STATE

KS program targets dentist gap

Tim Carpenter

Pittsburg dentist Daniel Minnis is a lonely enthusiast for a new approach for filling a service gap plaguing more than 90 percent of counties in Kansas.

He is convinced people living in more than a dozen counties without a dentist and more than 80 counties underserved by dentists would benefit from introduction of a new health professional — registered dental practitioner — to perform routine procedures under the guidance of a full-fledged dentist. These state regulated therapists could regularly cover the basics in community health offices and pass complex cases on to dentists in the region.

It is no easy task to convince dentists, many of whom invest hundreds of thousands of dollars in an education and facilities to operate a practice, of the need to welcome new business competitors. The same was true of some doctors who previously opposed authorization of nurse practitioners and physician assistants.

"I'm aware of very few dentists who believe in the mid-level provider," Minnis said.

Similar occupational reforms surfaced in other states, most notably Alaska and Minnesota, to expand the cadre of trained people working in the oral health field. These policy initiatives were met with intense opposition from dentists and the state and national associations representing them.

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Skepticism

Kevin Robertson, executive director of the Kansas Dental Association, said adding a new layer of dental worker to the profession carried risk.

"Providing access to all Kansans cannot be accomplished by simply creating a new dental therapist or other new dental provider whose inadequate training and education puts the very patients they are intended to help at serious risk," he said.

He said strategies KDA "is exploring" include expanding Medicaid dentistry programs for the poor, promoting fluoridation and preventative education, broadening functions of dental hygienists, offering incentives for dentists to locate in underserved areas and requiring Kansas' students educated under a cooperative agreement at University of Missouri-Kansas City to work in rural counties after graduation. Kansas doesn't have a dental school.

"Preserving and increasing dental health to all Kansans is a complex issue requiring personal choice, action and responsibility," said David Hamel, a Marysville dentist and the KDA's president.

Minnis, who overcame logistical challenges to help start the first community dental health clinic in southeast Kansas, said reform designed to address the shortage would eventually occur. Kansans living outside dentist-dense counties — Shawnee, Douglas, Johnson, Wyandotte and Sedgwick have two-thirds of the state's dentists — will demand action, he said.

If dentists decline to participate in shaping a solution, he said, lawmakers will fill the vacuum.

"This change will happen," Minnis said. "We can come up with a good model."

New muscle

The W.K. Kellogg Foundation is financing the Dental Therapist Project in Kansas and four other states to build awareness of oral health challenges and to lobby for adding dental therapists to the mix.

The foundation, working through the advocacy organization Community Catalyst, is earmarking $16 million over the next four years to promote change in Kansas, Ohio, New Mexico, Washington and Vermont. Collaborating on the campaign are Kansas Action for Children, the Kansas Health Consumer Coalition and the the Kansas Association for the Medically Underserved.

Demographic shifts are exacerbating the challenge in Kansas. As population dips in rural communities, experienced dentists move offices elsewhere and new dentists choose to put down roots in urban centers. Aging of the state's rural dentists is a concern, said Cathy Harding, executive director of state association for the medically underserved.

The shortage is compounded because no more than 25 percent of Kansas' 1,300 dentists accept low-income adults and children who are insured through Medicaid. Comparatively, almost 90 percent of Kansas physicians accept Medicaid patients as part of their practices. The state's Medicaid roster could expand in 2014 as eligibility rules change.

"Dental care is out of reach for far too many Kansans," said Anna Lambertson, executive director of the Kansas Health Consumer Coalition. "We're talking about farmers, small business owners, families that have lost their jobs in this economy being unable to find a dentist."

Numbers

The Kansas Health Policy Authority produces an annual summary of active dentists in Kansas. The 2009 document outlines each county's number of dentists and the number of county residents available to each of those practitioners. Minnis, the Pittsburg dentist, said the American Dental Association suggests one dentist can handle a caseload of 2,000.

The state's 1,353 dentists served an average client base of 2,083 Kansans, KHPA records show. However, Minnis said distribution of those health professionals fostered problems with access.

KHPA says the top five counties in Kansas in terms of dentists were: Johnson, 425 dentists with 1,277 residents per dentist; Sedgwick, 225 dentists and 2,182 people; Shawnee, 94 dentists and 1,875 people; Douglas, 63 dentists and 1,847 people; and Wyandotte, 44 dentists and 3,525 people. The agency lists 15 counties, as of 2009, without a dentist. They are: Barber, Chase, Clark, Elk, Gray, Greeley, Haskell, Hodgeman, Kiowa, Lane, Ness, Rawlins, Trego, Wabaunsee and Wallace.

Seventeen counties had enough dentists to bring the client base below 2,000, while KHPA says 17 counties were served by dentists with at least 4,000 potential patients. The worst ratio, excluding counties without a dentist, is Doniphan County. There was one dentist for 7,624 people. Logan County had the best ratio. Two dentists with 1,274 possible clients each.

"We can't just continue to look the other way and hope the problem will get better on its own because it won't," said Shannon Cotsoradis, president of Kansas Action for Children. "We might not be able to solve a lot of the workforce shortage problems in rural areas. But, with the addition of a dental therapist to the team, we can solve this one."