Dental grads find tough pull

When Casey Allman entered the University of Nevada, Las Vegas School of Dental Medicine five years ago, his sights were set on getting a degree and landing a lucrative job in the wide-open dental market in Las Vegas.

But a series of events out of his control radically altered that objective, forcing him to find work elsewhere.

"I had every intention of practicing here in Nevada," Allman said. "But when I graduated, I found that the market was not as good as what I was hoping for."

Allman, who found a job practicing in Albuquerque, N.M., is one of the few students in his graduating class who was licensed in Nevada.

Of the school's 71 graduates last year, only 27, including Allman, bothered to obtain their licenses in the state. And many of those, like dental school grad Jeremy Wilson, have struggled to find work.

Wilson is working two part-time jobs, one at the School of Dental Medicine's clinic on Shadow Lane and another at a private practice, and hasn't been able to find a full-time job.

"There are a lot of dentists (in Southern Nevada), and it's always difficult starting off in your profession," Wilson said.

Their situations represent a problem that was predicted years ago by dentists: Changes in licensing would open the floodgates to out-of-state dentists, eliminating the need for a steady stream of dentists from an expensive dental school.

But lawmakers ignored the warnings and charged ahead with a dental school.

Now, graduates are struggling to find work, and dental school officials are re-evaluating their practices to ensure more dentists stay in the state.

"Obviously it sounds like they were right," Steve Sisolak, a Nevada System of Higher Education regent, said of the dentists.

Dr. Arnold Pitts, Nevada Dental Association chairman, said the mistake came in the beginning: Officials never took a serious look at whether the state needed a dental school to begin with.

Led by then-UNLV President Carol Harter and championed in the Legislature by then-state Sen. Ray Rawson, a Las Vegas dentist, officials made the pitch to regents and lawmakers in the late 1990s that the dental school would pay for itself and increase the number of much-needed dentists in Nevada.

Lawmakers were given statistics showing that Nevada was last, or close to last, in the nation in the number of dentists per capita.

Members of the dental community were almost universally opposed to the idea of building a school, arguing that the dental shortage wasn't nearly as dire as Rawson and Harter made it out to be.

Rawson could not be reached for comment for this story. Harter said she hoped the number of dentists getting licensed in the state would increase.

But if the number doesn't increase, Harter said, producing dentists wasn't the only reason to justify creating the school. Its dental clinic, for example, serves 3,800 people per month, primarily those who don't have insurance or can't afford other means of dental care.

Dr. Robert Anderson, executive director of the Southern Nevada Dental Society, said that the notion that there was a lack of dentists was a misnomer and that the real problem was a "maldistribution" of dentists.

"There were, for example, Indian reservations and rural areas in the north where there was one dentist or no dentists," Anderson said. "You can have one zip code that has 18 dentists, and the zip code next to it has no dentists in it."

Instead of creating a dental school, members of the dental community argued, the state should change the licensing process, create a dental clinic to serve the poor or pay to send students out of state to be educated and require they practice in Nevada upon graduating, options that would cost less than creating a dental school.

There were also concerns about financial viability.

At the time, dental schools at Northwestern University, Emory University, Washington University of St. Louis and Georgetown University were among at least seven that had closed in the past 10 years.

Rawson originally pitched that Medicare revenue would cover the operating costs of the school, but that notion gradually eroded for a more realistic expectation that the state would have to fund several million dollars of costs.

That's on top of the $13 million legislators awarded the school for a building and equipment.

"We were originally told that this was not going to be a lot of money out of the taxpayers' pockets," Regent Mark Alden said.

Now the dental school is one of the most expensive individual programs in the Nevada System of Higher Education per student, receiving more than $8 million in state funding during the current fiscal year.

"It's a very expensive proposition for the state," said Dr. Bradley Welch, a Henderson dentist who works at the dental school a half-day each week. "That's the nature of dental education. Initially, I was not real thrilled about a dental school in Nevada just because I knew it would cost state money."

When officials were arguing about the need for a dental school, they said the state needed about 40 new dentists per year to keep up with growth.

Since 1998, the number of dentists in Nevada has more than doubled to more than 1,700, according to the Nevada Board of Dental Examiners.

The Legislature made it much easier for dentists to get licensed when, in 2005, it began accepting the Western Regional Examination Board instead of its own test for licensure.

That freed up thousands of dentists who take the Western Regional board to easily apply for licensure in Nevada.

"We've had a massive influx of dentists from out of state, enough to handle the future need of dentists," Pitts said. "I personally think that there's plenty of dentists."

The increase in dentists peaked last year when, between January and August, the State Board of Dental Examiners granted licenses to more than 300 new dentists.

The influx has made it tougher for graduates to find work.

Dr. Jeffrey Thayer, a 2006 graduate, feels lucky to have a job he likes working at the Southern Desert Correctional Center performing mostly extractions on inmates.

Many of his peers have not been so lucky, he said.

"They have had trouble," he said. "There's so many dentists here. Every corner you drive by there's a dentist's office."

Despite the competitive market, however, dentists and university system regents said they were surprised that fewer than 40 percent of the school's first graduates stayed in Nevada.

Officials at the dental school admit that the first graduating class has had trouble getting jobs in Nevada, although Dr. Karen West, who took over as the school's dean this year, said 24 members of the graduating class chose to get residencies in Nevada and other states instead of jumping into the job market.

Also, 10 students from the first graduating class were not able to get licensed in Nevada after they were found to have used the computer password of a part-time faculty member to sign off on their work.

Still, West said the school will try to recruit incoming students from Nevada, and rural Nevada in particular, in an attempt to get more students who might be more inclined to stay in Nevada.

Of the dental school's first class, 43 were from in state and 33 were from out of state. With its entering class this fall, 50 are from Nevada and 20 are from out of state, West said.

But regents and other officials said it is a problem if graduates from the dental school are going out of state.

"With the state (budget) shortfall, we can't be paying to train dentists to go to Iowa and New Hampshire," Sisolak said.

Chancellor Jim Rogers said he wasn't aware of the number of dental students who had been licensed, but "it's always a disappointment when the students you graduate go out of state."

Alden said that if less than half of graduates are staying in Nevada, "we're in serious trouble."