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

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  1. 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

  2. Project Goals • Promote California licensure by credential • Increase dentist employment at community clinics • Survey California Dental Directors on licensure by credential beliefs and vacancy trends

  3. Outline • Introduction • The golden state • Dental licensure solutions • Dental licensure solutions—pending • Licensure by credential awareness program

  4. Outline • Part one: California Dental Director licensure/vacancy survey • Part two: Advertising campaign • Results of survey • Conclusion • ADA Institute for Diversity in Leadership

  5. Survey • 1970

  6. Introduction • Clinicas de Salud del Pueblo, Inc. • Imperial County, California

  7. Introduction 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

  8. Introduction 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

  9. Introduction 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

  10. Introduction Imperial County, California • 142,000 population (2000 Census) • Primary industry: agriculture • Many migratory farmworkers • 70% Hispanic population • Many Spanish-speaking only

  11. Introduction Imperial County, California • 24.5% unemployment rate (2004) • 23% living in poverty • 44% of all children living in poverty

  12. The golden state • The children • Poverty • Fluoridation • Access to care

  13. The golden state • 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

  14. The golden state • 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

  15. The golden state • 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

  16. The golden state • State dental workforce • Dentist participation in Medicaid • Dental workforce distribution • Public sector infrastructure

  17. Dental licensure solutions Previously approved and passed into law • AB 1045 • AB 801 • AB 982 • SB 1865 • AB 1428

  18. California AB 1045 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

  19. California AB 801 • 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

  20. California AB 982 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

  21. California SB 1865 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

  22. California AB 1428 • 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

  23. Dental licensure solutions-pending For 2005: • SB 299: Licensure by Credential (modified) • SB 683: Recognition of Postdoctoral Residency Programs

  24. California SB 299 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

  25. California SB 683 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

  26. Licensure by credential awareness program • Part one: California Dental Director licensure/vacancy survey • Part two: Advertising campaign

  27. Part one: CA Dental Director licensure/vacancy survey • 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

  28. Part one: CA Dental Director licensure/vacancy survey • Mailed June 2005 • One-page survey • Self-addressed stamped envelope • 30 day survey period • No follow-ups attempted

  29. Part one: CA Dental Director licensure/vacancy survey Sent to 190 dental clinics compiled from: • California Dental Association • California Primary Care Association • Bureau of Primary Health Care • Dental Board of California

  30. Part one: CA Dental Director licensure/vacancy survey • 50 surveys returned • 26.3% response rate • 95% confidence level with sample size gives confidence interval of 11.9%

  31. Part two: advertising campaign • 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

  32. Part two: advertising campaign • Display ad for the Dental Board of California prominently announces the webpage for licensure by credential information: www.dbc.ca.gov/licbycred.htm

  33. Part two: advertising campaign Information at Dental Board’s website: • Licensure by credential application • Complete requirements • Clinic forms • Dental community/public health agencies

  34. Results of survey • California Dental Director licensure/vacancy survey results

  35. #1: Do you believe licensure by credential with U.S. dentists will improve access to care in California? yes (71%) no (29%) n = 48

  36. #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

  37. #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

  38. #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

  39. #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

  40. #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

  41. #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)

  42. #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)

  43. #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

  44. #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

  45. #9: Favors licensure by credential and also has a current dentist vacancy yes (49%) no (51%) n = 35

  46. #10: Favors licensure by credential and also supports licenses for dentists from Mexico to improve access to care yes (38%) no (62%) n = 34

  47. #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

  48. Conclusion • 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

  49. ADA Institute for Diversity in Leadership • 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

  50. ADA Institute for Diversity in Leadership • 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