Getting to Work and Getting it Done

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1 Steve Geiermann, D.D.S., Interim Director, Council on Access, Prevention and Interprofessional Relations, ADA Captain, U.S. Public Health Service, retired National Network for Oral Health Access (NNOHA) Board of Directors Workforce and Staffing Getting to Work and Getting it Done Ohio Association of Community Health Centers 2013 Annual Spring Conference March 5, 2013

2 Learning Objectives Understand statistics and issues around the current CHC workforce Provide an understanding of efficient recruitment and retention strategies Provide an understanding of appropriate staffing and operatory ratios

3

4 Workforce: A Challenge for Health Center Oral Health Programs A recent report by the National Association of Community Health Centers (NACHC) stated: 48% of Health Centers reported at least one dentist vacancy Almost half of all rural Health Centers have had a vacant dentist position for 7 months or more. Approximately 1 to 2% of the entire dental workforce can be found within health centers.

5 2010 NNOHA Workforce Survey - Dental Vacancies Of the 338 executive directors surveyed, 39% reported having at least one dentist vacancy, and of those vacancies, 52% were of greater than six months duration. An additional 4% of executive directors reported more than one vacancy in the dental component of their Health Centers.

6 Top 3 Reasons for Dentists Choosing a Health Center Career 39.1% - Felt a mission to a dentally underserved population 13.6% - Loan repayment was available in Community Health Center practice 12.4% - Attracted by work schedule/leave policies/fringe benefits of Community Health Center practice *One answer per respondent.

7 2010 NNOHA Workforce Survey Career Prior to Health Centers: Dentists Dentist Frequency % Private practice owner/partner/associate Dental student Private practice employed dentist Local, state, public health agency/other community dental center Grad dental program/specialty program Commissioned Officer PHS/Military Retired Total

8 2010 NNOHA Workforce Survey 80% of dentists and 93% of dental hygienists indicated intent to remain in Health Center practices. Approximately what percentage of health center dentists belong to organized dentistry?

9 2010 NNOHA Workforce Survey No Significant Association Between Intention to leave Health Center practices and: HRSA region (you are in Region V) The population served by the health center The dentist s position in the health center Salary reported Perception of on-call responsibilities Number/experience/quality of dental assistants Number of dental hygienists employed

10 2010 NNOHA Workforce Survey Statistical Associations with job satisfaction Significant associations as measured by intent to leave the Health Center practice: Females were more likely to stay than males. Providers planning to stay had 8.12 years of HC service, while those planning to leave had 4.65 Pre-existing altruistic motivation keeps you there

11 2010 NNOHA Workforce Survey Statistical Associations with job satisfaction Significant associations as measured by intent to leave the Health Center practice: Those citing loan repayment as first reason to choose health center employment were more likely to leave once obligation was complete. Adequacy of Support by Administration Dental directors who reported to a Chief Medical Officer were 2.2 times more likely to leave than those who reported to the CEO.

12 Survey of Health Center Oral Health Providers: Dental Salaries, Provider Satisfaction, and Recruitment and Retention Strategies Webinar, The NNOHA Survey of Health Center Dental Salaries: Trends and Analysis :

13 Recruiting, Hiring and Retaining Providers

14

15 Recruitment Considerations: Mission alignment Scope of services and patient population Cultural competency and sensitivity Language considerations Productivity expectations

16 Recruitment Strategies Connecting with Private Practice National Health Service Corps Dental Schools & Residencies Primary Care Associations NNOHA Job Bank

17 Hiring Process Clearly defined job description Reporting relationship Major job duties Specific responsibilities Comprehensive orientation Description of organization, mission and history Education on CHC history, model, regulations and structure Description and possible introduction to Board

18 Retaining Good Providers Work environment Salary and Benefits Incentive Programs Continuing Education and Training

19 Work Environment: Create a positive work environment Inspire a shared vision Enable others to act Build trust Ensure that every member of the dental team feels valued

20 Work Environment: Adequate number and quality of auxiliaries Adequate administrative time Adequate administrative support Up to date equipment, instruments and supplies

21 Salary and Benefits: Fully competitive salary Loan repayment (in addition) Retirement plan Insurance coverage Paid leave time Professional dues reimbursement

22 Incentive Programs Simple, easy to understand and manage Based on a target goal that directly influences the organizations income Achievable and attractive Frequent (e.g. monthly or quarterly rather than annually

23 Continuing Education and Training Median number of 5 days for CE Median amount of $2,000 of CE expense reimbursement for dentists National Primary Oral Health Conference

24 Maximizing Efficiency Staffing, Equipment and Productivity

25 Resource Challenges

26 Staffing Recommendations For Health Centers, NNOHA recommends 2.0 or more full-time dental assistants per 1 full-time dentist for optimum service. Make full use of Expanded Function Dental Assistants Dedicated dental front desk staff Welcoming Experienced basic triage questions Not afraid to ask for payment Protocol for non-dental/primary care referrals

27 Ratios for success: 2 to 3 operatories per FTE Dentist excluding operatories used for hygienist. Preferably, dental hygienists should have a separate and dedicated operatory. Block scheduling/squeezing emergencies Creative use of extended hours

28 Encounter Rates & Productivity Standards Factors to consider: Patient mix Procedure mix and scope of service Experience level of providers Emergency patient load Practice act allowances for auxiliaries Scheduling efficiency

29 Productivity standards 2011 UDS Data 2682 encounter/fte/year/dds 1314 encounters/fte/year/rdh Relative value units (RVUs) More on productivity standards:

30 Expect New Requirements in Dental Productivity Measures Output to be measured in terms of contributions to oral health, not visits Use of dental auxiliaries and their skill level be measured, not just their availability Utilization of dental technology and space utilization be measured more precisely Patient mix (demographics and oral health) be included in production models

31 Changing course at the Health Center

32 Other providers students, volunteers and contractors

33 Non-Traditional Staffing Contract Dentists Volunteers/Mentors Students and Residents Dentists serving on Health Center Board of Directors or advisory committees

34 Students and Residents Potential recruitment Positive retention tool Clinical productivity

35 Students and Residents Operatory space Auxiliary support Sufficient patient/ procedure pool Engaged Providers/Educators Organizational commitment to hosting students/residents Good working relationship with Dental School or Residency Program

36 What should you expect from the School or Residency Program? Effective and frequent communication before and during rotations through a specific program contact for all administrative and clinical issues. Clear requests for site and provider information Send prepared, competent and educated students Professional liability coverage for the students.

37 What should you expect from the School or Residency Program? Communicate specific clinical procedure requirements Adequate length of rotations Housing expectations Revenue sharing expectations

38 What should the School or Residency Program expect from you? They expect you to be a good site! What defines a good external rotation site?

39 Characteristics of a successful site Hosting the student well Keeping the student busy Providing quality faculty feedback

40 Benefits to the Site The dental staff has the opportunity to share their expertise and experience. The experience that the student receives at the site can be a very effective recruiting tool. In most cases, all revenue produced by the student is retained by the site. The organization has the opportunity to be a partner educating future dental professionals about cultural, societal and health issues unique to the communities they serve.

41 Benefits to Students Exposure to a variety of community-based clinical environments and situations An opportunity to be taught and mentored by excellent clinicians Student competence and confidence dramatically increased Ability to treat significantly more patients per day than in the dental school clinic A deeper understanding of the unique oral health challenges faced by many communities, and the opportunity to learn first hand how to address those challenges.

42

43 National Oral Health Learning Institute Yearlong leadership and practice management training for Dental Directors/Dental Program Managers in their position for 5 years or less. Combination of online and in-person sessions. Topics include: Leadership, Quality, Financials, and more! NNOHA will accept applications in the summer of 2013 for the class.

44 Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it s the only thing that ever has. -- Margaret Mead

45 Thank you!! Dr. Steve Geiermann Interim Director and Senior Manager Access, Community Oral Health Infrastructure and Capacity Council on Access, Prevention and Interprofessional Relations

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