Military Personnel: DOD Needs to Improve Dental Clinic Staffing Models and Evaluate Recruitment and Retention Programs
Fast Facts
The Army, Navy, and Air Force have implemented common standards for how they determine necessary staffing levels at their health clinics for a number of medical specialties—but haven’t done so for their dental clinics. As a result, DOD dental clinics may not be staffed as efficiently as possible to provide dental care across the military services.
The military services have also struggled to recruit and retain certain types of dental specialists, such as oral surgeons. We recommended that the services develop a common set of dental staffing standards and a process to evaluate recruitment and retention efforts.
Photo of servicemember receiving dental care from a military dentist.
Highlights
What GAO Found
The Army and the Air Force use validated staffing models for their respective dental clinics, and the Navy has developed a model that is under review. The Army and the Air Force's models are based on service-specific staffing standards. For example, the Army's model generally projects dental clinic staffing based on historical facility data and, according to officials, the Air Force model is largely a population-based model that requires one dentist for every 650 servicemembers. In contrast, in the absence of a validated model, officials stated that, the Navy uses a general ratio of one dentist for every 1,000 servicemembers to staff its dental clinics. The Navy has developed a model that is under review, and if approved, according to officials, will be subject to the Navy's validation processes.
While the services have developed and implemented cross-service staffing standards for 42 medical specialties, according to a key official involved in developing these standards, they currently do not plan to develop a similar set of standards for dental care. Cross-service staffing standards help the services standardize clinic staffing to address the common day-to-day health needs of patients. Service officials maintain that they must operate their respective dental clinics autonomously and in a manner that best supports their service-specific needs and unique command structures. However, as oral health requirements for servicemembers are standardized across the Department of Defense (DOD), it is unclear why dental care has been excluded from the staffing standardization effort—especially because the services have implemented cross-service staffing standards for 42 other medical specialties.
The Army, the Navy, and the Air Force meet their needs for military dentists by recruiting both dental students and fully qualified dentists. The services generally met their recruitment goals for dental students between fiscal years 2012 and 2016, but faced challenges recruiting and retaining fully qualified dentists during that period. For example, the Army missed its recruitment goals for fully qualified dentists in all 5 years, the Navy missed its goals in 2 out of 5 years, and the Air Force missed its goals in 3 out of 5 years. These challenges are most pronounced for certain specialties. For example, service data indicate that the Army and the Navy were unable to recruit any oral surgeons, while the Air Force recruited 50 percent of the oral surgeons it needed. Service officials cited various reasons for not meeting recruitment goals, including the availability of more lucrative careers in the private sector and quality of life concerns associated with military service.
The services rely on various programs, including scholarships and special pay and incentives, to attract and retain military dentists, and service officials stated that they monitor their programs by reviewing their goals, among other actions. However, GAO found that some services continue to provide incentive bonuses for positions that are overstaffed and have met or exceeded recruitment goals, but they do not know whether this is necessary because they have not evaluated the effectiveness of their programs. Without evaluating their programs, the services lack the information necessary to ensure that they are using recruitment and retention incentives effectively and efficiently for attracting and retaining dentists.
Why GAO Did This Study
DOD has taken steps to modernize its Military Health System to ensure that it operates efficiently. For example, in September 2013, the Defense Health Agency was created, in part, to implement common clinical and business processes across the services. Essential to this effort are the services' ability to effectively staff their medical facilities, including the processes used for staffing dental clinics and the services' ability to recruit and retain military dentists.
Senate Report 115-125 included a provision for GAO to review the services' processes for determining requirements for dentists and its programs for recruiting and retaining military dentists, among other things. GAO assessed the extent to which the services (1) use validated dental clinic staffing models that also incorporate cross-service staffing standards, and (2) have recruited and retained military dentists and measured the effectiveness of their recruitment and retention programs. GAO assessed service dental clinic models, analyzed recruitment and retention data from fiscal year 2012 through 2016, and interviewed DOD and service officials.
Recommendations
GAO recommends that each of the services develop cross-service staffing standards to be incorporated into their staffing models, and evaluate the effectiveness of their recruitment and retention programs. DOD did not provide comments on a draft of this report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of the Army | The Secretary of the Army should ensure that the Surgeon General of the Army Medical Command (1) collaborate with the Navy Bureau of Medicine and Surgery and the Air Force Medical Service to develop a common set of planning standards to be used to help determine dental clinic staffing needs, and (2) incorporate these standards into the Army's dental corps staffing model. (Recommendation 1) |
On January 15, 2019, DOD sent a correspondence that indicated they are taking steps to develop and implement a common set of planning standards, which will be incorporated into the military department staffing models, to help determine dental clinic staffing needs and these changes will be complete by January 1, 2020. In a letter dated April 27, 2020, DOD stated that a tri-service working group, that was formed in January 2019, has evaluated the services' perspectives on dental manpower requirements for resourcing within military treatment facilities. Additionally, the working group evaluated commonalities and dissimilarities between the existing Air Force, Army, and Navy dental clinic staffing models. The outcome of the study are common planning standards to be integrated into the services' dental manpower models in the functional areas of Preventive Care, Routine Care and Specialty care based on 32 clinical procedures and treatment times that were evaluated as part of the commonalities garnered from separate services specific dental workload-based studies. DOD requests GAO close this recommendation. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. On May 1, 2023, GAO met with DOD representatives, who stated that department-wide staffing models are being developed through a Defense Health Agency initiative. These models are planned for completion in March 2027. On May 23, 2023, DOD updated its corrective action plan, indicating that although the services did agree on the 32 clinical procedures and treatment times, they did not agree on how the data would be aggregated to determine staffing needs. DOD is considering three possibilities on how to use these data to determine staffing, with an estimated completion date of July 2023. As of January 2024, DOD has not provided additional information on the status of its efforts to address this recommendation. GAO will continue to monitor DOD's efforts and update the recommendation as more information becomes available.
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| Department of the Navy | The Secretary of the Navy should ensure that the Surgeon General of the Navy Bureau of Medicine and Surgery (1) collaborate with the Army Medical Command and the Air Force Medical Service to develop and implement a common set of planning standards to be used to help determine dental clinic staffing needs, and (2) incorporate these standards into the Navy's dental corps staffing model. (Recommendation 2) |
On January 15, 2019, DOD sent a correspondence that indicated they are taking steps to develop and implement a common set of planning standards, which will be incorporated into the military department staffing models, to help determine dental clinic staffing needs and these changes will be complete by January 1, 2020. In a letter dated April 27, 2020, DOD stated that a tri-service working group, that was formed in January 2019, has evaluated the services' perspectives on dental manpower requirements for resourcing within military treatment facilities. Additionally, the working group evaluated commonalities and dissimilarities between the existing Air Force, Army, and Navy dental clinic staffing models. The outcome of the study are common planning standards to be integrated into the services' dental manpower models in the functional areas of Preventive Care, Routine Care and Specialty care based on 32 clinical procedures and treatment times that were evaluated as part of the commonalities garnered from separate services specific dental workload-based studies. DOD requests GAO close this recommendation. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. On May 1, 2023, GAO met with DOD representatives, who stated that department-wide staffing models are being developed through a Defense Health Agency initiative. These models are planned for completion in March 2027. On May 23, 2023, DOD updated its corrective action plan, indicating that although the services did agree on the 32 clinical procedures and treatment times, they did not agree on how the data would be aggregated to determine staffing needs. DOD is considering three possibilities on how to use these data to determine staffing, with an estimated completion date of July 2023. As of January 2024, DOD has not provided additional information on the status of its efforts to address this recommendation. GAO will continue to monitor DOD's efforts and update the recommendation as more information becomes available.
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| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force Medical Service (1) collaborate with the Army Medical Command and the Navy Bureau of Medicine and Surgery to develop and implement a common set of planning standards to be used to help determine dental clinic staffing needs, and (2) incorporate these standards into the Air Force's dental corps staffing model. (Recommendation 3) |
On January 15, 2019, DOD sent a correspondence that indicated they are taking steps to develop and implement a common set of planning standards, which will be incorporated into the military department staffing models, to help determine dental clinic staffing needs and these changes will be complete by January 1, 2020. In a letter dated April 27, 2020, DOD stated that a tri-service working group, that was formed in January 2019, has evaluated the services' perspectives on dental manpower requirements for resourcing within military treatment facilities. Additionally, the working group evaluated commonalities and dissimilarities between the existing Air Force, Army, and Navy dental clinic staffing models. The outcome of the study are common planning standards to be integrated into the services' dental manpower models in the functional areas of Preventive Care, Routine Care and Specialty care based on 32 clinical procedures and treatment times that were evaluated as part of the commonalities garnered from separate services specific dental workload-based studies. DOD requests GAO close this recommendation. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. On May 1, 2023, GAO met with DOD representatives, who stated that department-wide staffing models are being developed through a Defense Health Agency initiative. These models are planned for completion in March 2027. On May 23, 2023, DOD updated its corrective action plan, indicating that although the services did agree on the 32 clinical procedures and treatment times, they did not agree on how the data would be aggregated to determine staffing needs. DOD is considering three possibilities on how to use these data to determine staffing, with an estimated completion date of July 2023.As of January 2024, DOD has not provided updated information on the status of this recommendation. GAO will continue to monitor DOD's efforts and will update the recommendation when more information becomes available.
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| Department of the Army | The Secretary of the Army should ensure that the Surgeon General of the Army Medical Command evaluates the effectiveness of its recruitment and retention programs for military dentists, including the need for and effectiveness of the recruitment and retention incentives currently offered. (Recommendation 4) |
On January 15, 2019, DOD sent a correspondence that indicated the military departments are taking steps to study the effectiveness of their recruitment and retention programs for military dentists including the need for, and effectiveness of, the recruitment and retention incentives currently offered. In a letter dated April 27, 2020, DOD stated the Army has conducted a survey of private sector retention, including a supply, demand, and cost analysis in order to identify strategies and initiatives to improve overall end strength for hard to fill specialties. This report was initially due June 2020, however in an update provided by the Army in October 2020, officials told us that the survey driving the report's findings was just completed and the final report should be issued in January 2021. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. As of May 12, 2022, DOD had not provided supporting documents. GAO followed up with DOD representatives on May 1, 2023. DOD representatives requested further clarification on the types of supporting documents to provide GAO, and indicated they will provide these documents. On May 23, 2023, DOD provided an updated corrective action plan that indicates some Army actions related to this recommendation hwere completed in 2019, and additional actions are estimated for completion in July 2023. As of January 2024, DOD has not provided additional information on the status of its efforts to address this recommendation. GAO will continue to monitor DOD's efforts and update the recommendation as more information becomes available.
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| Department of the Navy | The Secretary of the Navy should ensure that the Surgeon General of the Navy Bureau of Medicine and Surgery evaluates the effectiveness of its recruitment and retention programs for military dentists, including the need for and effectiveness of the recruitment and retention incentives currently offered. (Recommendation 5) |
On January 15, 2019, DOD sent a correspondence that indicated the military departments are taking steps to study the effectiveness of their recruitment and retention programs for military dentists including the need for, and effectiveness of, the recruitment and retention incentives currently offered. This study will be complete by January 1, 2020. In a letter dated April 27, 2020, DOD stated the Navy has initiated a study to evaluate the effectiveness of recruitment and retention programs for military dentists, including the need for and effectiveness of currently offered incentives. The final report is due June 2020. As of October 2020, GAO has requested, but has not received documentation to show that the final report has been completed. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. As of May 12, 2022, GAO had not yet received these supporting documents. GAO followed up with DOD representatives on May 1, 2023. DOD representatives requested further clarification on the types of supporting documents to provide GAO, and indicated they will provide these documents. On May 23, 2023, DOD provided an updated correction action plan indicating that activities related to this recommendation will be complete by July 2023. As of January 2024, DOD has not provided additional information on the status of its efforts to address this recommendation. GAO will continue to monitor DOD's efforts and update the recommendation as more information becomes available.
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| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force Medical Service evaluates the effectiveness of its recruitment and retention programs for military dentists, including the need for and effectiveness of the recruitment and retention incentives currently offered. (Recommendation 6) |
On January 15, 2019, DOD sent a correspondence that indicated the military departments are taking steps to study the effectiveness of their recruitment and retention programs for military dentists including the need for, and effectiveness of, the recruitment and retention incentives currently offered. This study was to be complete by January 1, 2020. In a letter dated April 27, 2020, DOD stated that the Air Force has introduced Accession and Retention (Incentive) topics as a standard agenda item at the Dental Board of Directors and reviews trends, retention gaps/overages and recruitment incentives. According to officials, the data are used to validate, adjust, or eliminate various incentives. Officials also stated that the Air Force collects and utilizes survey data, exit surveys and private sector benchmarks to evaluate the effectiveness of its recruitment programs. On June 8, 2021, DOD representatives from Health Affairs and the Services met with the GAO to discuss what is needed to close the recommendations. GAO requested evidence that the actions have been completed. As of May 12, 2022, GAO had not yet received supporting documents. GAO followed up with DOD representatives on May 1, 2023. DOD representatives requested further clarification on the types of supporting documents to provide GAO, and indicated they will provide these documents. On May 23, 2023, DOD provided an updated corrective action plan indicating that actions related to this recommendation will be complete in July 2023. As of January 2024, DOD has not provided any additional information on the status of this recommendation. GAO will continue to monitor DOD's efforts and will update the recommendation's status as more information becomes available.
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