How North Carolina’s New Center on the Workforce for Health Can Contribute to Oral Health Improvements

Andy MacCracken

doi:10.18043/001c.125710

Introduction

We know North Carolina faces concerning workforce challenges in oral health, especially in rural communities where too many people lack access to basic dental care. The pandemic accelerated these disparities. In 2019, 74 counties were designated as dental health professional shortage areas.¹ Today that number sits at 97 counties.² While we have a strong sense of the seriousness of the issue, the report of a recent North Carolina Institute of Medicine (NCIOM) task force, Transforming Oral Health Care in North Carolina, elevates the need for improved data infrastructure and coordination to thoughtfully deploy limited resources and build long-term momentum.³

The North Carolina Center on the Workforce for Health (the Center), a relatively new initiative, is positioned to collaboratively tackle current challenges and prepare for the future. Strategy 16 of the NCIOM report envisions the Center:

Seeking funding to lead a collaborative e_ort to develop, deploy, monitor, and assess efforts to address oral health workforce issues.
Collaborating with the North Carolina Dental Society (NCDS), NC Medicaid, the North Carolina Office of Rural Health (NC OHR), and the North Carolina Department of Health and Human Services (NCDHHS) Division of Public Health (DPH) Oral Health Section to develop and deploy an education strategy to increase awareness of oral health workforce challenges among the general assembly; local, state, and federal elected officials; economic development officials; and the public.
Providing data on the diversity of the current and projected workforce and convene oral health professionals, along with professionals from other sectors, to identify innovative and evidence-based strategies for retention.

This article provides background on the Center and how its work can contribute to improvements in oral health in North Carolina, including by helping to ensure an adequate oral health workforce to appropriately meet the dental care needs of all our state’s residents.

Building Infrastructure for Sustained Action The North Carolina Center on the Workforce for Health is a statewide organization that grew out of a partnership among North Carolina Area Health Education Centers (NC AHEC), the NCIOM, and the Cecil G. Sheps Center for Health Services Research’s Program on Health Workforce Research and Policy. The Center is focused on the collaborative and comprehensive development of the workforce needed for all in North Carolina to be healthy. The work of the Center revolves around a few critical observations:

The workforce shortages and maldistribution that we see today have existed for a long time, especially in rural communities, and the COVID-19 pandemic exacerbated those problems.
Well-intentioned efforts to address these issues have often been too siloed, fragmented, or underresourced to effectively address the interconnected ecosystem affected by these challenges.
Persistent collaboration across sectors, professions, settings, and geography is necessary to reflect the scale of the shared problems that need attention.

What has been missing in North Carolina is a place—a Center—where people and organizations can collaborate and be supported to address the challenges. The Center is designed to build on the best attributes of NC AHEC, NCIOM, and Sheps by convening stakeholders to leverage the best available data and information to catalyze and sustain local and statewide action. A broad group of more than 70 statewide organizations and agencies, including NCDHHS, the North Carolina Department of Commerce, the UNC System, North Carolina Community Colleges System, and North Carolina Independent Colleges and Universities (NCICU), have contributed to organizational planning and operations in the lead-up to hiring a Center team.

Principles for Action

Collaboration is critical to our shared success. The Center provides a forum for health employers, personnel, and professionals; educators; regulators; policymakers; and others throughout North Carolina to convene, discuss challenges and opportunities, share best practices and lessons learned, identify potential solutions and metrics for success, and monitor progress toward addressing health workforce challenges. We will begin by engaging the key stakeholders specifically named in Strategy 16 of the NCIOM task force’s report on transforming oral health in our state (NCDS, NC Medicaid, NC OHR, and DPH’s Oral Health Section) as a starting point, in addition to inviting others to contribute to the process.

Persistence is required to realistically tackle today’s crises while steering clear of future problems. It takes a while to steer a workforce. While some relatively quick interventions may exist, we will need to be strategic and tenacious as we confront systemic barriers to our success, particularly in addressing care gaps in rural communities. Attention to addressing those challenges frequently increases as the challenges become more acute and then declines as other challenges require more immediate attention. The Center is here to provide a continuous focus on the health workforce to help ensure that focus remains on the challenges and actions—including investments—needed to address those challenges.

Shared learning through better data infrastructure and identifying promising practices sharpens our collective ability to improve efforts, and ultimately conditions, over time. We will help improve alignment and utilization of the best available data and information to shape strategic action. North Carolina has wonderful data resources, including the Health Professions Data System (HPDS) produced by the Sheps Center, which partners with state licensing boards to gather and analyze data on the supply and distribution of many health professionals, including dentists and dental hygienists.⁴ The Center’s website will help connect stakeholders to this and similar data resources and create space for the field to curate and organize lessons learned, case studies, and relevant research.

Challenges and Opportunities

Even with powerful data through HPDS, we miss some segments of the unlicensed oral health workforce that are critical members of the care team in many practices. The Center will serve as a convener but cannot solve these issues alone. This will be a team sport, and we invite everyone to get on the court.

One promising model stems from our work on the North Carolina Health Talent Alliance (NCHTA), which is a program that the Center leads in partnership with the North Carolina Chamber Foundation and regional North Carolina Area Health Education Centers (NC AHECs).⁵ The NCHTA leverages the nationally developed framework called Talent Pipeline Management® (TPM) to drive a process that puts employers at the heart of data-informed problem-solving in collaboration with education and workforce partners. Informed by the TPM process, NCHTA is in the process of forming local collaboratives comprised of a cross-sectional group of employers in AHEC regions; collecting and analyzing new data to provide timely, relevant information to those employer groups; facilitating a process that helps the employer groups prioritize specific problems and coordinate efforts to solve them; and engaging education, workforce, and similar partners to design and deploy solutions.

For a sense of scale, our data-collection efforts revolved around an employer needs survey that we deployed in collaboration with Sheps. We received data on critical job needs from more than 200 health employers representing roughly 1,000 facilities statewide. Those employers reflect the full range of health, from major hospital systems to small independent practices across disciplines, including oral health. This survey builds on the past work of the North Carolina Sentinel Survey,⁶ which helped inform the team’s initial focus on registered nurses, licensed practical nurses, nursing assistants, and medical assistants. The Health Talent Alliance job demand survey also allowed employers to identify their critical job needs in up to four additional roles, and dentists were among the top three employer-identified responses (unpublished data).

Employers involved in the regional Health Talent Alliance process are now in the throes of determining priorities and defining problem statements. To support their success and our shared learning, the Center is developing a Solutions Playbook. The Solutions Playbook is a suite of resources to support data-based understanding of challenges, provide frameworks for strategically mapping and prioritizing specific interventions, and offer existing case studies, toolkits, and more to help stakeholders avoid recreating wheels. This is a resource that will require leaders across all disciplines to curate content to build shared institutional memory for health workforce development efforts across the state.

We started out in five of the nine NC AHEC regions and are already seeing remarkable progress, with employer collaboratives launching and identifying critical job needs using the demand data we’ve collected. Thanks to recent support from the Blue Cross and Blue Shield Foundation of North Carolina, the remaining NC AHEC regions will launch their own TPM processes, providing NC HTA with statewide coverage with regionally relevant action. Soon North Carolina will have 10 full-time people employed by NC AHEC regions waking up every day and driving action through this process.

What’s Next

As recognized by the NCIOM task force’s report on oral health transformation in our state, more work is required to define and measure the scope of North Carolina’s oral health care workforce challenge and educate key constituencies about the urgency of these issues. The Center is continuing to build internal capacity so that we can better serve the capacity of the broader community to confront these often-entrenched issues. To animate the ideas of the report, the Center is committed to putting its core principles into practice. The task of our time is to align the remarkable resources, organizations, and interests to focus on tangible action where it is most needed. The Center is committed to supporting that action.

We recognize that there are health providers other than those listed here—including oral health providers—who are also experiencing acute workforce shortages. As the Center onboards teammates who can do policy research, facilitate data analytics and visualization, and lead communities of interest, we are optimistic our work will broaden to include the oral health workforce. Our hope rests in the understanding of the important role that oral health plays in a person’s wellness.

We are grateful to The Duke Endowment and the Blue Cross and Blue Shield of North Carolina Foundation for the funding they have provided to launch the Center. We are also grateful to all of the statewide and local organizations that have partnered with us as we moved from concept to implementation, and soon to action. We invite you to join these efforts.

Acknowledgments

Andy MacCracken serves as Director of the NC Center on the Workforce for Health. Center funder The Duke Endowment also provides significant funding for the North Carolina Medical Journal. No further interests were disclosed.