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Statewide difficulty in recruiting dentists extends to Bennington County

Aging population of dentists, low Medicaid reimbursements, few group practices in state add to challenge

By Edward Swanson

eswanson@manchesterjournal.com @eswanmj on Twitter

POSTED:   12/31/2014 12:24:02 PM EST 0 COMMENTS

 

BENNINGTON COUNTY >> Tis the season for candy canes, hot chocolate, and other sugary holiday treats, but there is some sobering news on the dental front in Vermont, with Bennington County not being exempt.

According to the Vermont Department of Health 2011 Dentist Survey Statistical Report, there were 17 primary care dentists and eight specialists within Bennington County. Vaughn Collins, executive director of the Vermont State Dental Society, feels that although statistically Bennington County has enough dentists, there are still issues surrounding the topic of dental care in the area.

“Bennington County is certainly not short on dentists,” said Collins in an interview. “But something that is obfuscating the issue is as the result of the Affordable Care Act, this year the Medicaid rolls expanded by over 40,000 adults. As you can imagine, this puts pressure on dental offices because dental offices only get a 50 percent reimbursement rate to see a Medicaid patient.”

Collins went on to say that due to this low reimbursement rate, many dental practices take on a certain number of Medicaid patients and then refuse to take on any more.

“So that doesn’t mean that there is a shortage of dentists,” Collins continued. “It means there’s a shortage of money to pay the dentists from the Medicaid program. This is happening all over the state.”

Collins pointed to recruiting young dentists to Vermont as one possible solution. However, with average dental school debt loads of $300,000 (Tufts University, for example, charges $70,000-$80,000 per year), it is difficult to attract young dentists to the state, according to Collins. He cited Vermont’s income rates, which are low when compared to the rest of New England, as a major factor. The need for recruitment is looming ever larger, as the population of Vermont dentists is static now but is poised to dwindle.

“I don’t think our [dentist] population is going to grow in the next few years, but there is going to be a stronger need to recruit because we are going to have a lot of dentists retiring,” said Collins. “The future is a challenge.”

Of the 17 primary care dentists in the county cited by the 2011 Dentist Survey, seven fell within the 60-64 age bracket, and two within the 65 and older bracket. Four more were in their 50s, leaving only four primary care dentists in the county under the age of 50.

Dr. Michael Brady of Bennington’s Molly Stark Dental Program is a former president of the Vermont State Dental Society and former chairman of the State Board of Dental Examiners. He attested to the ageing population of Vermont’s dentists.

“The problem you have is that the dentists are older,” he said in an interview. “They’re practicing less, they’re seeing fewer patients, they’re not being as energetic in their practices. Consequently, you do have a lack of access to dentists in the area, whether you have regular insurance or Medicaid.”

Brady, who is 68, talked of attracting young dentists to Vermont, citing the lack of dental school in Vermont as a major stumbling block to progress.

“There is one [dental] hygiene school in Burlington, and that’s it,” said Brady. “By educating dentists in-state you would increase the odds of keeping them here.”

He also revealed that most young dentists are accustomed to working in a group practice, of which there are only two in Bennington County. The single practice style of dentistry is the dominant style in this county, and it is one that is unfamiliar to young dentists coming out of school.

Brady, who has been in practice for 40 years, believes that an expanded-function dental assistant role would increase dental care in Vermont. These assistants could fill cavities and perform certain procedures with only minimal preparatory help from the dentist. But again, in Vermont there is no facility that trains dental assistants. He did see an avenue by which to encourage the development of such a position.

“It is encouraging that Federally Qualified Health Centers have blossomed throughout Vermont,” Brady said. “If they are properly done you could really make use of the expanded function dental assistant role, as well as fully trained dental hygienists, and dentists and really provide for the community.”

One such facility already has a new building site secured off of Route 7A in Arlington. As a FQHC, the Battenkill Valley Health Center must provide dental care alongside medical and other services. The new building, once completed, will do just that.

“My goal is to put a new building up with a minimum of four dental offeratories,” said Grace Gilbert-Davis, CEO of the BVHC. “This will include a dentist, a hygienist, a dental practitioner, and a practice manager. As a FQHC we will provide preventative dental care, like basic dental hygiene, and restorative care, which would include tooth extractions,”

Gilbert-Davis has herself experienced the problems with dental access.

“As a newcomer to the area this past May, I had dental insurance and could also afford to pay out of pocket,” she said. “I was on a waiting list for eight months and only got in because one of my employees was a patient at this practice and lobbied for me. I had re-engaged with my former dentist up in Burlington.”

Beth Nolan, outreach coordinator for the Vermont Oral Health Care for All Coalition, is all too familiar with such stories.

“What we’re going to end up with within the next decade is far too few dentists, while at the same time demand for dental services increasing, therefore leading to a shortage,” said Nolan. “In some communities, while there might be a dentist, it doesn’t necessarily mean that a patient can get in to see that dentist, depending on their insurance.”

It is more difficult by far for Medicaid patients.

“The reimbursement rate for Medicaid for a dentist is too low,” said Nolan. “If you look at numbers, about 80 percent of dentists in the state of Vermont have accepted Medicaid patients in the last year. But what that means is that 80 percent of Vermont dentists accepted at least one patient with Medicaid coverage in a year’s span. What we’re seeing is a about third of that 80 percent are taking the bulk of the Medicaid patients.”

Nolan also spoke of Bennington County’s dental access issue.

“Bennington County in particular has found access to dental care to be not only a problem but one of the largest health care access problems they are finding. Even Chittenden County, which boasts the highest rate of dentists and contains almost all of the pediatric dentists in the state, Fletcher Allen (recently renamed The University of Vermont Medical Center) still identified dental access as one of the top needs in that community.”

In her opinion, another option by which to combat this is the introduction of a mid-level provider in the form of a licensed dental practitioner.

This would be a trained hygienist who would then receive additional training to become an LDP. The focus would be prevention, but they would also do some basic restorative care that dentists perform which hygienist does not. With fewer years of training, less debt, and less pay than a dentist, Nolan believes that this position would make it easier for a dentist’s office or FQHC to take Medicaid or uninsured patients.

“Let’s take a workforce that we already have in the state of Vermont, let’s give the more training, increase their economic opportunity while at the same time increasing access to dental care,” said Nolan.

The Vermont State Dental Society opposed Coalition’s proposed Licensed Dental Practitioner Bill in the last legislative session. The bill was not heard in the Senate. The VSDS pointed to issues with monitoring the extensive proposed training for the position and economic infeasibility as reasons for opposing the bill. The bill will be reintroduced in 2015.