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CAREERS FOR DENTISTS�IN HEALTH CENTERS

Considering all the options

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ARE INDIVIDUALS GETTING THE ORAL HEALTH CARE THEY NEED?

Access to oral health care

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UTILIZATION BY AGE

  • Percent reporting a dental visit in the past year, by age group (2010)
    • Age < 19: 46%
    • Age 19-34: 30%
    • Age 35-49: 38%
    • Age 50-64: 44%
    • Age 65 and over: 41%

Source: Medical Expenditure Panel Survey, AHRQ. Cited in ADA HPRC Research Brief, 2013

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TRENDS IN GENERAL POPULATION

  • Change in percent between 2000-2010, of people who had dental visit in past year
    • Children increased 9.2%
      • from 42.4% to 46.3%
    • Adults decreased 5.0%
      • from 39.0% to 37.0%

Source: Medical Expenditure Panel Survey, AHRQ. Cited in ADA HPRC Research Brief, 2013

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GETTING NEEDED CARE

  • Utilization is increasing for children at all income levels
    • But remains lower with lower incomes
  • For lower income adults, utilization is decreasing
    • While increasing for higher income adults
  • Access to needed care is decreasing
    • Persistent disparities based on income, ethnicity and age

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INCOME AND CHILD ORAL HEALTH

  • Percent with dental visit in past year increased between 2000 and 2010 for children in all income groups
    • Income < 100% of FPL increased 38.5%
    • Income 100-200% of FPL increased 35.5%
    • Income 200-400% of FPL increased 2%
    • Income 400% or more of FPL increased 5.5%

Source: Medical Expenditure Panel Survey, AHRQ. Cited in ADA HPRC Research Brief, 2013

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DISPARITIES AMONG CHILDREN

  • Untreated dental caries
    • 25.1% of children 3-5 yrs of age living below 100% FPL (vs. 14.4% of all children 3-5 yrs)
  • Presence of dental sealants
    • 26.8% of Hispanic and 27.3% of African-American children 6-9 years of age have sealants (vs. 32% of all children 6-9 yrs)

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Source: NCHS, 2012

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INCOME AND ADULT ORAL HEALTH

  • Percent with dental visit decreased between 2000 and 2010 for adults in all income groups below 400% of FPL
    • Income < 100% of FPL decreased 17.4%
    • Income 100-200% of FPL decreased 11.5%
    • Income 200-400% of FPL decreased 2.6%
    • Income 400% or more of FPL increased 4.1%

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Source: Medical Expenditure Panel Survey, AHRQ. Cited in ADA HPRC Research Brief, 2013

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DISPARITIES AMONG ADULTS

  • Reporting no lost permanent teeth
    • 15.2% of adults 45-64 years of age living below 100% FPL (vs. 29.3% of all adults 45-64 yrs)
  • Reporting total edentulism
    • 34.3% of adults 65-74 years of age living below 100% FPL (vs. 15.0% of all adults 65-74 yrs)

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Source: NCHS, 2012

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NEED CARE BUT CAN’T AFFORD IT

Source: National Health Interview Survey, Cited in Breaking Down Barriers, ADA 2012

ALL AGES

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GETTING ORAL HEALTH CARE IN A FEE-FOR-SERVICE SYSTEM

Sources of care

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PAYING FOR DENTAL CARE

  • Nearly two-thirds (63.6%) of patients have dental insurance
  • Percent of oral health expenditures, by source
    • Dental insurance: 48.2%
    • Out-of-pocket payment: 43.5%
    • Payment by public program: 8.2%

Source: CMS National Health Expenditures Data, Cited in Breaking Down Barriers, ADA 2012

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PAYMENT SOURCE AND ACCESS

  • Visit within past year, by source of coverage
    • Dental insurance coverage: 57%
    • Public program coverage: 32%
    • No dental coverage: 27%
  • Oral health and finances
    • Oral health needs tend inversely related to income and insurance coverage

Source: CMS National Health Expenditures Data, Cited in Breaking Down Barriers, ADA 2012

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PRIVATE PRACTICE & ACCESS

  • Independent US dentists report providing charitable care
    • 69.5% of general practitioners
    • 75.3% of specialists
  • Value is significant
    • Fees reduced by 29.8%
    • Average value of uncompensated care provided: $11,500

Source: ADA Survey of Dental Practice, 2006

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THERE’S ANOTHER DENTAL CARE DELIVERY SYSTEM

Health Centers in the United States

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THE OTHER DELIVERY SYSTEM

  • Public entities
    • Public Health Service
    • Department of Veterans Affairs
    • State, city or county governments
  • Community-based organizations
    • Health Centers
    • Other not-for-profits

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PUBLIC ENTITIES

  • Public Health Service
    • Delivery systems include Indian Health Service, Bureau of Prisons
  • Department of Veterans Affairs
    • Hospitals & outpatient centers
  • State & local governments
    • Hospitals, community health networks

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COMMUNITY-BASED ORGANIZATIONS

  • Health Centers
    • Considerable funding as Federally Qualified Health Center (FQHC)
    • Usually focus on geographic area
  • Other not-for-profits
    • Usually philanthropically funded
    • Community focus often less geographic

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HEALTH CENTER CLINICS

  • Provide wide range of services
    • Diagnostic, preventive, restorative
    • Urgent care, oral surgery, rehabilitative care
    • Care of patients with complex needs
  • Reputation for high quality care
    • Staff often includes an experienced senior dentist willing to mentor
    • Practice with interdisciplinary team of other health care providers supporting each other

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COMMUNITY CONNECTIONS

  • Strong involvement with community
    • More than half of governing board members are patients of Health Center
  • Located in areas of great need
    • Must be in a dental HPSA to be established
  • Open to anyone in “catchment area”
    • Patients without insurance can pay for care on sliding fee scale, based on ability to pay

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HEALTH CENTER PRACTICE

  • Enjoyable patient care experience
    • Professional and personal freedom
    • Provider is able to focus on patient needs
    • Costs, revenue, & marketing are not factors
    • Opportunity for leadership
    • Minimal evening & weekend responsibilities
  • Patient education is part of mission
    • Wellness education is not an “extra”
    • Prevention is highly valued

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PROFESSIONAL GROWTH

  • Practice without feeling isolated
    • Consult with another dentist on tough cases
    • Collaborate with medical providers to manage systemic illness
    • Network with other Health Center dentists
  • Continuing education & training
    • Health Centers make an investment in providers
    • They encourage ongoing professional development

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PRACTICE PUBLIC HEALTH

  • Leverage your skills and intellect
    • Monitor patterns of health and disease
    • Look for ways to intervene, educate and prevent disease
    • Work with colleagues to change the factors that put people at risk
    • Prevent more disease than you could ever hope to treat
    • Change lives

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FINANCIAL SECURITY

  • Competitive salaries
    • $100,000 to $140,000 per year for new grads in five day/week practices
    • Salary not dependent on pace of clinical productivity
  • Student loan repayment often available (federal & state programs)
    • Full-time 2-year or half-time 4-year options
    • Total $40k-$60k, depending on community’s HPSA score

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BENEFITS RARE IN ASSOCIATESHIPS

  • Typical Health Center fringe benefits
    • Paid vacation, personal leave and sick leave
    • Paid leave & funds (median $2k/year) for CE
    • Liability insurance & professional dues
    • Health insurance
    • Contributions to retirement savings account
  • Comparing to an associateship?
    • Add 20-30% to Health Center salary

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WHO WE ARE

  • On average, dentists have worked at their Health Center for about 8 years
    • About 60% have been in Health Center practice for 10 or more years
    • About half were previously in private practice as owners, associates, or employed providers
    • About one in four came directly from dental school to Health Center practice

Source: NNOHA Survey of Health Center Oral Health Providers, 2010

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SATISFACTION WITH CHOICE

  • Health Center dentists say facilities have great appearance & condition
    • 72.6% rated them “good” or “very good”
  • They see Health Centers as most desirable current practice option
    • 82% of survey respondents intend to continue with Health Center practice

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Source: NNOHA Survey of Health Center Oral Health Providers, 2010

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WHY HEALTH CENTER PRACTICE?

  • Top 3 motivations for choosing
    • Felt mission to underserved population
    • Loan repayment availability
    • Attracted by personal benefits
      • Work schedule and leave policies
      • Available fringe benefits

Source: NNOHA Survey of Health Center Oral Health Providers, 2010

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WHY HEALTH CENTER PRACTICE?

  • Other common motivations
    • Desire to work in community-based settings
      • Chance to feel connected
      • Desire to help others
    • Avoid practice financial commitments
      • No need to invest capital or borrow money
      • Time and income to stabilize personal finances after dental school

Source: NNOHA Survey of Health Center Oral Health Providers, 2010

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A PLACE TO BE INSPIRING

  • Live generously
    • Act on your best instincts
    • Use your skills where they’re most needed
    • Practice for the pleasure of it
  • Be part of something larger
    • Feel appreciated
    • Earn respect and gratitude
    • Carry on a tradition

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NNOHA CAN HELP YOU FIND A PLACE IN THE HEALTH CENTER WORLD

Find out more

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LEARN THE TERRAIN

  • There’s no single place to�find Health Center jobs
    • It’s not like the PHS or VA: Each Health Center organization is unique
  • Get to know Health Center dentists
    • Relatively small, interconnected group
    • Face-to-face conversations invaluable
    • Your skills and interest won’t go unnoticed

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FINDING YOUR SPOT

  • Health Center dentists work together through NNOHA
    • Online opportunity listings
    • Career-related resources
    • Information about access issues
    • Literature reviews and webinars
    • Free membership for dental students
    • Network at annual National Primary Oral Health Conference
    • Visit: http://www.nnoha.org/

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CONSIDER BECOMING A HEALTH CENTER DENTIST

Join us!