recruiting and retaining dental recruiting and retaining

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Recruiting and Retaining Dental Recruiting and Retaining Dental Providers in Florida Providers in Florida s County s County Health Department Dental Services Health Department Dental Services By By Douglas T. Manning DMD, JD, MPH Douglas T. Manning DMD, JD, MPH Division of Family Health Services Division of Family Health Services Public Health Dental Program Public Health Dental Program Senior Health Services Analyst Senior Health Services Analyst and and Dr. Inge Ford Dr. Inge Ford Martin County Health Department Martin County Health Department Dental Director Dental Director

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Page 1: Recruiting and Retaining Dental Recruiting and Retaining

Recruiting and Retaining Dental Recruiting and Retaining Dental Providers in FloridaProviders in Florida’’s County s County

Health Department Dental ServicesHealth Department Dental ServicesByBy

Douglas T. Manning DMD, JD, MPHDouglas T. Manning DMD, JD, MPHDivision of Family Health ServicesDivision of Family Health Services

Public Health Dental ProgramPublic Health Dental ProgramSenior Health Services AnalystSenior Health Services Analyst

andandDr. Inge FordDr. Inge Ford

Martin County Health Department Martin County Health Department Dental DirectorDental Director

Page 2: Recruiting and Retaining Dental Recruiting and Retaining

“Oral health is integral to general health… and should not be interpreted as separated entities”

Donna E. ShalalaSecretary,

U.S. Department of Health & Human Services

David Satcher, MD, PhDSurgeon General

Oral Health in America: A Report of the Surgeon General

Dept. of Health & Human Services, 2000

Page 3: Recruiting and Retaining Dental Recruiting and Retaining

Diamonte Driver1995 - 2007

February 28, 2007

“A Routine $80 Extraction Might Have Saved Him…

If Medicaid dentists weren’t so hard to find…”

By the time Diamonte’s tooth got attention, the infection had spread to his brain, and after two operations

Diamonte passed away 6 weeks later.

Page 4: Recruiting and Retaining Dental Recruiting and Retaining

Distribution and Burden of Dental Distribution and Burden of Dental DiseaseDisease

80% of Dental Disease is 80% of Dental Disease is in 20% of the Populationin 20% of the Population..Who are the 20%?Who are the 20%?

Page 5: Recruiting and Retaining Dental Recruiting and Retaining

Disadvantaged Populations Disadvantaged Populations -- the 20% the 20% who suffer 80% of the dental disease who suffer 80% of the dental disease Florida DemographicsFlorida Demographics (according to the 2000 U.S. (according to the 2000 U.S.

Census)Census)Pop. Pop. -- ~19 million. Of these:~19 million. Of these:

Disabled ~ 3.5 millionDisabled ~ 3.5 millionHomeless ~ 68,000 any given dayHomeless ~ 68,000 any given dayHIV/AIDS ~ 70,000HIV/AIDS ~ 70,000Migrant Farmworkers ~ 200,000 (90,000 children)Migrant Farmworkers ~ 200,000 (90,000 children)Immigrants ~ 20,000/year (FL top 6 in US)Immigrants ~ 20,000/year (FL top 6 in US)Minorities Minorities –– 31.7%31.7%Children Children –– 22.8%22.8%Women Women –– 51.2% (but higher in older age groups)51.2% (but higher in older age groups)Elderly Elderly –– 17.6% (and growing)17.6% (and growing)Poverty Poverty –– 12.6% (one of top 5 in U.S)12.6% (one of top 5 in U.S)

Page 6: Recruiting and Retaining Dental Recruiting and Retaining

Most Common Barrier to Oral Most Common Barrier to Oral Health CareHealth Care

Workforce IssuesWorkforce Issues•• Lack of providers who treat Lack of providers who treat

disadvantaged populationsdisadvantaged populations•• Lack of adequately trained Lack of adequately trained

providers who can treat providers who can treat disadvantaged populationsdisadvantaged populations

Page 7: Recruiting and Retaining Dental Recruiting and Retaining

Florida Workforce StatisticsFlorida Workforce StatisticsLicensed Dentists Licensed Dentists –– 9464946490% of dentists are in private practice90% of dentists are in private practiceDentists enrolled in Medicaid Dentists enrolled in Medicaid –– 1479 (15.6%)1479 (15.6%)Dentists actively accepting Medicaid Dentists actively accepting Medicaid -- 912 912 (9.6%)(9.6%)Dentist to Pop ratioDentist to Pop ratio•• U.S. U.S. –– 54.2/100,00054.2/100,000•• FL FL –– 49.4/100,000 (rural areas & inner city 49.4/100,000 (rural areas & inner city

areas the ratio is worse)areas the ratio is worse)Only ~300 Dentists (2Only ~300 Dentists (2--3%) specialize in 3%) specialize in Pediatric dentistryPediatric dentistryLack of Minority DentistsLack of Minority Dentists

Page 8: Recruiting and Retaining Dental Recruiting and Retaining

Access to Dental Care in Florida

In 2005, only 11% of the population below 200% of the Federal Poverty

Level received at least one documented dental visit through

publicly funded & volunteer programs.

Just 24% of children --- 4% of adults

Page 9: Recruiting and Retaining Dental Recruiting and Retaining

Some Sad Facts…

June, 2007 3 Counties Had No Licensed Dentists(Glades, Lafayette & Union)

January 2007 7 Counties Had No Medicaid Dentist(Bradford, Columbia, Franklin, Glades, Levy, Suwannee & Union)

FY 2006-7 9 Counties Had No Medicaid Children’s Dentist(Bradford, Columbia, Franklin, Gadsden, Glades, Levy, Monroe, Suwannee & Union)

FY 2006-7 7 Counties Had Only 1 Medicaid Children’s Dentist(Calhoun, Charlotte, Gilchrist, Hamilton, Holmes, Santa Rosa & Walton)

As of

Page 10: Recruiting and Retaining Dental Recruiting and Retaining

Safety Net ProvidersSafety Net Providers

Safety net providers are the primary Safety net providers are the primary caretakers of Medicaid patientscaretakers of Medicaid patients (and the (and the under and uninsured) under and uninsured) Primary Safety net Providers include:Primary Safety net Providers include:•• County Health DepartmentsCounty Health Departments (CHD) (CHD)

However, only 44 of the 67 However, only 44 of the 67 CHDsCHDs have dental services have dental services

•• Community Health Centers (Community Health Centers (CHCsCHCs))•• Dental (& dental hygiene) Schools (& programs)Dental (& dental hygiene) Schools (& programs)•• Community Health OrganizationsCommunity Health Organizations

Page 11: Recruiting and Retaining Dental Recruiting and Retaining

DOH CHD Dental Workforce DOH CHD Dental Workforce ShortageShortage

Based on the data reports provided by Based on the data reports provided by Human Resources, as of 2/19/2008:Human Resources, as of 2/19/2008:•• 44 dentist vacancies44 dentist vacancies•• average days vacant were 286average days vacant were 286•• The The turnover rateturnover rate for calendar year for calendar year

2007 appears to be around 2007 appears to be around 16%.16%.

Page 12: Recruiting and Retaining Dental Recruiting and Retaining

Project HypothesisProject Hypothesis

With so many disadvantaged Floridians With so many disadvantaged Floridians needing a dental home, needing a dental home, why do the why do the Department of Health County Health Department of Health County Health Department Dental Services have so Department Dental Services have so much trouble filling dental positions much trouble filling dental positions and retaining dental providersand retaining dental providers??

Page 13: Recruiting and Retaining Dental Recruiting and Retaining

Project DesignProject Design

SurveySurvey•• Existing CHD dental providersExisting CHD dental providers•• Recently departed CHD providersRecently departed CHD providers•• Senior Dental StudentsSenior Dental Students

NovaNovaUFCDUFCD

Data AnalysisData AnalysisPresentation to Florida Surgeon Presentation to Florida Surgeon GeneralGeneral’’s Ad Hoc Committees Ad Hoc Committee on on Dental WorkforceDental Workforce

Page 14: Recruiting and Retaining Dental Recruiting and Retaining

Senior Dental StudentsSenior Dental Students

Nova SoutheasternNova SoutheasternUniversity of FloridaUniversity of FloridaSurvey Questions:Survey Questions:

•• DemographicsDemographics

•• Public Health KnowledgePublic Health Knowledge

•• Job Search and RecruitmentJob Search and Recruitment

Page 15: Recruiting and Retaining Dental Recruiting and Retaining

Current CHD DentistsCurrent CHD Dentists

Survey Questions:Survey Questions:

•• DemographicsDemographics

•• Why and How did the providers choose Why and How did the providers choose public healthpublic health..

•• Job Satisfaction and RetentionJob Satisfaction and Retention

Page 16: Recruiting and Retaining Dental Recruiting and Retaining

Results Results –– Dental StudentsDental StudentsDemographics & Public Health IQDemographics & Public Health IQ

*primarily Nova vs. UFCD*primarily Nova vs. UFCD

Most of the candidates are Most of the candidates are femalefemale. . More than More than half of the class was half of the class was White, no Blacks and oneWhite, no Blacks and one--third Latinthird LatinMost are or came from Most are or came from middlemiddle--upper upper income familiesincome families..ThreeThree--fourths were Florida residentsfourths were Florida residents. . Practically all took a Practically all took a Public Health Public Health course and enjoyed the experiencecourse and enjoyed the experience. .

Page 17: Recruiting and Retaining Dental Recruiting and Retaining

Results Results –– Dental Students Dental Students Factors Affecting Job SearchFactors Affecting Job Search

*primarily Nova vs. UFCD*primarily Nova vs. UFCD

Most were seeking loans for their Most were seeking loans for their education education -- >100K in debt>100K in debt. . OneOne--half of the class feels that half of the class feels that pay is TOO pay is TOO LOW in PH. LOW in PH. Major factors in their job decisions would Major factors in their job decisions would be the be the type of practice, mentor support, type of practice, mentor support, economics, and schedule flexibilityeconomics, and schedule flexibility..The The internet, FDA, and family/friendsinternet, FDA, and family/friends will will be the primary sources in finding job be the primary sources in finding job positions.positions.

Page 18: Recruiting and Retaining Dental Recruiting and Retaining

Results Results –– CHD DentistsCHD DentistsDemographics & Public HealthDemographics & Public Health

CHD dentists are CHD dentists are primarily whiteprimarily white. (36 white, 4 black, . (36 white, 4 black, 4 Hispanic, 4 Asian)4 Hispanic, 4 Asian)Dentists who come to Dentists who come to CHDsCHDs generally have 2generally have 2--5+ 5+ years of years of experienceexperienceMost have a Most have a private practice backgroundprivate practice backgroundThe reason most come to public health practice is The reason most come to public health practice is because of because of altruistic reasons, no overhead, the altruistic reasons, no overhead, the benefits, and a flexible schedulebenefits, and a flexible schedule•• Although the Although the younger, less experienced listed younger, less experienced listed

mentor/support and to gain experiencementor/support and to gain experience as the reason for as the reason for going to a CHD going to a CHD

People FirstPeople First is a source for CHD positions, but many is a source for CHD positions, but many used used local sources (family, friends, local newspapers, local sources (family, friends, local newspapers, and word of mouth)and word of mouth) for finding a CHD position.for finding a CHD position.

Page 19: Recruiting and Retaining Dental Recruiting and Retaining

Results Results –– CHD Dentists CHD Dentists Factors Related to Job SatisfactionFactors Related to Job SatisfactionCHD providers liked: the CHD providers liked: the benefits; no overhead; benefits; no overhead; the hours;the hours; and the and the sense of giving backsense of giving back..•• Interestingly, Interestingly, salarysalary was listed by 25% as a positive!!!was listed by 25% as a positive!!!

CHD providers did not like: CHD providers did not like: SalarySalary (was a primary (was a primary negative, but not far and away the biggest negative, but not far and away the biggest negative); negative); Bureaucracy, administrative duties and Bureaucracy, administrative duties and the lack of controlthe lack of controlChanges that providers wanted to see were pretty Changes that providers wanted to see were pretty equal across the board equal across the board -- more and better quality more and better quality staff, modern technology including staff, modern technology including EMRsEMRs, and , and changes to the work environment to make it less changes to the work environment to make it less sterilesterile..Additionally, respondents provided many other Additionally, respondents provided many other suggestions to improve CHD positionssuggestions to improve CHD positions

Page 20: Recruiting and Retaining Dental Recruiting and Retaining

ConclusionsConclusionsThe majority of dental students are planning to The majority of dental students are planning to go into private practice vs. considering public go into private practice vs. considering public health practice health practice •• debt & economicsdebt & economics

Many dental students do not know about public Many dental students do not know about public health opportunities and the benefits of CHD health opportunities and the benefits of CHD positionspositionsCHD dentists see public health as a careerCHD dentists see public health as a careerSalary is not the sole influence in job Salary is not the sole influence in job satisfaction and the reason providers stay in satisfaction and the reason providers stay in CHD positionsCHD positions

Page 21: Recruiting and Retaining Dental Recruiting and Retaining

ConclusionsConclusionsRecruitmentRecruitment: : •• Need to educate and actively recruit at dental Need to educate and actively recruit at dental

schools schools –– in person and utilize career servicein person and utilize career service•• Need to recruit minority providersNeed to recruit minority providers

RetentionRetention::

•• But, also need to improve nonBut, also need to improve non--monetary issuesmonetary issuesAdministrative dutiesAdministrative dutiesBureaucracyBureaucracyModern technologyModern technologyPleasing facilitiesPleasing facilitiesStaff upgradesStaff upgrades