In this issue...




"You Have to Start Somewhere"

Charles N. Bertolami, DDS, DMedSc
Herman Robert Fox Dean
NYU College of Dentistry

When someone asks me, "Why create a partnership between dentistry and nursing?" I say, why not? You have to start somewhere, and a dentistry/ nursing alliance is as good a place as any to begin to deal with the enormous healthcare challenges facing our nation. The United States spends 16 percent of its GNP on prevention and treatment of disease, yet we lag behind other Western nations on such basic indicators of health as infant mortality and life expectancy. Nor are there signs that this trend will reverse anytime soon. On the contrary, it is estimated that by 2015, America will spend 20 percent of its GNP on health care, and that number is expected to rise to a staggering 50 percent by 2050. Yet despite these huge expenditures, tens of millions of Americans cannot afford basic treatment and must put their health care on hold, which leads to worsening conditions and even greater healthcare costs down the road - a classic example of negative return on investment. Adding to the dysfunction of the current system is the fact that, by 2030, the number of older adults in the US will almost double, and the nation is not prepared to meet their social and healthcare needs.

In 2002, the Institute of Medicine (IOM) convened a group of over 150 leaders and experts from health professions education, regulation, policy, advocacy, quality, and industry to discuss health care in the US and help develop strategies for restructuring clinical education to be consistent with the principles and goals of 21st century health care. In its 2004 report, Health Professions Education: A Bridge to Quality, the IOM published the group's consensus, which called for a radical overhaul of all health professions education.

According to the report, it is past time to dispense with the traditional practice of educating health professions students in "silos" when patients expect them to work in collaborative teams in clinical practice. In place of the "silo" approach, the report calls for all healthcare professions to pursue new, interdisciplinary directions in education, research, and clinical care. The IOM mandate is clear: There must be immediate systemic change in the way we think about, educate for, and deliver health care. The IOM report outlines five key competencies for 21st century healthcare professionals: delivering patient-centered care; working in interdisciplinary teams; practicing evidence-based health care; emphasizing quality improvement; and using information technology. It was in this context of a national healthcare system in crisis and of the IOM report's call for reform of our nation's health professions education system that the decision was made in 2005 to create a dentistry/nursing alliance at NYU by moving the nursing programs into the College of Dentistry, where they formed a new academic unit, the College of Nursing at the College of Dentistry. The alliance, conceived of and created by the Dean of NYUCD at the time, Dr. Michael C. Alfano, and Dr. Terry Fulmer, then Head of the NYU Division of Nursing, recognized the urgency of the situation and saw a dentistry/nursing alliance as a fitting response to the IOM mandate to educate health professionals across disciplines and to foster new healthcare paradigms to better address our nation's responsibility for promoting health and providing quality care to all of our citizens. The alliance was founded on three basic premises:

  • Approximately 30 million Americans regularly access dental services but not other health care, making the dental visit their only contact with healthcare professionals and a key point of entry into the entire healthcare system.
  • Dentists, who by law are primary care providers, are in a privileged position to further serve the public by becoming locations for patients to receive the screenings and other basic preventive services that they might not otherwise have access to, including diabetes, hypertension and high cholesterol screenings, and flu immunizations.
  • By collaborating with Nurse Practitioners (NPs) - licensed, registered nurses who have completed advanced education and training at the master's or doctoral level and are qualified to diagnose and manage common health problems, including chronic illnesses - dentists will be in a position to identify and facilitate treatment for chronic conditions early, thereby reducing costs that result when secondary events take hold.

The dentistry/nursing alliance is not about dentists becoming nurses or nurses becoming dentists. It's about enabling dental students and nursing students to enhance their skill sets in order to fill important gaps in patient care. By bringing the disciplines of dentistry and nursing together, we are creating a whole that is greater than the sum of its parts. Dental and dental hygiene students are being educated to become more interested and comfortable in doing health risk assessments in the dental practice, and future nurses are being educated to recognize the oral health needs of their patients and to make referrals to dentists. To put it another way, our students are getting something more from their education, and they will be able to choose whether or not to use the additional experience as they proceed into various private practice and institutional settings. In addition to enhancing our students' knowledge and skill sets, the alliance has also created a vibrant culture of collaboration among dental and nursing researchers, who are investigating the many evolving links between oral and systemic health, such as pain control, the emerging role of oral infection in systemic conditions, including premature birth, diabetes, lung infection, and heart disease, and the increasing use of saliva in non-invasive tests of both oral and general health. It is predictable that the results of these studies will ultimately change the way dentists, physicians, and patients view oral health.

In this regard, I'm pleased to note that last year the American Association of Medical Colleges (AAMC), the American Dental Education Association (ADEA), and the Macy Foundation, took the unprecedented step of convening a panel of medical and dental educators to identify shared requisite knowledge, skills, and attitudes related to the recognition, diagnosis, treatment, and referral for clinical dentistry appropriate for medical students, and of the same knowledge base in terms of clinical medicine for dental students.

I was honored to co-chair this joint committee along with Dr. Wendy Mouradian of the University of Washington. The findings and recommendations of this panel are entirely consistent with the efforts taking place at the NYU College of Dentistry and the NYU College of Nursing, and it is a point of pride for us to be at the forefront of this movement toward greater collaboration in health professions education, research, and clinical care.

When someone asks me, "Why create a partnership between dentistry and nursing?" I say, why not? You have to start somewhere, and a dentistry/ nursing alliance is as good a place as any to begin to deal with the enormous healthcare challenges facing our nation. The United States spends 16 percent of its GNP on prevention and treatment of disease, yet we lag behind other Western nations on such basic indicators of health as infant mortality and life expectancy. Nor are there signs that this trend will reverse anytime soon. On the contrary, it is estimated that by 2015, America will spend 20 percent of its GNP on health care, and that number is expected to rise to a staggering 50 percent by 2050. Yet despite these huge expenditures, tens of millions of Americans cannot afford basic treatment and must put their health care on hold, which leads to worsening conditions and even greater healthcare costs down the road - a classic example of negative return on investment. Adding to the dysfunction of the current system is the fact that, by 2030, the number of older adults in the US will almost double, and the nation is not prepared to meet their social and healthcare needs. In 2002, the Institute of Medicine (IOM) convened a group of over 150 leaders and experts from health professions education, regulation, policy, advocacy, quality, and industry to discuss health care in the US and help develop strategies for restructuring clinical education to be consistent with the principles and goals of 21st century health care. In its 2004 report, Health Professions Education: A Bridge to Quality, the IOM published the group's consensus, which called for a radical overhaul of all health professions education.

According to the report, it is past time to dispense with the traditional practice of educating health professions students in "silos" when patients expect them to work in collaborative teams in clinical practice. In place of the "silo" approach, the report calls for all healthcare professions to pursue new, interdisciplinary directions in education, research, and clinical care. The IOM mandate is clear: There must be immediate systemic change in the way we think about, educate for, and deliver health care. The IOM report outlines five key competencies for 21st century healthcare professionals: delivering patient-centered care; working in interdisciplinary teams; practicing evidence-based health care; emphasizing quality improvement; and using information technology. It was in this context of a national healthcare system in crisis and of the IOM report's call for reform of our nation's health professions education system that the decision was made in 2005 to create a dentistry/nursing alliance at NYU by moving the nursing programs into the College of Dentistry, where they formed a new academic unit, the College of Nursing at the College of Dentistry. The alliance, conceived of and created by the Dean of NYUCD at the time, Dr. Michael C. Alfano, and Dr. Terry Fulmer, then Head of the NYU Division of Nursing, recognized the urgency of the situation and saw a dentistry/nursing alliance as a fitting response to the IOM mandate to educate health professionals across disciplines and to foster new healthcare paradigms to better address our nation's responsibility for promoting health and providing quality care to all of our citizens. The alliance was founded on three basic premises:

  • Approximately 30 million Americans regularly access dental services but not other health care, making the dental visit their only contact with healthcare professionals and a key point of entry into the entire healthcare system.
  • Dentists, who by law are primary care providers, are in a privileged position to further serve the public by becoming locations for patients to receive the screenings and other basic preventive services that they might not otherwise have access to, including diabetes, hypertension and high cholesterol screenings, and flu immunizations.
  • By collaborating with Nurse Practitioners (NPs) - licensed, registered nurses who have completed advanced education and training at the master's or doctoral level and are qualified to diagnose and manage common health problems, including chronic illnesses - dentists will be in a position to identify and facilitate treatment for chronic conditions early, thereby reducing costs that result when secondary events take hold.

The dentistry/nursing alliance is not about dentists becoming nurses or nurses becoming dentists. It's about enabling dental students and nursing students to enhance their skill sets in order to fill important gaps in patient care. By bringing the disciplines of dentistry and nursing together, we are creating a whole that is greater than the sum of its parts. Dental and dental hygiene students are being educated to become more interested and comfortable in doing health risk assessments in the dental practice, and future nurses are being educated to recognize the oral health needs of their patients and to make referrals to dentists. To put it another way, our students are getting something more from their education, and they will be able to choose whether or not to use the additional experience as they proceed into various private practice and institutional settings. In addition to enhancing our students' knowledge and skill sets, the alliance has also created a vibrant culture of collaboration among dental and nursing researchers, who are investigating the many evolving links between oral and systemic health, such as pain control, the emerging role of oral infection in systemic conditions, including premature birth, diabetes, lung infection, and heart disease, and the increasing use of saliva in non-invasive tests of both oral and general health. It is predictable that the results of these studies will ultimately change the way dentists, physicians, and patients view oral health. In this regard, I'm pleased to note that last year the American Association of Medical Colleges (AAMC), the American Dental Education Association (ADEA), and the Macy Foundation, took the unprecedented step of convening a panel of medical and dental educators to identify shared requisite knowledge, skills, and attitudes related to the recognition, diagnosis, treatment, and referral for clinical dentistry appropriate for medical students, and of the same knowledge base in terms of clinical medicine for dental students.

I was honored to co-chair this joint committee along with Dr. Wendy Mouradian of the University of Washington. The findings and recommendations of this panel are entirely consistent with the efforts taking place at the NYU College of Dentistry and the NYU College of Nursing, and it is a point of pride for us to be at the forefront of this movement toward greater collaboration in health professions education, research, and clinical care.