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Dental Licensure by Credential in California, A Health Disparities Successful Innovation. National Primary Oral Health Care Conference August 9, 2005 Atlanta, GA Brian Shue, DDS Clinicas de Salud del Pueblo, Inc. Brawley, California

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Dental licensure by credential in california a health disparities successful innovation l.jpg

Dental Licensure by Credential in California, A Health Disparities Successful Innovation

National Primary Oral Health Care Conference

August 9, 2005

Atlanta, GA

Brian Shue, DDS

Clinicas de Salud del Pueblo, Inc.

Brawley, California

American Dental Association Institute for Diversity in Leadership Program


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Project Goals Disparities Successful Innovation

  • Promote California licensure by credential

  • Increase dentist employment at community clinics

  • Survey California Dental Directors on licensure by credential beliefs and vacancy trends


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Outline Disparities Successful Innovation

  • Introduction

  • The golden state

  • Dental licensure solutions

  • Dental licensure solutions—pending

  • Licensure by credential awareness program


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Outline Disparities Successful Innovation

  • Part one: California Dental Director licensure/vacancy survey

  • Part two: Advertising campaign

  • Results of survey

  • Conclusion

  • ADA Institute for Diversity in Leadership


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Survey Disparities Successful Innovation

  • 1970


Introduction l.jpg
Introduction Disparities Successful Innovation

  • Clinicas de Salud del Pueblo, Inc.

  • Imperial County, California


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Introduction Disparities Successful Innovation

Clinicas de Salud del Pueblo, Inc.

  • FQHC: Organization with 7 medical, 2 dental clinics, and 3 WIC facilities

  • Located in Southeastern California at the border with Mexico

  • In Imperial and East Riverside Counties


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Introduction Disparities Successful Innovation

Clinicas de Salud del Pueblo, Inc.

  • 157,000 patient visits in 2004

  • 41,000 unduplicated users in 2004

  • Then: founded in 1970 by farmworkers

  • Now: $16 million budget 2004


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Introduction Disparities Successful Innovation

Imperial County, California

  • Location: rural

  • geography: desert

  • Temperature: “scorching hot”

  • 120 degrees on July 17, 2005

  • 2 hours east of San Diego, “the big city”

  • Minutes from International Border


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Introduction Disparities Successful Innovation

Imperial County, California

  • 142,000 population (2000 Census)

  • Primary industry: agriculture

  • Many migratory farmworkers

  • 70% Hispanic population

  • Many Spanish-speaking only


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Introduction Disparities Successful Innovation

Imperial County, California

  • 24.5% unemployment rate (2004)

  • 23% living in poverty

  • 44% of all children living in poverty


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The golden state Disparities Successful Innovation

  • The children

  • Poverty

  • Fluoridation

  • Access to care


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The golden state Disparities Successful Innovation

  • Over 50% of school-age children have untreated decayed teeth

  • Twice national average

  • 1 in 8 American children live in CA

  • 69% caries rate in K—3rd grade

  • Well above national average


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The golden state Disparities Successful Innovation

  • Medicaid dental coverage frequently placed on the chopping block

  • Fewer than 1 in 3 Medicaid-eligible children have access to dental services

  • Poor children: 61% Hispanic, 21% white, 7% African-American

  • 46% of children are immigrant children

  • 60% of children both poor and immigrant


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The golden state Disparities Successful Innovation

  • 30% of CA population receives fluoridated water (US 66%)

  • One of the lowest rates in the US

  • Law: communities with more than 10,000 water connections must fluoridate, “when funding is available”

  • history of controversy on fluoridation


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The golden state Disparities Successful Innovation

  • State dental workforce

  • Dentist participation in Medicaid

  • Dental workforce distribution

  • Public sector infrastructure


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Dental licensure solutions Disparities Successful Innovation

Previously approved and passed into law

  • AB 1045

  • AB 801

  • AB 982

  • SB 1865

  • AB 1428


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California AB 1045 Disparities Successful Innovation

The physicians and dentists from Mexico pilot program

  • Became law in 2003

  • 30 dentists from Mexico to receive 3-year provisional “permits” to work in community health clinics, without board exam

  • Support: CHHCA, CPCA, various community health centers

  • Opposition: ADA, CDA


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California AB 801 Disparities Successful Innovation

  • The physicians’ cultural competency act

  • became law in 2003

  • Dental portion of bill: Modifies AB 1045 to make eligible foreign dental school graduates (not just from Mexico), once school is approved by the Board

  • Support: CHHCA, CMA, CPCA

  • Opposition: CDA


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California AB 982 Disparities Successful Innovation

CA Dental Corps Loan Repayment Program

  • Became law in 2002

  • 3 year commitment to HPSA region with up to $105,000. Program FY2005 = $1,000,000.00

  • Program to continue in 2006

  • Support: CDA, CMA, CPCA

  • Opposition: none identified


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California SB 1865 Disparities Successful Innovation

Western Regional Examination Board as an alternative path to licensure

  • Became law in 2004

  • Probably goes into effect in late 2005

  • Option of taking the WREB instead of the CA clinical exam

  • Support: CDA, CA dental school deans

  • Opposition: none identified


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California AB 1428 Disparities Successful Innovation

  • Licensure by credential

  • Became law in 2002

  • Licensure with 5 years of clinical practice experience, or if 2-plus years of clinical practice and contract to fulfill remainder of 5 year requirement in clinic setting or school

  • Support: CDA, CPCA CHA

  • Opposition: SCFDS, LADA, IDAC


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Dental licensure solutions-pending Disparities Successful Innovation

For 2005:

  • SB 299: Licensure by Credential (modified)

  • SB 683: Recognition of Postdoctoral Residency Programs


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California SB 299 Disparities Successful Innovation

Licensure by credential (modified)

  • Not law--yet

  • Eliminates 5 year clinical experience

  • 2 year contract in community clinic (or school)

  • Can graduate from dental school and immediately matriculate

  • Support: CDA, CPCA

  • Opposition: Dental Board


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California SB 683 Disparities Successful Innovation

Recognition of postdoctoral residency programs

  • Not law--yet

  • Recognize completion of an accredited clinically-based 1 or 2 year postdoctoral residency program

  • Support: CDA

  • Opposition: Dental Board


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Licensure by credential awareness program Disparities Successful Innovation

  • Part one: California Dental Director licensure/vacancy survey

  • Part two: Advertising campaign


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Part one: CA Dental Director licensure/vacancy survey Disparities Successful Innovation

  • Focus on Dental Directors of community clinics

  • Inform about the licensure by credential awareness campaign

  • Dental Director one-page survey on licensure and vacancy data


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Part one: CA Dental Director licensure/vacancy survey Disparities Successful Innovation

  • Mailed June 2005

  • One-page survey

  • Self-addressed stamped envelope

  • 30 day survey period

  • No follow-ups attempted


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Part one: CA Dental Director licensure/vacancy survey Disparities Successful Innovation

Sent to 190 dental clinics compiled from:

  • California Dental Association

  • California Primary Care Association

  • Bureau of Primary Health Care

  • Dental Board of California


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Part one: CA Dental Director licensure/vacancy survey Disparities Successful Innovation

  • 50 surveys returned

  • 26.3% response rate

  • 95% confidence level with sample size gives confidence interval of 11.9%


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Part two: advertising campaign Disparities Successful Innovation

  • Advertising campaign (August 2005)

  • Display ad in the Journal of the American Dental Association

  • Runs three consecutive months

  • Goal is to have the advertising campaign picked up by another organization


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Part two: advertising campaign Disparities Successful Innovation

  • Display ad for the Dental Board of California prominently announces the webpage for licensure by credential information:

    www.dbc.ca.gov/licbycred.htm


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Part two: advertising campaign Disparities Successful Innovation

Information at Dental Board’s website:

  • Licensure by credential application

  • Complete requirements

  • Clinic forms

  • Dental community/public health agencies


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Results of survey Disparities Successful Innovation

  • California Dental Director licensure/vacancy survey results


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#1: Do you believe licensure by credential with U.S. dentists will improve access to care in California?

yes (71%) no (29%)

n = 48


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#2: Do you believe giving dental licenses to dentists from Mexico will improve access to care in California?

yes (31%) no (67%) unsure (2%)

n = 49


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#3: Do you believe giving dental licenses to foreign dentists (not from Mexico) will improve access to care in California?

yes (25%) no (71%) unsure (4%)n = 49


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#4: Did you already know the Dental Board of California will post job openings for free at its licensure by credential webpage?

yes (22%) no (78%) n = 49


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#5: If you have a dentist job opening, will you post it on the Dental Board of California’s licensure by credential webpage?

yes (76%) no (22%) unsure (2%) n = 46


6 how many dentist position s are currently vacant unfilled in your organization l.jpg
#6: How many dentist position(s) are currently vacant (unfilled) in your organization?

0 1 2 3 4

# of vacancies at each organization n = 50


6 how many dentist position s are currently unfilled vacant in your organization l.jpg
#6: How many dentist position(s) are currently unfilled (vacant) in your organization?

# of vacanciesresponses

None 29

1 13

2 6

3 1

4 1

  • 32/137 total unfilled full time dentist positions (23.4% overall vacancy rate)


6 how many dentist position s are currently unfilled vacant in your organization42 l.jpg
#6: How many dentist position(s) are currently unfilled (vacant) in your organization?

  • 23.4% CA overall vacancy rate

  • 19.7% US overall vacancy rate (Bolin, 2003, n = 159)

  • CA dentist vacancies by center: 42%

  • US dentist vacancies by center: 48% (Bolin, 2003)


7 average vacancy time in months it takes before hiring a permanent dentist l.jpg
#7: Average vacancy time (in months) it takes before hiring a permanent dentist

0 1 2 3 4 6 9 10 12+months (rounded) n = 43


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#8: Longest vacancy time (in months) before hiring a permanent dentist

1 2 3 4 5 6 7 8 9 10 11 12 12+months (rounded) n = 39


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#9: Favors licensure by credential and also has a current dentist vacancy

yes (49%) no (51%) n = 35


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#10: Favors licensure by credential and also supports licenses for dentists from Mexico to improve access to care

yes (38%) no (62%)

n = 34


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#11: Does not favor licensure by credential and also supports licenses for dentists from Mexico to improve access to care

yes (14%) no (86%) n = 14


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Conclusion supports licenses for dentists from Mexico to improve access to care

  • Licensure by credential awareness

  • Many solutions, many players, common goal: increase the dentist employment at community clinics to improve access to care

  • California Dental Directors Survey


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ADA Institute for Diversity in Leadership supports licenses for dentists from Mexico to improve access to care

  • Personal leadership training

  • Diverse group of dentists who belong to racial, ethnic and/or gender groups traditionally underrepresented in leadership roles

  • Enhance ability to make a difference in communities, organizations and the profession of dentistry


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ADA Institute for Diversity in Leadership supports licenses for dentists from Mexico to improve access to care

  • Create a project, collaborate, present it to ADA

  • 12 dentists chosen each year

  • 50% of my 2004-2005 group is in or involved with primary care

  • Expenses-paid travel to Chicago 3 times

  • Go to: www.ada.org for more information