La. Admin. Code tit. 48 § I-11905

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-11905 - Dentists

A. Introduction

1. Dentists are an important primary health care provider. Like primary care physicians, it is essential that dentists be available and reasonably accessible to a population if regular preventive care is to be obtained and acute health problems minimized.

B. Availability/Supply

1. In evaluating dental manpower in Louisiana in terms of overall supply, there are significantly fewer dentists in the state as compared to the United States as a whole. Most recent statistics show Louisiana with 39.7 dentists per 100,000 population while the United States average is 54.2 per 100,000. This comparison does not reveal much about the actual sufficiency of the state's supply of dentists, however, since several studies have noted the oversupply of dentists as a problem in many areas of the country. Louisiana ranks on middle ground in dentist to population ratio in comparison to other states in the region, as depicted in Table 11.3.

Table 11.3 Active Dentists in the Population 1980
Number of Dentists per 100,000 pop.	Number of Dentist per 5,000 pop.
United States	54.2	2.71
Louisiana	39.7	1.99
Mississippi	31.7	1.59
Alabama	35.2	1.76
Arkansas	33.3	1.67
Texas	42.4	2.12
Tennessee	47.6	2.38
Kentucky	42.3	2.12
Oklahoma	41.5	2.08

2. The National Guidelines for Health Planning suggest that an appropriate supply of dentists is one dentist to every 5,000 population except in areas of high need or where there is an insufficient capacity of existing dental care providers. As can be seen in Table 11.3, Louisiana as a whole has nearly two dentists to every 5,000 people.

3. Areas of "high need" are defined as those in which:

a. more than 20 percent of the area's population lives below poverty level; or

b. a majority of the area's population does not have a fluoridated water supply.

4. "Insufficient capacity of care" exists when:

a. there is an average of more than 5,000 visits per year to each active dentist in the area; or

b. there are waiting periods of more than six weeks for appointments for routine dental services with most dentists in the area; or

c. two-thirds or more of the area's dentists do not accept new patients.

5. The National Health Planning Guidelines suggest a supply ratio of one dentist to every 4,000 population when a condition of high need or insufficient capacity exists. This ratio of 1 to 4,000 would be applicable in many parts of Louisiana as only 28.9 percent of the state's population has fluoridated water and 41 of the state's 64 parishes have poverty levels exceeding 20 percent of the population.

6. In Louisiana, despite an adequate overall supply of dentists to serve the population, there are many areas where there are not enough dentists to provide adequate services for the population. Basically these areas are in rural low-income parts of the state where there are few active dentists. Eighteen of the twenty-nine parishes in the North Louisiana health system area are dental manpower shortage areas. Designated dental manpower shortage areas are depicted in Table 11.4. Other than West Baton Rouge Parish, all parishes with dental manpower shortages are in the North Louisiana area, with other designated shortage areas lying in urban poverty pockets.

Table 11.4 Dental Manpower Shortage Areas 1980
Service Area	FTE Dentist	Pop. (00s)	Pop. to Dentist Ratio	Pop. Below Poverty
New Orleans/Bayou-River
New Orleans-Desire/Florida	4.0	321	8,035	46%
New Orleans-Irish Channel	0.0	200	43%
Mid-Louisiana
West Baton Rouge Parish	3.0	202	6,733	35%
Baton Rouge-Eden Park	1.2	230	19,182	37%
North Louisiana
Bienville Parish	2.0	172	8,613	38%
Caldwell Parish	.6	102	17,078	41%
Catahoula Parish	1.0	117	11,765	43%
Concordia Parish	5.0	222	4,447	39%
DeSoto Parish	4.0	237	5,926	44%
East Carroll Parish	2.0	116	5,827	60%
Franklin Parish	3.0	239	7,990	50%
Grant Parish	1.0	151	15,151	36%
Jackson Parish	3.0	168	5,631	29%
Lincoln Parish	8.0	371	4,649	32%
Madison Parish	1.0	149	14,980	54%
Morehouse Parish	7.0	336	4,813	40%
Natchitoches Parish	9.0	361	4,019	45%
Red River Parish	0.0	92	9,250	47%
Tensas Parish	1.0	84	8,400	54%
Union Parish	5.0	200	4,017	32%
Vernon Parish	2.3	537	23,347	19%
West Carroll Parish	1.0	128	12,835	43%

C. Accessibility/Distribution

1. The problem with supply of dentists in Louisiana is one of distribution, which is much the same problem as is seen with primary care physicians. Louisiana's manpower goals for dentists should then focus on making dental health care more accessible to residents of rural North Louisiana parishes, possibly through establishment of part-time clinics, mobile screening programs and other innovative ways in which dental services can be provided most cost effectively to poor, rural populations. Another goal for dental manpower is in increased accessibility of dental services to residents of poor central city areas of Baton Rouge and New Orleans.

2. In alleviating problems with dental health care accessibility, attention should also be given to programs which provide low cost or subsidized services to low-income citizens. At present only children under the age of 21 are eligible for Medicaid-reimbursable general dental services. The only subsidized dental services available to adults are the Medicaid denture program (partial or complete dentures for appropriately-referred Medicaid eligibles) and treatment provided through the L. S. U. School of Dentistry in New Orleans.

3. The inability of people at poverty level incomes to pay for preventive and maintenance dental services is a factor which influences the distribution of dentists. Dentists will probably continue to find it difficult to maintain a profitable practice limited strictly to one setting in a poor rural area. It is for this reason that it is recognized that minimizing the problems of dental service inaccessibility will have to include the development of special methods of service delivery and will require commitment on the part of the state and/or federal government to support initiatives in this area.

D. Resource Renewal. Available data indicates that the growth of the number of dentists in Louisiana is fairly consistent with population, though not growing as fast as in the United States as a whole. Between 1975 and 1979, the number of active dentists in Louisiana increased 7.4 percent; in the United States the growth rate was 9.3 percent. Louisiana's population increased 15.3 percent during the decade between 1970-80, or an average of 6.1 percent for the four year period between 1975-79. It would appear then that the number of dentists entering active practice each year is sufficient to meet the needs of the state's population.

E. Resource Goals

1. Increased accessibility of dentists in all designated manpower shortage areas, particularly through the development of innovative and cost effective means of delivering services to residents of sparsely populated areas.

2. Increased accessibility of dental services through initiatives designed to reduce consumer costs, especially for low-income citizens.

F. Louisiana Dental Association-Manpower Planning Survey

1. In 1981, the Louisiana Dental Association commissioned the Division of Business and Economic Research, University of New Orleans to examine the workload and busyness of dentists by major types of practice (general practitioners and specialists) and geographical regions. The findings from the study were to be used to provide guidance to manpower planning for dentists in Louisiana during the decade of the 1980's.

2. The findings suggest that there is an excess of general practitioners and specialists relative to effective demand. Specialists tend to be less busy than general practitioners. As for general practitioners, there were geographical differences in workload measures, excess capacity and perception of busyness. Information gaps were found in the attempt to gather data from the files of the Louisiana Dental Association. It was recommended that a systematic means of gathering and maintaining profile data, workload data, etc., concerning Louisiana-based dentists be installed. In order to do a proper job of manpower planning, an improved data base is needed.

3. The conclusions from the survey have been summarized as follows:

a. General Practitioners

i. There is an excess of general practitioners relative to effective demand.

ii. General practitioners in Louisiana tend to have a lower workload and are less busy than dentists in the West South Central Region of the U.S. and the U.S. in general.

iii. Urban general practitioners are no more or no less busy than rural general practitioners.

iv. Younger and less-experienced general practitioners are less busy than experienced dentists, especially those in mid-career. This may be explained by one or more of the following reasons:

(a). an excessive supply of dentists;

(b). low consumer demand; or

(c). the problem of getting a practice started up and established.

v. There are geographical differences in workload measures, excess capacity, and perception of busyness within the state.

b. Specialists

i. There is an excess of specialists relative to effective demand.

ii. Specialists in Louisiana tend to have a lower workload and are less busy than dentists in the West South Central Region and the U.S. in general.

iii. There is no difference in the business of rural versus urban specialists.

iv. An examination of workload and capacity factors and perception of busyness show the findings to be mixed. In general, it seems that younger specialists may be somewhat busier than older, more experienced specialists. On the other hand, younger specialists felt they could handle a larger patient load.

v. Specialists tend to be less busy, in their perception, than general practitioners. Basically, specialists feel that they can handle more patients.

c. Other Comments

i. There is a need for an improved system of collecting profile and other data concerning Louisiana dentists. For example, in addition to profile data, information such as that collected in the UNO study or the ADA survey could be collected every two years.

ii. The LDA should investigate the need for an effective education and promotion program directed toward consumers to raise effective demand.

La. Admin. Code tit. 48, § I-11905

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P. L. 96-79, and R.S. 36:256(b).