Jared Kaltwasser

[<a href="//storify.com/dentistsmoney/the-dmd-top-5-for-the-week-ending-aug-26" target="_blank">View the story "The DMD Top 5 for the Week Ending Aug. 26" on Storify</a>]

Articles

Which stories were most popular last week? Here's a roundup.

The DMD Top 5 for the Week Ending Aug. 26

, reporter Ed Rabinowitz discussed the increasing problem of market saturation facing dentists and dental hygienists. In many areas, the market already has enough dental professionals, creating a surplus and causing business and career headaches for dentists.

However, as the article noted, much of the problem has to do with an unequal distribution of the dental health workforce. While some areas are flush with dental professionals, other areas have major shortages. Below, we take a look at the states with the biggest shortages of dentists.

The US Department of Health and Human Services regularly publishes reports on what it terms “Health Professional Shortage Areas (HPSAs).” These areas are local municipalities and regions in which the number of healthcare professionals doesn’t meet the government’s standard of adequacy. In this case, the government says any area with a population-to-provider ratio of more than 3,500 to 1 qualifies as an HPSA. If the area has population or geographic factors that cause it to have an unusually high need, the government’s benchmark ratio is 3,000 to 1.

For each state, the government adds up the number of HPSAs, along with the percentage of need met in those areas, and the number of dental health professionals that would be required in order to eliminate all of the state's HPSA designations (provided those new professionals were distributed throughout the state based on need).

Overall, according to HHS, about 50 million Americans live in a Health Professional Shortage Area, when it comes to oral health. On average, the nation’s 5,366 HPSAs have just 39% of the number of dentists needed. In order to eliminate all of the United States’ HPSAs, we would need an additional 7,712 dental health professionals (although those numbers would only be sufficient if those dentists were spread out according to need).

What follows are the 12 states that need the most dental professionals in order to remove their HPSA designations. In addition to the raw number of dentists needed, we’ve included the total HPSA designations in the state, the population of those HPSAs, and the percentage of need met within those areas. All data is current as of today.

To see the government's latest HPSA report in full, 

While many areas have plenty of dental professionals (or, in many cases, too many dental professionals), other regions have localized dentist shortages. Here's a look at the states with the biggest deficits.

The 12 States with the Largest Dentist Shortages

[<a href="//storify.com/dentistsmoney/the-dmd-top-5-for-the-week-ending-aug-19" target="_blank">View the story "The DMD Top 5 for the Week Ending Aug. 19" on Storify</a>]

These stories were our most popular articles last week.

The DMD Top 5 for the Week Ending Aug. 19

The Centers for Disease Control and Prevention doesn’t mince words when it discusses the problem of opioid addiction in the United States. The problem, according to the CDC, is nothing short of an epidemic.

Indeed, 28,000 people died of opioid overdoses in 2014, and the CDC estimates that at least half were due to prescription opioid pain relievers.

Increasingly, the focus around the opioid problem has turned toward healthcare providers and their role prescribing painkillers. Dentists are taking notice.

“Honestly, there is a lack of education around the disease concept of addiction and the differentiation between chronic and acute paid and good opioid prescribing habits,” said Joseph Garbely, DO, medical director at Caron Treatment Centers. “Now we’re finally having that conversation. But we haven’t had that conversation; it’s new.”

MORE: See the results of Dentist's Money Digest's reader survey on opioid abuse

One way dentists contribute to the problem is by not being careful enough in their prescribing, Garbely said.

“Dentists will write a larger quantity maybe than is necessary,” he said. “One reason is so they don’t get inundated with phone calls; the other reason is to make sure the patient has the amount they need.”

Garbely said dentists and other healthcare professionals are trained to think in monthly cycles, so it can be difficult to break out of that mindset when prescribing pain relievers. He said state regulatory boards ought to do more to establish clear guidelines for prescribing addictive drugs. Pennsylvania, where Garbely is based, is coming out with precisely that, he said, though Garbely said his state is on the leading edge.

However, dentists’ roles in the opioid epidemic extend beyond the prescription pad. Many dentists end up addicted themselves. Addiction can stem from stress, personal issues, or simply the access healthcare workers have to such drugs. Whatever the cause, Garbely said it’s often difficult for dentists and other healthcare professionals to ask for help.

“It takes far more courage to put up your hand and ask for help than it does to pretend there’s nothing wrong,” he said. “Eventually the disease, as it progresses, will take other things from your life, and ultimately your career.”

Garbely said many worry that their professional societies will ban them from practice. However, he said state dental and medical boards are doing a better job now of understanding that addiction is a disease and, like any disease, it can be treated.

“As a human being first they are entitled to have diseases,” he said. “And there is help.”

Some states require specific treatment up front. Dentists are often also asked to sign monitoring contracts that require after-care and random drug testing. Those requirements in fact give dentists an advantage.

Garbely also said dentists can protect themselves and their employees by making sure multiple staff members have a role.

“I think we have to empower office managers and other colleagues to intervene on the dentist in question if there are discrepancies in counts and scrips and things of that sort, or if they’re acting impaired,” he said.

Garbely also said the healthcare industry generally needs to do a better job at learning and identifying signs of impairment. He said sometimes it can be difficult to spot an addicted dentist.

“The last thing to go with every healthcare professional is work,” he said. “So there’s usually a path of destruction that leads to work and the other domains of one’s life. But I do think it’s important for colleagues and office managers to have an idea what impairment looks like.”

That can mean constricted or dilated pupils, long absences during the course of the day, or changes of behavior.

An addiction specialist with decades of experience counseling healthcare providers says addiction is a disease, and like any disease, it can be treated.

Addiction Expert Says There's Hope for Opioid-Addicted Dentists

Nearly one in three dentists say they know of a dentist who has been addicted to prescription opioids, according to a new 

Thirty-two percent of respondents said they are personally aware of a dentist colleague with a painkiller problem. The results are based on a survey of 196 dental professionals, conducted online from July 7 through August 6.

Respondents were anonymous, but one commenter recalled a tragic case, around 40 years ago.

“…A dentist lost his license due to opioid addiction following [an] airplane crash. Very nice guy. Unfortunately, he committed suicide by jumping in front of an Amtrak train.”

Joseph Garbely, DO, medical director at Caron Treatment Centers, said many dentists fear professional repercussions if they seek help for addiction. But he said most regulatory boards now understand that addiction is a disease, and, like any disease, can be treated.

“Addiction’s not going to be fixed by self-will,” he told 

“Self-will will not work. You have to surrender to a (treatment) process.”

The 196 dentists were primarily general practitioners (82%), nearly two-thirds (62%) worked as solo-practitioners, and most (82%) had been practicing for more than 20 years.

Despite the fact that one-third of dentists say they know or knew of an addicted dentist, nearly two-thirds (65%) said they see opioid abuse as a “minor” problem. Another 28% said it is a “significant, but not pressing” issue.

“I don't think a lot of dentists are personally addicted to opioids, no more than the general population, however I do believe some are over-prescribers,” said one respondent.

The survey also asked dentists about their prescribing habits.

Three-quarters (77%) said NSAIDS are “usually” adequate for post-operative pain relief. Another 17% said NSAIDS are “always” adequate.

When prescribing opioids, 51% of dentists said they prescribe less than a two-week supply, and many said they only prescribe two to four days’ worth of pills.

“I will only prescribe enough for the evening after the procedure,” one respondent wrote.

About one-third (33%) said they always warn patients about the addictive properties of opioids prior to prescribing the pills. Another 41% said they “sometimes” warn patients, but only if they have reason to believe the particular patient might be susceptible to addiction.

However, only 59% said they screen patients for possible addiction problems before prescribing opioids.

And while the vast majority of dentists say they won’t prescribe opioids without an office visit, 17% said they had done so at least once.

Continue reading to see the full results in chart format

A new survey of 196 dentists finds dental professionals believe opioid abuse is a minor problem in the industry, though nearly one-third say they know of a dentist colleague who has or had a prescription drug abuse problem.

DMD Survey: One-Third of Dentists Know of an Opioid-Addicted Colleague

Sending your kid off to college can be a big adjustment. One way to make the transition smoother is to ensure your newly minted freshman has reliable transportation to and from campus.

As it turns out, reliable transportation doesn’t have to mean spending a lot of money.

Kelley Blue Book, the vehicle valuation service, is out with 

its list of the 10 best “back to school cars.

” The models on the list were chosen based on a variety of criteria, and all have a price tag under $20,000.

“Safety is the paramount decision when it comes to back-to-school cars, and practicality and affordability are also high on the list of desirable characteristics, at least according to parents,” said Jack R. Nerad, executive editorial director and executive market analyst for 

On the other hand, college students tend to care more about style, Nerad said, in a KBB press release.

So which car wins? Kelley Blue Book says the 2016 Honda Fit 

 is parents’ best bet. It’s the third straight year the subcompact car has topped the list. KBB says a fair purchase price for the car is $15,776, slightly lower than the manufacturer’s suggested retail price of $15,890.

The most expensive car in the Top 10 is the 2016 Mazda CX-3, which KBB says is one of the 10 most fuel-efficient sport utility vehicles on the market, making about 35 miles per gallon on the highway. A fair price for the CX-3 is $19,902, according to KBB.

The least expensive car on the list is the 2016 Chevrolet Spark, which has a KBB fair purchase price of $12,544. It’s a four-door “mini car” but KBB says it’s surprisingly comfortable for four people.

When choosing a car, KBB encourages buyers to test drive at least two or three different models before making your choice. And while all of the cars on this list are new, the automotive information service says car buyers should consider certified pre-owned cars, which come at a lower price than a new car, but also carry a manufacturer-backed warranty.

The full list of KBB’s Best Back-to-School Cars, along with KBB’s fair purchase prices is:

Sending the kid off to school for the first time? Here are 10 cars that will please your kid but spare your wallet.

The 10 Best Back-to-School Cars for Your College Student (and Your Wallet)

[<a href="//storify.com/dentistsmoney/the-dmd-top-5-for-the-week-ending-aug-12" target="_blank">View the story "The DMD Top 5 for the Week Ending Aug. 12" on Storify</a>]

Our weekly look at last week's most popular stories.

The DMD Top 5 for the Week Ending Aug. 12

A lawsuit in Pennsylvania is raising questions about what role dentists should play in policing colleagues’ practices.

Steven S. Pesis, DDS, who was fired in November from Penn Dental Medicine in Philadelphia, is suing his former employer, alleging he was terminated after he blew the whistle on a colleague that Pesis says was ordering unnecessary procedures.

The University of Pennsylvania, which owns the clinic, said in court filings that Pesis was fired for reviewing a colleague’s patient records without permission. The university 

 that it would not comment on the case beyond what was in the court filings.

Pesis began working at the clinic in 2012, according to the Inquirer. In November 2015, the practice hired a new dentist. Two days later, Pesis said he began looking at the new dentist’s charts and decided that the new dentist was ordering expensive crowns that were not medically necessarily. Pesis reported his findings to supervisors, and was fired 12 days later.

In its court filing, the university stood behind the new dentist’s work and alleged that Pesis had engaged in unprofessional behavior that violates the practice’s policies as well as the Health Insurance Portability and Accountability Act (HIPAA).

Rules governing intra-office access to dental records vary from state to state and practice to practice. New York State, for instance, says practices should use a “need to know” standard when governing access to records.

“Patient information should be shared only on a need-to-know basis with those who participate in the care of the patient,” the 

Though Pesis and his former employer disagree on whether this particular dentist was performing too many dental crowns, federal officials believe the issue is a major problem.

In June, US Sen. Charles Grassley (R-IA) 

 to the US Attorney General’s Office and the US Department of Health and Human Services seeking information into the extent of fraud among providers of dental care to Medicaid patients.

"Some dentists are clearly performing unwanted and unneeded medical procedures on children without the consent of parents and bilking Medicaid for the privilege," Grassley wrote.

A Pennsylvania dentist was suspicious of a colleague, so he evaluated the colleague's patient records. Two weeks later, the dentist was fired.

Pennsylvania Dentist Claims He Was Fired for Blowing Whistle on Co-Worker

When it comes to travel, the affluent prefer to spend their time in Europe.

That’s the finding of a new report from 

, an international travel agency network specializing in luxury travel. The company analyzed $35 billion worth of travel transactions to come up with a list of travel trends and top destinations.

The company says Europe will be the favorite destination for affluent travelers this fall and winter, with Italy, France, and the United Kingdom filling the top three spots, respectively.

Virtuoso says rates at its partner hotels are down from summer peak rates. In Barcelona, travelers will save 15% by traveling this fall or winter; in London, prices are down 7% from the summer.

Rounding out the Top 10 destinations are South Africa, Spain, Mexico, China, Australia, New Zealand, and Israel. Virtuoso noted that Zika fears don’t seem to have had an effect on rates of travel to Mexico. Israel, too, is seeing normal business even amid growing tension in the middle east.

“(Israel) is a sought-out destination not only for its religious significance, but also for its history, food, culture, and adventure experiences,” 

If Europe is a mainstay atop travelers’ wish lists, Virtuoso says Africa is the up-and-comer to watch. Bookings to Kenya are up 59% versus last year. South Africa’s bookings are up 28%, and Tanzania is seeking a surge of 27% versus 2015. All three countries are on Virtuoso’s “Hot 10” list of trending travel destinations.

Overall, the destinations with the biggest increases in bookings are: South Africa (59%), Iceland (56%), Saint Martin (39%), China (35%), and Ecuador (34%).

“According to Virtuoso’s travel advisors, safaris are particularly appealing for multigenerational family trips, with plenty to see and enjoy for travelers of all ages,” the company said. “Iceland has been a growing favorite in recent years, and its prominent showing on the Hot 10 proves that its popularity is extending into the fall.”

The findings are based on international travel, so it does not include travel within the US or Canada.  

A new report looks at travel trends among affluent tourists from the US and Canada. It finds Europe remains the favored destination.


Affluent Travelers Love Europe, But Africa's on the Rise

You know the feeling: You mention your profession at a cocktail party or class reunion and people assume you make a lot of money. You grudgingly concede that yes, dentists earn a good salary, but you quickly insert the caveat: You’ve also got six figures of student loan debt.

Though student loans come with low interest rates and are generally considered “good” debt, the fact remains that the personal finances of most new dentists are impacted greatly by the fact that they begin their career lugging a millstone of debt.

According to the American Dental Education Association

, the average dental school graduate left school with $247,227 in student loan debt in 2014. That number has more than doubled since 2001, 

according to the American Student Dental Association

, which is working to find ways to curb the increases. One of the major culprits is simply the cost of dental school. The ASDA says in-state dental school tuition is nearly $39,000 per year on average; out-of-state tuition is nearly $54,000 on average.

In an ideal world, the areas with the highest tuition would also have the highest salaries and most job opportunity, thereby best equipping students to pay off their high student debt. Unfortunately, that’s not always the case. A new study by the consumer finance website 

 recently looked at the “best and worst states” when it comes to student debt. They found some states, such as West Virginia, have the toxic combination of high rates of student debt and low rates of employment opportunity. On the flip side, West Virginia’s neighbor, Virginia, has relatively low student loan debt and a high level of opportunity.

What follows are the 10 “best” and 10 “worst” states for student debt, according to WalletHub’s report.  For each state, we list the state’s rank in two composite categories: student loan indebtedness, and grants and work opportunities.

The “student loan indebtedness” rank is based on a number of factors, including the state’s average student debt, student debt as a proportion of income, and the state’s student loan default rate.

The “grants and work opportunities” category includes factors such as the unemployment rate for people ages 25-34 and the availability of grants and paid internships for college students.

The two composite categories are weighted, with student indebtedness carrying the most weight in the rankings. Note: The composite category rankings are out of 51, with 1 being the best, and 51 being the worst. (The list includes the District of Columbia, even though it’s not a state.)

Read through the list, and share your comments with us on 

New Mexico has the second-lowest average student debt, and has the fifth-lowest proportion of students graduating with debt. However, those positive marks are counter-balanced by the fact that the state has the third-highest default rate of any state.

The Aloha State gets its high marks in part because it has the third-lowest proportion of students graduating with student debt. Unfortunately, those students with debt have the third-highest debt as a percent of average income (adjusted for cost of living).

Colorado has the fifth-lowest unemployment rate for workers ages 25-34. According to the 

, the average Colorado graduate had about $25,000 in student loan debt in 2014.

Like New Mexico, Alaska students have relatively low student debt, though they face an economy that is one of the least favorable for young workers. On the plus side, the state has its own 

 for healthcare professionals (including dentists) who agree to work in the state for at least three years.

As in Colorado, the average graduate in Washington leaves school with about $25,000 in student debt. About 58% of the state’s graduates will have student loans. The state has also had problems with predatory student loan adjustors. In April, the 

 said 346 students would get back an average of $468 from adjustors who collected illegal fees.

Virginia, which comes is fifth overall, is the one state to score in the top 10 in both composite categories. The state has the fifth-lowest student debt level as a percentage of income.

Nevada has the lowest proportion of students with debt and the third-lowest average student debt, helping it claim the No. 4 spot on this list. Another sign that the state is doing well is the fact that it has the third-lowest percentage of student loan borrowers among those aged 50 and older.

North Dakota has the third-lowest student debt as a percentage of income. It also has the third-lowest unemployment rate among young people and the second-lowest percentage of borrowers with past due payments or defaults.

Wyoming ties with Nevada for the lowest proportion of students with debt. It also comes in first place for the lowest student debt as a proportion of income. However, when it comes to total average debt, the state doesn’t crack the Top 5.

Utah has the lowest average student debt, the second-lowest debt-to-income ratio, and the lowest unemployment rate for people ages 25-34.

Ohio ranks in the upper half when it comes to work and grant opportunities for students and recent graduates. Unfortunately, students graduated with about $29,000 in student loan debt, on average, in 2014, according to the Institute for College Access and Success. That level of debt helps land Ohio in the Bottom 10.

Mississippi has the second-highest rate of student loan borrowers with past due balances or defaults. About 60% of its graduates leave school with student loan debt.

New Hampshire lands in the Bottom 10 despite a very good economy, including the fourth-lowest unemployment rate for young adults. The reason? For one thing, the state has the highest proportion of students graduating with debt, among the 49 states for which data were available. It also has the third-highest percentage of people aged 50 and older who still carry student debt.

South Carolina residents have the fourth-highest debt as a percentage of income, and their relatively weak economy means the state lands in the bottom 10 in both composite categories. The average student there graduates with a bit more than $29,000 in student loan debt.

The average dentist enters practice with six figures worth of student loan debt. What about their non-dentist peers? A new report offers insights.