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www.kdheks.govwww.kdheks.gov/ohi
Our Vision – Healthy Kansans living in safe and sustainable environments.
Daniel LassleyBureau of Oral Health
Kansas Department of Health and Environment
785-296-1314 [email protected]
Improve Access to Dental Care by Strengthening the Kansas Dental
WorkforceHOW?
Provide Data on the Strength of the KS Dental Workforce in Kansas
Bring Together an Advisory Group for On-Going Discussions about Dental Workforce Issues
Provide Funds to Create Programs to Increase the Numbers of Dentists and Dental Hygienists Serving Kansas Underserved Communities
Dentists, Dental Hygienists, Extended Care Permit Hygienists, Dental Assistants
Private Practices, Safety Net Clinics, Outreach Sites
1,404 Dentists Licensed and Active in KS
1,187 General Dentists (Non-Specialists)
Kansas Law Regulates Dentistry through the Kansas Dental Practice Act
4 Year Graduate Program but Kansas has no In-State Dental School
1,656 RDHs Actively Practicing in Kansas
Must be Supervised by a Dentist, Although Not Necessarily on Site
Scope of Practice: Cleaning, Scaling & Root Planing, Sealants, Preventive Procedures – Fl Varnish, Oral Hygiene Instruction
Five Dental Hygiene Programs in Kansas in Addition to UMKC and Concorde (KCMO)
Hygienists are Licensed by the Kansas Dental Board in Accordance with the Kansas Dental Practice Act
Experienced Dental Hygienists May Obtain an Extended Care Permit (ECP) ECP I (43) – Schools, FQHCs, LHDs ECP II (81) – Patients with Special Needs, Elders
ECPs Perform Hygiene Services in Public Health Settings (NO Expanded Scope of Practice) Without a Dentist Seeing the Patient
ECPs Have a Sponsoring Dentist who Reviews their Charts, But May Not Ever See the ECP’s Patients
Assist Dentist Chairside under Direct Supervision
Generally not Regulated by Kansas Dental Board….except for: Scaling Assistants – Assistants that have been
trained to clean teeth above the gumline. Other than Scaling Assistants, No
Educational Program is Required to Work as a Dental Assistant in Kansas.
Access to Dental Professionals is Crucial to Good Oral Health.
Dentists are Hard to Find in Certain Geographic Areas and for Certain Population Groups: Frontier and Rural
Areas Children on Medicaid Uninsured and Low
Income Populations Cannot Afford Care
People with Disabilities Racial and Ethnic
Minorities
264,430 Kansas Children on Medicaid or Healthwave
411 Dentists are Enrolled Medicaid Providers who had a Paid Claim Last Year
153 Treated 100 or more Medicaid Patients
Why so Few? Low Reimbursement Patients are Difficult – No Shows, High Trt
Needs
25% of Kansas Kids Have Untreated Dental Decay Highest in NW (54%), NC (64%) and SW (46%)
55% of Kansas Kids Have Experienced Dental Decay by 3rd Grade
34% had Dental Sealants Higher Decay Rates in Low Income
Families African American Children had Fewer
Sealants
No Complete Dental Benefit for Most Adults on Medicaid
Medicaid Only Covers Eligible Groups – Children, Pregnant Women, People with Disabilities
Very Limited Dental Benefits in Medicare State Budget Cuts Ended Dental Benefits
for Elders and Disabled on HCBS Waivers.
Recruit Dentists to Kansas, Especially in Underserved Areas and the Safety Net
Encourage Kansans, Especially Students from Rural Areas and Minority Groups to Look at Dental Careers
Promote ECP Workforce Data Collection Programs to Support Retention Dental
Professionals in Underserved Areas
Bureau of Oral Health – KDHE Kathy Weno – Project Coordinator Daniel Lassley – Program Manager Ashley Streeter – Program Assistant
Oral Health Kansas – Dental Workforce Cabinet, ECP Outreach Tanya Dorf Brunner, Marcia Manter
Office of Local and Rural Health - KDHE Robert Stiles – Primary Care Office Barbara Huske – Loan Repayment, Underserved
Designations
Kansas Association for Medically Underserved Safety Net Clinic Workforce Coordinator
University of Kansas Medical Center Kim Kimminau, Anthony Wellever – Workforce Research
Wichita State - Advanced Education in General Dentistry Program Continuing Dental Education, Dental Career Outreach
Program
UMKC School of Dentistry Continuing Dental Education, Dental Career Outreach
Program
Community Health Center of SE KS ECP Hygiene Outreach Program
Kansas Dental Association Access Pilot Programs, Dentist Supports
Completed in Sept 2009
Telephone Survey of Dentists and ECP Hygienists
Community Focus Groups about Dental Access Issues
Creates a Project Baseline, Data Suggests Policy
Dentistry is an Aging Profession. in Kansas
Average Dentist Age : 50
KS Dentists are overwhelming white and male
91.2% white, 76% male
64% of Kansas Dentists are Kansas Natives
69% are UMKC Graduates
Reason for Practicing in Kansas: Family, Quality of
Life
Dentists choose to “slow down” by reducing hours over time rather than full retirement . They are slow to plan for retirement, only 2% planned to retire in 2009. 31% have never thought about what to do with their practices when they retire.
As Frontier and Rural providers are older, they (Frontier - 54.3%, and Rural - 24.2% ) report planning to retire in next 3-5 Years.
Those who have retirement plans usually involve taking on an Associate or selling their practice. This may not be realistic. 48.5% of those recruiting for a dentist say it has been
difficult Of those practices currently for sale, 69.7% have been for
sale over one year.
82% of Dentists Employ Hygienists 56.9% of Dentists Employ 2-4 Hygienists 9.4% are Currently Recruiting for a
Hygienist 19% of Dentists Employ a Scaling
Assistant 18% of Dentists Employ ECPs 15.9% of Dentists Sponsor ECPS 43.6% of Dentists Unaware of ECP
ECPs practice in 53 counties (approximately one-half of all KS counties) ECPs practice in all five urban counties ECPs practice in 48% of rural counties
Top ECP Practice Sites: Early Childhood Centers (Head Start), Schools (K-12), Safety Net Clinics and Long Term Care Facilities
ECPs are Concentrated in the Safety Net Clinics – 62.1% of Safety Net Clinic Dentists Employ ECPs 55.2% of Safety Net Clinic Dentists Sponsor ECPs
Most ECPs work 8 hours a Week or Less
Perceptions about Access Vary Based on Practice Type and Location Dentists have a Chair-Side View ECPs Awareness Based on Community Practice
Both ECPs and Dentists Support More Community Water Fluoridation
Strong Disagreement about the Importance of the Development of New Dental Provider Models
38 Dentists in that work in Safety Net Clinics Safety Net Clinic Dentists are Younger
Average Age is 43.5. More Racially Diverse – 77.4% White 52% are Female
58 Dentists who Participated in the Kansas Mission of Mercy in Manhattan No Significant Difference from Total
Sample Qualitative Comments Documented
Conducted Five Focus Groups: Hays, Dodge City, Wichita, Lawrence and Topeka
Invited Participants that has Experience in Dental Recruitment or Access to Care – Dentists, ECPs, Safety Net Clinic Administrators, Dental Educators, Community Service Providers, Workforce Development
Kansas Dental Charitable Foundation Videowww.ksdentalfoundation.org
Facebook – “Visualizing Oral Health in Kansas” – Be a Fan!
Geographic Location Shaped the Discussion
Rural - Dodge City, Hays
Distance to Providers and Specialty Care Dentist Recruitment to Rural Areas, Scarcity of
Providers ECPs – Need for More RDHs and Dentists Awareness
Wichita, Lawrence, Topeka
Number of Patients Needing Care is Overwhelming Lack of Prevention – Water Fluoridation Success of Community Based Services – Schools Collaboration among Community Partners and
Coalitions to Provide Care and do Advocacy
Rural Dental Access Research 2011
KU Medical Center Researchers Looking at optimal ways to
seed projects and provide care for rural and frontier populations
Information for Funding Rural Projects
Complete by July 2011
Primary Objective:Use GIS to inform dental workforce issues Identify population-specific areas of high need Go beyond county level shortage analysis
Additional Aims:Focus on primary care dentists Additional analysis of ECP Additional analysis of high volume Medicaid
dentists Overlay rural Kansans’ reported routine travel
distance/time for services
Location Average Time (Min.)
Frequency/Yr
Groceries 17.5 71.9
Chain Store 29.8 44
Auto Repair 15.9 6.1
Church 9.6 36.2
Movie Theater 30.6 10.7
Outlets 83.4 8
Pharmacy 14 13.5
Veterinarian 19.5 3.1
Chiropractor 17 4.4
Optometrist 25.1 1.6
Dentist 21.2 2.6
Identify alternative GIS units useful in pinpointing shortage “crisis” areas
Finalize adjacency maps Complete the 8 community sub-study Map rural residents’ distance reported to
various key resources, including dentistry Use the findings from Dental Workforce I
study to inform the identification of shortage “crisis” areas; e.g., which dentists from DWI report retirement or practice is for sale planning
Funding for State Loan Re-Payment, ECP, Dental Recruitment, and Dental Camp
Funding for Creative Access Projects for Dentists, Hygienists, Community Groups and Clinics at the Discretion of the Workforce Cabinet
Project Evaluation
Kathy WenoProject [email protected]
Daniel LassleyDental Recruitment
Program [email protected]
Ashley StreeterDental Club Project [email protected]
Tanya Dorf BrunnerDental Workforce Cabinet
Meeting [email protected]
www.kdheks.govwww.kdheks.gov/ohi
Our Vision – Healthy Kansans living in safe and sustainable environments.
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