A lasting impact from COVID-19: Managing with less support

With the easing of COVID-19 travel restrictions, my wife and I decided to meet our daughters in Colorado for a spring ski vacation. Thanks to workforce contraction during the pandemic, merely getting started on our trip proved to be an adventure. Our early morning cab ride failed to materialize. When we called to see if they were on the way, the dispatcher stated there weren't any drivers available for our scheduled pick-up. Hurriedly, we drove ourselves to the airport, parked in the long-term lot and rushed to board the plane. Once in our seats, the pilot announced a delay in our departure because the airport only had sufficient personnel to load bags onto one aircraft at a time, and our flight was fourth in line. A wry smile came across my face, oddly worker shortages for something as essential as air travel validated that I was not alone. Employers throughout our economy are struggling to fill job vacancies.

Like the airline, dentistry is struggling to manage with less support. The exodus of workers during the "Great Resignation" is due, in part, to worker stress, opportunities for more significant compensation, and a desire for work-life balance. Additionally, the pressures of COVID-19 protocols and perceived risks from working in our environment caused some to reconsider a career in health care.

Even before COVID-19, dentistry was experiencing a shortage of licensed, expanded function registered dental assistants. That reality has spread to registered dental hygienists and business staff over the past two years. With a diminished supply, those seeking employment find themselves in a bidding war for their services, creating inflationary pressures on practice management. The growth of dental support organizations, backed by venture capital, accelerates these trends. These large group practices are well positioned to offer higher wages to attract workers, and thus the available employee pool is constricting for traditional standalone practices.

To address workforce shortages, several state dental societies have banded together to urge the Commission on Dental Accreditation to ease accreditation standards for training programs, but it is not clear how this will fill the pipeline of available employees. Moreover, relaxing training requirements may risk patient safety when care is delegated to someone who isn't fully educated to provide the service. Workflow in a busy practice may slow, but if appropriately educated team members are not available for delegation, the care should be delivered by the dentist.

There is a small pool of fully trained individuals who could be a source of relief. State dental boards should investigate the possibility for rule changes to facilitate the return to practice of retired assistants and hygienists whose licenses have expired. Cumbersome relicensure requirements are a barrier for otherwise qualified individuals re-entering the workforce. In Michigan, oral health care providers must retake the exam if their license has expired for three or more years. Allowing these individuals to return to practice under direct supervision, with specified continuing education requirements, may provide a limited increase of available employees. Such a rule change would not be an immediate fix and will likely take time to achieve through the regulatory process.

Refilling the pool of prospective employees will require individual and collective advocacy by each of us. We must engage in grassroots legislative efforts for funding higher education. We must reach out to local allied dental education programs and urge them to expand their facilities and grow their class size, and we must recruit within our practices and social circles to encourage prospective students to seek education to join the dental team.
Without individual and collective action, COVID-19’s acceleration of workforce trends will create lasting change in patient care and dental practice administration. A lack of team members to accept delegation is a long-term change from the pandemic that will increase the need for hands-on delivery by dentists of preventive and diagnostic services.

Shortages of essential support staff will be a lasting impact on health care in a post-COVID-19 world. Employers across society are struggling to fill job vacancies. Without a quick fix, reducing barriers to employment and providing a competitive wage are long-term strategies to recruit and retain those who support us in the care of our patients.

A version of this editorial was printed in the May issue of the Journal of the Michigan Dental Association. Dr. Smiley is the editor of the publication.