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1 Our Vision – Healthy Kansans living in safe and sustainable environments.

2 Daniel Lassley Bureau of Oral Health Kansas Department of Health and Environment 785-296-1314 dlassley@kdheks.go v

3 Improve Access to Dental Care by Strengthening the Kansas Dental Workforce HOW?  Provide Data on the Strength of the KS Dental Workforce in Kansas  Bring Together an Advisory Group for On-Going Discussions about Dental Workforce Issues  Provide Funds to Create Programs to Increase the Numbers of Dentists and Dental Hygienists Serving Kansas Underserved Communities

4  Dentists, Dental Hygienists, Extended Care Permit Hygienists, Dental Assistants  Private Practices, Safety Net Clinics, Outreach Sites

5  1,404 Dentists Licensed and Active in KS  1,187 General Dentists (Non-Specialists)  Kansas Law Regulates Dentistry through the Kansas Dental Practice Act  4 Year Graduate Program but Kansas has no In-State Dental School

6  1,656 RDHs Actively Practicing in Kansas  Must be Supervised by a Dentist, Although Not Necessarily on Site  Scope of Practice: Cleaning, Scaling & Root Planing, Sealants, Preventive Procedures – Fl Varnish, Oral Hygiene Instruction

7  Five Dental Hygiene Programs in Kansas in Addition to UMKC and Concorde (KCMO)  Hygienists are Licensed by the Kansas Dental Board in Accordance with the Kansas Dental Practice Act

8  Experienced Dental Hygienists May Obtain an Extended Care Permit (ECP)  ECP I (43) – Schools, FQHCs, LHDs  ECP II (81) – Patients with Special Needs, Elders  ECPs Perform Hygiene Services in Public Health Settings (NO Expanded Scope of Practice) Without a Dentist Seeing the Patient  ECPs Have a Sponsoring Dentist who Reviews their Charts, But May Not Ever See the ECP’s Patients

9  Assist Dentist Chairside under Direct Supervision  Generally not Regulated by Kansas Dental Board….except for:  Scaling Assistants – Assistants that have been trained to clean teeth above the gumline.  Other than Scaling Assistants, No Educational Program is Required to Work as a Dental Assistant in Kansas.

10 Access to Dental Professionals is Crucial to Good Oral Health. Dentists are Hard to Find in Certain Geographic Areas and for Certain Population Groups:  Frontier and Rural Areas  Children on Medicaid  Uninsured and Low Income Populations Cannot Afford Care  People with Disabilities  Racial and Ethnic Minorities


12  264,430 Kansas Children on Medicaid or Healthwave  411 Dentists are Enrolled Medicaid Providers who had a Paid Claim Last Year  153 Treated 100 or more Medicaid Patients  Why so Few?  Low Reimbursement  Patients are Difficult – No Shows, High Trt Needs

13  25% of Kansas Kids Have Untreated Dental Decay  Highest in NW (54%), NC (64%) and SW (46%)  55% of Kansas Kids Have Experienced Dental Decay by 3 rd Grade  34% had Dental Sealants  Higher Decay Rates in Low Income Families  African American Children had Fewer Sealants


15  No Complete Dental Benefit for Most Adults on Medicaid  Medicaid Only Covers Eligible Groups – Children, Pregnant Women, People with Disabilities  Very Limited Dental Benefits in Medicare  State Budget Cuts Ended Dental Benefits for Elders and Disabled on HCBS Waivers.


17  Recruit Dentists to Kansas, Especially in Underserved Areas and the Safety Net  Encourage Kansans, Especially Students from Rural Areas and Minority Groups to Look at Dental Careers  Promote ECP  Workforce Data Collection  Programs to Support Retention Dental Professionals in Underserved Areas

18  Bureau of Oral Health – KDHE  Kathy Weno – Project Coordinator  Daniel Lassley – Program Manager  Ashley Streeter – Program Assistant  Oral Health Kansas – Dental Workforce Cabinet, ECP Outreach  Tanya Dorf Brunner, Marcia Manter  Office of Local and Rural Health - KDHE  Robert Stiles – Primary Care Office  Barbara Huske – Loan Repayment, Underserved Designations  Kansas Association for Medically Underserved  Safety Net Clinic Workforce Coordinator

19  University of Kansas Medical Center  Kim Kimminau, Anthony Wellever – Workforce Research  Wichita State - Advanced Education in General Dentistry Program  Continuing Dental Education, Dental Career Outreach Program  UMKC School of Dentistry  Continuing Dental Education, Dental Career Outreach Program  Community Health Center of SE KS  ECP Hygiene Outreach Program  Kansas Dental Association  Access Pilot Programs, Dentist Supports

20  Completed in Sept 2009  Telephone Survey of Dentists and ECP Hygienists  Community Focus Groups about Dental Access Issues  Creates a Project Baseline, Data Suggests Policy

21  Dentistry is an Aging Profession. in Kansas Average Dentist Age : 50  KS Dentists are overwhelming white and male 91.2% white, 76% male  64% of Kansas Dentists are Kansas Natives  69% are UMKC Graduates  Reason for Practicing in Kansas: Family, Quality of Life

22  Dentists choose to “slow down” by reducing hours over time rather than full retirement. They are slow to plan for retirement, only 2% planned to retire in 2009. 31% have never thought about what to do with their practices when they retire.  As Frontier and Rural providers are older, they (Frontier - 54.3%, and Rural - 24.2% ) report planning to retire in next 3- 5 Years.  Those who have retirement plans usually involve taking on an Associate or selling their practice. This may not be realistic.  48.5% of those recruiting for a dentist say it has been difficult  Of those practices currently for sale, 69.7% have been for sale over one year.

23  82% of Dentists Employ Hygienists  56.9% of Dentists Employ 2-4 Hygienists  9.4% are Currently Recruiting for a Hygienist  19% of Dentists Employ a Scaling Assistant  18% of Dentists Employ ECPs  15.9% of Dentists Sponsor ECPS  43.6% of Dentists Unaware of ECP

24  ECPs practice in 53 counties (approximately one-half of all KS counties)  ECPs practice in all five urban counties  ECPs practice in 48% of rural counties  Top ECP Practice Sites: Early Childhood Centers (Head Start), Schools (K-12), Safety Net Clinics and Long Term Care Facilities  ECPs are Concentrated in the Safety Net Clinics –  62.1% of Safety Net Clinic Dentists Employ ECPs  55.2% of Safety Net Clinic Dentists Sponsor ECPs  Most ECPs work 8 hours a Week or Less

25  Perceptions about Access Vary Based on Practice Type and Location  Dentists have a Chair-Side View  ECPs Awareness Based on Community Practice  Both ECPs and Dentists Support More Community Water Fluoridation  Strong Disagreement about the Importance of the Development of New Dental Provider Models


27  38 Dentists in that work in Safety Net Clinics  Safety Net Clinic Dentists are Younger Average Age is 43.5.  More Racially Diverse – 77.4% White  52% are Female  58 Dentists who Participated in the Kansas Mission of Mercy in Manhattan  No Significant Difference from Total Sample  Qualitative Comments Documented

28  Conducted Five Focus Groups: Hays, Dodge City, Wichita, Lawrence and Topeka  Invited Participants that has Experience in Dental Recruitment or Access to Care – Dentists, ECPs, Safety Net Clinic Administrators, Dental Educators, Community Service Providers, Workforce Development  Kansas Dental Charitable Foundation Video  Facebook – “Visualizing Oral Health in Kansas” – Be a Fan!

29 Geographic Location Shaped the Discussion  Rural - Dodge City, Hays  Distance to Providers and Specialty Care  Dentist Recruitment to Rural Areas, Scarcity of Providers  ECPs – Need for More RDHs and Dentists Awareness  Wichita, Lawrence, Topeka  Number of Patients Needing Care is Overwhelming  Lack of Prevention – Water Fluoridation  Success of Community Based Services – Schools  Collaboration among Community Partners and Coalitions to Provide Care and do Advocacy

30  Rural Dental Access Research 2011  KU Medical Center Researchers  Looking at optimal ways to seed projects and provide care for rural and frontier populations  Information for Funding Rural Projects  Complete by July 2011

31  Primary Objective: Use GIS to inform dental workforce issues  Identify population-specific areas of high need  Go beyond county level shortage analysis  Additional Aims: Focus on primary care dentists  Additional analysis of ECP  Additional analysis of high volume Medicaid dentists  Overlay rural Kansans’ reported routine travel distance/time for services



34 LocationAverage Time (Min.)Frequency/Yr Groceries17.571.9 Chain Store29.844 Auto Repair15.96.1 Church9.636.2 Movie Theater30.610.7 Outlets83.48 Pharmacy1413.5 Veterinarian19.53.1 Chiropractor174.4 Optometrist25.11.6 Dentist21.22.6

35  Identify alternative GIS units useful in pinpointing shortage “crisis” areas  Finalize adjacency maps  Complete the 8 community sub-study  Map rural residents’ distance reported to various key resources, including dentistry  Use the findings from Dental Workforce I study to inform the identification of shortage “crisis” areas; e.g., which dentists from DWI report retirement or practice is for sale planning

36  Funding for State Loan Re-Payment, ECP, Dental Recruitment, and Dental Camp  Funding for Creative Access Projects for Dentists, Hygienists, Community Groups and Clinics at the Discretion of the Workforce Cabinet  Project Evaluation

37 Kathy Weno Project Coordinator 785-296-6536 Daniel Lassley Dental Recruitment Program Manager 785-296-1314 Ashley Streeter Dental Club Project 785-296-5116 Tanya Dorf Brunner Dental Workforce Cabinet Meeting Facilitator 785-235-6039

38 Our Vision – Healthy Kansans living in safe and sustainable environments.

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