. The first of these awards were made in 2006.

These awards answer a critical need. Especially wrenching are the uncounted numbers of gifted young periodontists who either forego their dreams of teaching or, once teaching, leave academia for the more lucrative option of private practice. And once on board, educators don’t necessarily stay. According to the previously cited ADEA report, in 2001-2002 more than 50 percent of the faculty separations represented a move to private practice.

Reversing the outflow from academia

As a stopgap measure, the Foundation is making a concerted effort to find additional avenues for supporting current educators and even reversing the outward flow by helping interested periodontists in private practice launch a second career as academics.

During 2006 the Foundation awarded six fellowships for periodontists to the Institute for Teaching and Learning in the Health Professions (ITL) Program for Dental School Faculty. The ITL program helps academics and dentists in private practice who hope to enter academia to hone their teaching skills.

One of the Fellows was Maria Fernanda Fiocchi, D.D.S., M.S., a part-time faculty member at UT-Houston and part-time private practitioner, who aspires to become a full-time educator. Dr. Fiocchi feels that the ITL experience gave her the educational tools that will ease her transition into full-time academia. “I now have information to practice ‘evidence-based teaching,’” she says. “I can already observe the positive change in my students’ learning experience based on their enthusiastic comments.”

Another ITL Fellow has already made the transition: After 21 years in private practice, Dr. Joe Krayer joined the division of periodontics at the Medical University of South Carolina as full-time faculty. Although he’d already been teaching one day per week while maintaining a full-time private practice, Dr. Krayer credits his experience as an ITL Fellow for giving him the tools he needs to polish his teaching skill. He also illustrates the value a private practitioner who transitions to teaching can bring to students: “We bring real life experience to the classroom. The ITL program helped me to teach what I have learned and to function effectively as a full-time academic.”

The High Cost of Inaction

There are numerous anecdotal stories of promising educators abandoning academia for private practice. For example, the brilliant dental scientist who, after completing a combined program in clinical research and periodontology and also receiving his PhD in immunology, became full-time faculty where he was funded by a career development award. The expectation was that by end of the award period, the recipient would apply for an NIH Research Project Grant (an RO1 award). However, facing the financial pressures of having a young family, this promising academic did not apply for the grant, opting instead to leave his teaching and research career to go into full-time practice and part-time teaching.

There is also the foreign-trained dentist who then trained in periodontology in the U.S. and also received his MPH here. He became a U.S. citizen with the intention of staying in the States as a teacher and researcher, and did teach in a U.S. periodontal training program for several years as full-time faculty. However, he ultimately moved to full-time practice. While money was a factor, he was also frustrated by lack of time with family due to teaching and research commitments, and frustration in getting ahead. The program director noted that young faculty are often frustrated by administrative aspects of academia.

While these anecdotes clearly demonstrate academia’s loss of extraordinary brain power, gifted periodontal teachers and researchers who were slated to make significant contributions in the classroom and in the laboratory, they do not capture the loss of those dental students, or even university undergraduates, who although drawn to an academic path choose another route instead. An MBA from a top-ranked program surely holds potential for greater wealth and, in fact, the New York Times on November 27, 2006, carried a feature titled “Lure of Great Wealth Affects Career Choices.” The article featured, among others, a promising physician-scientist who left medical practice to become a Wall Street adviser on medical investments, and a managing director of a private equity firm who began in academia and still feels the tug of teaching. While the move from academia to Wall Street was well documented in the article, it also noted the move from medicine to more lucrative fields and even in law, where fewer law school graduates are entering government or public interest jobs. The impetus seems not so much to be the money per se but the need for future security. Who can assess how many potential periodontal educators are siphoned off in this manner?

Ramping Up for the Future

The Foundation’s AAP Educator Scholarships, AAP Teaching Fellowships, and ITL Fellowships move the specialty further along the continuum of addressing the problem of recruiting and retaining periodontal educators, but much more needs to be done if we are to resolve the issue in a way that secures the specialty’s future.

If we lose a significant number of periodontal educators in the coming decade—a possibility given the age of our educators and retirement trends—we will need to increase the number of these awards to support a sufficient pool of academics needed to take their place.

This is the time for bold action. The specialty has a very narrow window of opportunity, a decade perhaps, to create a pool of talented educators who can fill the gaps created by retirement and declining interest in an academic career.

The AAP Foundation, with the commitment of the AAP, has taken up the challenge in periodontal education by creating the AAP Educator Scholarships and Teaching Fellowships, and Foundation ITL Fellowships—programs that attract our most gifted colleagues to a career in academia, and make it possible for them to pursue their dreams as educators. Moreover, these initiatives directly relate to recommendations coming out of the 2006 ADEA Summit meeting, which cited loan forgiveness and the identification of incentives for an academic career as methods of countering the issues of graying faculty and difficulties in recruiting and retaining new faculty.

These initiatives are an important step, but they need ongoing and increased support. The future will not wait. What happens to periodontal education, and to the specialty, is in our hands today.