Community dentistry: Procedures and Reality of the Position

[parttimedreamer]

This is addressed to those who either currently do, or did, work at a "community health center". I have a list of some questions, and if anyone could, please respond. Also, if there are any further websites anyone knows about (I have looked but have not been successful) that can teach me more about community dentistry, this would also be appreciated:

-What are the common procedures?
-Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
-What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
-Overall, what are some realities of this specific dental position that I am potentially overlooking? Yes, salary and all that are important to be realistic on. I'll take any advice about what I don't know.

Thank you.

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[Molar Whisperer]

I did an externship at a community health center. I believe it is an excellent option to start your career or become a lifer. For the most part, it is fairly low stress. Depending on which area and state, you may or may not do many rcts. The pay is very low but I believe there are tuition assistance and or forgiveness.

 

[drindia]

I used to work for a community health center until recently.

What are the common procedures?
Exams, prophylaxis, SRPs, restorations, extractions, dentures, pedo exams, sealants and restorations. Some crowns. There may be lot of walk-ins and emergencies.

Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
Yes. Thats what ours is like. But you have to do some dentures as well. No RCTs. Crowns is your choice. Basically, at our community clinic (I guess its the same with all), you do whatever procedure you are comfortable with. There is no pressure from management to do a certain procedure. You can refer out if you think something is complicated. But the management wants you to see a certain number of patients per day (I guess thats how they get their funding).

What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
We see about 12-15 patients a day. Sometimes a little more. If you are okay with less pay, I guess it gives the best balance between personal and professional life. It is much less stressful as compared to a private office

Overall, what are some realities of this specific dental position that I am potentially overlooking? Yes, salary and all that are important to be realistic on. I'll take any advice about what I don't know.
Like I said, it is definitely less stressful. But you have to compromise on the pay. You will get a fixed salary without much raise. This is especially true if you work at a community clinic in a city or urban area. If you go to a remote area, may be the pay would also be good. You get all the benefits including malpractice coverage and CE. There are PTOs. But you may not have much growth clinically. Like you may not be doing implants, esthetic restorations like veneers, molar endo, etc.

 

[zdoq]

Do any specialists work in community clinics? If not full time, then maybe part time once a week or once a month?

 

[shendo]

Do any specialists work in community clinics? If not full time, then maybe part time once a week or once a month?

Yes, there are some community clinics that have specialists working part time/full time. For example, at the community clinic I used to work for before I went to endo residency- we had a full time pediatric dentist, part time prosth, endo, perio, and OS. Bascially all specialties except ortho. Part of the reason why we had so many specialists is because our site was also a training site for AEGD residents.

 

[UncleJoesVeneers]

I had a four year service commitment in community dentistry. Worked at 3 FQHCs in three different states spanning my GPR and scholarship. No matter what anyone tells you, every FQHC/health center is different. The administration, culture, director, staff, equipment, procedure mix, and patient population can vary widely. The consistent things are generally the pay and benefits for a 40 hour work week: $130k+ salary with 10 federal holidays, 20+ PTO/CME/sick, 403(b) with match, health insurance, CME stipend, paid fees (license, DEA, ADA), etc. PTO is either accrued (sucks), or given up front. Contracts are usually for at least a 2 year commitment, with 90 day notice for employer and employee (anything longer than this is BS and you should run).

Community dentistry can be very rewarding .... for a time. I think anything longer than 2 years will result in at least some level of burnout. That said, there are some good gigs out there where you can ride an FQHC job for a while and be happy, especially if you only have to work 4 days per week. But for most people, the 5 day week in an FQHC seeing 14+ adult op (20+ for pedo) while covering multiple hygienists will burn you out. Why? The patients are one thing - seeing meth mouth and pain patients all the time gets exhausting, especially every time you go to do a "hygiene check" and it's a patient with cavities in every single tooth that you're supposed to treatment plan in 5 minutes. But the staff is the problem I've noticed across sites being the biggest drain. You will work with the absolute bottom of the barrel in terms of assistants. Meaning, they know nothing. And you often have zero input into hiring/firing or who you have to work with. Sites are frequently understaffed due to high turnover. The closer you are to a major city, the easier it is to keep staff. But if you're in the boonies or a less desirable area to live? Good luck.

Anyway, I had a public health background and was set on the community dentistry gig. Almost five years later I'm burned out and going back to specialize (partly because community dentistry allowed me to do a bit of everything, and I found what I enjoyed and what I strongly disliked). I often wondered if it was just me, but considering all the dentists I've worked with at each site also hated working there/were burned out, I'm gonna say it's simply the nature of it. Especially for NHSC or J-1 visa people - the site knows you're less of a flight risk, so they'll pile **** on you.

The dentists who seemed to be able to do OK at FQHCs long term were the ones who worked part time or less than 5 days per week. Even within the same organization, some offices will be better than others. Some dentists will be expected to only do simple fillings and extractions, while others are expected to do the full gamut of general dentistry. Obviously one is more taxing than the other.

Again, some sites can be great. But be wary of when people give global answers for it, or say they enjoyed community health when they only did it for 1-2 years. The burnout starts after 2 years for most. If you go the community health route, get your loan forgiveness and have an exit strategy.

 

[parttimedreamer]

I had a four year service commitment in community dentistry. Worked at 3 FQHCs in three different states spanning my GPR and scholarship. No matter what anyone tells you, every FQHC/health center is different. The administration, culture, director, staff, equipment, procedure mix, and patient population can vary widely. The consistent things are generally the pay and benefits for a 40 hour work week: $130k+ salary with 10 federal holidays, 20+ PTO/CME/sick, 403(b) with match, health insurance, CME stipend, paid fees (license, DEA, ADA), etc. PTO is either accrued (sucks), or given up front. Contracts are usually for at least a 2 year commitment, with 90 day notice for employer and employee (anything longer than this is BS and you should run).

Community dentistry can be very rewarding .... for a time. I think anything longer than 2 years will result in at least some level of burnout. That said, there are some good gigs out there where you can ride an FQHC job for a while and be happy, especially if you only have to work 4 days per week. But for most people, the 5 day week in an FQHC seeing 14+ adult op (20+ for pedo) while covering multiple hygienists will burn you out. Why? The patients are one thing - seeing meth mouth and pain patients all the time gets exhausting, especially every time you go to do a "hygiene check" and it's a patient with cavities in every single tooth that you're supposed to treatment plan in 5 minutes. But the staff is the problem I've noticed across sites being the biggest drain. You will work with the absolute bottom of the barrel in terms of assistants. Meaning, they know nothing. And you often have zero input into hiring/firing or who you have to work with. Sites are frequently understaffed due to high turnover. The closer you are to a major city, the easier it is to keep staff. But if you're in the boonies or a less desirable area to live? Good luck.

Anyway, I had a public health background and was set on the community dentistry gig. Almost five years later I'm burned out and going back to specialize (partly because community dentistry allowed me to do a bit of everything, and I found what I enjoyed and what I strongly disliked). I often wondered if it was just me, but considering all the dentists I've worked with at each site also hated working there/were burned out, I'm gonna say it's simply the nature of it. Especially for NHSC or J-1 visa people - the site knows you're less of a flight risk, so they'll pile **** on you.

The dentists who seemed to be able to do OK at FQHCs long term were the ones who worked part time or less than 5 days per week. Even within the same organization, some offices will be better than others. Some dentists will be expected to only do simple fillings and extractions, while others are expected to do the full gamut of general dentistry. Obviously one is more taxing than the other.

Again, some sites can be great. But be wary of when people give global answers for it, or say they enjoyed community health when they only did it for 1-2 years. The burnout starts after 2 years for most. If you go the community health route, get your loan forgiveness and have an exit strategy.

May I PM you? I have some follow-up questions.

 

[UncleJoesVeneers]

May I PM you? I have some follow-up questions.

Sure thing

 

[pubhealthdent]

been working for an FQHC for the last 2.5 years

-What are the common procedures?
most common: fillings, extractions, endo, dentures
Less common: crown & bridge
Almost never: implants
-Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
yes. Best advice is to see what medicaid covers in the state(s) you want to live/work in. Some states are very limited and medicaid only covers like pedo only, while other states have very robust medicaid programs that cover removable, fixed, endo, etc.
-What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
definitely varies from clinic to clinic. Pre-covid, I was seeing 15 or so pts per day (8 hrs day)
-Overall, what are some realities of this specific dental position that I am potentially overlooking? Yes, salary and all that are important to be realistic on. I'll take any advice about what I don't know.
best advice I got in dental school: if you've seen one FQHC, you've seen one FQHC. They're all different so its very important to cast a wide net and find one that works
best for you.
the pay can be good if you're in the right place. When I was looking I had offers ranging from $120k-200k because I didn't limit myself geographically. Now, making 270k in in FQHC 2.5 years out of school is rare but possible.
Benefits are great. Very rare in private practice to get have access to 401k, health insurance, paid vacation and CE reimbursement. Also the loan repayment helps.
Going more rural means you'll likely have to do more procedures as there's less referral sources - i do almost any extraction because our closest OS is 1.5 hours away and booked out 18 months. No endo close (and they don't take medicaid) so if I'm not comfortable doing to endo then patient is going to lose that tooth. In big cities, this isn't as much of a concern.
Burnout is real and most dentists in FQHCs will experience it. But with enough vacation and CE days, I've been able to avoid it thus far.

TLDR: every FQHC is different, shop around and find one you that matches your wants and it can be a very rewarding career

 

[allDAT]

Do any specialists work in community clinics? If not full time, then maybe part time once a week or once a month?

Yes, usually part time.

 

[allDAT]

I had a four year service commitment in community dentistry. Worked at 3 FQHCs in three different states spanning my GPR and scholarship. No matter what anyone tells you, every FQHC/health center is different. The administration, culture, director, staff, equipment, procedure mix, and patient population can vary widely. The consistent things are generally the pay and benefits for a 40 hour work week: $130k+ salary with 10 federal holidays, 20+ PTO/CME/sick, 403(b) with match, health insurance, CME stipend, paid fees (license, DEA, ADA), etc. PTO is either accrued (sucks), or given up front. Contracts are usually for at least a 2 year commitment, with 90 day notice for employer and employee (anything longer than this is BS and you should run).

Community dentistry can be very rewarding .... for a time. I think anything longer than 2 years will result in at least some level of burnout. That said, there are some good gigs out there where you can ride an FQHC job for a while and be happy, especially if you only have to work 4 days per week. But for most people, the 5 day week in an FQHC seeing 14+ adult op (20+ for pedo) while covering multiple hygienists will burn you out. Why? The patients are one thing - seeing meth mouth and pain patients all the time gets exhausting, especially every time you go to do a "hygiene check" and it's a patient with cavities in every single tooth that you're supposed to treatment plan in 5 minutes. But the staff is the problem I've noticed across sites being the biggest drain. You will work with the absolute bottom of the barrel in terms of assistants. Meaning, they know nothing. And you often have zero input into hiring/firing or who you have to work with. Sites are frequently understaffed due to high turnover. The closer you are to a major city, the easier it is to keep staff. But if you're in the boonies or a less desirable area to live? Good luck.

Anyway, I had a public health background and was set on the community dentistry gig. Almost five years later I'm burned out and going back to specialize (partly because community dentistry allowed me to do a bit of everything, and I found what I enjoyed and what I strongly disliked). I often wondered if it was just me, but considering all the dentists I've worked with at each site also hated working there/were burned out, I'm gonna say it's simply the nature of it. Especially for NHSC or J-1 visa people - the site knows you're less of a flight risk, so they'll pile **** on you.

The dentists who seemed to be able to do OK at FQHCs long term were the ones who worked part time or less than 5 days per week. Even within the same organization, some offices will be better than others. Some dentists will be expected to only do simple fillings and extractions, while others are expected to do the full gamut of general dentistry. Obviously one is more taxing than the other.

Again, some sites can be great. But be wary of when people give global answers for it, or say they enjoyed community health when they only did it for 1-2 years. The burnout starts after 2 years for most. If you go the community health route, get your loan forgiveness and have an exit strategy.

This is a very honest opinion of community health and consistent with my experiences.

 

[HowIMetYourMolar]

This is addressed to those who either currently do, or did, work at a "community health center". I have a list of some questions, and if anyone could, please respond. Also, if there are any further websites anyone knows about (I have looked but have not been successful) that can teach me more about community dentistry, this would also be appreciated:

-What are the common procedures?
-Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
-What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
-Overall, what are some realities of this specific dental position that I am potentially overlooking? Yes, salary and all that are important to be realistic on. I'll take any advice about what I don't know.

Thank you.

I'm a new grad who decided to work at a community health center after graduation this spring. I'm not on NHSC scholarship but I knew I was applying to Pediatric Residency and want to do outreach/public health dentistry/teaching in the future. I think it's a great stepping stone into real-world dentistry, I'm in a busy metropolitan FQHC and the patient pool is really similar to those I served in dental school so patient pool had little to adjust to. I spent more time adjusting to the fact that I now have assistants (and yes, some are great, some are not so great), focusing on what I like / getting faster and better at what I want. A lot of my classmates went on to GPRs but I have no interest in molar endo or implants, so thought it'd be better to get paid more and get to practice. I specifically wanted at least 1 other dentist so we could bounce treatment planning ideas off each other / wanted some mentorship and guidance my first year out of school. I got exactly that and am very happy with everything!

-What are the common procedures?
Operative, Extractions, Removable (a lot easier than dental school, lab basically does 3/4 of everything). SDF, sealants, operative on kids. I'd say my patient pool is 50/50 kids and adults, on any given day my age range is 2 y/o to 90 y/o.

-Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
I personally only do simple extractions. We're lucky to have a ton of specialists in our area so if I can't do the procedure in 20 mins, I refer out. We only have 30 min appt blocks per patient and 5-10 mins are intake or dismiss so really treatment time should be 20 mins otherwise you'll run behind schedule.

-What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
My company has many different sites. Our site in particular has a 90% show rate due to the population and demographics so we work out of 2 columns. All the other sites in our company have like a 30% show rate so they have 3 columns, but on the days that everyone shows up, it's crazy busy and those sites can see up to 24 patients. My site has great scheduling people / front desk so I see 15 patients consistently everyday with a good balance of recalls with an extraction (say I have two 1 pm appts, one will be a recall and 1 will be an EXT, rarely 2 EXTs booked in the same 30 mins or 2 fillings, etc). Occasionally it happens but I've also gotten faster over the months and feel OK doing it as well.

-Overall, what are some realities of this specific dental position that I am potentially overlooking?
I thought the salary was reasonable considering I was a fresh grad being hired in the middle of the pandemic. What I like is that I get paid no matter what procedure I do, whether I do cleanings all day or RCTs. My friends who are getting paid on 30% production hate seeing their HMO patients because they don't get as much production off of them. The most frustrating thing would be to spend 30 mins talking to patients trying to sell treatment and they reject everything aka a waste of your time/earning potential. I do this all the time and get paid no matter what so I have less pressure. Depending on where you're located, you could be capping your earning potential but I did the math and let's just say I'm making a ton more than if I got paid 30% of what I do everyday.. If you're interested in doing complicated / "cool" dentistry like implants, sinus lifts, community dentistry and this population is not for you in general. But my fqhc allows you to do surgical EXT, molar endo, and they have great materials like SDF, good composite, corebuild-up material, as much heavy/medium body you need. Whenever I have to retake an impression, I don't feel as bad because they get discounts buying in bulk also as a community health center so purchasing power is better as well.

 

[zxcvbmm]

been working for an FQHC for the last 2.5 years

-What are the common procedures?
most common: fillings, extractions, endo, dentures
Less common: crown & bridge
Almost never: implants
-Are there some clinics where the procedures boil down to just restorations, extractions (both surgical and "simple") and peds procedures? I have thought these would be my three main interests at the moment.
yes. Best advice is to see what medicaid covers in the state(s) you want to live/work in. Some states are very limited and medicaid only covers like pedo only, while other states have very robust medicaid programs that cover removable, fixed, endo, etc.
-What is the "daily life" of a community dentist? As in, are you swamped with patients? Do you have too few?
definitely varies from clinic to clinic. Pre-covid, I was seeing 15 or so pts per day (8 hrs day)
-Overall, what are some realities of this specific dental position that I am potentially overlooking? Yes, salary and all that are important to be realistic on. I'll take any advice about what I don't know.
best advice I got in dental school: if you've seen one FQHC, you've seen one FQHC. They're all different so its very important to cast a wide net and find one that works
best for you.
the pay can be good if you're in the right place. When I was looking I had offers ranging from $120k-200k because I didn't limit myself geographically. Now, making 270k in in FQHC 2.5 years out of school is rare but possible.
Benefits are great. Very rare in private practice to get have access to 401k, health insurance, paid vacation and CE reimbursement. Also the loan repayment helps.
Going more rural means you'll likely have to do more procedures as there's less referral sources - i do almost any extraction because our closest OS is 1.5 hours away and booked out 18 months. No endo close (and they don't take medicaid) so if I'm not comfortable doing to endo then patient is going to lose that tooth. In big cities, this isn't as much of a concern.
Burnout is real and most dentists in FQHCs will experience it. But with enough vacation and CE days, I've been able to avoid it thus far.

TLDR: every FQHC is different, shop around and find one you that matches your wants and it can be a very rewarding career

Could I ask what state? Or how rural? Thanks!

 

[pubhealthdent]

Could I ask what state? Or how rural? Thanks!

Upper midwest, working in a town of 2000 with a patients that come from up to 2.5 hours away