By Kevin Henry, Managing Editor, Dental Economics
With all of the talk about access to care and the dwindling population of dentists in rural areas, Maine is a state that comes under the microscope any time the subjects are mentioned. A March 2009 article in the New York Times stirred up some discussion when it talked about primary care doctors learning basic dental procedures. You can read the article by clicking here.
Maine dental facts to ponder
* Maine currently has the highest dentist-to-population ratio, as there is one dentist for every 2,300 people in the land of lobsters and lighthouses.
* Right now, in all of the dental schools throughout the nation, only nine of those students hail from Maine.
Quotes from Maine Dental Association CEO Frances C. Miliano
I think we’re like many other states that have a lot of rural areas. We have one controlled access highway that runs right up the middle of our state, and that means we have a lot of small towns that aren’t on the main highway. However, I don’t think every small town can support a dentist. People are going to have to travel from some smaller towns for a lot of services, including shopping and medical needs. I don’t think our goal should be a dentist in every small town, but rather a dentist in every county seat, and making sure that every county has access to adequate dental care.
We don’t have a dental school right now and we have a bubble of dentists who are over 50 and looking toward retirement. We have been working on strategies to get more dentists, and we’ve had some success. The number of dental licenses granted in Maine has gone up over the last 10 years, including right around 40 over the last three years. Some of that can be traced back to the outreach we’ve done to dental students all over the country, especially in the Boston schools and at the University of Connecticut. We’ve sent letters to the deans of every dental school in the country, inviting their students to come to Maine to see what we have to offer. The first year we had 19 students visit, and the next year we had more than 40. We’re hoping they will go back and talk about what they saw. One of the comments I received from a student was the camaraderie he felt among the dentists in Maine. It’s not a sense of competition, but rather a sense of community among Maine dentists. These trips have given us a chance to dispel the myth that one can’t make a good living in Maine, and that everyone in the state is happy with dentures.
When the dental school at the University of New England becomes a reality, it will have a focus on public health. I think dental students will have the chance to get out into the rural areas and check if what they see strikes a chord with them. I think it’s very important for Maine to be able to “grow our own” dentists through a dental school.
If you talk to the dentist who is training residents at the Dartmouth Medical School in Augusta, he’s the immediate past president of the Maine Dental Association. One of the reasons he is training them is because the medical students get very limited oral health instruction. They should be able to recognize a problem and refer patients to the dentist as well as have the ability to extract teeth in a rural location should the situation call for that. I don’t think family care physicians are interested in becoming dentists, but it’s good to know that they’re knowledgeable in dental situations.
Regarding mid-level providers, the Maine Dental Association is on record as supporting well-trained and fully supervised dental extenders. We were very supportive of the EFDA programs that have gone through, and I believe we would support a “super EFDA” who is properly trained in a CODA dental school and has direct supervision, but I don’t believe we would be in support of ADHPs. We’re looking at what is being done in Minnesota and Massachusetts and will be learning from those states.
It’s important to remember that “access” isn’t just about work force numbers. Access is about the ability of patients to pay, just as much as it is about how many dentists there might be in a location, and I think we’re in the same boat as many other states. With the recent economy, dentists in Maine are like dentists in other states in that they aren’t booked out nearly as much as they were a couple of years ago. Access may be improved, but what if people can’t pay for services? The number of workers is certainly a piece, but not the only piece, of the puzzle. We’re working with Maine Care (the state version of Medicare) by advocating increased fees for procedures.
Quotes from Dr. Walt Harrison in Brunswick, Maine
I sold my practice 2.5 years ago and am just now working three days a week there. I’ve been in dentistry for 44 years so I ask myself now, “What am I going to do on Thursday?” I’m not used to having that free day.
Many people in Maine can’t afford dentistry right now. A lot of jobs have left Maine and that’s made a huge difference in the economy. There’s a clinic in Bath called Oasis Dental where people come on a first-come, first-served basis one night a month. Two dentists start seeing people at 6 p.m. and work for a couple of hours. They might see three to four patients each during that time, and these patients range from those who have used meth, to women who just lost their jobs, have cavities, and can’t afford to see a dentist.
I think a lot of kids are coming out of dental school with huge amounts of debt and they feel like they have to be able to produce immediately. To do that, they have to do cosmetic work so they can charge a higher price, and that works better in New York or Boston than it does in Maine.
Teaching medical students how to do extractions is fine with me, but I want to make sure the students can differentiate between a simple extraction and a complex extraction. Just because you’re in a rural area doesn’t mean that you deserve any lower level of dental work than someone who lives in Portland.
I know of two dental practices in Brunswick that had to close their doors because the dentists couldn’t find anyone to buy them. I think the new generation of dentists wants to come in and establish themselves rather than pick up what someone else has started. A lot of dentists here will see someone on the weekend if they need help. The state has the feel of a smaller town, and I’m not sure that the next generation of dentists coming to Maine understands that. I hope they do, because that will help them succeed.
Quotes from Dr. Robert Nelson of Falmouth, Maine
I think it’s difficult to get people to come to Maine, whether you’re talking patients or dentists. I love Maine, but I think a lot of people believe it’s too rural. It’s a very casual state and that gives it a very good feel, but if you’re looking for an area of the country that’s growing, this isn’t it.
Quotes from Steve Carlin, branch manager of Patterson Dental in South Portland, Maine
This is the fourth Patterson branch that I’ve been affiliated with and I’ve seen areas of the country, such as San Diego and Phoenix that are saturated with dentists. I wouldn’t say that Portland or Bangor is saturated with dentists, but I also wouldn’t say that you could notice a shortage either. If you get into northern or western Maine, away from the I-95 corridor, you start seeing where there are shortages. Those areas have well-structured public health programs, which are helpful, and we are starting to see mid-level providers pop up in those locations as well. Those people are trying to fill the gaps, but there are certainly areas that are very scarce when it comes to dentists. North of Bangor is a perfect example as the population numbers go down, but so do the number of dentists available to those people. I grew up in Iowa, but the diversity in dentists in nothing there like it is here.
If I had a magic wand, I would love to see a new generation of dentists come into the state. There is talk of a dental school possibly starting at the University of New England (located in Biddeford, Maine) in 2012. If that can get off the ground, I think there will be a very positive effect on some of the areas without adequate dentist coverage. Right now, there are just nine dental students from Maine in the combined classes of every dental school in the United States. That has to change.
Honestly, what would lure dentists here are the same things that drew me here. Quality of life is a big thing. This is a great place to raise a family. Once you get into the nuts and bolts of dentistry, you’ll find that this is a state with a very active patient base. Patients are looking for dentists here, so the new patient possibilities are much easier to come by than in many locations. This is a great state in which to run a profitable practice.
Facts about Maine…
* Population of Maine in 2000: 1,274,923
* Persons per square mile: 41.3 (79.6 in USA)
* Land Area: 30,862 square miles
* Length of coastline: 3,500 miles
* Forest: 17 million acres
* Home ownership rate (2000): 71.6%
* Largest city by population: Portland
* State Capital: Augusta
* Approximately 40 millions pounds (nearly 90 percent) of the nation's lobster supply is caught off the coast of Maine.
* Maine produces 99% of all the blueberries in the country making it the single largest producer of blueberries in the United States.
* 90% of the country's toothpick supply is produced in Maine.
* Eastport is the most eastern city in the United States. The city is considered the first place in the United States to receive the rays of the morning sun.
* Aroostook County at 6,453 square miles covers an area greater than the combined size of Connecticut and Rhode Island.
* Acadia National Park is the second most visited national park (behind Yellowstone) in the United States.
