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To Teach – If Not Now, When?

Posted in Education | September 26, 2023

By Bradley H. Gettleman, DDS, MS; Susan B. Paurazas, DDS, MS; and Colten Frost, BS

There is a crisis in our field affecting both specialty dentists and dental students alike: the severe shortage of endodontists in education. Unfortunately, we are relying on general dentists to teach endodontics.  Endodontists are the diagnosticians of pulpal and periapical disease; unlike general dentists they have a full understanding of and experience with performing endodontic therapy. However, we lack them in our education system. This is not a new problem. Over 20 years ago a report by the American Association of Dental Schools found. “There are currently 55 U.S. dental schools, so there are approximately 6.3 openings per school.  They project further that in the next 10 years there will be 800 to 1200 unfilled, full-time positions and approximately 2000 part-time positions open.”1,2  Around the same time our association published: “Although the shortage of educators covers all of dentistry, 75% of vacancies are in specialty education.”3 Based on the narrative at AAE23 in Chicago this problem hasn’t improved over the past 2 decades, but has worsened.  According to the American Dental Education Association (ADEA) 2020/21 report, there has been a 78% increase in full-time and 118% increase in part-time faculty vacant positions since 2000/01.4

There are several factors leading to the shortage of endodontists in education. The top four reasons appear to be: low salaries, educational debt, not being their own boss, and lack of interest in research.2 What a shame it is that to get an endodontic education a person must go into so much debt and then can’t afford to teach endodontics.  Since general dentists are left with less debt, they are the ones teaching endodontics.  Ironically, another finding from the same study speaks to the interest that endodontists have in education: “93% of the respondents reported an interest in teaching on a part time basis, and of those, 51% were willing to teach 1.5 days/week, but only 16% were willing to teach more than 1.5 days/week.”2  Why is it that there is such a large interest in teaching, but such a lack of endodontic teachers?  Endodontists aren’t given the information and material necessary to be a part of endodontic education.  There seems to be the expectation that endodontists will seek open teaching positions.  The fact is that recruitment is vital to finding endodontic educators.  Endodontists might have confidence in their clinical skills but believe they lack the skills required to teach.  Most endodontists are already extremely busy; therefore, chances are slim that they are going to seek teaching opportunities on their own.

Another concern is the fact that dental schools have an aging faculty.  The data from 2015-16 indicate that over 40% of faculty at academic dental institutions are over 60 years of age.5   The average age of retirement is increasing due to the rising amount of educational debt.  It is estimated that Americans over the age of 50 have 20% of student debt.6 This changes the demographics of those retiring.  Traditionally endodontists sought faculty positions after retiring from private practice, however that option may be delayed due to the rising cost of dental education.  The debt income ratio is rising more in dentistry than in other health professions.  From 2010 – 2016 dentists had the largest increase in debt compared to physicians and other healthcare professionals.7

The American Dental Education Association (ADEA) is taking an active approach to addressing this problem.  ADEA is helping its member institutions address this issue by promoting awareness among predoctoral, allied dental student, advanced education residents, and their fellows regarding the importance of academic careers.5 This should also help with the mentoring, or lack thereof, for both those entering academia and students alike.  The deficiency in mentoring could lead to dental students lacking the confidence and clinical skills when performing endodontic therapy.  Many graduate dental schools only having done a minimal number of root canals and not having any form of endodontic mentor.  With a decrease in the number of experienced educators there will subsequently be a decrease in the mentoring needed to help young educators.  This is not good for the future of endodontic education.  Mentoring in education is not only necessary in the development of quality educators but also in helping them with their career advancement and individual success.  How do we increase the quantity of qualified mentors for current and upcoming dental students?  We need to retain existing faculty.  Some ideas which have been mentioned are increase salary or allow for external practice time built into the schedule and demonstrating his/her importance to the teaching community by giving them opportunities to increase their salaries.8,9 Periodic recognition for achievements and opportunities for promotion were also suggested.8,9 So how often are dental education careers discussed in dental school?  Sadly, in conversations with many dental students from various dental schools, we’ve heard multiple times: “not once have I heard any instructor discuss opportunities for careers in education since I started dental school”10 In a report from the American Dental Education Association, in 2019 only 0.9% of new dental school graduates selected an academic position as a primary form of employment.11

This problem is not limited to endodontics or even dentistry. There are many other medical professions exhibiting this same issue.  Nursing has worked on specific strategies to recruit, retain, and develop faculty.  They have established mentoring programs which have been successful.  Mentoring programs tailored to experienced providers who enter academia have been successful in nursing education, enhancing the transition to academia and assisting faculty in developing relationships and knowledge of role, rules, and procedures.12 

One would hope that dental schools are putting in the much-needed time to recruit full-time endodontic educators, but it appears that this is not the case.  A survey was performed asking full-time endodontic educators the following questions: 1. “Have you or your school used any unique or creative approaches to attract an individual to a full or part-time endodontic teaching position? Yes – 13% and No – 87%. 2. As an Endodontic educator, were you recruited by an innovative approach? Yes – 7% and No – 93%. 3. Have you or your school used any unique approaches to help ensure retention of existing endodontic faculty? Yes – 12% and No – 88%.”8,9  See the crisis?  There is a substantial amount of room for growth.  Where do we begin?

Some of the ideas that have been previously mentioned are: develop methods to reduce or forgive educational debt, develop more positions for part-time faculty, make educational careers more attractive to women, encourage mentors to emphasize the benefits of educational careers.2 The reason they mentioned making education more attractive to women was because their survey found that women had more interest in teaching than did men.2 Although women constitute approximately 50% of dental graduates, women made up only 36.2% of dental school faculty.11  Data also showed an increase in female faculty in all age categories from 2017 to 2018.  The percentage of female dental graduates in 2020 was 51.4%, however the percentage of female endodontic residents was 41.5%.  Underrepresented minority residents consisted of 8.6%.13

In addition, implementing a recruitment program in schools would help reach the endodontists that may not see a benefit in teaching. Most endodontists work a maximum of 4 days a week.  Through recruitment, endodontists would receive the material and direction necessary to be passionate endodontic mentors that students need to reach their greatest potential as specialty dentists before diagnosing and performing root canals on patients.  Having a work-life balance is increasingly becoming a priority.  Academic careers can provide such benefits with innovative flexible strategies related to scheduling, redefining what is considered full-time academics, and restructuring tenure track timelines to accommodate work-life balance issues.

Two more questions to consider: Who’s doing all the root canals? What is a teacher?

Who’s doing all the root canals? Surveys have shown the 84% of general dentists perform endodontic therapy.14 In 2007, general practitioners were reported to perform 68% of the root canal treatments in the United States.15 Therefore, the importance of having well trained endodontists teaching pre-doctoral students cannot be understated.

What is a teacher?  A person who helps students to acquire knowledge, competence, or virtue, via the practice of teaching.16   There’s no question that being an educator is an extremely rewarding profession.  While the financial rewards may not be able to compete with that of private practice, there are many other extremely rewarding aspects.  Some of these include but are not limited to: making a positive impact on society, shaping your own work environment, appreciation from former students, high job security, appropriate work-life balance, watching your students succeed, develop lasting relationships, and you receive respect.17  One practitioner, of over 31 years, stated that when he finally transitioned to academia he actually had a lunch hour.  Many private practitioners work through lunch seeing emergency patients.  You also get paid vacation and sick time, that certainly doesn’t happen when you’re running your own practice.

Time to answer our very first question which we used as the title for this article.  The answer is, NOW! That would be best for our patients, general practitioners’ patients, and the preservation of our specialty.  To quote Dr. John Olmsted in his President’s Message from August of 2006 titled: To Teach or Not to Teach? As “doctors”, we must all teach; whether it be full-time academics, part-time, or in a voluntary capacity.  “To teach…that is the answer!”18

References

  1. Report of the 77th Annual Session of the American Association of Dental Schools, April 1-5, 2000.
  2. McNally MA, Dunning DG, Lange BM, Gound TG. A Survey of Endodontic Residents’ Attitudes About a Career in Dental Education. J Endod 28: 592 – 594. 2002.
  3. Foundation focus. Publication of the American Association of Endodontists Foundation. Vol VI. Chicago: January 2001.
  4. Association ADE. Surveys of current vacant budgeted faculty positions, 2000-01 to 2010-11; Faculty salary surveys, 2011-12 to 2018-19; and 2020-21 ADEA vacant and lost faculty positions inventory 2020 (cited 2022).
  5. American Dental Education Association (ADEA), Policy Brief October 2018.
  6. Ferguson RW. Outside the Box: Opinion: soaring student debt is keeping people of all ages from a stable retirement. Here’s how to help. 2019.
  7. Chislom-Burns MA, Spivey CA, Stallworth S, Zivin JG. Analysis of Educational Debt and Income Among Pharmacists and Other Health Professionals. Am J Pharm Educ. Nov;83(9):7460. 2019.
  8. Glickman GN, Gluskin AH, Johnson WT, Lin J. The Crisis in Endodontic Education: Current Perspectives and Strategies for Change. J Endod 31: 255 – 261. 2005.
  9. The Steward Group Survey: The State of Endodontic Education. American Association of Endodontists, 2003.
  10. Personal communication with dental students from four different dental schools.
  11. American Dental Education Association. Snapshot of dental education 2019-20. American Dental Education Association.
  12. Feldman HR, Greenberg MJ, Jaffe-Ruiz M, Kaufman SR, Cignarale S. Hitting the Nursing Shortage Head On: Strategies to Recruit, Retain, and Develop Nursing Faculty. J Prof Nurs. 31: 170 – 178. 2015.
  13. American Dental Association, Health Policy Institute. Trends in Endodontic Education Programs in the U. S.
  14. Savani GM, Sabbah W, Sedgley CM, Whitten B. Current Trends in Endodontic Treatment by General Dental Practitioners: Report of a United States National Survey. J Endod 40: 618 – 624. 2014.
  15. American Dental Association. The 2005 – 6 Survey of Dental Services Rendered. Chicago: American Dental Association; 2007.
  16. https://en.wikipedia.org/wiki/Teacher
  17. Indeed Editorial Team. Indeed March 30, 2023.
  18. Olmsted JS. To Teach or Not to Teach. J Endod 32: 803. 2006.
Posted in Education