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Introduction

Practice management and health law are among the most important aspects of running a dental practice; however, the majority of the dental schools don't emphasize these subjects when designing their curricula [1]. Fluctuations in the economy and dynamics in the financial market have had a major impact on dental practices and, thus, on dental education during the past decade. One such impact, among several, is the creation of business and practice management module/s which have become a vital part of dental curricula. Advancements in technology, high inflation, and rising cost of dental schools are some examples of why practice management and health law have become increasingly important aspects of running a dental practice.

Practice management is an essential ingredient of a successful practice and is of paramount importance for any business survival. Even for skillful practitioners, lack of practice management skills is a recipe for failure. Because dental education intends to produce competent graduates for the holistic patient care and integration of management skills into the curriculum, in some form, is important.

In 2015, the issues described above prompted the American Dental Association and the Council on Dental Practice to oversee the development of a series of practice management guidelines to assist dentists in understanding the implementation of business aspects to the practice of dentistry [1].

According to American Dental Education Association (ADEA), competencies for the new general dentist should include practice management and informatics. Considering this competency and, to improve practice management at the Arizona School of Dentistry & Oral Health, a pilot health law and practice management course has been created in partnership with the Summit Law School.

The objective of the current research is to determine the effect of a tailored pilot program focused on business and legal healthcare management and offered by the designated law school, for third and fourth year dental students. The evaluation indicates the importance of providing education in the advanced business management field for dental students prior to their graduation. The study assesses the importance of the pilot program as a supplement to existing curriculum at Arizona School of Dentistry & Oral Health (ASDOH).

Methods

The pilot program was offered to a total of 150 third and fourth year dental students and 16 of who volunteered to register for the program. Methods used for collecting data included both quantitative (survey) as well as qualitative (focus group interview) assessments. The survey instrument focused on determining if students perceived benefits from the pertinent information received through the pilot program and was sent to the participants. Survey questions were designed to explore the extent of learning of new material, support for developing material in area of need, and readiness of practitioners to start their own practice. The questions were also designed to investigate the confidence, career paths, overall knowledge and the management of dental practice amongst the participants. Focus group interviews were also conducted by small volunteer groups comprised of four to five students at a time led by a moderator. Focus group questions were designed to be open ended with sequence that went from general to specific with intention of using reflection to get the participants involvement. Questions were as general as "what do you think about the program" to as specific as "what did you like and/or disliked about the program".

All of participants who attended the program were asked to fill out an anonymous online SurveyMonkey provided to them at the end of their sessions. SurveyMonkey questionnaires were distributed after the pilot program was completed and the results were collected anonymously. Participants were also asked to volunteer to participate in a focus group to discuss the program.

Results

Ninety- six percent of the attendees participated in the focus group interview discussions. Eighty-four percent of the attendees returned completed questionnaires. Majority of respondents (92%) indicated that they were interested in opening their general dental practice sometimes following their graduation. As a result of the pilot program, more than 60 percent of the respondents felt better prepared to deal with practice management and legal issues; however, they lacked confidence to begin their own dental practice/business. Fifteen percent reported that even though they didn't feel completely prepared, they now are aware of their weaknesses and the areas in which they need to improve. The majority of respondents indicated that they were partially or not confident in their preparedness for managing a private practice on their own.

The open-ended question explored the insight on the pilot program and suggestion of the students, such as, "increased knowledge on practice management and help with enhancing their employability" (Table 1).

Discussion

After graduation, a new dentist is immediately faced with many challenging decisions, such as: knowing the best job offers, owning a practice, leading a team, employability, operating a successful business, and most importantly, providing the optimum level of oral health care to the patients. According to surveys from ADEA, dental students learn to diagnose and treat dental disease but spent relatively little time learning how to own and operate a small business [2]. The report says: more than 40 percent of graduating senior dental students report that the amount of time dedicated to preparing them for practice administration and understanding the organization and financing of health services was inadequate to prepare them for a career in dentistry. A majority of students desire a curriculum with focus on integration of general dental practice into practice management [3].

The challenge starts with the lack of an adequate amount of knowledge regarding the business of a dental practice. Due to challenges faced in traditional solo practices, the new trend is toward other practice options such as the group practice models [4]. The focus group interview also revealed that educational debt is influencing graduates to seek employment rather than own private practice immediately following the graduation. Regardless of their specific choice, new dentists do not have the luxury of waiting years to implement efficient business systems, as there is too much financial investment at stake [4].

While most of the curricular concentration in dental schools is placed on the development of clinical dental skills, students lack many skills that are necessary to be successful and efficient practice managers [1,5]. There is inadequate training in the practice management and it has been suggested that the dental school curriculum needs to address this topic as an important component of the curriculum [6].

Without proper preparation, many new dentists make poor business choices, with life-long consequences, because they are not well versed in the value and knowledge of good business (practice management) decisions [7].

Therefore, at ASDOH, a tailored Health pilot Law program has been developed and offered to the third and fourth year dental students, to help mitigate these deficiencies. The topics were as follows:

1. Leadership skills to be the best leaders, managers, and dentist to a team

2. Business Formation and Management

3. Business Plan Development

4. Risk Management, Including HIPAA and Malpractice Law

5. Interpreting and Negotiating Professional Instruments (Including Commercial Leases and Employment Contracts)

6. Asserting and Defending Intellectual Property Rights

7. Employment Law, Human Resources, and Staff Management

8. Emotional Intelligence and Conflict Management

9. Team Leadership, Relationship-Building, and Collaboration

10. Networking, Marketing, and Social Media, Including HIPAA Issues

By including the aforementioned topics mentioned in the pilot program, the importance of Inter-professional Education is addressed as well. The students reported that by providing Health-Law modules and modifications like this, they felt enhanced in their employability and widen their career choice.

Conclusion

Many practice management consultants argue that business management education, along with dental education, are essential parts of a successful practice in the current business world. However, for the students who have never owned a dental practice, the practice management information historically presented has been inadequate. The addition of more robust practice management content is paramount to the success of dental graduates. Most schools do an excellent job of preparing students clinically, but are remiss in providing business management training in the curriculum. This study showed that even though students were keen on increasing their knowledge of practice management in today's competitive work market, they still need more background and previous experience in order to identify the area in which they need most improvement. Even though, dental curricula should consider integration of more practice management skills, additional research is necessary to further demonstrate the need for the most appropriate practice management piece in dental school curriculum.

1. Soderlund K. House approves development of practice management guidelines. 2014.

2. Okwuji I, Anderson E, Volchovic R. Annual ADEA Survey of dental School Seniors:2009 graduating Class. J Dent Educ. 2010;74(9):1024-1045.

3. Henzi D, Davis E, Jasinevicius R, Hendricson W. "In the students' own words: what are the strengths and weaknesses of the dental school curriculum?" J Dent Educ. 2007;71(5):632-645.

4. Levin RP. Practice options for new dentists. Journal of the American Dental Association 2010;141(8):1023-1024.

5. Gorter RC, Storm MK, te Brake JH, Kersten HW, Eijkman, MA. Outcome of career expectancies and early professional burnout among newly qualified dentists. Int Dent J. 2007;57(4):279-285.

6. Houlberg BJ. "Dental resident's perception of practice and patient management training during postgraduate education". J Dent Educ. 2008;72(6):643-652.

7. Van Dyk WA. In the beginning... Journal of the California Dental Association. 2007;35(2):123-125.

Table 1: Survey questionnaires (6= Exceeded, 1= Not at all)

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Effect of a Pilot Program in Business and Legal Healthcare Management Designed for Third and Fourth Year Dental Students

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