Kansas coalition believes mid-level therapists can alleviate dental work force shortage
- on December 10, 2010
Anna Lambertson hears about the ill effects of the state’s dental work force shortage time and again.
The rural western Kansans who have to drive a couple of hours to see a dentist, taking time off work and taking their children out of school.
The 5-year-old boy who has holes in his teeth because his mother is unable to find a nearby dentist who accepts Medicaid. She can’t afford to drive far.
“Not having enough dental care is affecting the daily lives of Kansans,” said Lambertson, executive director of the Kansas Health Consumer Coalition. “If you have a need that worsens while you are waiting to see a dentist, or you have to drive two or three hours to see a dentist — the gas, time you are taking off of work — all of that plays into how expensive it might be for a family. In this economy, every penny counts.”
Fourteen counties do not have a dentist, including Wabaunsee, Chase and Elk. And, another 14 of the state’s 105 counties do not have enough dentists to serve their county populations.
A typical dental practice with one dentist can handle about 2,100 patients per year, according to KAC. Here’s the ratio of people per one dentist in some of the 28 counties:
• Jefferson — 6,069.
• Osage — 5,368.
• Doniphan — 7,624.
• Pottawatomie — 4,999.
In Douglas County, there are 1,847 people per dentist. But, the county is among 63 that don’t have enough dentists who accept Medicaid or help the uninsured. There are 63 licensed dentists in the county and, of those, 22 are registered to accept the 9,094 Douglas County residents on Medicaid. But few of these dentists do.
The Douglas County Dental Clinic, 316 Maine, has taken care of 1,377 Medicaid patients since Jan. 1. These are mostly children because dental services are included as part of their Medicaid benefits package. For adults, it only pays for pulling teeth.
Julie Branstrom, executive director of the clinic, said the practice accepts Medicaid patients from other counties, including Jefferson, Franklin and Shawnee.
“We know that a shortage exists because we have people that are willing to drive 45 minutes to come to Lawrence to get their kids care,” she said.
According to KAC, only 25 percent of Kansas dentists accept Medicaid, compared with 95 percent of medical providers. The Medicaid reimbursement rate is debated among dental providers, clinics and agencies. Some private practice offices and for-profit clinics that accept Medicaid patients are profitable. While others argue that they lose money.
Dr. Jim Otten, of Lawrence, accepted Medicaid patients for a few years when he first started practicing 25 years ago, but quit because of all the governmental red tape and low reimbursement rate.
Instead, he donates about 5 percent of his total care to the uninsured for free.
“We are eliminating all of the bureaucratic nonsense and really getting down to just what’s best for the patient,” he said.
Calls to the offices of Wilkerson, Saunders & Anderson and Legends Drive Dental Center were not returned.
The three state agencies — KAC, KAMU and KHCC — have formed the Kansas Dental Project, a coalition that will pursue legislation in January to permit midlevel dental providers to practice in Kansas.
These would be licensed dental therapists, similar to a medical nurse practitioner, who can do more work than a hygienist, but not as much as a dentist. They would be able to fill cavities and do simple extractions, among other things.
The coalition is determining what kind of training this individual would need and is looking at other states and countries who use dental therapists.
“They really help provide much-needed dental care to individuals who live in rural parts of the state and maybe can’t access a dentist because the dentist is too far away,” Lambertson said. “There’s a lot of research that has proven that the care that the dental therapist provides is safe, appropriate and competent. We’ve yet to see a study that shows the contrary.”
Lambertson said dental therapists also are cost-effective because dental practices and clinics can see more patients, and dentists would be able to concentrate on the more complex cases.
“It could potentially create jobs, so I think there are a lot of benefits to this model from the financial prospective,” she said.
The initiative already is creating a buzz in the dental industry. Many dentists, like Otten, are skeptical about the training and expertise of a dental therapist. Others are taking a wait-and-see approach to the legislation that is introduced.
But nobody will deny that there is a dental work force shortage that is only going to get worse as dentists retire and there are fewer graduates to replace them.
“Right now, we are seeing a situation where low-income and rural citizens can’t get access to a dentist, but I think as that shortage grows everyday people — even those with dental insurance — are going to have trouble finding a dentist, and that’s what we want to solve before that happens,” said Stephanie Mullholland, communications director for KAC.
There’s a shortage of dentists in Kansas. In 28 counties, there are not enough to care for the population, and in 63 others there’s not enough who accept Medicaid or help the uninsured.
Here’s how Douglas County and its surrounding neighbors are faring:
• Douglas County — 63 dentists, 1,847 people per one dentist, 22 dentists accept Medicaid, and 9,094 Medicaid patients.
• Jefferson — 3 dentists, 6,069 people per one dentist, 2 dentists accept Medicaid, and 1,668 on Medicaid.
• Leavenworth — 24 dentists, 3,134 people per one dentist, 7 dentists accept Medicaid, and 6,388 on Medicaid.
• Johnson — 425 dentists, 1,277 people per one dentist, 75 dentists accept Medicaid, and 32,819 on Medicaid.
• Franklin — 7 dentists, 3,777 people per one dentist, 8 dentists accept Medicaid, and 3,994 on Medicaid.
• Osage — 3 dentists, 5,368 people per one dentist, 0 dentists accept Medicaid, and 2,212 on Medicaid.
• Shawnee — 94 dentists, 1,875 people per one dentist, 41 dentists accept Medicaid, and 28,714 on Medicaid.