Slow going in efforts to solve state’s dentist shortage

Anticipated retirement of veteran dentists could worsen access problems in rural areas

0 | Workforce, Oral Health

Dr. Andrea Boothe, who recently joined the dental staff at GraceMed Health Clinic in Wichita, examines the teeth of patient Maria Monzon. Boothe graduated from the dental school at the University of Missouri-Kansas City earlier this year. She says more dental school graduates would move to Kansas if the state offered more loan-retirement programs.

Dr. Andrea Boothe, who recently joined the dental staff at GraceMed Health Clinic in Wichita, examines the teeth of patient Maria Monzon. Boothe graduated from the dental school at the University of Missouri-Kansas City earlier this year. She says more dental school graduates would move to Kansas if the state offered more loan-retirement programs.

— Five years ago, 1,402 dentists were practicing in Kansas. There are more today, but only 25.

The failure thus far of state and local recruitment efforts to produce better results is a concern to Tanya Dorf Brunner, executive director of Oral Health Kansas, a statewide advocacy group.

“It’s pretty scary, actually,” Brunner said. “People tend to think the concern over access centers around the uninsured or those who are low-income, but we’re headed in a direction where, at some point, people who are able to pay or who have insurance are going to have to wait a long time for an appointment or drive a long way. Their access is going to be limited as well.”

Last year, the state Department of Health and Environment’s Office of Local and Rural Health found that 91 of the state’s 105 counties didn’t have enough dentists to meet their populations’ needs.

A survey by the department’s Bureau of Oral Health found that in 2009, the average dentist in Kansas was 50 years old, and that many of those who practice in rural counties said they were planning to retire in six to 10 years.

“In certain parts of the state, we definitely have a shortage of dentists,” said Dr. Katherine Weno, a dentist and director at the oral health bureau. “I’m afraid that as time goes on, the oral health needs in those areas are going to be increasingly difficult to meet.”

In 2008, 14 counties — Barber, Chase, Clark, Elk, Greeley, Haskell, Hodgeman, Kiowa, Lane, Ness, Rawlins, Trego, Wabaunsee, and Wallace — were without a dentist.

“We’ve been without a dentist now for about 10 years,” said Jessica Rausch, who runs the chamber of commerce office in Medicine Lodge. “We’ve had dentists come look, but they don’t come back because we don’t have the kind of money that other places can offer them. The issue is funding.”

Medicine Lodge, population 2,200, is the county seat of Barber County.

State looking to do more

The Department of Health and Environment has started a task force to look for ways to attract more dentists and to gather data that both demonstrate the impact of the shortage and point the way to possible solutions.

“The biggest thing we’re up against is that there are only so many new dentists from Kansas that we can recruit back to Kansas in a year,” Weno said. “At the same time, every state is dealing with the issues we’re dealing with, so we’re having to compete for those Kansas dentists on a national level.”

Because Kansas doesn’t have a dental school, the state negotiated an arrangement with the School of Dentistry at the University of Missouri-Kansas City. Since 1998, UMKC has set aside 20 slots in each year’s incoming class for students from Kansas and allowed them to pay in-state tuition.

In exchange, Missouri students may attend architecture school at either the University of Kansas or Kansas State University, where they, too, are charged in-state tuition.

According to the Kansas Board of Regents, 93 Kansas students are enrolled in UMKC’s dental school. The architecture schools at KU and KSU host 209 and 254 Missouri students, respectively.

Dr. John Killip, an assistant dean at the dental school, said it’s unclear how many of the Kansas students return to the state to practice.

“It’s been our experience that it takes about five years for a graduate to be in what you’d call a permanent or final location,” Killip said. “Unfortunately, we don’t have a strong mechanism for tracking students five years out.”

High hopes for new residency program

Last year, Wichita State University started a one-year residency program for new dentists with plans to add an additional year of training. Officials hoped that many of those who participated in the program would decide to remain in Kansas to practice.

The first class of seven students graduated in July, but only one decided to stay in Kansas.

“We’re hoping another one (of the seven) will be able to return to Kansas,” said Dr. Dexter Woods, director of the program.

“Three are going back to Chicago for family reasons, one is going to the Cherokee Nation in Oklahoma, another was going to North Carolina, but her husband got a promotion so they’re moving to Texas,” he said.

Woods is expecting four to five new residents this fall. A year from now, Woods said he hopes to be directing a two-year program with 10 residents. Eventually, he said he thinks the program could grow to 20 residents.

“We’re building a new building, and that’s really going to help,” Woods said. “Right now, we’re the new kids on the block; we’re going up against programs that have been in existence for 20 or 30 years.”

Currently, the residents take part in clinical rotations at GraceMed Health Clinic and at the Dole Veterans Administration Medical Center, both in Wichita. After next year, second-year residents will be stationed in safety net clinics in underserved areas of the state.

“It’s at that point that I think we’ll have a better model, and you’ll start seeing more people getting their loans paid down, liking where they are, and staying in Kansas,” Woods said.

The debt problem

Doing more to help graduating dentists pay off student loans could be an effective recruitment strategy, said Dr. Mark Herzog, an Ellsworth dentist and member of the KDHE task force.

“It’s kind of hard to come out of school $200,000 in debt and justify buying somebody’s practice for $300,000 to $400,000 — that’s with equipment and a building,” Herzog said. “That’s a pretty good-size note.”

Herzog said most new dentists become associates — employees of other dentists — because they can’t afford to buy an existing practice or start one on their own. Most of these associate positions are in the bigger cities.

“There isn’t a shortage problem as much as there’s a distribution problem,” he said. “Johnson, Douglas, Sedgwick and Shawnee counties — they’re probably pretty full. The issue is how do you get dentists into the smaller communities, and that’s where some kind of loan forgiveness program would really help.”

In Kansas, new dentists are eligible for similar state and federal loan-repayment programs if they agree to practice in a nonprofit setting in an underserved area for at least two years. Typically, the dentists are eligible for $25,000 to $30,000 in loan repayments a year.

They can remain eligible for the payments as long as they continue to meet both requirements.

Currently, two dentists and three hygienists are enrolled in the state’s loan-repayment program; 18 dentist and hygienists take part in the federal program.

Related coverage: Kansas' Oral Health Care Provider Shortage

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