Michigan Department of Michigan Department of Community HealthCommunity Health

Bureau of Health ProfessionsBureau of Health ProfessionsPreventionPreventionRegulatoryRegulatoryDisciplinaryDisciplinaryWorkforce ExcellenceWorkforce Excellence

Health Licensing DivisionHealth Licensing Division

26 Licensed Health Professions26 Licensed Health Professions

Over 400,000 Health Care ProfessionalsOver 400,000 Health Care Professionals

19,713 Dentistry Licenses Granted (7,637 19,713 Dentistry Licenses Granted (7,637 Dentists; 9,623 Dental Hygienists; 1,263 Dentists; 9,623 Dental Hygienists; 1,263 Dental AssistantsDental Assistants

Health Regulatory DivisionHealth Regulatory Division

Receives Allegations of Misconduct from Receives Allegations of Misconduct from the public or health professionalsthe public or health professionals

3,121 Allegations of Misconduct in FY 3,121 Allegations of Misconduct in FY 20062006

27,859 Allegations 1994 through 200627,859 Allegations 1994 through 2006

Top Five in FY 2006:Top Five in FY 2006:

Negligence/Incompetence: 1080 (35%)Negligence/Incompetence: 1080 (35%)

Criminal Conviction: 345 (11%)Criminal Conviction: 345 (11%)

Substance Abuse: 291 (9%)Substance Abuse: 291 (9%)

Drug Diversion: 157 (5%)Drug Diversion: 157 (5%)

Continuing Education: 111 (4%)Continuing Education: 111 (4%)

Top Four Professions:Top Four Professions:

Nursing: 1,002/157,193 (.6%)Nursing: 1,002/157,193 (.6%)

Medicine: 828/33,528 (2.5%)Medicine: 828/33,528 (2.5%)

Dentistry: 254/19,713 (1.3%)Dentistry: 254/19,713 (1.3%)

Osteopathic: 239/7,001 (3.4%)Osteopathic: 239/7,001 (3.4%)

Health Investigation DivisionHealth Investigation Division

Investigates factual allegations that Investigates factual allegations that represent true violationsrepresent true violations

832 investigations authorized from 3,121 832 investigations authorized from 3,121 allegations in FY 2006 (27%)allegations in FY 2006 (27%)

519 disciplined health professionals (from 519 disciplined health professionals (from 832 investigations) in FY 2006832 investigations) in FY 2006

Top Four Disciplinary Actions Top Four Disciplinary Actions in FY 2006:in FY 2006:

Probation: 238 (46%)Probation: 238 (46%)

Suspended License: 205 (39%)Suspended License: 205 (39%)

Fine Imposed: 52 (10%)Fine Imposed: 52 (10%)

Voluntary Surrender: 27 (5%)Voluntary Surrender: 27 (5%)

Workforce Development, Research, Workforce Development, Research, & Evaluation Section (WDRE)& Evaluation Section (WDRE)

WDRE Section formed in August 2006WDRE Section formed in August 2006

WDRE staffs the Michigan Healthcare Workforce CenterWDRE staffs the Michigan Healthcare Workforce Center

MHWC major functions:MHWC major functions:Serves as a clearinghouse for workforce dataServes as a clearinghouse for workforce dataAdministers surveys to licensed health professionalsAdministers surveys to licensed health professionalsConvenes and/or participates with groups to address workforce Convenes and/or participates with groups to address workforce issuesissuesConducts research and publishes papers on workforce related Conducts research and publishes papers on workforce related issuesissues

(WDRE) Section (WDRE) Section (cont’d)(cont’d)

MDCH/MDE/MDLEG/MDHS/MHC/OCNE Serve MDCH/MDE/MDLEG/MDHS/MHC/OCNE Serve as Advisory Body to MHWCas Advisory Body to MHWC

Professional Licensee Workforce Surveys Professional Licensee Workforce Surveys (Phys/Dental/Nurs/Pharm/PA)(Phys/Dental/Nurs/Pharm/PA)

Professional Scope of Practice/Corporate Professional Scope of Practice/Corporate Structure for Professional PracticeStructure for Professional Practice

Healthcare Information for Healthcare Information for Professionals and Health ConsumersProfessionals and Health Consumers

Two NewslettersTwo Newsletters

Six WebsitesSix Websites

Board Support: Over 1,600 Professional Board Support: Over 1,600 Professional Practice Inquiries from Professionals or the Practice Inquiries from Professionals or the public responded to annuallypublic responded to annually

Professional Practice Issues Professional Practice Issues Currently Being InvestigatedCurrently Being Investigated

Continuous Professional DevelopmentContinuous Professional Development

E-HealthE-Health

Pain & Symptom ManagementPain & Symptom Management

Sexual Boundary ViolationsSexual Boundary Violations

Patient SafetyPatient Safety

FY 2007 Dental Survey FindingsFY 2007 Dental Survey Findings

Two-page (21-22 questions) survey Two-page (21-22 questions) survey available online and through mailavailable online and through mailCollects demographic, employment, Collects demographic, employment, practice, and patient informationpractice, and patient informationOne-third of all Michigan dentists and One-third of all Michigan dentists and hygienists received the surveyhygienists received the survey697/2,777 renewing dentists (25%) and 697/2,777 renewing dentists (25%) and 2,062/3,433 renewing DYHGs (60%) 2,062/3,433 renewing DYHGs (60%) completed the surveycompleted the survey

FY 2007 Dental Survey Findings FY 2007 Dental Survey Findings (cont’d)(cont’d)

43% Dentists and 38% DHYGs plan to 43% Dentists and 38% DHYGs plan to work only one to ten more years work only one to ten more years (compared to nurses and physicians at (compared to nurses and physicians at 33% and 34% respectively)33% and 34% respectively)

7% of dentists plan to reduce patient care 7% of dentists plan to reduce patient care hours within three yearshours within three years

FY 2007 Dental Survey Findings FY 2007 Dental Survey Findings (cont’d)(cont’d)

7% of dentists plan to retire in the next three 7% of dentists plan to retire in the next three yearsyears

80% of dentists who plan to retire or reduce 80% of dentists who plan to retire or reduce patient hours cite age as a factor in their patient hours cite age as a factor in their decision.decision.

37% of dentists are 55 years of age or older37% of dentists are 55 years of age or older

81% of dentists are male; 99% of DHYGs are 81% of dentists are male; 99% of DHYGs are femalefemale

FY 2007 Dental Survey Findings FY 2007 Dental Survey Findings (cont’d)(cont’d)

85% of dentists and 95% of DHYGs are white85% of dentists and 95% of DHYGs are white64% of dentists report seeing no Medicaid or 64% of dentists report seeing no Medicaid or MIChild children in a typical month. Only 1% of MIChild children in a typical month. Only 1% of dentists report seeing an average of 250 or more dentists report seeing an average of 250 or more of these patients each month.of these patients each month.86% of dentists report that none of their patients 86% of dentists report that none of their patients in a typical month are covered by Medicaid. in a typical month are covered by Medicaid. Only 1% report seeing an average of 60 or more Only 1% report seeing an average of 60 or more of these patients each month.of these patients each month.

FY 2007 Dental Survey Findings FY 2007 Dental Survey Findings (cont’d)(cont’d)

75% of dentists report seeing 20 or fewer 75% of dentists report seeing 20 or fewer uninsured children in a typical month. Only 1% uninsured children in a typical month. Only 1% report seeing an average of 300 or more of report seeing an average of 300 or more of these patients each month.these patients each month.75% of dentists report 30 or fewer uninsured 75% of dentists report 30 or fewer uninsured adults each month. Only 1% report seeing an adults each month. Only 1% report seeing an average of 500 or more of these patients each average of 500 or more of these patients each month.month.82% of dentists renewing their license in 82% of dentists renewing their license in Michigan attended a Michigan Dental School.Michigan attended a Michigan Dental School.

Findings of the FY 2007 Dental Findings of the FY 2007 Dental Surveys Reflect National Findings:Surveys Reflect National Findings:

The aging healthcare workforce is likely to result in a The aging healthcare workforce is likely to result in a worsening shortage of dental health care in Michigan.worsening shortage of dental health care in Michigan.Few Michigan dentist are seeing low income, uninsured Few Michigan dentist are seeing low income, uninsured or underinsured children and adults.or underinsured children and adults.Ethnic minorities are underrepresented among dental Ethnic minorities are underrepresented among dental health professionals.health professionals.There is a gender bias toward male dentists and female There is a gender bias toward male dentists and female dental hygienists.dental hygienists.The greatest predictor of what state a dentist practices in The greatest predictor of what state a dentist practices in is where s/he attended dental school.is where s/he attended dental school.

Michigan’s Shortage of Dental Care Michigan’s Shortage of Dental Care Compared to other Midwest States*Compared to other Midwest States*

State Total Pop Underserved Pop % Pop Underserved FTEs Needed

MI 10,120,860 1,120,860 11.1% 238.5

OH 11,464,042 741,658 6.5% 169.3

IL 12,763,371 1,419,912 11.1% 349.2

IN 6,271,973 134,651 2.1% 36.9

WI 5,536,201 398,060 7.2% 104.0

Target Ratio for Dental Care is:

1 FTE for every 5,000 people located in a geographic shortage area

1 FTE for every 4,000 low income population area (30% are at or below 250% Poverty)

Michigan Dental HPSA Severity Michigan Dental HPSA Severity Among 83 CountiesAmong 83 Counties

2 Full County Geographic HPSAs (2%)2 Full County Geographic HPSAs (2%)

54 Full County Population Group HPSAs 54 Full County Population Group HPSAs (66%)(66%)

9 Partial County Population Group HPSAs 9 Partial County Population Group HPSAs (11%)(11%)

65 Michigan HPSA Counties (79%)65 Michigan HPSA Counties (79%)

18 Non-HPSA Counties (21%)18 Non-HPSA Counties (21%)

Recruitment and Retention Tools in Recruitment and Retention Tools in Midwest StatesMidwest States

State School/Students in 2007 Current NHSC Placements SLRP Placements

MI 2 (184) 36 53 (total = 89)

OH 2 (190) 15 33 (total = 48)

IL 2 (118) 20 26 (total = 46)

IN 1 (101) 6 13 (total = 19)

WI 1 (80) 9 36 (total = 45)

Dental Recruitment & Retention Dental Recruitment & Retention Challenges/OpportunitiesChallenges/Opportunities

Weakness/Challenges:Weakness/Challenges: Low number of dentists serving Low number of dentists serving

uninsured/Medicaid populationuninsured/Medicaid population High percentage of at risk (High percentage of at risk (uninsureduninsured and and

Medicaid enrolledMedicaid enrolled) population) populationMichigan = 11% and 15.1%Michigan = 11% and 15.1%Ohio = 11.7% and 16.7%Ohio = 11.7% and 16.7%Illinois = 14% and 16.3%Illinois = 14% and 16.3%Indiana = 12.9% and 14.5%Indiana = 12.9% and 14.5%Wisconsin = 9.5% and 15.9%Wisconsin = 9.5% and 15.9%

Dental Recruitment & Retention Dental Recruitment & Retention ChallengesChallenges/Opportunities (cont’d)/Opportunities (cont’d)

Aging dental workforceAging dental workforce Poor Michigan economy (lure of states with better Poor Michigan economy (lure of states with better

weather & better economies)weather & better economies) Increased demand for dentists in other Midwest states Increased demand for dentists in other Midwest states

due to closure of 2 Chicago dental schoolsdue to closure of 2 Chicago dental schools Low Medicaid reimbursement ratesLow Medicaid reimbursement rates Michigan’s State Loan Repayment Program (SLRP) Michigan’s State Loan Repayment Program (SLRP)

places relatively few dentists in southeast Michigan.places relatively few dentists in southeast Michigan. There are only 3-6 dentist applicants to SLRP each There are only 3-6 dentist applicants to SLRP each

year.year.

Dental Recruitment & Retention Dental Recruitment & Retention Challenges/Opportunities (cont’d)Challenges/Opportunities (cont’d)Strengths/OpportunitiesStrengths/Opportunities Michigan’s beauty and low-cost housingMichigan’s beauty and low-cost housing High percentage of underserved provides opportunity High percentage of underserved provides opportunity

for new dentistsfor new dentists High percentage of underserved provides opportunity High percentage of underserved provides opportunity

for federal & state loan repayment reimbursement and for federal & state loan repayment reimbursement and scholarship opportunityscholarship opportunity

Michigan has the largest State Loan Repayment Michigan has the largest State Loan Repayment Program in the nationProgram in the nation

Michigan has a disproportionately larger share of Michigan has a disproportionately larger share of federal (NHSC) loan repayment recipientsfederal (NHSC) loan repayment recipients

Dental Recruitment & Retention Dental Recruitment & Retention Challenges/Challenges/OpportunitiesOpportunities (cont’d) (cont’d)

Michigan SLRP and NHSC could target Detroit and Michigan SLRP and NHSC could target Detroit and other metro areas for dental placementsother metro areas for dental placements

The SLRP and NHSC could be marketed to Michigan The SLRP and NHSC could be marketed to Michigan dental schoolsdental schools

Establish another Michigan dental school and Establish another Michigan dental school and increase admissions to current schoolsincrease admissions to current schools

Legislation for increased Medicaid reimbursement for Legislation for increased Medicaid reimbursement for practicing in a dental HPSApracticing in a dental HPSA

Develop and national Develop and national Practice in MichiganPractice in Michigan campaign campaign that targets or includes dental professionalsthat targets or includes dental professionals

Increase Medicaid reimbursement rates and reduce Increase Medicaid reimbursement rates and reduce reimbursement processing timereimbursement processing time

Healthcare Workforce Healthcare Workforce WebsitesWebsites

Michigan Healthcare Workforce Center Michigan Healthcare Workforce Center www.michigan.gov/mhwcwww.michigan.gov/mhwc

Michigan Health CareersMichigan Health Careerswww.michigan.gov/healthcareerswww.michigan.gov/healthcareers

Michigan Center for Health ProfessionsMichigan Center for Health Professionswww.mhc.orgwww.mhc.org

Michigan Center for NursingMichigan Center for Nursingwww.michigancenterfornursing.orgwww.michigancenterfornursing.org

Pain and Symptom ManagementPain and Symptom Managementwww.michigan.gov/pmwww.michigan.gov/pm

Patient SafetyPatient Safetywww.michigan.gov/pswww.michigan.gov/ps

Bureau of Health Bureau of Health ProfessionsProfessions

Steven Creamer, ManagerSteven Creamer, ManagerWorkforce Development, Research, and Evaluation Workforce Development, Research, and Evaluation

SectionSection517-335-3294517-335-3294

creamers1@michigan.govcreamers1@michigan.gov