2+ Year Member
- Aug 14, 2018
October 6, 2021 at 2 PM Eastern/11 AM Pacific
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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?
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
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 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?
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.
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.