Finding New Ways

Trained dental technicians are aging and will continue to retire over the next decade. The overall number of technicians reported by the U.S. Department of Labor, Bureau of Labor Statistics, and the National Association of Dental Laboratories has shown a trend over the past 10 years, down -9.7% from 49,278 technicians in 2006 to 44,662 technicians in 2016.¹ Bennett Napier, MS, Chief Staff Executive of the National Association of Dental Laboratories (NADL; nadl.org), commented on the decline. “Laboratory owners are finding it difficult to find qualified and knowledgeable dental technicians, because qualified workers are aging out and not being replaced; this trend may only get worse by 2018 and continue to do so.” Furthermore, the drastic decline in the number of dental laboratory technology accredited education programs has resulted in a current graduation rate of only approximately 300 students a year.² The diminishing number of graduates compared to the growing numbers of technicians expected to exit the profession is leaving the industry with a talent crisis. “Five to 7 years out, we predict that we'll be down to 10 accredited programs. This will limit the marketplace's access to the science and art of dental technology,” says Napier. This is all happening while demand for laboratory services is going up, due to an aging population base of patients and the increased number of new dentists graduating from dental school and going into practice. As the profession grapples with finding solutions to these challenges, some industry players have set out to create new educational pathways to meet the dental profession's needs. 

In the midst of the continued decline of dental technology programs in the US, it seems unlikely that new academic dental laboratory programs would be opened or existing programs expanded. But that is exactly what is happening in both Gransboro, North Carolina, and Pasadena, California. Gransboro is the location of a newly opened dental laboratory 2-year program. First offered in August 2017 by Pamlico Community College (PCC; pamlicocc.edu), the 2-year AAS degree in dental laboratory technology was founded by Kathy Nicodemus, CDT, a dental laboratory instructor who taught and ran a dental technology training program for inmates that focused on removable prosthetics in the North Carolina's prison system. Recognizing a need in her rural community for employment opportunities for high school students, she set out to create the program with the help of her institution, and local dental laboratories, dentists, and a prominent Dental Service Organization (DSO) in the region, Affordable Dentures & Implants (affordabledentures.com). Its laboratory division, Affordable Dentures Dental Laboratories, recognized the need for formally trained technicians and therefore partnered in order to help elevate the program. It demonstrates industry's involvement with educational programs and a means to capture much-needed talent. Director of Lab Operations, Keith Morris, CDT, Lab Recruiter, Stuart Raney, and Manager of Lab Recruitment and Industry Outreach, Tiffany Stark, are all members of PCC's advisory board and have helped in developing the program curriculum. 

The program offers a pathway for high school students to matriculate to the program in their junior or senior year of high school and earn college credits while getting this knowledge (and a career opportunity) free of charge, according to Nicodemus. “We live in a rural area, where employment is difficult to attain,” says Nicodemus. “Our program is focused on giving the students a good education and career, something both our local community and dental community expressly need.” Although the program is not Commission on Dental Accreditation (CODA)-accredited, nor are there any plans in the near future to become accredited, Nicodemus was happy to report that within 2 weeks of announcing the program, three students registered. She is optimistic about soon having a full class of 15 students and partnering with entities to grow the market share of qualified and knowledgeable dental technicians.

Efforts to revamp a curriculum to better prepare students for the realities of modern digital technology-aided production processes are underway on the West Coast at Pasadena Community College (pasadena.edu) in Pasadena, California. Program Administrator, Anita Bobich, CDT, recognized the profession's need for qualified technologists at a higher level than previously taught and more in line with the current needs of the profession. She embarked on revamping their entire CODA-accredited program to include the most relevant and current technologies, while still focusing heavily on the fundamentals that are so crucial to the science of dental technology.  The new, revamped program will be called “Restorative Dental Technology," and all the courses will have both analog and digital workflows incorporated in all areas of study in restorative dentistry. “We want our students to not only understand the ‘why' but also be prepared for the ‘how' of current digital technology realities being used in the profession,” says Bobich. “We teach them that there is power in knowledge and it will solidify their professional endeavors—what we call the bigger picture.” What led Bobich to focus on a new path to education was the feedback she received from graduates, the department's strong advisory board, and local dental laboratories and dentists. “We will be graduating the first students of this program in 2 years and the profession will certainly take notice. Having the ability to provide an education that is relevant will also fit well in clinical settings, which seems to be a trend as practices are getting larger and have technologists on-site” said Bobich. This endeavor required a lot of hard work, taking well over 5 years to go through all the appropriate channels to gain College and State of California approvals, but Bobich feels strongly that being able to provide an education that is current and relevant to the profession's needs is paramount. “The industry keeps evolving, and we need to keep abreast of the technology. Creating graduates who are successful in the current laboratory environment is a win-win for all.”

Pasadena Community College also has recognized the need for more highly specialized technologists and as a result has embarked on creating a Master Dental Technologist (MDT) certificate program. Slated to commence in the fall of 2018, the 1-year program is designed to meet the needs of the profession for both restorative dentistry providers and laboratory technologists. Led by Bobich and Lead Instructor, Domenico Cascione, MDT, BSc, CDT, the MDT program will consist of 44 consecutive weeks of Saturday and Sunday studies at the college. “The goal is to bring the dental technician to the next level,” says Cascione. “Understanding how to restore full mouth reconstructions and having in-depth implant restorative knowledge will be critical to meet future patient demands. That means more training and education is needed in order to achieve professionalism and successful completion of complex cases, which will provide for an elevated knowledge base and raise the level of dental technology.” Students looking to embark on the MDT certificate program will be required to either be graduates of an accredited program or provide document equivalency, as well as take specific tests for didactic skills and manual dexterity, along with an interview.

Today learning is not confined to the classroom or to professional events, especially for those living and working in areas of the country where no educational programs or industry meetings are existent. E-learning has evolved from a trend to mainstream as a means to help business owners educate themselves as well as their employees. In recognition of this evolution, the NADL through the Foundation for Dental Laboratory Technology has been creating new pathways for training and education in an attempt to meet the needs of the profession. Several resources have been made available by the Association, one of which is the Wealth of Knowledge (WOK) videos. Additional videos were donated to the Foundation by entities and individuals such as Dentsply Sirona (dentsplysirona.com), the Pankey Institute (pankey.org), and Matt Roberts, CDT, AAACD. Recently, the NADL transitioned their WOK library to the Foundation Learning Library. “We first launched with only three courses and now we have over 50 videos available on demand,” says Rachel Luoma, MS, CAE, Chief Staff Executive for the Foundation for Dental Laboratory Technology.  “Laboratories and individuals can access the videos for 90 days and supplement their on-the-job education. It's for both laboratory owners looking to educate their technicians as well as individual technicians seeking to grow professionally.” Many are free to NADL members. While the WOK videos focus on specific topics and are still great resources, the Foundation felt there was more they could do. Their board approved a new program, the Fundamentals of Dental Laboratory Technology, in October 2017; it's expected to launch at the Vision21 meeting this month. This will be a comprehensive program with 101 modules, offering a series of courses from A to Z, housed and facilitated on the Web. The core courses will cover general information pertinent to dental technology such as anatomy, dental science, and material science. According   to Luoma, “the program will offer hundreds of hours of education catering to the beginner level with no prerequisites, while teaching a core competency of concepts for a comprehensive dental technician.”

The program was initiated by the Foundation's board, which recognized its responsibility for ensuring and preserving the education and training of the dental technology profession, according to Napier. It will serve those who live in states that do not offer an accredited dental technology program and allow them to access a sound, affordable education from the convenience of their homes 24 hours a day/7 days a week. “Regrettably, the decline of accredited programs that offer dental technology education will continue,” says Napier. “The Foundation's program will offer the market access to a learning series on the science of dental technology to ensure and preserve the education and training of dental technology professionals,” says Napier. “It is not meant to compete with or replace formal education programs, but rather acknowledges the NADL's and the Foundation's continued commitment to support education and institutional knowledge.”

The need for this program was initiated by laboratory owners, who still struggle to find qualified and knowledgeable dental technicians. Experienced workers are aging out and not being replaced by new talented and educated technicians quickly enough to meet demands. This is a challenge that Napier believes will continue to plague the industry moving forward. “We are also finding that more and more technicians are employed in dental offices and the dentists are also driving this market need,” says Napier. “The hope for the future is that both the clinical side and the laboratory side have a clear vision as to what is needed to preserve the science-based knowledge of the dental technology profession, and not waiting till the ninth inning to start looking into remedies.” As part of the development process, the Foundation assembled a focus group of laboratory owners, technicians, educators, and manufacturers to build content and have been working for more than a year, honing in on and creating the best content for the program. “As we develop the actual modules, there will be a peer review process to make sure it is authoritative. We feel we have created a product as dictated by the entire industry.” Similar to the NADL and the Foundation, corporate dentistry recognized the dire need to cultivate qualified dental technology talent from within, as well as bring in new talent to sustain their business growth and strategy.

Dental Service Organizations (DSOs) are quickly becoming some of the larger providers of restorative dentistry in the US. Michael Thomas, CDT, Vice President of Laboratory Operations for Affordable Dentures & Implants, explains the difficulties his company faces in terms of finding qualified technical knowledge. “Our company is growing at a steady pace and is so heavily dependent on the dental technician's expertise. They are our backbone,” says Thomas. “And we are reliant on their skill set for our continued growth.” The impact of the constricted knowledgeable and talented technician pool, he says, is felt exponentially in their business model, as multiple centers each have an in-house laboratory. “Our company is specific to dentures and also focuses on speed and production, so we need technicians who clearly know the ‘why' and ‘how' to successfully navigate for the best patient outcome.”

The need for qualified removable technicians and the company's steady rate of growth, prompted Affordable Dentures Dental Laboratories (ADDL) to start its own training program, the Affordable Dentures Institute (ADI). This program is a 6-month paid opportunity for potential candidates, offering full benefits. The candidate becomes an employee of ADDL and reports three days to the Institute and two days to the laboratory on a weekly basis. “We wanted to use what we are good at—which offers the hands-on work—and truly couple it with the comprehensive understanding of the ‘why,'” says Thomas. “So we spent a year putting together a curriculum to help trainees understand landmarks, what they mean, and why they are important, as well as educating them on important specifics such as oral anatomy, tooth morphology, and the general principles and history of dentistry, to provide a comprehensive knowledge base,” said Thomas.

ADDL is not the only DSO establishing its own education and training center. ClearChoice Implant Centers found itself in a similar conundrum needing “new blood,” but also sought trainees who fit the culture of the company. “We can hire someone who knows how to do what we need them to do, but it is equally important they understand the ClearChoice culture,” says Scott Adams, Senior Director of Dental Services. “We work on optimization, not just performance. Human assets are key to providing our patients with the best experience.” Because some DSOs are becoming very specialized in what they deliver, it is critical the training becomes even more specific for their employees to perform those duties to the best of their abilities. “Our employees are trained specifically on what they do within the ClearChoice ecosystem,” he says. “This way they know what they need to be doing, how to interact with others on the treatment team, and how to relate to others in their respective roles. We put a lot of emphasis on leadership skills and characteristics, which provides them with a great deal of ownership for their own development.”

When ClearChoice's CEO, Kevin Mosher, came on board, he recognized the need to provide customized internal educational training for ClearChoice team members in order to maximize their effectiveness, through the use of a learning model implemented in all departments: dental technician, oral surgeon, and prosthodontist. “A comprehensive and overreaching educational program for clinical, operational, and cultural training,” says Adams. “The market is changing for the DSOs and the demand for laboratory technicians is increasing while the challenge lies in the ability to train in a time frame conducive to support our growth.” ClearChoice has developed a training program that is broken down by skill level and job capacity, which will be facilitated in their new state-of-the art headquarters and training center. There, employees will be immersed in education for a 2- to 4-week period, depending on the level of pertinence to their role, followed by practical training at active ClearChoice centers, referred to as Centers of Excellence.

Both Affordable Dentures & Implants and ClearChoice offer distinct paths to career success. “We are completely committed to our employee success rates, and the commitment begins really early on,” says Adams. “This allows our employees to focus on their learning and personal development. We have very low attrition. Our laboratory teams work in the same office as their doctors and work together to improve the lives of every patient treated at ClearChoice. Each team member gets to personally see the effect of their work on the patient's life. We offer a competitive compensation package and tremendous opportunities for career advancement, but I think our culture really is a key reason that we are able to retain our technicians.” Similarly, Affordable Dentures Dental Laboratories have a significantly low turnover/retention rate of less than 11% for those in the ADI training program, and approximately 18% fully skilled technicians network-wide, on average over the past 5 years.    “Our employees recognize the investment and dedication the company is making in them and their professional development, and most employees have risen internally to the ranks of laboratory managers,” says Thomas. In addition, great lengths are taken to place the right person in the right center's dental laboratory. “We are very calculating when placing an employee, so that we can achieve the best fit, as far as personalities, skill set, and culture. We embrace and foster continued education and provide a clear career path of about a year to a year and half to attain manager level.” ADDL fosters a culture of respect among dentists, technicians, and staff. Each graduate leaves the program with a very strong understating that they play a vital and integral role in the organization. “The dentists respect that the graduates have completed the program and agree to foster continued learning. They embrace and appreciate their knowledge base because it helps them successfully deliver the best care for their patients,” says Thomas.

As dental laboratory service providers attempt to attain and retain a dwindling pool of skilled and knowledgeable dental technicians, much can be learned from these new approaches to education. As Michael Thomas said, “for me, it's more than an Affordable Dentures Institute, it's a larger thought. This is not the ‘be all, end all'—the need is so broad with so many moving parts that we have to embrace each one and figure out how to connect. If we work together to elevate the educational acumen of the industry, all involved will be the benefactors. So even though there are entities that on paper are competitors, collaborating together to reach a higher level in our profession would be a win-win for all and our respective businesses will benefit greatly.” ADDL partners with several schools—such as McFatter Technical College, Atlanta Technical College, and Durham Technical Community College—on internship and externship programs and continues to show interest in establishing relationships with additional schools, all in hopes of elevating the profession.

Fostering a culture of education and developing career opportunities are key for laboratory owners expecting to retain a strong workforce. There are positive signs that owners understand the need to invest in their employees. NADL's April 2017 “Cost of Doing Business” survey provided some insights.³ Out of 5,979 valid email addresses, 659 responses were received for a response rate of 11%. According to the survey results, it is common for laboratory owners to cover continuing education/outside training expenses for employees. More than half (61.7%) of laboratory owners cover all training costs, including fees and travel expenses. Owners also value the importance and value of technician certification. According to survey results, nine out of 10 owners/managers encourage technicians to become Certified Dental Technicians, and 78% of owners/managers say certification is a factor in determining compensation.

In a rapidly changing landscape of both technology and human talent, the discerning dental laboratory owner or manager needs to recognize challenges and establish sound business strategies to navigate through these challenges. Providing a clear and decisive investment in the business's talent, whether through education, financial backing for education, certification, career trajectory roadmaps, and cultural wellness and certainly the combination of all mentioned, will help owners provide and retain a successful stream of qualified talent. As Maris A. Vinovskis⁴ wrote, “Education is of limited value if [dental laboratory stakeholders] refuse to acknowledge and reward those with better educational preparation and training.” Operating a successful restorative dental business requires focus on many variables that directly influence the business's success. Oftentimes in dental laboratories, the prosthetics fabricated are the focus, and as critical as they are, a business owner's focal point shouldn't only be the product the business is selling, but rather the many important peripheral components that support their ability to sell that same product.

These new education pathways are launching and many will follow, as replacing qualified talent, the lifeline of dental service providers, will continue to be a challenge. Education and certification is often looked upon, by those who work in the profession and motivated to grow professionally, as a decisive criteria in making employment moves. Organizations, entities and individuals alike, are striving to promote the education of the dental laboratory profession and there are opportunities to take advantage of these programs. Laboratory owners and managers offering support and incentives create a significant competitive advantage for their respective businesses and therefore will attract the best talent and thrive. For the future of the industry, we need better trained and qualified dental technicians, since prosthetics and the fabrication processes are not getting simpler, but rather they are becoming more complex. Therefore, it is incumbent upon all laboratory owners and managers to elevate the skill level of their employees; not doing so will produce dire results for the laboratory, the profession, and ultimately the patients.

Elevate and inspire with knowledge.