Dentist Serving Native Communities:

Joseph P. Kelly, DDS MCH Research Festival

June 7, 2006

Sources of Satisfaction

Why survey dentists who serve American

Indian/Alaska Natives?Longest history of health care for the underserved

Demanding dental practice situations

Similar conditions of employment to other programs

Includes rural and urban practice sites

Dental caries prevalence in American Indian/Alaska Native children is among the highest in the world.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Percent

1971-74

1988-94

1999-2000

Select Years

Percent U.S. Untreated Dental Caries by Poverty Status

Children 2 to 5 yrs

Poor………..Less than FPL

Near poor…100-200% FPL

Nonpoor....…> 200% FPL

Untreated Dental Caries by Poverty Status(Health, United States 2004)

*

IHS Dentist WorkforceVacant Positions

IHS Dental Vacancies1995-2006

91 87

134

11698

92

4650 53

79

0

20

40

60

80

100

120

140

160

Year

Vacant Positions

Specific Aims

1) Identify characteristics of the dentists currently serving AI/AN populations and determine proportion intending to remain.

2) Identify factors associated with the initial decision to work with underserved AI/AN populations.

3) Explore individual- and environment-related factors in relationship to their intention to remain.

4) Explore of the dentists’ intention to remain in relationship to their attitudes, perceptions, and evaluation of this experience.

98-item mailed survey - Multiple choice, Likert type, and Open-ended questions - Ten domains

Study population: - 525 dentists

- All twelve IHS Service Areas

Data entered manually using StatPac-Gold & MS Excel

Analysis using Intercooled Stata 8.2

Survey

Survey of Dentists Serving Native Communities – 2005

Response 354/525 = 67.4%

Portland

40/56=71.4%

California37/68=54.4%

Phoenix37/51=72.6%

Tucson5/7=71.4%

Alaska32/53=60.4%

Albuquerque24/37=64.9%

Oklahoma42/68=61.8%

Nashville15/21=71.4%

Bemidji24/28=85.7

%

Aberdeen22/25=88.0%

Billings26/36=72.2%

Navajo47/72=65.3%

National Response Rates by Area

Career Decision Making

Primary Reason for I/T/U Choice n=230

Felt a mission to underserved 61 (26.5%)

Lifestyle and recreational opportunities 26 (11.3%)

Possibility of loan repayment 26 (11.3%)

Intention to Remain n=351 266 (75.8%)

Personal & Professional Characteristics

Median age at time of survey n=348 45 (26-78) yr

Gender

Male n=350 271 (77.4%) Female 79 (22.6%)

Practice dentistry > ten years 236 (67.4%)

Intend to Remain

Older age (p<0.001)

More years practicing dentistry (p<0.001)

Had school-aged children during service (p<0.001)

0

10

20

30

40

50

60

70

80

90

Frequency

25-34yrs 35-44yrs 45-54yrs 55yrs +

Age Categories

Age Distribution by Gender

Male

Female

I/T/U Practice Characteristics

Median I/T/U Practice Years n=348 7 yrs (0-34)

Intend to Remain

Employed as other than civil servant (p<0.001)

Dental director or specialist (p<0.001)

Post-doctoral training in general dentistry (p<0.01)

More experience in native community dentistry (p<0.001)

0

20

40

60

80

100

120

Frequency

25-34yrs 35-44yrs 45-54yrs 55yrs +

Age Cohort

Employment Type Distribution by Age Cohort

Agency/Urban

Tribal Hire

Civil Service

CommissionedCorps

Dental Program Characteristics

Program - Community size 351

Urban area (More than 50,000) 93 (26.5%)

Micropolitan (10,000 to 49,999) 73 (20.8%)

Small town (2500 to 9,999) 79 (22.5%)

Rural (Less than 2500) 106 (30.2%)

Intend to remain

Positive assessment of dental staff (p<0.001)

Reported less restriction on professional freedom related to:

Patient compliance (p=0.01),

Budgetary restraints (p<0.01),

IHS levels of service (p<0.001)

Interpersonal patient care 264 74.5 (21.6) 85 71.2 (22.7)Practice Management 262 68.7 (19.4) 81 67.0 (20.1)Delivery of quality care* 265 67.5 (27.2)Medical liability environment 265 67.2 (27.2) 85 66.2 (27.7)Supervisor support 263 65.8 (29.1)Income to support family* 264 63.5 (26.0)

Sources of Dental Satisfaction by Intention to Remain Serving Native

Communities

DSS-Short scale Intention=Yes Intention = NoItem n=266 n=85

Overall DSS-Short score* 254 57.5 (12.7) 8053.5 (12.7)

Perception and Evaluation of Experience Scores

by Intention to RemainSatisfaction with Life Scale Cronbach’s alpha= 0.85

Intend to Remain Intend to Leave

SWLS Overall 259 64.8 (19.4) 85 56.3 (18.5)p<0.001

Dental Attitudes toward the Underserved Cronbach’s alpha= 0.81

Intend to Remain Intend to Leave

DATU Overall 260 74.8 (17.8) 83 69.5 (17.8)p=0.02

Native Community Practice Experience Cronbach’s alpha= 0.78

Intend to Remain Intend to Leave

NCPE Overall 256 71.2 (13.0) 82 60.4 (12.7)p<0.0001

Project Mentors & Collaborators

Thesis Committee:

Christine Riedy, PhD, MPH – Chair

Colleen Huebner, PhD, MPHWendy Mouradian, MD, MS

Doug Schaad, PhD

IHS NOHC Advisory Group:

Woody Crow, DDS, MPHMichael Crutcher, DDS

Partial Funding of this Project by:

U.S. DHHS, HRSA, Maternal and Child Health Bureau: Maternal and Child Health Program Grant # T76MC00011-21-00

Center for Leadership Training in Pediatric Dentistry Grant # 1T17MC00020-01

U.S. DHHS, HRSA, DSCPH, Bureau of Health Professions:“Enhancing Health Care in Western Washington’s Rural Areas” Grant #

1D36HP10027

UW Department of Pediatric Dentistry

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Inform Recruitment Inform Interventions

Inform Support New Dental Remain in Career Path AI/AN Dentistry

INFORM PROGRAMMATICS

INFORM SUPPORT

INFORM RECRUITMENT

New Dental Career Path

INDIVIDUAL FACTORS

ENVIRONMENTAL FACTORS

Career Decision

Evaluation of Experience

Perceptions of Experience

Native Community

Dentistry

Remain in AI/AN Dentistry

Conceptual Model

Survey of Dentists Serving

Native CommunitiesJoseph Kelly, DDSUniversity of Washington

MCH Research FestivalJune 7, 2006