Getting to Work and Getting it Done

(1)

Workforce and Staffing

Getting to Work and

Getting it Done

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

(2)

Learning Objectives

• Understand statistics and issues around the current CHC workforce

• Provide an understanding of efficient recruitment and retention strategies

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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

(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

(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

(7)

2010 NNOHA Workforce Survey –

Career Prior to Health Centers: Dentists

Dentist Frequency %

Private practice owner/partner/associate 179 31.9 Dental student 134 23.9 Private practice employed dentist 104 18.5 Local, state, public health agency/other

community dental center

57 10.2

Grad dental program/specialty program 46 8.2 Commissioned Officer PHS/Military 36 6.4

Retired 5 0.9

(8)

• 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

(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

(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

(12)

“Survey of Health Center Oral Health Providers:

Dental Salaries, Provider Satisfaction, and Recruitment and Retention Strategies”

http://www.nnoha.org/generalpage.html

Webinar, “The NNOHA Survey of Health Center

Dental Salaries: Trends and Analysis”:

(13)

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Recruitment Considerations:

• Mission alignment

• Scope of services and patient population

• Cultural competency and sensitivity

• Language considerations

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Recruitment Strategies

• Connecting with Private Practice

• National Health Service Corps

• Dental Schools & Residencies

• Primary Care Associations

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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

(18)

Retaining Good Providers

• Work environment

• Salary and Benefits

• Incentive Programs

(19)

• 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

(21)

Salary and Benefits:

• Fully competitive salary

• Loan repayment

(in addition)

• Retirement plan

• Insurance coverage

• Paid leave time

(22)

Incentive Programs

• Simple, easy to understand and manage

• Based on a target “goal” that directly

influences the organizations income

• Achievable and attractive

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Continuing Education and Training

• Median number of 5 days for CE

• Median amount of $2,000 of CE expense

reimbursement for dentists

(24)

Maximizing Efficiency –

Staffing, Equipment and

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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

(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

(28)

Encounter Rates &

Productivity Standards

Factors to consider:



Patient mix



Procedure mix and scope of service



Experience level of providers



Emergency patient load

(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

(31)

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Non-Traditional Staffing



Contract Dentists



Volunteers/Mentors



Students and Residents

Dentists serving on Health Center

Board of Directors or advisory

(34)

Students and Residents

(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

(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

(37)

What should you expect from the

School or Residency Program?

• Communicate specific clinical procedure

requirements

• Adequate length of rotations

• Housing expectations

(38)

What should the School or Residency

Program expect from you?

• They expect you to be a good site!

(39)

Characteristics of a successful site

• Hosting the student well

• Keeping the student busy

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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.

(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

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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 2013-2014 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.”

(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