Given the access to dental care issue, why aren't...?

[Destiny11]

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Do your research before complaining about the lack of desire to work in the underserved. What you will find once you do this research, is that there's a reason why some cities have no to few dentists: those cities can't support a dental clinic. There are too few patients within a reasonable surrounding distance to sustain a practice. In many high need cities, you WILL go broke.

What about a large city such as SF where it's saturated with hundreds of dentists? Why are there only ~ 40 private dentists that may accept new patients with Denti-Cal? SF is lucky to be blessed with 2 dental schools, and that they take referrals from all over the bay area.

In my hometown, patients with Denti-Cal have 5 private dentists to choose from, or be put on the waiting list for at least 3 months at the county clinic. I know there are many other cities that are not as lucky.

http://www.denti-cal.ca.gov/WSI/Bene.jsp?fname=ProvReferral

 

[Montserrat]

Do your research before complaining about the lack of desire to work in the underserved. What you will find once you do this research, is that there's a reason why some cities have no to few dentists: those cities can't support a dental clinic. There are too few patients within a reasonable surrounding distance to sustain a practice. In many high need cities, you WILL go broke.

You should do some more research yourself pal. You identified one example where a practice or clinic wouldn't provide a favoreable earnings to cost ratio (either from a non-profit or a private practice startup.) However, your example is not representative of all or even a majority of areas that are underserved.

There are many, many underserved areas where a practicing dentist will receive loan forgiveness by working at clinics or private practices whose patient volume includes at least a quarter of those on public programs or eligible for sliding scale fees. It's quite possible to do, but it's really tough for a dentist because these areas operate by volume. It's hard to blame someone for not wanting to work within Medicaid dentistry. However, that doesn't mean the city or area can't sustain a Medicaid practice or dental clinic -- it just means dentists will choose options that they feel are better.

 

[Destiny11]

OP what would you do to make more applicants consider working in undeserved areas? Make them promise? Make people sign a contract at the interview that should they get accepted they have to work in such an area?
It's pretty much impossible to do.

Haha definitely can't make anyone promise or sign a contract for anything. I would like to see more funding for the NHSC scholarship and loan repayment program, and higher reimbursements for government insurance programs.

That being said, I would like to see more dental schools adapt an admissions policy similar to ASDOH and apparently Western too, that puts a premium on long term dedicated service to the underserved, on top of good GPA and DAT scores. Long term volunteering is a developed habit, and it has taught me a lot about the kind of dentistry I would like to practice. By accepting a student who has already developed a habit in giving back to the society, he or she will most likely continue to do the same during and after dental school. I would also like to see more dental schools teach more classes in public health/community dentistry, integrate community rotations, and encourage their students to serve the underserved communities.

 

[UCSF2012]

What about a large city such as SF where it's saturated with hundreds of dentists? Why are there only ~ 40 private dentists that may accept new patients with Denti-Cal? SF is lucky to be blessed with 2 dental schools, and that they take referrals from all over the bay area.

In my hometown, patients with Denti-Cal have 5 private dentists to choose from, or be put on the waiting list for at least 3 months at the county clinic. I know there are many other cities that are not as lucky.

http://www.denti-cal.ca.gov/WSI/Bene.jsp?fname=ProvReferral

Because Denti-cal reimbursement rates are below operating cost. You lose money for each procedure you perform. I've done the research. I've done the math. You lose about $100 for each crown you do, because the income you generate don't meet your own clinic/lab costs. I personally WANT to serve the underserved, but after doing the research and math, there's more risk than I'd like.

Private practice dentists aren't in the best position to serve the underserved. Universities can get state funding to make up for some loss.

 

[Destiny11]

Oh and thank you everyone for your constructive comments/opinions/thoughts on this issue! 1000 views in 3 days!

 

[UCSF2012]

You should do some more research yourself pal. You identified one example where a practice or clinic wouldn't provide a favoreable earnings to cost ratio (either from a non-profit or a private practice startup.) However, your example is not representative of all or even a majority of areas that are underserved.

There are many, many underserved areas where a practicing dentist will receive loan forgiveness by working at clinics or private practices whose patient volume includes at least a quarter of those on public programs or eligible for sliding scale fees. It's quite possible to do, but it's really tough for a dentist because these areas operate by volume. It's hard to blame someone for not wanting to work within Medicaid dentistry. However, that doesn't mean the city or area can't sustain a Medicaid practice or dental clinic -- it just means dentists will choose options that they feel are better.

Have you, yourself, done the research before making such a claim? I've researched multiple states, and multiple cities within those states. I simply feel like I'd be taking too big a personal risk in working in certain cities. It's all about RISK. Do you feel confidant enough in your word to open a clinic in a risky city? Confidant enough to risk bankruptcy? We all know that business will be slow the first few years of practice, so do you feel that you can survive these first few years with few patients, low reimbursement rates, etc???? It's easy to talk a big game, but will you back up your word with a 200-300k loan?

If there were an established clinic and I'd be taking over...well, that's another story.

 

[Destiny11]

Because Denti-cal reimbursement rates are below operating cost. You lose money for each procedure you perform. I've done the research. I've done the math. You lose about $100 for each crown you do, because the income you generate don't meet your own clinic/lab costs. I personally WANT to serve the underserved, but after doing the research and math, there's more risk than I'd like.

Private practice dentists aren't in the best position to serve the underserved. Universities can get state funding to make up for some loss.

By not accepting Denti-Cal, the people suffering the most are children and seniors. You don't have to do a crown if it costs you too much. You can refer that to UCSF. However, you can at least do your part on preventive services such as routine check ups and sealants for children.

 

[Montserrat]

Have you, yourself, done the research before making such a claim? I've researched multiple states, and multiple cities within those states. I simply feel like I'd be taking too big a personal risk in working in certain cities. It's all about RISK. Do you feel confidant enough in your word to open a clinic in a risky city? Confidant enough to risk bankruptcy? We all know that business will be slow the first few years of practice, so do you feel that you can survive these first few years with few patients, low reimbursement rates, etc???? It's easy to talk a big game, but will you back up your word with a 200-300k loan?

If there were an established clinic and I'd be taking over...well, that's another story.

Yes, I have. I volunteered for a dental non profit and helped with grant submissions in the tri state area. For private and state grant submissions, we required quite of bit of compiled demographic data to make our case of sustainability and continuity of care. If you're preaching to me about risk, drop it. A ridiculous amount of paperwork is required just for the right to serve people who otherwise would not receive care and it revolves around sustainability and continuity of care.

You do realize that you do not have to own your own practice in underserved areas, correct ? You also realize that established clinics (non-profit or state funded) are not always those you can "take over", right? Your seem to be confused about the topic by tying together practice/clinic ownership as necessary for serving the underserved. If that is the only way you envision the underserved receiving care, by all means. However, why obfuscate the question -- first you say it's not economically viable and then you say it's too much risk... make up your mind.

 

[dentalWorks]

Question:

I was looking at the NHSC website, there seems to be ALOT of job openings by other dental offices in areas that are considered undeserved. Aside from loan-repayment, what kind of salaries are these dentists expected to make in working at such locations?

 

[Destiny11]

Question:

I was looking at the NHSC website, there seems to be ALOT of job openings by other dental offices in areas that are considered undeserved. Aside from loan-repayment, what kind of salaries are these dentists expected to make in working at such locations?

I know for NHSC sites, you negotiate your pay directly with the site that hires you.


Here are 2 links that talks about compensation for IHS...I don't know if it's relevant for loan repayment programs.

http://www.dental.ihs.gov/index.cfm?module=cs_comp
http://www.dental.ihs.gov/index.cfm?module=cc_comp

 

[UCSF2012]

Yes, I have. I volunteered for a dental non profit and helped with grant submissions in the tri state area. For private and state grant submissions, we required quite of bit of compiled demographic data to make our case of sustainability and continuity of care. If you're preaching to me about risk, drop it. A ridiculous amount of paperwork is required just for the right to serve people who otherwise would not receive care and it revolves around sustainability and continuity of care.

You do realize that you do not have to own your own practice in underserved areas, correct ? You also realize that established clinics (non-profit or state funded) are not always those you can "take over", right? Your seem to be confused about the topic by tying together practice/clinic ownership as necessary for serving the underserved. If that is the only way you envision the underserved receiving care, by all means. However, why obfuscate the question -- first you say it's not economically viable and then you say it's too much risk... make up your mind.

Have you researched OUTSIDE NY state? From your list of experiences, you likely havn't. Among the states I researched is NY, and NY is one of few states where reimbursement rates EXCEED operation costs. You're lucky. Don't take it for granted. But don't take your understanding of NY as the rule of thumb.

Are you seriously going to argue about word choice? Seriously? Being economically viable and risk are inter-related ideas. You assess the chances of a business being economically viable. You're never sure of anything at the beginning. You only make predictions. Have you ever been involved in big business transactions before? Perhaps once you get yourself in 6 figure purchases, you'll be more learned. Your list of duties during a volunteer position barely makes you knowledgeable. I have a personal friend who's an analyst that helps guide my decisions.

You're welcome to work for others in an underserved city. My own goal is to open a clinic, and I'm still in search of a locale.

 

[Montserrat]

Have you researched OUTSIDE NY state? From your list of experiences, you likely havn't. Among the states I researched is NY, and NY is one of few states where reimbursement rates EXCEED operation costs. You're lucky. Don't take it for granted. But don't take your understanding of NY as the rule of thumb.

Are you seriously going to argue about word choice? Seriously? Being economically viable and risk are inter-related ideas. You assess the chances of a business being economically viable. You're never sure of anything at the beginning. You only make predictions. Have you ever been involved in big business transactions before? Perhaps once you get yourself in 6 figure purchases, you'll be more learned.

You're welcome to work for others in an underserved city. My own goal is to open a clinic.

You yourself said it wasn't economically viable, as in you would "go broke." Then you turn around and say maybe not broke... "just too much risk!" If you've done even a modicum of work, that which is risky is not necessarily economically unviable. Don't equate the two and get your own story straight..

If you researched NY state as whole, I'm sure you enjoyed the regional differences in compensation throughout the state before making a broad generalization. That would take several years to analyze, but hey, you know your stuff! Therefore, you would know that compensation changes from one county to another, and it also changes ANNUALLY based upon feeder money through Medicaid subsidiaries. I only looked at a few counties, but I'm sure you'll enjoy giving us a county by county breakdown of compensation, because you've crunched all the numbers.

And no, I have not been involved in six figure personal transactions that tally up to a practice. Too rich for my blood at the moment. Then again, I bet you have !

 

[Montserrat]

Question:

I was looking at the NHSC website, there seems to be ALOT of job openings by other dental offices in areas that are considered undeserved. Aside from loan-repayment, what kind of salaries are these dentists expected to make in working at such locations?

I looked into this and prison dentistry jobs out of curiosity and it is really going to vary. The thing is, depending on which state you are in, certain private practices are also designated as service centers. I would think that compensation as an associate in a private practice service center would depend on how procedures/patients you see whereas in a clinic, your salary might not be as dependent on that.

 

[UCSF2012]

You yourself said it wasn't economically viable, as in you would "go broke." Then you turn around and say maybe not broke... "just too much risk!" If you've done even a modicum of work, that which is risky is not necessarily economically unviable. Don't equate the two and get your own story straight..

If you researched NY state as whole, I'm sure you enjoyed the regional differences in compensation throughout the state before making a broad generalization. That would take several years to analyze, but hey, you know your stuff! Therefore, you would know that compensation changes from one county to another, and it also changes ANNUALLY based upon feeder money through Medicaid subsidiaries. I only looked at a few counties, but I'm sure you'll enjoy giving us a county by county breakdown of compensation, because you've crunched all the numbers.

And no, I have not been involved in six figure personal transactions that tally up to a practice. Too rich for my blood at the moment. Then again, I bet you have !

Yet you persist in arguing about word choice. You don't seem to understand what it means to assess "risks" in starting a business, the chances that your goals aren't achieved. I'm going to stop arguing right here, because it's become evident that you have no business experience to draw from. Nothing I say now will matter.

...and to answer your question. I'm a non-trad, so yes. Yes, I have.

 

[Montserrat]

Yet you persist in arguing about word choice. You don't seem to understand what it means to assess "risks" in starting a business, the chances that your goals aren't achieved. I'm going to stop arguing right here, because it's become evident that you have no business experience to draw from. Nothing I say now will matter.

...and to answer your question. I'm a non-trad, so yes. Yes, I have.

Of course I argue the usage of words. In this horrid economy, you don't actually think you're the only non-trad out there, do you? For the sake of explanation, here is the difference between risk as you see it and risk as it exists. SDN bloke # 1 invests a pretty paltry amount in class C international petrol shares a short while ago. The risk is higher due to his status as a foreign class C shareholder with limited to no voting rights. However, he will receive a higher dividend in return, as that is the nature of the share. Despite the higher risk, it is not a doomed venture. Similarly, a risky investment in business is not the same as "going broke", as you say.

Now, let's rewind to what you said earlier. You said that "You will go broke" because apparently your research indicates that many cities cannot support such a venture. Then you parlay into risk once another poster finds a wealth of opportunities to serve the underserved via the NHSC. That about sum it up?

Since you ignored it, I'll repost it for ya :
If you researched NY state as whole, I'm sure you enjoyed the regional differences in compensation throughout the state before making a broad generalization. That would take several years to analyze, but hey, you know your stuff! Therefore, you would know that compensation changes from one county to another, and it also changes ANNUALLY based upon feeder money through Medicaid subsidiaries. I only looked at a few counties, but I'm sure you'll enjoy giving us a county by county breakdown of compensation, because you've crunched all the numbers.

 

[corpus luteum]

C'mon mate.... everyone knows before getting into ds what kind of debt they are getting into… it is not like playing black jack at a casino table in LV for the first time…OK bad analogy but you get the point …lol

Also, don’t we all answer this “why dentistry” question and supposedly “truthfully” without bringing “money” into the discussion so why is change of heart all of a sudden 😉

Frankly speaking no government loan forgiveness program or anything else similar to that can make an individual go and serve in those areas unless he or she has “that” thing inside them, period!!

good discussion nevertheless.....👍

Yes, perhaps everyone "knows" what kind of debt they are getting into.. but how much do they actually comprehend about financial debt, paying bills, and supporting oneself and one's family? We're talking about students who have spent the majority of their lives in school, investing in themselves for the future, never having worked to actually support themselves or anyone else (generalization, obv). Devoting your life to helping those who need it most sounds just peachy until you actually face those realities.

As for your response about the "why dentistry" question, I think many people who choose health care professions do have "that" thing inside of them (by which I think you mean altruistic tendency)... There are lots of ways to make money. Yet, why choose a career in health care? Because we want to care for people! (AND get paid doing it!) So, I guess what I'm saying is, you're right... no loan forgiveness program would make someone who doesn't have that altruistic sense go practice in an underserved area. But for those who do, it would offer a sense of comfort that at least their own financial situations will be somewhat under control while they live out their dreams of service.

 

[UCSF2012]

Of course I argue the usage of words. In this horrid economy, you don't actually think you're the only non-trad out there, do you? For the sake of explanation, here is the difference between risk as you see it and risk as it exists. SDN bloke # 1 invests a pretty paltry amount in class C international petrol shares a short while ago. The risk is higher due to his status as a foreign class C shareholder with limited to no voting rights. However, he will receive a higher dividend in return, as that is the nature of the share. Despite the higher risk, it is not a doomed venture. Similarly, a risky investment in business is not the same as "going broke", as you say.

Now, let's rewind to what you said earlier. You said that "You will go broke" because apparently your research indicates that many cities cannot support such a venture. Then you parlay into risk once another poster finds a wealth of opportunities to serve the underserved via the NHSC. That about sum it up?

Since you ignored it, I'll repost it for ya :
If you researched NY state as whole, I'm sure you enjoyed the regional differences in compensation throughout the state before making a broad generalization. That would take several years to analyze, but hey, you know your stuff! Therefore, you would know that compensation changes from one county to another, and it also changes ANNUALLY based upon feeder money through Medicaid subsidiaries. I only looked at a few counties, but I'm sure you'll enjoy giving us a county by county breakdown of compensation, because you've crunched all the numbers.

I'm afraid you suffer from the disease of selective reading. I said, "...there's a reason why some cities have no to few dentists: those cities can't support a dental clinic. There are too few patients within a reasonable surrounding distance to sustain a practice. In many (not "all," not "most," but "many") high need cities, you WILL go broke."

You've misquoted me, taken things out of context, put words into my mouth, ignored clarifications, and the works. The problem here is that you don't know how to read. You don't even know what I said.

PS - I know about loan repayment programs. We've had numerous lectures on it, and I see it as a signing bonus and nothing more. If I need to re-iterate, I'm addressing the issue of opening a private practice. I'm not addressing the issue of working for another entity. They sometimes pull funding from other sources many private practices don't have the liberty of.

PSS - I love how you raised a claim about NY state, made mockery of your own claim, then kick me for the claim as if I made it. Crafty technique.

 

[Montserrat]

Unfortunately, I did read your first post. In case you forgot what you said, here it is below :

Do your research before complaining about the lack of desire to work in the underserved. What you will find once you do this research, is that there's a reason why some cities have no to few dentists: those cities can't support a dental clinic. There are too few patients within a reasonable surrounding distance to sustain a practice. In many high need cities, you WILL go broke.

You seem to think that because some cities you claim to look at aren't "sustainable", you will go broke and this thought path causes others not to pursue working for the underserved. That's a pretty weak argument because many new dentists who work in underserved areas do so in established clinics and practices. You haven't really stated much beyond "it's a losing proposition. I've done the numbers, trust me yo." You haven't really explained anything, at all. When you claim to have looked at NY, I replied with how New York's compensation system is ******edly organized, as compensation amounts vary by region and will further vary based upon the Medicaid subsidiary you are looking at. Compensation isn't streamlined at all, so I'm curious as to how you came up with a consensus for the state when it's difficult to come up with a definitive answer between adjacent counties. Despite the mess however, one telltale sign of viability is that medicaid practices continue to exist and turn profits -- and good for them, because they serve a need and deal with crap that some other dentists don't want any part of.

It's not that anyone is putting words in your mouth. You just aren't making any sense.