As dean of the Arizona School of Dentistry and Oral Health in Mesa, Dr. Jack Dillenberg has spent the past 10 years training dentists who do more than just cleaning crowns, bridges and teeth.
“It’s not just about the tooth,” Dillenberg likes to say. “It is about the person attached to the tooth, the family attached to the person and the community attached to the family. We want to train leaders in the community and, along the way, teach them how to be great doctors.
But perhaps the most unusual thing about Dillenberg School is its primary mission: to provide dental care in underserved areas. All 15 counties in the state, including Maricopa, have areas designated by the US Department of Health and Human Services, Dental Health Professional Shortage Areas, or HPSA.
This may come as a surprise to residents of the East Valley accustomed to finding their mailboxes filled with prospectuses from new dentists in the area looking for business. Are we really facing a shortage of dentists here? Is Arizona Heading For A Statewide Bad Teeth Epidemic?
Not exactly, says Kevin Earle, executive director of the Arizona Dental Association.
“I don’t agree with the assumption that there aren’t enough dentists here,” he says. “In fact, data has just come out of the American Dental Association’s Health Policy Institute that even adjusted for population, the supply of dentists in Arizona has increased 7.1% over the past 10 years. last years. We also have two dental schools here, including ASDOH, which graduate over 200 dentists each year.
“Our problem is not a manpower problem, because there are a lot of dentists to treat the population,” he says. “Our problem is, how do we get people to work in areas where they can treat underserved people?”
Naturally, it is easy to find graduate dentists keen on doing cosmetic dentistry in North Scottsdale, where the financial rewards for the simple application of porcelain veneers and teeth whitening treatments can be substantial. It is more difficult to persuade dentists who are still paying off their college loans to move to a small rural town or to a Native American reservation in Arizona, where the need for their services is much greater but the average family income may be well. lower than national income. poverty level.
“Typically in the state of Arizona we have a total of 177 dental HPSAs,” says Ana Roscetti of the Arizona Department of Health Services. This office determines these shortages, along with shortages of primary care and mental health providers, by comparing the distribution of full-time providers in a given geographic area of the state to residents living in that specific area.
“And about 2.3 million residents live in these dental HPSAs. So basically we need 338 more dentists to quash all the shortages in the state of Arizona and 181 to eliminate the shortages in Maricopa County alone.
Fortunately, there are incentives to sweeten the pot. ADHS Arizona State Loan Repayment Programs allow dentists and other healthcare professionals to receive generous loan repayments while providing services in underserved areas.
“Since many graduate dentists enter the field with a lot of student debt as a result of their training, the loan repayment program is a great incentive to work in these underserved areas,” says Roscetti.
To become a priority candidate for the program, the dentist must first choose to work in a field designated as dental HPSA. The amount awarded to them will depend on that locality’s score on the National Health Services Corps’ determination of “high need” areas, a ranking that doesn’t just weigh on the dentist shortage in the area (anything less than to one dentist per 5,000 inhabitants is considered insufficient), but also what proportion of the population lives at 200 percent or below the federal poverty line.
“The score can go from 0 to 26,” explains Roscetti. “The higher the need, the higher the score.”
According to this scale, a dentist working in an area of greatest need (with a score between 18 and 26) can receive an annual award of $ 65,000 during their first two years of service in that community, rising to 35,000. $ the third year and $ 25,000. in their fourth. Working in an HPSA designation with the lowest needs score (0 to 13) will net the dentist $ 52,000 in their first two years, $ 28,000 in the third, and $ 20,000 in the fourth.
The program was successful not only in attracting dentists to areas of high need for those first four years, but also in keeping them in communities long after their student loans were paid off.
“According to a study by the National Health Services Corps, which manages the federal loan repayment program, 87% of providers who received funding under the program continue to practice in the same underserved area for at least 10 years afterward. the end of their engagement. »Says Roscetti. “It’s a pretty high retention rate.”
But the director of the Arizona Dental Association says the loan repayment program only benefits a handful of select graduates and is not enough on its own to address these shortages.
In a state where many underserved communities fall under Native American reservations, Earle says there are also issues with the Indian Health Services loan repayment program.
“This is the only government-run loan repayment program that is not tax exempt, so IHS has to allocate millions a year to pay taxes on the loans they forgive, which makes them prevents them from filling the niches in their facilities and offering more opportunities. for people to work in these underserved areas. “
Getting dentists to work in underserved communities can be made easier through funding or innovative uses of technology. But for Jack Dillenberg, the best way to solve the problem is to find aspiring dentists who already have a desire to help those who need it most.
“One of the critical issues in dealing with underserved areas and areas where there are shortages is who you choose to become a dentist,” says Dillenberg.
“If I see someone whose main goal is to get well in cosmetic dentistry in Scottsdale, that is not my prime candidate. I want to find a man or woman who has documented community services, who wants to make a difference and who realizes that they can make a good living even working on an Indian reserve or in a community health center in a community rural. What we do is pick these young men and women and put them in a dental school that nurtures that.