State short on dentists Options examined to entice more professionals

Topeka Capital-Journal, The, Jan 30, 2005 by Capital-Journal

FINDING DOCTORS

PHOTOGRAPHS BY MIKE SHEPHERD/THE CAPITAL-JOURNAL

Beth Feldman has her teeth checked by dentist Ted Jowett at his office, 1017 S.W. Gage Blvd. When Jowett began practicing in 1983, the nation was suffering from a surplus of dentists. Now, more than 20 years later, there is a shortage.

An array of molds sits on a counter to be examined at Ted Jowett's family dentistry office. Jowett says human teeth aren't capable of matching the lifespan of an average human, causing the need for more dentistry work in the later stages of life.

By Michael Hooper

THE CAPITAL-JOURNAL

When Ted Jowett graduated from dental school in 1983, he sought a job by writing letters to the chambers of commerce in hundreds of cities across the state.

Not one needed him.

Today, Kansas towns are in dire need of these medical professionals, and a Kansas Health Institute Study shows 10 counties in the state have no dentists.

Thirty-six Kansas counties have been designated as Dental Health Professional Shortage Areas by the U.S. Health Resources and Services Administration. The dentist-to-population ratio in most rural counties is below 40 dentists for 100,000 people, while the ratio in metropolitan areas is more than 50 dentists for 100,000 people.

"The Declining Supply of Dental Services in Kansas: Implications for Access and Options for Reform" by R. Andrew Allison, Ph.D., and Dan Bryan, M.P.A., studied the difference between dental demand and supply.

"It was clear from the report that low-income and rural areas are suffering," said Teresa Schwab, executive director of Oral Health Kansas, a coalition that seeks to increase access to dental care.

Jowett, who graduated from the University of Missouri-Kansas City in 1983, ended up working for another dentist in Topeka after graduation. He later struck out on his own and now has an office at 1017 S.W. Gage Blvd.

In 1983, there were too many dentists as a result of government subsidies in the 1970s and 1980s that had attracted more students to the field. Another factor was declining patient needs from fluoridation, which took a bite out of decay.

Today dentists are operating in a market that is more favorable to them, Allison said, as the need for services has again outstripped the number of providers.

In 2001, the average independent general practitioner's net income was $173,140, according to the American Dental Association. The average independent specialist's income was $275,270.

Allison's study showed Kansas dentists work about 35 hours per week.

Jowett said he works four 10- to 12-hour days and occasionally works on weekends to do paperwork and work in the lab.

Kansas has 1,278 licensed dentists and 1,445 dental hygienists who have primary offices in the state, according to the Kansas Dental Board.

Jowett said there also is a need for more dental hygienists, who earn $25 to $35 per hour.

"They're kind of mini specialists in gum care," he said. "They are very well-trained, and they help out quite a bit."

Oral Health Kansas and others are working on plans to bring more dentists to Kansas.

Schwab suggested a loan forgiveness program to entice graduating dentists to locate in underserved areas in Kansas.

Kansas, with 2.7 million people, has no dental school, while Nebraska, with a population of 1.5 million, has two: the University of Nebraska Medical Center College of Dentistry in Lincoln and the Creighton University School of Dentistry in Omaha.

Kansas receives 20 dental student slots annually at the University of Missouri-Kansas City. Those students pay in-state tuition. In exchange, Missouri receives 400 architecture student slots, charging in-state tuition, at the University of Kansas and Kansas State University.

Jowett said there is no requirement for Kansas graduates of UMKC dental school to return to Kansas to practice after they are finished.

"They can go anywhere they want," he said.

Jowett, president of Delta Dental Plan of Kansas Foundation, said a plan to expand UMKC to Wichita was considered, but the plan fell through. It costs millions to start a dental school, he said.

"It boils down to who is going to pay for it," he said.

Schwab suggested the state could try to get slots from the two dental schools in Nebraska.

"A (new) dental school is not the end all and be all for solving our problems," she said.

Jowett said four years of dental school tuition costs about $190,000, plus living expenses. It costs another $200,000 to $300,000 to open a practice with the right equipment.

The temptation for new dentists is to open a practice in metropolitan areas where there are more people and specialists to refer to if needed, Jowett said. In a rural community, "you're it," he said.

The study also pointed out the disparity between treatment received by higher income patients versus lower income patients. The lower a patient's income, the less frequently they will see a dentist.

Kansas has a dental insurance program for children in poor families, but most dentists don't use it, according to the KHI study. Jowett said some dentists do work for indigent patients and write it off as a loss rather than go through the hassle of getting reimbursement through a government program.