Bulletin of Dental Education

Crisis in California: Keeping Priorities Straight

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Dean John D. FeatherstoneWhile schools across the country face tough economic times, the situation has been particularly challenging at the University of California, San Francisco (UCSF) School of Dentistry. The state of California is facing unprecedented funding shortages. As a state school, UCSF feels the impact through reduced direct support and the elimination of state programs like adult Denti-Cal, which serves Medicaid eligible dental patients in California. In addition, increases in health care and retirement costs are threatening UCSF's ability to invest in its mission.

However, the picture is far from gloomy at UCSF, thanks to dedicated faculty, staff, and students and a culture of inclusive, transparent, two-way communications. Last spring, John D.B. Featherstone, M.Sc., Ph.D., Dean of the UCSF School of Dentistry, adopted a straightforward strategy: keep people at every level well-informed about the issues, encourage a team environment, and ask for solutions.

He has held quarterly town halls for all faculty and staff, meets monthly with department leaders, and increased "Deans & Department Chairs" meetings from monthly to biweekly as needed for budget development.

"We are one of the largest dental schools nationally, and our school includes clinicians and researchers. It is important that everyone hears the same information and shares the same school vision," said Dean Featherstone.

Early discussions focused on identifying the school's core priorities - predoctoral, graduate, and residency programs and research - and ways to maintain and enhance their quality more cost-efficiently.

In addition, suggestions to alleviate budget concerns were requested from faculty, staff, and students in discussions, forums, and a task force assembled to evaluate the submissions. Recommendations included improving patient scheduling in the clinics and revisiting class scheduling. Predoctoral clinics were closed on Friday afternoons, when patient load is the lightest, and didactic teaching for third- and fourth-level students was consolidated into that period. The change resulted in substantial cost savings for the school and more patient experience for the students, and enabled continuation of the critical 1:8 faculty:student ratio in predoctoral clinics.

Other suggestions included better "marketing" of the school's clinical services. Patient facilities were upgraded with brighter, more attractive spaces, and the name UCSF Dental Center (as opposed to "School") for the clinics was adopted to better convey the full range of available services.

UCSF was the largest provider of services to California Denti-Cal patients. Anticipating the July 1, 2009, elimination of the program, the school implemented a lower fee schedule for individuals with Medi-Cal benefits. The schedule allowed students to continue providing dental care to a majority of former Denti-Cal patients, which has maintained student training and retained revenue for the school.

"Remarkably, we've continued to see approximately 74% of the patients who previously had Denti-Cal benefits. This new program removed what was a significant barrier to care for most of these individuals," said Dean Featherstone.

School tuition and fees also have been increased, and there is a renewed focus on attracting more scholarships to offset student debt.

Town halls, requests for solutions, and task forces have been implemented university-wide by UCSF Chancellor Susan Desmond-Hellmann, M.D., M.P.H., who also has communicated to the campus through videos and the UCSF website. She has reiterated that every dollar spent should be in service of the university's mission - patients and health, discovery, and education. She also has stated her commitment to look for diversified revenue streams, advocate for UCSF with state and federal legislators, and encourage more partnerships between UCSF and industry.

"The School of Dentistry, and UCSF as a whole, is focused on maintaining and enhancing our excellence throughout these difficult times. And we are starting to see the benefits of our actions through leaner, more efficient, yet effective programs," said Dean Featherstone.

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