J Dent Educ. 70(4): 448-462 2006
© 2006 American Dental Education Association
ADEA Survey of Clinic Fees and Revenue: 2003–04 Academic Year
Richard G. Weaver, D.D.S.;
Richard W. Valachovic, D.M.D., M.P.H.
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Abstract
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The American Dental Education Association’s 2003–04 Survey of Clinic Fees and Revenue obtained data by which to report, by school, clinic revenue information per student. Fifty-one of the fifty-four dental schools that had third- and fourth-year students responded to the survey. The median revenue per third-year student was $9,937. It was $13,602 for fourth-year students. Clinic revenue was also obtained for programs of advanced dental education. General Practice Residency programs generated the highest revenue per student at $66,474, followed by programs of Advanced Education in General Dentistry at $63,860. Other areas of the survey provided information regarding clinic fees by type of program, levels of uncompensated care by type of program, clinic revenue by source of payment, and dental school fees as a percent of usual and customary private practice fees.
There continues to be little change in the mean of student dental clinic revenue as a percentage of dental school revenue from all major sources.1 In 1990 this mean for all schools was 11.3 percent, increasing to 13.7 percent in 2000, and remaining at 13.7 percent in 2003 (Table 1
). Public dental schools, between 1990 and 2003, have had a slight continuing increase from 8.7 to 12.3 percent, while the private dental schools fluctuated between 15.5 and 18.8 percent, standing at 17.1 percent in 2003; and the private state-related dental schools, in their fluctuations, reached 17.5 percent in 1996 but have declined to 13.6 percent in 2003. In quickly looking at the percentages, it could be surmised that the private dental schools are clinically more efficient and productive than the public schools, since their student clinic revenue as a percent of total dental school revenue is higher. But is the difference due to more efficient and more productive clinics or to a lower total revenue base?
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Table 1. Mean student dental clinic revenue as a percentage of dental school revenue from major sources: selected years 1990–2003
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Public dental schools generally report greater total revenue per student than the private schools.1 Students, regardless of type of school, could be generating similar amounts of revenue; but because of the larger total revenue base of public schools, the percent of revenue from public school students would be smaller than at the private schools with their lower total revenue base. Still, it could be said that private schools’ clinics are operating more efficiently and productively since their students may be generating similar revenue as public school students, but doing so from a smaller total revenue base by which the school operates. It is probably best not to try to read any degrees of clinic efficiency and productivity into the differences in these percentages and just leave it as the percent of total revenue that comes from student clinics.
However, when one looks at the range of student clinic revenue as a percentage of total dental school revenue (Table 2), questions of clinic efficiency and productivity can arise. What accounts for a tenfold difference between the high and low percentages of total revenue that come from student clinics? This is a sixfold difference at public schools and almost a sevenfold difference at private schools. Such ranges call for a study to ascertain what might account for these percentages and ranges. The findings would help give better understanding to the student clinic revenue tables in the American Dental Association’s annual report of dental school finances.1 The findings would also help with further designing and interpreting data from the ADEA survey of clinic fees and revenue because large high-low range differences occurred in all aspects of this survey also.
The ADEA Survey of Clinic Fees and Revenue supplements the clinic revenue information reported by the American Dental Association.1 The ADEA survey delineates clinic charges and revenue collected by student year of education and by type of program (pre- and postdoctoral), from which percents of uncompensated care and per-student revenue can be determined by school year, type of program, and type of school. Obtaining the number of clinic clock hours per year of training allows further breakout of clinic revenue to revenue per student per hour. The ADEA survey also identifies fees charged for selected procedures, as well as an estimated relative value of dental school services as a percent of the usual and customary rate for services of the private practice community. In addition, percent sources of payment (self-pay, private insurance, federal/state government) are reported.
The ADEA collection and reporting of clinic fees and revenue create an opportunity for schools to review their clinic income information systems and assess their revenue data in comparison with revenue data from other schools. It must be recognized, though, that in making comparisons, as mentioned above, there were sizeable variations in reported clinic clock hours, individual procedure fees, total fees charged, and total revenues collected. While efforts were made to obtain uniform data through the use of prescribed terms, schools do use differing methods of accounting for and reporting total fees charged and fees reduced or waived. Likewise, there undoubtedly are differences in how schools account for on-site and off-site clinic clock hours. No information was collected or reported that might help explain the wide variations. Overall, caution must be used in interpreting survey findings, making comparisons between schools or reaching conclusions difficult.
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Methodology
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The data-reporting period for this survey of clinic fees and revenue was the 2003–04 academic year, including summer clinics. Only fees and revenues generated by students and residents were reported. Separate survey items were used to obtain the dental school on-site and off-site clinic revenue by type of program. If revenue was not recorded for a particular program, the school provided reasonable estimates. And if revenue was aggregated among programs, the school made estimates for each specific program.
The following definitions were used for the survey:
- Enrollment: The number of students/residents, by class or program area, who are providing patient care and generating revenue. As might be necessary for advanced education programs, if the dental school is the rotation and the off-site is the main site, as might be the situation for a hospital-based program, indicate enrollment as FTEs at the dental school clinic rather than the number of residents or trainees in the program.
- Clinic Clock Hours: The number of hours per academic year a student/resident is typically scheduled for providing patient care.
- Dental School Clinic: A clinic within the dental school (or of such proximity, affiliation, and accountability that it is not considered an off-site clinical setting) serving as a primary site for undergraduate and/or postgraduate clinical training.
- Off-Site Clinic: A clinical setting removed from the dental school that serves as a site for undergraduate and/or postgraduate clinical training. The site may be owned by the dental school or one established through appropriate affiliation agreements.
- Total Charges: The sum of the value of services provided as determined by the rate of usual and customary dental school fees, before a dental school’s usual and customary fee is discounted, reduced, or waived to meet a fee set or negotiated through any public, private, or patient self-pay dental plan.
- Total Clinic Revenue: The amount of total charges actually collected during the 2003–04 academic year. (The 2003–04 accounts receivable carrying over into academic year 2004–05, while not received, are offset by the 2002–03 accounts receivable that were received in 2003–04. This will also account for debt write-off.)
- Uncompensated Patient Care: The difference between total charges and clinic revenue actually collected.
Information was collected for enrollment, clinic clock hours, total charges, and total clinic revenue by type of dental educational program (pre- and postdoctoral). The difference between total charges and total clinic revenue identified uncompensated clinic revenue. Fee data were collected on selected procedures in the undergraduate and postdoctoral programs. The procedures were specified by their respective ADA procedure code. Percent estimates were requested for listed sources of expected payment for clinical services (patient self-pay, third-party insurance, and federal/state programs). Estimates were also requested for the relative value of dental school services, by type of program, as a percent of the usual and customary rate for services of the private practice community.
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Information Describing Undergraduate Clinic Fees and Revenue
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Clinic Revenue Per Student
Fifty-one of fifty-four schools returned the clinic fee and revenue survey. (The University of Nevada, Las Vegas School of Dental Medicine and the Arizona School of Health Sciences School of Dentistry & Oral Health were not included in that they did not yet have third- or fourth-year students.) Forty-two schools provided information by individual class year. It is these forty-two schools that establish the database for this presentation of survey findings. Five schools reported junior and senior clinic revenue in aggregate; four schools reported revenue in the aggregate of all four years. Since the intent is to present revenue by year, by student, it was not possible to include these schools’ aggregated information into the analysis of data. Regarding the University of the Pacific Arthur A. Dugoni School of Dentistry, which administers a three-year curriculum, its second-year student information was included with the third-year information of the other schools, and its third-year information was included with the other schools’ fourth-year information. To assist in maintaining individual school confidentiality in this report, individual school information is presented by a school code established for this survey.
Tables 3, 4, and 5 present the data received from the forty-two schools included in the analysis. Most of the schools provided enrollment and clock hour information; for those, the three right columns of these tables display the revenue information by student as per student charges, per student revenue, and student revenue per hour for their school. At the bottom of each of these three columns are the average, median, high, and low values for these columns. Individual schools, by their code, can see how they compare to the average, mean, and range and ask questions of themselves as to what they are doing that enables them to be above or why they are below the median.
Also at the bottom of these tables is a line reporting the percentage of uncompensated care. In providing the information from which uncompensated care was to be computed, it turned out that the schools did so in one of three ways. Some schools indicated no difference between total charges and total revenue. In other words, there was no uncompensated care. For some schools, reported uncompensated care was the difference between total charges and total revenue. And for some schools, uncompensated care was a specifically reported amount that was sometimes greater than and sometimes less than the difference between total charges and total revenue. But whether computing uncompensated care using the difference between total charges and total revenue or using the specifically reported amount, the average amount of uncompensated care was within a percentage point or less either way. Uncompensated care in the third and fourth clinic years was 15 to 15.5 percent.
Table 6 displays the charges, revenue, and revenue per hour per student for the second-, third-, and fourth-year students. These are the amounts reported in those respective columns in Tables 3
, 4, and 5. (Data regarding first-year students have not been reported because most data cells were empty. Only eight of the forty-two schools reported first-year students providing patient care, ranging from one to fifteen clock hours. Where sufficient information was provided by four of the eight schools, per student revenue ranged from about $7.00 to $35.50. First-year student revenue per hour could be computed for only two of the four schools—one at $6.88 per hour, the other at $5.93 per hour.) The median revenue per second-year student was $771.38, with a high of $4,092.66 and low of $11.61. The median revenue per hour per second-year student was $6.66—with a high of $22.12 to a low of 39 cents. The median revenue per third-year student was $9,937.13—with a high of $21,516.76 and a low of $4,103.45. The median revenue per hour per third-year student was $10.08—with a high of $24.80 and a low of $4.40. For fourth-year students, the median revenue per student was $13,602.26—with a high of $31,341.26 and a low of $3,388.74. The median revenue per hour per fourth-year student was $15.59—with a high of $29.03 and a low of $3.94.
Tables 7 and 8 display the charges, revenue, and revenue per hour per student by type of school for their third- and fourth-year students, respectively. As reported, public dental school third-year students generated slightly more revenue per student and revenue per hour per student than the private and private state-related dental schools: $10,432 vs. $8,400 median revenue per student and $10.16 vs. $9.54 median revenue per student per hour (Table 7). In the fourth year, it was the private and private state-related schools where the students generated slightly more revenue per student and revenue per student per hour than the public school fourth-year students: $13,749 vs. $13,602 median revenue per student and $15.64 vs. $13.58 median revenue per hour per student.
Clinic Clock Hours
As displayed in Tables 3 through 8, there were large differences in revenue being generated per student by school, regardless of type of school. There are three determinates of revenue: clinic clock hours, clinic fees, and student productivity. Main-site clinic clock hours for second-year students who were providing patient care, excluding the University of the Pacific Arthur A. Dugoni School of Dentistry, ranged from a low of eight to a high of 1,052, with a median of 132 hours. Main-site, third-year clinic clock hours ranged from a low of 357 to a high of 1,460; with a median of 934 hours. And main-site clinic clock hours for fourth-year students ranged from a low of 515 to a high of 1,600, with a median of 1,053 hours (Table 9).
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Table 9. Range of main-site clock hours and off-site clock hours (where all students were at the off-site location) by year of students
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But students are also receiving clinical patient care experiences off site. How do off-site hours affect total clock hours? Table 9 also displays total clinical clock hours, for main-site plus off-site work. The off-site hours used in the computation were those in which all students participated equally in the number of hours at the off-site location(s). Of the twenty-four schools that reported second-year students providing patient care, only three reported all of their second-year students rotating to off-site locations for patient care experiences, ranging from twelve to twenty hours that were in addition to their main-site hours. Two of these three schools already had main-site hours that exceeded the 132 median, and their total hours now further exceeded the main-site median. Of the forty-two schools in the database for analysis, eight of them reported that all of their third-year students had off-site rotations of equal duration that added twelve to 176 hours to their main-site number of clinic clock hours. The range of total clock hours for these eight schools was 461 to 1,136. Still three of the eight schools had total main-site plus off-site hours below the 934 median main-site hours; one school’s off-site hours brought it above the median; and the three remaining schools further exceeded the median. And of the forty-two schools in the database, eighteen reported that all of their fourth-year students had off-site rotations of equal duration that added twelve to 800 hours to their main-site number of clinic clock hours. The range of total clock hours for these eighteen schools was 600 to 1,700. Adding in their off-site hours, four schools still were below the median number of main-site hours of 1,053, and four schools rose to exceed the median. The remaining ten schools further exceeded the median number of main-site hours.
Overall in the senior year, when most of the off-site experiences occur, when including off-site hours (if there were off-site hours to include), fourteen of the schools still reported a total of clinic clock hours below the median of 1,053—eight of which reported 800 or fewer total clinic clock hours for their fourth-year students.
This creates a question as to what is happening at these schools with the low clock hours. Is this an underreporting of clock hours because a school that has separate pediatric dentistry, oral surgery, and special care clinics has not included these clinic hours and revenues with their reporting of main-site clinic hours and revenue? Or is this truly the number of clock hours? Future clinic fee and revenue surveys will have to clarify this reporting of clock hours at the main site.
Another point that will require effort in the design of future clinic fee and revenue surveys is obtaining a more complete reporting of off-site information. The 2003 ADA Curriculum Survey of Dental Education, volume 4, indicates that forty-nine schools reported some aspect of off-site patient care. In the ADEA survey of clinic fees and revenue, only thirty of the fifty-one schools reported any off-site data. Why this underreporting? Was this section of the survey left blank because there was no patient revenue data to report? While there may be no direct patient revenue, are revenues being received from the off-site location through contracted patient care? Or are local or state funds received by the school for providing care to special patient groups or settings? As off-site clinical experiences are increasing in dental education, it becomes important to obtain accurate and complete information about time obligations to these settings and associated costs and revenues. There is need to determine what of this information can be accurately obtained through future clinic fee and revenue surveys.
Table 10 displays the revenue generated at off-site locations and accounted for back at the main sites for the schools that reported off-site rotations for some or all of their students, along with revenue information. One school reported first-year students having an off-site rotation, but no revenue back to the school. Three schools reported second-year students having an off-site rotation, also with no revenue back to the schools. There were nineteen schools that reported off-site rotations for third-year students; eighteen of the schools reported that all students participated in the rotation, and one reported that only fourteen students participated in the rotation and did so on a full-time basis. Only eight of the eighteen schools reported student-generated revenue. The median revenue per student for the eight schools was $1,237, with a high of $2,703 and a low of $211. Thirty schools reported off-site rotations for fourth-year students; two of those schools reported five and fourteen students on the rotations on a full-time basis. It appears that those students, from the two schools, had their full fourth-year clinical experience at the off-site location.
For the other twenty-eight schools, only seventeen of them reported student-generated revenue, with a median of $2,148, a high of $9,435, and a low of $680. Is it actually happening that about half of the schools with off-site rotations for their students are not receiving any revenue back to the school? This is an area that needs clarifying in any future clinic revenue survey.
Undergraduate Dental Clinic Fees
The clinic fee schedule is a second determinant of clinic revenue. Table 11 displays fee data for procedures selected for this survey, by high/low range, median, and type of school. In quick overview, there is a usual three- to fivefold difference between the low and high fee for any procedure. As reported in the past, anecdotal information indicates that some fees are set low, as "loss leaders," to attract patients to the dental school clinics or where there was a shortage of those patient needs in meeting specific student learning experiences. The individual median fees by procedure as well as the average of the median fees are higher at private schools than at public schools. This is undoubtedly due to the fact that most of the private schools are in the higher cost areas of the Northeast and Far West. And while not reported here, that is the overall case for fees by region: higher in the Northeast and Far West, lower in the South and Midwest.
Student Productivity
The 2003–04 survey of clinic fees and revenue attempted to collect productivity information, a third determinant of clinic revenue. This was a first-time effort. Each school was to provide the number of procedures completed for each of the above selected procedures at the main site, by class year. While there was a high response rate in providing data, preliminary analysis raised question as to the validity of the data provided. Before findings can be reported, follow-up efforts are needed to determine the reliability of the data collection process and whether the data obtained are valid.
Advanced Dental Education Program Clinic Fees and Revenue
The dental schools provided enrollment and revenue information for the various clinical advanced dental education programs they sponsored. This included information on sponsored programs that had rotations to or were fully located outside of the dental school, where charges and revenue may or may not be accounted for back to the dental school. These sponsored programs were usually oral and maxillofacial surgery, pediatric dentistry, general practice residency, and advanced education in general dentistry. The range between the high and low revenue per student was great. The large ranges could be caused by different accounting, contracting, and reporting procedures and nonreimbursed clinical rotations. (Off-site revenue reported back to the dental school was included in determining median revenue per student.) Differences in program education/service philosophies, program locations, and populations served, also, are factors that could have contributed to the revenue ranges. While the following data afford comparison and self-evaluation, they should be interpreted with care.
Endodontic Programs.
Forty-one schools reported advanced education programs in endodontics (Table 12). The median enrollment was eight. The high enrollment was twenty-seven; the low, two. One school reported an off-site rotation with revenue accounted for by the main site; another reported no revenue from its off-site rotation. The median revenue per student was $36,381, with a high revenue per student of $74,610 and a low of $7,142. The median fee for selected procedures was $292, $360, and $450 respectively for anterior, biscupid, and molar endodontics (Table 13). Uncompensated care averaged 18.4 percent.
Oral and Maxillofacial Surgery.
Thirty-seven schools reported programs of oral and maxillofacial surgery (Table 14). The median number of students enrolled in the programs was seven. Ten schools reported off-site rotations for the students. One school reported that the whole of patient care was off site. Only three of the programs reported off-site generated revenue coming back to the dental school. The median revenue per student was $49,003, with a high revenue per student of $343,483 and a low of $8,385.
Table 15 displays the median, high, and low clinic fees for selected procedures. The fee for a simple, single tooth extraction ranged from $35 to $145, with a median of $63. Removal of a bony impacted tooth ranged from $100 to $365, with a median of $193.50. A single implant ranged from $150 to $1,500, with a median of $710.50. Uncompensated care averaged 21.1 percent.
Orthodontic Programs.
There were forty-four reported orthodontic programs (Table 16). The median number of enrollees was twelve, with a high of thirty-four and a low of six. Two schools reported off-site rotations, with no revenue though reported back to the school. The median revenue per student was $43,462. The high revenue per student was $141,065; the low was $11,853. The median fee for the comprehensive treatment of the adolescent dentition was $2,826, with a high of $4,430 and a low of $2,056 (Table 17). Uncompensated care averaged 14.1 percent.
Programs of Pediatric Dentistry.
Thirty-three schools provided information on their advanced education programs in pediatric dentistry (Table 18). The median enrollment at the programs was ten, with a high of seventeen and a low of four. Thirteen of the programs reported off-site rotations; for two of these programs, the off-site location was the main site. Ten of these schools reported off-site revenue, which was included in determining per student revenue. The median student revenue was $38,997; the high per student revenue was $133,227 and the low was $6,374.
Table 19 displays the median, high, and low fees for selected procedures. The median fee for a comprehensive evaluation was $36. It was $68 for a two surface amalgam, $114 for a stainless steel crown, $75 for a pulpotomy, and $25 per tooth for sealants. Uncompensated care in the pediatric dentistry programs was a relatively high average of 29.2 percent.
Periodontology Programs.
Information was provided for forty-one periodontology programs (Table 20). Utilization of three off-site locations was reported, only one of which reported revenue back to the main site. The median enrollment was nine. The high enrollment was twenty-four; the low, three. The median revenue per student was $34,836. The high was $69,555; the low, $10,292. Median fee information is presented for selected procedures in Table 21: comprehensive periodontal evaluation $50; gingival flap $300; osseous surgery per quadrant $357.50; free soft tissue graft $311.50; and scaling and root planing per quadrant $96. The average uncompensated care in the periodontology programs was 15.8 percent.
Prosthodontic Dentistry Programs.
Thirty-four schools reported advanced education programs in prosthodontic dentistry (Table 22). The median enrollment was eight. The high was twenty-one; the low, one. One school reported an off-site rotation, with no revenue coming back to the main site. The median revenue per student was $49,862. The high revenue per student was $83,963. The low was $7,244. The uncompensated care average was 23.1 percent.
Fee information for selected procedures is displayed in Table 23. The median fee for a complete maxillary denture was $669. For a maxillary cast-frame partial denture, the median fee was $785. The median fee for a porcelain fused to noble metal crown was $602.50. For a similar implant crown, the median fee was $700.
Advanced Education in General Dentistry.
Information was provided for nineteen general practice residency programs (GPR) and thirty-three advanced education in general dentistry programs (AEGD) (Table 24). The median enrollment was five for the GPR programs and seven for the AEGD programs. Eight GPR programs reported off-site rotations. For three of these programs, the off-site location was the main site. Two of the GPR off-sites reported no revenue back to the main site. Eight of the AEGD programs also reported off-site rotations, one of which was the main site for the program. Two of the AEGD off-site locations reported no revenue back to the main site. The median revenue per GPR student was $66,474. It was $63,860 for AEGD students. The high revenue per GPR student was $127,571; the high per AEGD student was $343,890. The low revenue per GPR student was $10,523; the low revenue per AEGD student was $25,520. The uncompensated care average was 28.2 percent in the GPR programs and 12.2 percent in the AEGD programs.
Table 25 displays the fees for selected procedures in the GPR and AEGD programs. For most procedures, the fees were higher at the GPR programs, but the range of fees was generally greater at the AEGD programs.
Programs of Advanced Education in Operative/Restorative Dentistry.
Five schools reported information on programs of advanced education in operative and/or restorative dentistry (Table 26). No off-site rotations were reported. The median enrollment in the programs was six, with a high of fourteen and a low of two. The median revenue per student was $17,940. The high revenue per student was $21,479; the low was $6,559. The median fees for selected procedures provided in the advanced restorative dentistry programs were 27 to 34 percent higher than those same procedures provided in the undergraduate clinics (Table 27). Uncompensated care averaged 28.1 percent.
Source of Payment for Clinic Fees
Forty-eight schools provided information regarding clinic revenue by source of payment (Table 28). Thirty-eight schools reported third-party, fee for service, private insurance revenue, with a median percent of total clinic revenue being 19.5 percent. The high percent of clinic revenue from third-party, fee for service, private insurance was 76 percent; the low was 1 percent. Nine schools reported revenue from third party, capitation program sources at a median of 6.6 percent of total clinic revenue. The high percent of clinic revenue from these capitation sources was 30 percent; the low was 2 percent. Eleven schools reported Medicare as a revenue source and, as would be expected, at a very low percent of total clinic revenue. Forty-two schools reported Medicaid as a source of payment, with a median of almost 13 percent of total clinic revenue. The high percent of clinic revenue from Medicaid was 59 percent; the low was 1 percent. Eight schools reported state direct appropriations as a source of clinic revenue, with a median of 12 percent, a high of 24 percent, and a low of 1 percent. All forty-eight schools reported patient self-pay as a source of payment; and it was, by far, the highest median percent source of clinic revenue at 66 percent. Patient-self pay as a percent of clinic revenue had a high of 100 percent and a low of 27 percent.
To place dental school clinic revenue sources in some perspective, income sources in private practice were, on average, 43.9 percent of gross billing from third-party, fee for service, private insurance programs; 6.6 percent from third-party, capitation programs; 5.2 percent from government public assistance programs; and 43.5 percent from patient self-pay.2 (Other sources account for 1.1 percent of gross billings.) As determined by revenue/billing sources, it is evident that dental schools, relatively, do serve a large number of uninsured, self-pay, and public assistance patients.
Dental School Fees as a Percent of Private Practice Fees
In addition to sliding fees, waived fees, and uncollected fees, dental school fees are usually less than the customary rates of the surrounding practice community. In the survey of clinic fees and revenue, dental schools were to estimate the pricing of their services as a percent of the usual and customary rates of their service area. For the undergraduate programs, the median fee for services provided was 48 percent of the fee for such services in private practice, ranging from a high of 60 percent to a low of 23 percent. For the postdoctoral programs, the median was 66 percent of such services in private practice, ranging from a high of 100 percent to a low of 40 percent.
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Summary
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Figure 1 presents the median revenue per student by type of program. The GPR and AEGD programs had the highest median revenues per student: $66,474 for the GPR program and $63,860 for the AEGD program. There has been a change in the ordering of some programs since the 1998–99 survey of clinic fees and revenue.3 But most striking has been the amount of change that has occurred in the median revenues generated by the students. GPR students increased their median revenue per student by 83 percent. Prosthodontic students increased 72 percent. Oral and maxillofacial surgery students increased 140 percent; pediatric dentistry by 164 percent; and periodontal students by 96 percent. Senior dental students increased their median revenue per student by 16 percent. But the junior students increased by 57 percent. Inflation has been about 3 percent per year. Private practice income has increased about 6 percent per year. So these increases in revenue per student have been, apparently, through major increases in the productivity of the advanced dental education programs and of the junior students.
But the revenue data for Figure 1 still must stand alone in that they are unrelated to any assessment of or adjustment by student productivity or costs of clinic operations. While appreciating its limitations, the information can be of assistance to schools and programs in a review of their own clinic operations and management systems, in comparison with aggregated data from other schools and programs.
The original survey instrument of clinic fees and revenue, from around the late 1980s, has been added to over the last two times it has been conducted, in an effort to obtain a more complete reporting of main-site and off-site clinic hours and accounting of main-site and off-site revenues, so as to accurately report revenue changes that may be occurring as schools increase their use of off-site/community setting of patient care for their students. A section was added to the last survey in effort to obtain student productivity data to accompany the clock-hour and revenue data. Overall data assessment disclosed areas of incomplete reporting regarding the number of schools that have off-site rotations and the clock hours at off-site settings, which undoubtedly affected the reporting of revenue (or no revenue) from these settings back to the main site, by which to calculate total clinic clock hours of patient care and clinic revenue. And the number of times that some of the selected procedures were reported performed by class produced medians per student that appeared inordinately low, raising enough question as to the validity of the information that it was not included in this report.
Total clinic clock hours and changes occurring in clock hours at main-site and off-site clinical settings and resulting revenue changes, along with accurate reporting of student productivity, are essential in assessing, comparing, and understanding clinic revenue and revenue per student by school. Before the next survey of clinic fees and revenue is undertaken, the survey design and conduct need to be reviewed in an effort to correct shortcomings identified in the 2003–04 survey and ensure that reporting of the data will be complete and accurate in order to fulfill the purpose of the survey.
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Footnotes
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Dr. Weaver is Acting Director, Center for Educational Policy and Research, and Dr. Valachovic is Executive Director—both at the American Dental Education Association. Direct correspondence and requests for reprints to Dr. Richard Weaver, American Dental Education Association, 1400 K Street, NW, Suite 1100, Washington, DC 20005; 202-289-7201 phone; 292-289-7204 fax; WeaverR{at}ADEA.org.
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REFERENCES
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- 2003–04 survey of dental education, finances: volume 5. Chicago: American Dental Association, 2004.
- 2003–04 survey of dental practice, income from the private practice of dentistry. Chicago: American Dental Association, 2004.
- Weaver RG, Haden NK, Valachovic RW. ADEA survey of clinic fees and revenue: 1998–1999 academic year. J Dent Educ 2001;65:911–25.[Abstract]
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Abstract
Methodology
