“Federal Funding for Oral Health: The Financial Model for Federally Qualified Health Centers (FQHCs).” Successful Models of Partnership Between Schools and Health Centers 54th Annual ADEA Dean’s Conference November 12, 2012 Rick Mumford, DMD, MPH Clinical Associate Professor Director of DISC Program UNC-School of Dentistry Department of Dental Ecology

Extramural Clinical Rotation’s Role in Community – Based Clinical Dental Education UNC - SOD and Community Health Centers Our primary partners – NC AHECs & NCCHCA

How the parts work together to achieve our respective missions Dentistry In Service to Community – (DISC) Program Extramural Clinical Rotation’s Role in Community – Based Clinical Dental Education UNC - SOD and Community Health Centers How we make the program work - How the parts work together to achieve our respective missions

UNC – SOD DISC – Community-based Extramural Clinical Programs: An Educational Mission Dentistry In Service To Communities DDS Students Summer 3 rd Year clinical rotations – required (8 weeks) DDS Students All other clinical additional rotations Student Health Action Coalition (SHAC) - Volunteer student clinic entering its fourth decade. DH Student practicums – required (3 weeks) many NC communities International Projects – Students learn a global perspective of service ENNEAD Student Volunteers – NC Public Schools, NCDS-MOM clinics and community health fairs Student Organizations – such as “Sealant Saturdays” Greene County Notes: A full-time faculty or adjunct is required onsite as attending and preceptor for clinical activities. These are volunteer, non-paid adjuncts. UNC-CH partners with NC AHEC to provide AHEC housing during required clinical rotations

UNC - SOD Extramural rotations - 4th Year Students Dentistry in Service to Communities – DISC Program DISC PROGRAM GOALS The DISC IV extramural program has two primary goals: To give students an opportunity to observe and participate in a variety of oral health care delivery systems – public dental practices while providing clinical care To expose students to a diverse patient population, including those with special needs – which students would be unlikely to encounter in the dental school clinic - but which are represented in communities where dentistry is practiced (two 4-week rotations required; one - a public dental practice and one – a hospital rotation) Note: With course director permission, two general practice rotations are permitted

UNC-SOD DISC Students – Clinical Credit Received Currently four departments allow clinical credit for some procedures completed on extramural rotations: OMFS allows up to 20 extractions Prosthodontics allows 2 full sets of dentures Pediatric Dentistry allows credit for child patients seen in pre-approved sites with boarded pedodontists Diagnostic Sciences & General Dentistry Allows credit for biopsy submission

Extramural Clinical Rotation’s Role in: Community – Based Clinical Dental Education - UNC - SOD and NC AHEC: A training mission Our primary partners – NC AHECs & NCCHCA

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NC AHEC Regions

DISC Sites by AHEC Region

Extramural Clinical Rotation’s Role in: Community – Based Clinical Dental Education UNC - SOD and NC CHC: A healthcare access mission Our primary partners – NC AHECs & NCCHCA

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Dentistry In Service to Community – (DISC) Program

NC Counties served Summer 2011 Total students 78 Alamance Chatham Cumberland Durham ForsythBurke GastonBuncombe GreeneCatawba GranvilleRobeson GuilfordWayne OrangeWilkes New HanoverJones MecklenburgEdgecombe OrangeMoore PersonHaywood PittLincoln SampsonStanley RowanWake Wayne(Represents 66 active sites) DISC Rotations 2011 – Total (156) 115 Student Rotations in NC - 74% 41 Student Rotations U.S. other or international – 26%

10/19/12 Cherokee Graham Swain Clay Macon Jackson Transylvania Henderson Madison Yancey Mitchell Avery McDowell Polk Rutherford Cleveland Caldwell Watauga Ashe Alleghany Wilkes Alexander Iredell Davie Yadkin Surry Stokes Davidson Stanly Union Anson Richmond Montgomery Randolph Rockingham Caswell Wayne Scotland Hoke Robeson Columbus Brunswick Pender Bladen Cumberland Moore Lee Harnett Chatham Johnston Nash Person Vance Warren Halifax Northampton Duplin Onslow Jones Craven Carteret Hertford Gates Pasquotank Camden Currituck Bertie Martin Washington Tyrrell Dare Hyde Beaufort Pamlico Haywood Buncombe Burke Catawba Lincoln Gaston Mecklenburg Cabarrus Rowan Forsyth Guilford Alamance Orange Granville Durham Franklin Wake Sampson Lenoir Greene Pitt Wilson Edgecombe New Hanover DISC Rotation Sites in North Carolina by County 42 Blue Counties indicate presence of DISC Sites 66 Active NC DISC Sites

Dentistry In Service to Community – (DISC) Program Community Health Centers Outside NC: Colorado - Peak Vista CHC Georgia - Good Samaritan - Atlanta Maine - Penobscot CHS (some others less often)

Key Program Costs $: Staffing – 2 FTEs (1-Faculty, 1- Staff) Student Stipend (Inside NC ↑ 35 miles) Housing (Inside NC ↑ 35 miles) Preceptor Annual C.E. Event Travel (New sites, Troubleshooting) Misc.

Cost Estimates $: Staffing = ~ $250,000 Student Stipend = ~ $18,000 Housing = ~ $6,000 ($5.00/night) Preceptor Annual C.E. Event = ~ $5,000 Travel = ~ $3,000 Misc. = ~ $5,000 Approx. $287,000 to $290,000/yr

Funding Sources $: Staffing – 2 FTEs – AHEC (state funds) Student Stipend - AHEC (state funds) Housing - SoD (state funds/Dean’s Acct.) Preceptor Annual C.E. Event – (Dean’s Acct.) Travel - AHEC (state funds) or Dent Foundation Misc. - Dent Foundation + “In-Kind Cost of Preceptors & Clinics”

Find Partners with state funding and solid network of advocates & an inter-professional mission Maximize use of “in-kind” resources (Existing clinics and dental staffs) Incentives to partners: Community service reports to AHEC Waive fee to post job openings Reduced rate or free C.E. to preceptors Adjunct faculty appointments (CV help) Electronic use of health sciences libraries Student stores discount Grant letters of support Reciprocate Funding Sources $ Free Advice:

UNC – SOD DISC Program Highlight AHEC Annual Report—School of Dentistry October 2011 Using the UNC School of Dentistry's Dental Faculty Practice fee schedule, as it more closely reflects the cost assumed by patients at private practices, the students provided $1,302,938 in dental services to underserved populations in North Carolina.

UNC – SOD: Dentistry In Service to Communities Program DISC + CHCs & AHECs = a successful partnership Serving North Carolina “safety net” dental clinics and helping to expand access to oral health care across the the state for over 20 years! Rick Mumford, DMD, MPH Director, DISC Program UNC at Chapel Hill - School of Dentistry Campus Box # 7450 Chapel Hill, NC T F

Thank you – Questions? Sukriya Спасибо Merci Xièxiè nǐ!