Low Income Clinic/Underserved Community Dentistry

[zdoq]

Hello,
Does anyone have any experience with dedicating some portion of your career serving low-income patients/underserved communities? Or could anyone point me to resources/real-life examples to learn more about how to sustain a practice like this?

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[pubhealthdent]

Hello,
Does anyone have any experience with dedicating some portion of your career serving low-income patients/underserved communities? Or could anyone point me to resources/real-life examples to learn more about how to sustain a practice like this?

Are you looking for someone who owns/works in private practice and sees some medicaid patients or someone who works in an FQHC?

 

[zdoq]

Are you looking for someone who owns/works in private practice and sees some medicaid patients or someone who works in an FQHC?

I guess either, I’m having trouble finding info about it online myself. It would be nice to hear about the differences between the two in terms of difficulty in keeping the practice afloat, types of procedures done, and different frustrations/successes that come with the two. I’d love to hear some personal anecdotes & advice.

 

[pubhealthdent]

I guess either, I’m having trouble finding info about it online myself. It would be nice to hear about the differences between the two in terms of difficulty in keeping the practice afloat, types of procedures done, and different frustrations/successes that come with the two. I’d love to hear some personal anecdotes & advice.

I work in an FQHC so I can give you that aspect. There is no ownership aspect in these practices - most will have a dental director that oversees the running of the dental clinic, but financially speaking they receive most of their money from federal funding and grants. This makes them generally harder to "go out of business" than a private practice.
As far as procedure mix goes, this can vary greatly from one FQHC to another. For example, in some states medicaid doesn't cover dentures or crowns, so these procedures would be less frequent in those clinics. I live in Wisconsin, our medicaid program covers a wide variety of procedures. I do operative, oral surgery, fixed prosth, removable prosth, and endo. Not a lot of implant candidates coming through our door unfortunately.
For me, I have no interest in running my own practice. In my position now, its 8-5 and when I'm not there, I'm not thinking about it. There's minimal stress compared to some of my buddies who are now owning their own private practice and dealing with hiring/firing, insurance, billing, etc. Another big perk of FQHCs is loan repayment. I think at the least its a great stepping stone to ptivate practice - gives you time to build up speed and confidence before going off on your own

 

[zdoq]

I work in an FQHC so I can give you that aspect. There is no ownership aspect in these practices - most will have a dental director that oversees the running of the dental clinic, but financially speaking they receive most of their money from federal funding and grants. This makes them generally harder to "go out of business" than a private practice.
As far as procedure mix goes, this can vary greatly from one FQHC to another. For example, in some states medicaid doesn't cover dentures or crowns, so these procedures would be less frequent in those clinics. I live in Wisconsin, our medicaid program covers a wide variety of procedures. I do operative, oral surgery, fixed prosth, removable prosth, and endo. Not a lot of implant candidates coming through our door unfortunately.
For me, I have no interest in running my own practice. In my position now, its 8-5 and when I'm not there, I'm not thinking about it. There's minimal stress compared to some of my buddies who are now owning their own private practice and dealing with hiring/firing, insurance, billing, etc. Another big perk of FQHCs is loan repayment. I think at the least its a great stepping stone to ptivate practice - gives you time to build up speed and confidence before going off on your own

Thanks so much for your reply, this was really helpful. I have a few more specific questions if you could help me out. How did you decide to join a FQHC? Is it difficult or competitive to join one? Is it something you can do part time? Lastly, how common is it for specialists to join FQHCs?

 

[pubhealthdent]

Thanks so much for your reply, this was really helpful. I have a few more specific questions if you could help me out. How did you decide to join a FQHC? Is it difficult or competitive to join one? Is it something you can do part time? Lastly, how common is it for specialists to join FQHCs?

I always had an inkling that this would be the route I went. Having come from a low-income household and not a having had dental care for most of my childhood due to cost it just seemed like a way for me to hopefully help out others who came for a similar place as me. But also not wanting to run a business and and the loan repayment played a part in the decision as well.
Typically not difficult to find employment opportunities in FQHCs. May be a bit more difficult in bogger cities/more desirable areas but coming out of school I had like 15 offers across the country.
Many will hire oral surgeons or pediatric dentists, but other specialities would be hard to find in FQHCs.

 

[Molar Whisperer]

I work on mostly Medicaid population. The procedures that are covered at my state are fillings, extractions, full dentures and acrylic partials, molar endos for under 19 yrs old, SSC, and most pediatric procedures (usually done by pedodontists). At my capitation DMO, you can get valuable experience doing molar RCTs as well as other RCTs. You can build up your experience and efficiency prior to eventual private practice. The disadvantage is you don't do many crowns. However, many DMO clinics accept private ins so you can do some crowns.

My area in the Pacific NW is super saturated even in small towns an hr away. For example, a small town of 15k about 45 min away has 32 dentists (some may be part-time). There are many discussions about location, saturation, and income on this forum.

 

[zdoq]

I work on mostly Medicaid population. The procedures that are covered at my state are fillings, extractions, full dentures and acrylic partials, molar endos for under 19 yrs old, SSC, and most pediatric procedures (usually done by pedodontists). At my capitation DMO, you can get valuable experience doing molar RCTs as well as other RCTs. You can build up your experience and efficiency prior to eventual private practice. The disadvantage is you don't do many crowns. However, many DMO clinics accept private ins so you can do some crowns.

My area in the Pacific NW is super saturated even in small towns an hr away. For example, a small town of 15k about 45 min away has 32 dentists (some may be part-time). There are many discussions about location, saturation, and income on this forum.

How long do you expect to be working at this practice? Are you planning on building up experience to eventually work at a private practice/own a practice? Also, how did you personally decide to work in a saturated area in the Pacific NW?

 

[Saddleshoes]

Many of the posts have hinted at an important point to answer your question...
What state(s) are you talking about?
Some states are impossible to make a living if you were to try to provide "public aid" work alone. The reimbursement rates for dental care are simply too low.

 

[Molar Whisperer]

How long do you expect to be working at this practice? Are you planning on building up experience to eventually work at a private practice/own a practice? Also, how did you personally decide to work in a saturated area in the Pacific NW?

I'm in a different situation than most. I've been practicing for almost 23 yrs. I almost bought a 1.2 mil practice about 3 yrs ago but my wife was against it. I hope to work at my clinic for at least 7 more years to pay off my house. I grew up in a very undesirable area in the Great Plains and wanted to escape to the West Coast which is more friendly to Asians. Back in 2002 when I completed my USAF obligations, I chose to move to my area due to the balance of desirability and moderate saturation compared to other locations. I planned on buying a practice after a few years working at a capitation DMO. I ended up working there for 15 yrs being top dog until they fired me in 2017. It's way more saturated now and more difficult being a dentist here. But the most important to me is my family is thriving more here than if we were to stay at my home state which is in the bottom 5 of every statistical category such as education, income, and std of living.

 

[Molar Whisperer]

Many of the posts have hinted at an important point to answer your question...
What state(s) are you talking about?
Some states are impossible to make a living if you were to try to provide "public aid" work alone. The reimbursement rates for dental care are simply too low.

Usually the Blue (Democratic), highly taxed States have more budget for Medicaid. Through out the Pandemic closures, my clinic continued to pay all its employees their regular 40 hr work week. You are correct that "public aid" work pay is very low. I have no student loans after serving in the USAF so my pay is OK about $175 to $180k.

 

[lemoncurry]

I worked at an FQHC for 5 years and I absolutely loved the work. The only reason I left had to do with personality/administration issues.

My advice, look for an FQHC that compensates based on a percentage of production based on a set RVU fee schedule, NOT what the insurance charges. For example, the RVU for an extraction (which is close to or identical to the cash fee) could be around 170 and you would be paid a percentage of that instead of the $95 that medicaid reimburses. You're going to have to do a lot of looking to find out that information, but the place I worked at here in Vermont did that and you have the ability to make a very good living.

 

[pubhealthdent]

I worked at an FQHC for 5 years and I absolutely loved the work. The only reason I left had to do with personality/administration issues.

My advice, look for an FQHC that compensates based on a percentage of production based on a set RVU fee schedule, NOT what the insurance charges. For example, the RVU for an extraction (which is close to or identical to the cash fee) could be around 170 and you would be paid a percentage of that instead of the $95 that medicaid reimburses. You're going to have to do a lot of looking to find out that information, but the place I worked at here in Vermont did that and you have the ability to make a very good living.

100% agree with this! Unfortunately, very few FQHCs pay on production at all in ny experience. But finding the ones that do pay a percentage if RVU can lead to a great living and make paying back student loans a much quicker process