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www.kdheks.gov www.kdheks.gov/ohi. Our Vision – Healthy Kansans living in safe and sustainable environments. Kansas Dental Workforce. Daniel Lassley Bureau of Oral Health Kansas Department of Health and Environment 785-296-1314 dlassley@kdheks.go v.

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kdheks kdheks/ohi

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  1. www.kdheks.gov www.kdheks.gov/ohi Our Vision – Healthy Kansans living in safe and sustainable environments.

  2. Kansas Dental Workforce Daniel Lassley Bureau of Oral Health Kansas Department of Health and Environment 785-296-1314 dlassley@kdheks.gov

  3. The Objective of the Workforce Project 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. Kansas’ Dental Workforce • Dentists, Dental Hygienists, Extended Care Permit Hygienists, Dental Assistants • Private Practices, Safety Net Clinics, Outreach Sites

  5. Kansas Dentists • 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. KS Registered Dental Hygienists • 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. KS Registered Dental Hygienists (Cont.) • 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. Kansas RDH Extended Care Permits • 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. Dental Assistants • 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. Why Are We Concerned About Kansas’ Dental Workforce? 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

  11. Kansas Medicaid • 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

  12. Dental Needs In Kansas Children • 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 3rd Grade • 34% had Dental Sealants • Higher Decay Rates in Low Income Families • African American Children had Fewer Sealants

  13. Uninsured and Low Income Adults • 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.

  14. KDHE Bureau of Oral Health Workforce Project • 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

  15. Project Partners • 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

  16. Project Partners (continued) • 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

  17. Phase One – Collect Data on Kansas’ Dental Workforce • 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

  18. Highlights of the Dentists Survey • 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

  19. Dentist Retirement • 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.

  20. Hygienists, ECPs and Scaling Assistants • 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

  21. ECP Utilization • 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

  22. Caring for Underserved Populations • 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

  23. Most Dentists Accept Commercial Insurance; Fewer Accept Medicaid

  24. Survey Sub-Groups • 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

  25. Community Focus Groups • 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 www.ksdentalfoundation.org • Facebook – “Visualizing Oral Health in Kansas” – Be a Fan!

  26. Highlights of the Focus Groups 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

  27. Next Step In Workforce Research • 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

  28. Project Objectives • 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

  29. County shading is dentist: population ratio

  30. Significant Medicaid Providers

  31. Data collected from rural residents

  32. Next Steps • 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

  33. BOH Workforce Activities • 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

  34. Questions? Comments? Contact Info Kathy Weno Project Coordinator kweno@kdheks.gov 785-296-6536 Daniel Lassley Dental Recruitment Program Manager dlassley@kdheks.gov 785-296-1314 Ashley Streeter Dental Club Project astreeter@kdheks.gov 785-296-5116 Tanya Dorf Brunner Dental Workforce Cabinet Meeting Facilitator tdorf@oralhealhkansas.org 785-235-6039

  35. www.kdheks.gov www.kdheks.gov/ohi Our Vision – Healthy Kansans living in safe and sustainable environments.

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