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

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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

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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

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Outline

• Introduction
• The golden state
• Dental licensure solutions
• Dental licensure solutionspending
• Licensure by credential awareness program

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Outline

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

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Survey

• 1970

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Introduction

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

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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

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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

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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

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Introduction

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

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Introduction

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

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The golden state

• The children
• Poverty
• Fluoridation
• Access to care

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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 K3rd grade
• Well above national average

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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

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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

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The golden state

• State dental workforce
• Dentist participation in Medicaid
• Dental workforce distribution
• Public sector infrastructure

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Dental licensure solutions

• Previously approved and passed into law
• AB 1045
• AB 801
• AB 982
• SB 1865
• AB 1428

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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

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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

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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

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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

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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

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Dental licensure solutions-pending

• For 2005
• SB 299 Licensure by Credential (modified)
• SB 683 Recognition of Postdoctoral Residency
  Programs

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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

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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

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Licensure by credential awareness program

• Part one California Dental Director
  licensure/vacancy survey
• Part two Advertising campaign

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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

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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

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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

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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

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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

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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

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Part two advertising campaign

• Information at Dental Boards website
• Licensure by credential application
• Complete requirements
• Clinic forms
• Dental community/public health agencies

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Results of survey

• California Dental Director licensure/vacancy
  survey results

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1 Do you believe licensure by credential with
U.S. dentists will improve access to care in
California?
yes (71) no (29) n 48
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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
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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
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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 Californias
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
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6 How many dentist position(s) are currently
unfilled (vacant) in your organization?

• of vacancies responses
• None 29
• 1 13
• 2 6
• 3 1
• 4 1
• 32/137 total unfilled full time dentist positions
  (23.4 overall vacancy rate)

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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)

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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
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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
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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

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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

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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