© copyright the regents of the university of california the nicholas c. petris center on health...

© Copyright The Regents of The University of California

The Nicholas C. Petris Centeron Health Care Markets & Consumer Welfare

University of California, Berkeley

An Economic Analysis of the Labor Market for Dental

Hygienists and Dental Assistants in California: 1997-2005

Timothy T. Brown, Ph.D.

Tracy L. Finlayson, Ph.D.

Richard M. Scheffler, Ph.D.

Acknowledgements



This study was jointly funded by the California Dental Association Foundation and the UC Berkeley Petris Center.

The CDAF commissioned reports from the Petris Center and UCLA Center for Health Policy Research to answer the question: Is there a shortage of dental hygienists and assistants in California?

Executive Summary and final reports can be found online at: http://cdafoundation.org/study/index.htm

And on our webpage: www.petris.org

Article also forthcoming in the Journal of the American Dental Association

http://cdafoundation.org/study/index.htm




http://www.petris.org/

Perceived Shortages



1999 ADA Workforce Needs Assessment Survey

2/3 private dentists nationwide thought there were shortages of Registered Dental Hygienists (RDH) and Dental Assistants (DA) in their areas

Main Reason: Lack of training programs and grads



Evidence from CaliforniaEconomic Labor Market Framework study to compare labor markets and

outcomes for RDHs and DAs

Economic Framework

• Economic demand = refers to the amount of RDH/ DA services that dentists are able and willing to pay for at any given wage rate.

• Economic supply = refers to the amount of services that RDHs/DAs are willing to provide to dentists at any given wage rate.



What is a labor shortage?



• Labor Shortage = shortages occur in a market economy when the demand for workers for a particular occupation is greater than the supply of workers who are qualified, available, and willing to do that job at a given market wage

- U.S. Department of LaborBureau of Labor Statistics (BLS),

2005

How do we measure a labor shortage?



• Supply and demand for workers can change over time and affect whether or not there is a labor shortage

• Various market scenarios:– Shortage: Supply < Demand (rising wages) – Equilibrium: Supply = Demand (stable wages)– Surplus: Supply > Demand (declining wages)

DATA SOURCES• Occupational Employment Statistics (OES) Survey data

number of workers, average wages from 1997 – 2005

• Committee on Dental Auxiliaries (COMDA) data on hygiene candidates passing licensing exam

• California Health Interview Survey (CHIS) and CA Behavioral Risk Factor Surveillance Survey (BRFSS) insurance and dental visit data

• State Health Expenditure Account data from CMS

• Census population data for California

• Wage data adjusted for inflation using the 2005 BLS Consumer Price Index (CPI; U.S. City Average, All Items)



Average Inflation-Adjusted Hourly Wages

39.5139.91

43.7444.89

42.54

34.46

31.0131.5731.00

15.3815.6916.48

16.8517.1816.6915.7115.4415.09

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Wag

es in

200

5 D

olla

rs

Dental Hygienists

Dental Assistants

Shortage?



RDHs:

1999 = beginning of a clear rise in average inflation- adjusted wages, indicative of a labor shortage

2002 = wages peaked at 48% above 1999 levels

2003 - 2005 = leveled off, higher than in 1997

DAs:

Increase in wages by 13.9% between 1997 and peak in 2001, indicative of a labor shortage

Percent of Adults in California with a Dental Visit in the Last Year

70.466.868.469.468.267.0

65.263.364.966.5

0

10

20

30

40

50

60

70

80

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Per

cen

t

Demand for Dental Care



• Increasing percent of adults with an annual dental visit from 1999 – 2004.~4.6 million more adults receiving dental care.

• Dental insurance coverage increased 21.7% among adults from 1995 – 2001.

• Dental expenditures increased 18.6% (inflation adjusted) between 1995 – 2000.

Demand-side factors



• Increase in demand for dental services appeared to be driving the labor shortages

• Increased service demand would be expected to increase demand of dentists for RDHs and DAs

Number of Dental Hygienists and

Assistants in CA per 100,000 Population.

108.95

105.49107.06

122.88

115.06116.62

103.9599.11

95.99

52.43 52.1355.09

58.1254.44

50.77 47.7152.5453.32

0

20

40

60

80

100

120

140

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Nu

mb

er

pe

r 1

00

,00

0 p

op

ula

tio

n

Dental assistants

Dental hygienists

Supply-side factors



RDHs• Number per population is fairly constant

throughout this time period

DAs• Number per population increased, by 28%

from 1997 until the peak in 2003 • Strong supply response

1.781.72 1.73

1.95

2.22 2.23

2.34

2.20

2.041.99

0.00

0.50

1.00

1.50

2.00

2.50

1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05

Year

Can

did

ates

Pas

sin

g p

er 1

00,0

00 P

op

ula

tio

nCandidates Passing the CA Hygienist Licensing Exam per 100,000 population.

Hygienists in CA per 100,000 population

58.12

54.44

50.7747.71

52.5453.32

55.0952.1352.43

1.992.042.202.342.232.221.951.731.721.78

0

10

20

30

40

50

60

70

1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05

Year

Nu

mb

er p

er 1

00,0

00 p

op

ula

tio

n

RDH per pop

RDH candidates passing exam perpop

New RDH Supply



• A clear increase in the number of RDH candidates per population passing the licensing examination in California

• However, growth in the number of new RDHs was not enough to keep up with the faster growth in demand for services. New RDHs added to the labor force too small to make much of a difference in the wages.

Differences in supply responses

• Different training requirements for RDHs and DAs: – time requirement

– intensity of program

– number of training slots

• RDH supply is more constrained than for DAs



RESULTS – Shortage?



• From 1999-2002, RDH’s wages increased 48% then stabilized, indicating a fairly severe shortage had occurred, which the market resolved through higher wages.

• Wages for DAs increased 13.9% between 1997-2001, but then declined from 2001 to 2005 indicating a shortage, which then became a surplus. This market may not have stabilized yet.

CONCLUSIONS

• Economic framework is useful for monitoring trends in the supply and demand in the dental workforce

• Labor market responses to the shortages of RDHs and DAs were different – wage increases for both, but large supply response in the market for DAs brought wages back down

The Nicholas C. Petris Center

on Health Care Markets & Consumer Welfare


IMPLICATIONS



• Regular economic analysis could be helpful in determining and responding to labor market shortages or surpluses at local, state, and national levels

• Relevant for policy planning, making training capacity decisions, and assessing workforce needs

Economic Surplus in a Labor Market

Q Q

W WS1

S2

D11

q1 q2

w1

w2

w1

w2

q2 q1

D11

D21

S1

A A

Surplus – increase in supply

(a)

Surplus – decrease in demand

(b)

D = demand, S = supply, W = wages, Q = quantity, A = initial equilibrium

Economic Shortage in a Labor Market

Q Q

W WS2

S1

D11

q2 q1

w2

w1

w2

w1

q1 q2

D2

D11

S1

Shortage – decrease in supply

(a)

Shortage – increase in demand

(b)

D = demand, S = supply, W = wages, Q = quantity

THANK YOU

For further information, please visit www.petris.org

http://www.petris.org/

© copyright the regents of the university of california the nicholas c. petris center on health...

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