TESTIMONY OF THE AMERICAN DENTAL ASSOCIATION TO THE SUBCOMMITTEE ON HEALTH COMMITTEE ON VETERANS'AFFAIRS UNITED STATES HOUSE OF REPRESENTATIVES ON VETERANS HEALTH CARE WORKFORCE SUBMITTED BY DR. ROBERT M. ANDERTON APRIL 12,2000 On behalf of the American Dental Association (ADA), thank you Mr. Chairman for the opportunity to testify on the status of recruitment, retention, and compensation of dentists in the Department of Veterans Affairs. I am Dr. Robert M. Anderton, President-elect of the ADA and a practicing dentist in Carrollton, Texas. The ADA is a professional organization that represents 144,000 licensed dentists (73% of the profession) in the United States. The ADA seeks to advance the art and science of dentistry, and to promote high-quality dental care and the oral health care of the public. Over the years, the ADA has maintained a close liaison with the federal dental services, which include all three Service branches, the U.S. Public Health Service (PHS), and the Department of Veterans Affairs (VA). Just yesterday, the Association testified on behalf of the Indian Health Service's Fiscal Year 2001 appropriations, seeking improved oral health services for the American Indian and Alaska Native communities. The Association is proud to represent the needs of our nation's federal dental officers. Mr. Chairman, I am here today to address two areas of concern for VA dentistry:
Oral Health Needs of Veterans As you know, Mr. Chairman, outpatient dental benefits are provided by the VA pursuant to law. In some instances this dental care can be extensive, while in other cases treatment may be limited. Veterans are eligible for dental treatment if they meet one of the following criteria:
For those veterans who are eligible for dental care, I am certain the VA is committed to providing comprehensive health care and that oral health care is an essential component of those comprehensive services. However, difficulty in retaining and attracting dentists to the VA have made keeping this commitment to oral health care tenuous. While oral health care is urgently needed in its own right, in some instances the failure to adequately treat oral disease can also complicate the patient's medical condition and compromise effective medical treatment. That is why it is so important to eliminate infections in the mouth prior to surgery, chemotherapy or radiation treatment. Regular dental care is also important because dental exams can provide advance warnings of the onset and progression of numerous systemic diseases manifested in the mouth. For instance, studies suggest a link between the presence and severity of periodontal disease and risk of coronary heart disease and stroke. Gum problems, or periodontal diseases, occur when mouth bacteria grow unchecked, causing swelling, bleeding and bone loss around teeth. For years, we have known that people with diabetes are more likely to have periodontal disease than people without diabetes. Recently, research has suggested that periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. In a study by the National Institute of Dental and Craniofacial Research (NIDCR), dental researchers learned that by controlling a diabetic's periodontal disease, the overall diabetic condition of the patient improved. So you see, Mr. Chairman, there may be a direct link between veterans' oral health and their overall general medical health. To ignore the patient's oral health status is to invite more serious medical illness in an already aging and sicker patient population. Of course, access to dental services is important to remedy dental disease as well, some of it potentially life threatening. The Veterans Affairs Medical Center (VAMC) in Togus, Maine was downsized from five to three dentists in 1992 at which time routine oral exams, given to veterans as part of their incoming physicals, were phased out. This occurred despite that fact that for the preceding five years, dentists at the Togus VAMC found an unusually high number of oral cancers in veterans during those routine exams. Only after the veteran community complained did the Togus VAMC add another dentist. The facility once again provides oral exams. To address the oral health needs of VA patients in hospitals, the demand for dentists has increased in the area of providing needed consultations with their medical colleagues. For example, in 1989, VA dental services received over 95,000 consultation requests from other hospital services. By 1998, this number increased to over 104,000, a ten percent increase. With the demand for more hospital-based consultations, it appears to be counter intuitive that over the last three years 18 fewer VA hospitals have an oral surgeon on staff. Oral Health Care Services for VA Patients The number of VA patients receiving dental care is decreasing at the same time the number of total VA patients has increased. As discussed above, given the demand for dental services and oral health needs of the VA patient population, this trend presents a troubling picture. In 1997, the VA system treated over 3.1 million patients of whom 330,000 were dental patients, or roughly 10.5 percent. By 1999, the total number of VA patients treated grew to 3.4 million, while the number of dental patients fell to 318,000, or 9 percent. Significantly, the overall amount of dental services provided is declining at an alarming rate not only because of the fact that fewer dental patients are being treated, but also because the average amount of dental treatment provided per patient is also declining. And this is occurring in an environment in which the need for dental services is high due to an aging population. A recent study of patients in VA Hospital Based Home Care (HBHC) Programs indicates the following:
These statistics are alarming and indicate that most veterans in HBHC programs have oral health care needs that could affect their health and quality of life. When combined with the previous numbers indicating declining dental care for eligible veterans, these statistics become even more alarming. Recruiting and Retention of VA dentists The Association believes the primary reason for the reduction in dental care for eligible veterans is the shortage of VA dentists. In 1989 there were 850 full-time dentists working at VA dental clinics. By 1999, that number had fallen to 654 dentists, a 23 percent decrease. This occurred, as stated above, in an environment in which the oral health needs of the VA patients and the demands for more dental services increased. Unfortunately, the retention and recruitment numbers are projected to get even worse. Within the next three years, almost 70 percent of all VA dentists will be eligible for retirement. Recent statistics also show that those who resign from the VA system before they are eligible for retirement stay in the VA system for only 7.7 years. These are distressing statistics and require immediate attention by senior VA officials. The VA has become less competitive in recruiting and retaining full-time dentists because of inadequate financial incentives. The turnover rate during the past two years has been over 11 percent. An increasing number of young and mid-career dentists are leaving due to financial reasons. There are few highly qualified applicants applying to fill over 150 vacant, full-time positions and many vacancies take several months to fill. To help stem this tide of VA dental vacancies, the ADA is proud to support HR 2660, the "Put Your Money Where Your Mouth Is - The VA Dentists Equity Act" that calls for increases in tenure pay, full-time specialty pay, and responsibility pay for VA dentists. HR 2660 would amend Public Law 102-40 to increase tenure pay amounts to help retain VA dentists, raise the full time status component pay from $3500 to $9000 annually, and increase responsibility pay for VA dentists in management positions to mirror the same range of responsibility pay for physicians. Tenure Pay Section 7439 of Public Law 102-40 (The Department of Veterans Affairs Health Care Personnel Act of 1991) states: "it is the policy of Congress to ensure that the levels of total pay for physicians and dentists of the Veterans Health Administration are fixed at levels reasonably comparable-- (1) with the levels of total pay of physicians and dentists employed by or serving in other departments and agencies of the Federal Government; and (2) with the income of non-Federal physicians and dentists for the performance of services of physicians and dentists." Mr. Chairman, in recent years Congress has authorized additional pays for the Department of Defense (DoD) and PHS in the form of a $30,000 accession bonus, increased specialty pay up to $15,000, and multi-year contracts ranging from $4,000 to $14,000 in an effort to assist those departments' efforts to recruit and retain dental officers. These efforts are proving to be successful for DoD and the PHS. These additional pays are needed as incentives to attract new dentists to work for the federal services as opposed to entering private practice. Recent studies have shown that independent private practice general dentists earn over $133,400 and specialists earn over $197,000. Given that education debt can amount to well over $80,000 for a new dentist, it is critical that the VA, DoD, and the PHS be provided these financial incentive tools to attract and retain dentists to serve their respective populations. HR 2660 would increase tenure pay for VA dentists based upon their length of service as demonstrated by the following table:
2 years but less than 4 years $4,000 $6,000 4 years but less than 8 years $6,000 $12,000 8 years but less than 12 years $12,000 $18,000 12 years or more $12,000 $25,000 As previously stated dentists who leave the VA system without retiring do so after 7.7 years. These tenure pay increases would help ensure that mid-grade dentists continue their VA service. Full Time Pay Since the implementation of the incentive pay program for physicians and dentists as a result of Public Law 102-40 in 1991, most VA dentists have experienced a steady decline in their income as compared to other dentists in the federal and private sectors. Under Public Law 102-40, the "full time status" component of special pay for physicians and dentists were established as $9,000 for physicians and $3,500 for dentists. Because VA dentists have been denied the opportunity to receive locality pay, many dentists currently receive less pay than Title 5 civilians who are employed at the same GS pay grades. For example, when the current incentive pay plan was implemented in 1991, a VA staff dentist in Houston, Texas with 20 years of federal service received $7,500 more than their Title 5 counterparts. That difference has been eroded over time and VA dentists now receive over $5,000 less than their Title 5 counterpart. Congress implemented the incentive pay plan to help the VA remain competitive in recruiting and retaining a viable dental staff. This proposal would help to address the inequity caused by that fact that VA dentists do not receive locality pay and it would be instrumental in providing high quality dental care for our nation's veterans. Responsibility Pay The 1994 Department of Veterans' Affairs Quadrennial Report was submitted in accordance with Section 7439 of Public Law 102-40 (38 U.S.C. 7439). A VHA task force reviewed the findings of the report and recommended that the VA develop a legislative proposal to amend Public Law 102-40. The Report stated that the Assistant Chief Medical Director of Dentistry, dental directors, dentists serving as chiefs of staff, and dentists who are clinical service chiefs receive the same range of responsibility pay as currently authorized for physicians serving in similar positions. The Under Secretary of Health and the Secretary for the Department of Veterans Affairs concurred with this recommendation. Responsibility pay for dentists is several thousand dollars less than the amounts paid to their physician counterparts in similar positions. The lack of financial incentive for dentists to seek service chief positions and the recent resignations of several dental service chiefs, who linked their resignations directly to the lack of adequate compensation, have hindered recruitment. Conclusion Mr. Chairman, the ADA believes that good oral healthcare is an essential component of comprehensive health care. Failing to adequately treat oral disease can complicate the medical condition of the veteran population. As we have shown, fewer veterans are receiving needed dental care each year. This is a dangerous trend and must be addressed by senior VA health officials. The ADA recognizes the multitude of funding priorities Congress must reconcile this year but believes that the financial incentives detailed in this statement are urgently needed to recruit and retain an adequate supply of VA dentists who are vital to ensure the oral health of America's veterans. The ADA strongly urges this Committee to give serious consideration to our proposals. Back to Witness List |