Special Section for New Dentists: Considering Community Health Centers? by Dr. William Jacobson

 

CHCs as a career option: challenges, benefits and advice

by Dr. William Jacobson

Fig. 1: My drive to work at a rural clinic.

Fig. 2: My walk to work at the urban clinic.

Fig. 3: View from the operatory at the rural clinic.

Fig. 4: View from the operatory at the urban clinic.

• Interprofessionalism: These are patient-centered homes. At your building site, you have medical providers, nurses, a lab, social workers, pediatricians, pharmacists and more. This means you have valuable resources nearby if you have any medical questions or need behavioral health to step in.
• Salary: Competitive! However, the more rural, the higher the salary. You’re paid an annual salary, not based on a percentage of production or collection. Also to consider: The cost of living in rural settings is significantly less.
• Benefits: Excellent! These may include medical insurance, dental insurance, vision, 401(k) plans with employer matching, paid time off, paid sick time, paid federal holidays, continuing education reimbursement, continuing education paid time off, license and DEA renewal reimbursement, and malpractice insurance.
• Patient needs: I never encountered a patient who needed only a prophy. The two main diseases we treated were caries and periodontal disease. Fig. 5 shows a typical patient mouth.

Fig. 5: The mouth of a typical patient at a community health clinic.

• Location: Urban, suburban or rural.
• Scope of practice: May be limited to fillings, extractions and cleanings, or may also include root canal treatment, crowns, bridges, partials, dentures, relines, repairs, occlusal guards, nitrous oxide sedation, soft-tissue laser treatment and more.
• Budget for ordering supplies: Dentists may have to obtain special permission to place orders, or they might be given a budget that allows them to place orders for the supplies and materials they want to use.
• Supervisor: Could be a CEO (non-health care provider), a medical director (physician) or a dental director (dentist).
• Size of the dental team: On the smaller side, one dentist and one assistant; on the larger side, a team of 30 at multiple sites plus mobile vans.
• Population served: An underserved population or in an underserved area.
• Patient demographics: Vary in age, ethnicity and language. In general, the patients are medically compromised—multiple chronic illnesses and lists of medications—and the patient demographic could be a specific underserved population, such as people living with HIV/AIDS.
• Patient volume: From one to three-plus per hour. There may also be a high no-show rate.
• Specialty referrals: Could be well structured and supported by insurance or grants, or there could be barriers, such as a long distance to the nearest specialist (which requires transportation, which patients may not have) or a lack of nearby specialists who accept government-funded health insurance plans.
• Teaching opportunities: Some CHCs have dental students rotating through, or employ Advanced Education in General Dentistry (AEGD) residents. As a dentist, you obtain a certificate as an instructor and can mentor and oversee students/residents practicing dentistry.
• Schedule: Can work part time or full time. Definition of “full time” varies, from 30 to 32 to 40 hours. Some CHCs offer 10-hour shifts (instead of eight-hour). Lunch may be 30 minutes to one hour.
• Electronic health records: Programs vary, such as Epic, Next- Gen, Open Dental and Axium.

• Salary and benefits.
• Flexible work hours that fit your personal and financial needs.
• Loan forgiveness (PSLF) and loan repayment (NHSC) opportunities.
• You gain experience diagnosing and treating large cavities, many extractions and patient management.
• Career development leadership opportunities, such as becoming a dental director or chief dental officer, and involvement with local dental schools.
• Diagnosing and treating severe caries and gum disease. Not having to sell treatments.
• A rewarding, meaningful career helping those who struggle to have their basic needs met. Relieving pain, treating infections, improving self-esteem and quality of life. Learning to interact and treat patients with compassion and empathy.
• Less of a commitment if you don’t want to open and run a practice.
• You may have a boss you admire, who encourages you to grow and mentors you.
• You may have a team you really like and develop lifelong friendships.

• If you’re single, interested in having a social life and looking to meet someone special, do not go to a rural location!
• If you’re interested in implants, aesthetics (e.g., veneers) or digital dentistry, explore options outside of CHCs.
• You may have a supervisor you do not like or respect.
• Unlike being a private practice owner, you have no hiring or firing power. There is the potential for a toxic environment with staff issues or unprofessionalism.
• You’ll be working on challenging dentistry (preps are not ideal), medically complex patients and occasional behavior management issues at a clinic that cannot refuse to treat patients.

References
1. NNOHA Operations Manual for Health Center Dental Programs. 2023

William Jacobson, DMD, MPH, is a general dentist, clinical assistant professor, curriculum consultant and the author of Clinical Dentistry Daily Reference Guide, a book to help dental students and dentists with day-to-day decision-making for a myriad of clinical scenarios. The book is available on Amazon. Website: williamjacobson.net