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  • 1. Recruiting and Retaining Dental Providers in Floridas County Health Department Dental ServicesBy Douglas T. Manning DMD, JD, MPH Division of Family Health Services Public Health Dental ProgramSenior Health Services Analyst andDr. Inge Ford Martin County Health Department Dental Director

2. Oral Health in America: A Report of theSurgeon General Dept. of Health & Human Services, 2000Oral health is David Satcher, MD, PhD integral to generalSurgeon Generalhealth andshould not beinterpreted asDonna E. Shalalaseparated entities Secretary, U.S. Department of Health & Human Services 3. February 28, 2007 Diamonte Driver 1995 - 2007A Routine $80 Extraction Might Have Saved Him If Medicaid dentists werent so hard to find By the time Diamontes tooth got attention, the infection had spread to his brain, and after two operations Diamonte passed away 6 weeks later. 4. Distribution and Burden of Dental Disease80% of Dental Disease is in 20% of the Population. Who are the 20%? 5. Disadvantaged Populations - the 20% who suffer 80% of the dental diseaseFlorida Demographics (according to the 2000 U.S.Census) Pop. - ~19 million. Of these: Disabled ~ 3.5 million Homeless ~ 68,000 any given day HIV/AIDS ~ 70,000 Migrant Farmworkers ~ 200,000 (90,000 children) Immigrants ~ 20,000/year (FL top 6 in US) Minorities 31.7% Children 22.8% Women 51.2% (but higher in older age groups) Elderly 17.6% (and growing) Poverty 12.6% (one of top 5 in U.S) 6. Most Common Barrier to OralHealth CareWorkforce Issues Lack of providers who treat disadvantaged populations Lack of adequately trained providers who can treat disadvantaged populations 7. Florida Workforce Statistics Licensed Dentists 9464 90% of dentists are in private practice Dentists enrolled in Medicaid 1479 (15.6%) Dentists actively accepting Medicaid - 912 (9.6%) Dentist to Pop ratio U.S. 54.2/100,000 FL 49.4/100,000 (rural areas & inner cityareas the ratio is worse) Only ~300 Dentists (2-3%) specialize in Pediatric dentistry Lack of Minority Dentists 8. Access to Dental Care inFloridaIn 2005, only 11% of the population below 200% of the Federal Poverty Level received at least one documented dental visit through publicly funded & volunteerprograms.Just 24% of children --- 4% ofadults 9. Some Sad Facts As of June, 20073 Counties Had No Licensed Dentists (Glades, Lafayette & Union) January 2007 7 Counties Had No Medicaid Dentist (Bradford, Columbia, Franklin, Glades, Levy, Suwannee & Union) FY 2006-79 Counties Had No Medicaid Childrens Dentist (Bradford, Columbia, Franklin, Gadsden, Glades, Levy, Monroe, Suwannee & Union) FY 2006-77 Counties Had Only 1 Medicaid Childrens Dentist(Calhoun, Charlotte, Gilchrist, Hamilton, Holmes, Santa Rosa & Walton) 10. Safety Net ProvidersSafety net providers are the primary caretakers of Medicaid patients (and the under and uninsured) Primary Safety net Providers include: County Health Departments (CHD) However, only 44 of the 67 CHDs have dental services Community Health Centers (CHCs) Dental (& dental hygiene) Schools (& programs) Community Health Organizations 11. DOH CHD Dental WorkforceShortageBased on the data reports provided byHuman Resources, as of 2/19/2008: 44 dentist vacancies average days vacant were 286 The turnover rate for calendar year 2007 appears to be around 16%. 12. Project Hypothesis With so many disadvantaged Floridiansneeding a dental home, why do theDepartment of Health County HealthDepartment Dental Services have somuch trouble filling dental positionsand retaining dental providers? 13. Project Design Survey Existing CHD dental providers Recently departed CHD providers Senior Dental StudentsNovaUFCD Data Analysis Presentation to Florida Surgeon Generals Ad Hoc Committee on Dental Workforce 14. Senior Dental StudentsNova Southeastern University of Florida Survey Questions: Demographics Public Health Knowledge Job Search and Recruitment 15. Current CHD DentistsSurvey Questions: Demographics Why and How did the providers choose public health. Job Satisfaction and Retention 16. Results Dental Students Demographics & Public Health IQ*primarily Nova vs. UFCD Most of the candidates are female. More than half of the class was White, no Blacks and one-third Latin Most are or came from middle-upper income families. Three-fourths were Florida residents. Practically all took a Public Health course and enjoyed the experience. 17. Results Dental StudentsFactors Affecting Job Search *primarily Nova vs. UFCD Most were seeking loans for their education - >100K in debt. One-half of the class feels that pay is TOO LOW in PH. Major factors in their job decisions would be the type of practice, mentor support, economics, and schedule flexibility. The internet, FDA, and family/friends will be the primary sources in finding job positions. 18. Results CHD DentistsDemographics & Public Health CHD dentists are primarily white. (36 white, 4 black, 4 Hispanic, 4 Asian) Dentists who come to CHDs generally have 2-5+ years of experience Most have a private practice background The reason most come to public health practice is because of altruistic reasons, no overhead, the benefits, and a flexible schedule Although the younger, less experienced listed mentor/support and to gain experience as the reason for going to a CHD People First is a source for CHD positions, but many used local sources (family, friends, local newspapers, and word of mouth) for finding a CHD position. 19. Results CHD Dentists Factors Related to Job Satisfaction CHD providers liked: the benefits; no overhead; the hours; and the sense of giving back. Interestingly, salary was listed by 25% as a positive!!! CHD providers did not like: Salary (was a primary negative, but not far and away the biggest negative); Bureaucracy, administrative duties and the lack of control Changes that providers wanted to see were pretty equal across the board - more and better quality staff, modern technology including EMRs, and changes to the work environment to make it less sterile. Additionally, respondents provided many other suggestions to improve CHD positions 20. Conclusions The majority of dental students are planning to go into private practice vs. considering public health practice debt & economics Many dental students do not know about public health opportunities and the benefits of CHD positions CHD dentists see public health as a career Salary is not the sole influence in job satisfaction and the reason providers stay in CHD positions 21. Conclusions Recruitment: Need to educate and actively recruit at dental schools in person and utilize career service Need to recruit minority providers Retention: But, also need to improve non-monetary issues Administrative duties Bureaucracy Modern technology Pleasing facilities Staff upgrades 22. Contact Info Douglas_Manning@doh.state.fl.us Inge_Ford@doh.state.fl.us

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