Iowa town finds creative solution to dentist shortage

Faced with the prospect of losing its only dentist, officials in the small farming community of Fayette, IA, realized they would have to come up with a unique incentive to lure a new dentist to town.

So town officials decided to offer a financial plan to replace Rudy Kraus, DDS, the town's only dentist for 30 years, who retired in December. Through a collaboration with Upper Iowa University, the state, and Delta Dental of Iowa, the town is working with the innovative Fulfilling Iowa's Need for Dentists (FIND) loan repayment program, which offers $100,000 to new dentists who sign on to practice in underserved communities.

Charles Lee, DDS

Charles Lee, DDS

Participating dentists must pledge that 35% of their patients come from underserved populations to qualify for the program, which was started with a $150,000 grant from Delta Dental.

Charles Lee, DDS, a new dentist who was working for Aspen Dental in Waterloo, heard about the program and saw it as a way to repay $400,000 in school loans and also an opportunity to start his own practice.

"I was seeing 25 to 30 patients a day doing the corporate dentistry thing," Dr. Lee told DrBicuspid.com. "I was thinking if I were in a slower-paced office, I could do some magic; I could be on my own and have more freedom to maneuver."

Not enough dentists

Getting and keeping medical professionals in rural Iowa is a challenge. In fact, the state estimates that 55 of its 99 counties don't have enough dentists. And in Fayette County, seven of its eight dentists are older than age 50.

Dr. Lee heard a lot of dentists were retiring in the northeastern part of the state.

"I found this little satellite office and thought, 'Wow! This has the potential to be my first office,' " he said. "My vision is to have multiple offices; that's where I want to go with this."

"We feel like we're fortunate to get someone like Dr. Lee," Fayette City Administrator Christie Dennis told DrBicuspid.com. "We're trying to be proactive to bring in new businesses, and we want good dental care for our citizens."

Last fall, city officials decided to contribute $25,000 to the dentist recruitment fund. The state will pay $25,000 in matching funds and Delta Dental will add $50,000.

"It's a unique combination of the private, public, and nonprofit sectors working together to create something," Deb Hoyle, Iowa practice opportunities coordinator for the University of Iowa College of Dentistry, told DrBicuspid.com. "It's a win-win situation."

Her office helped another new dentist obtain a grant to help buy equipment to get his practice up and running. Fayette County has a large underserved population, Hoyle noted. "It was critical to bring in another dental provider," she said. "We wanted to get the ball rolling and at least do something on our own."

Delta Dental has contributed $1 million to the FIND program and has helped bring 18 new dentists through the program since 2002, Suzanne Heckenlaible, Delta Dental of Iowa's vice president of public affairs, told DrBicuspid.com.

"We think it's the right partnership," she said. "It not only addresses the oral health needs of the community and the underserved but also commercial vitality of community."

Busy transition

After providing emergency care while in dental school, Dr. Lee is committed to doing the same for his patients in Iowa.

"If you need emergency care, come in," he said, while still treating patients at 7 p.m. on the Friday before the long President's Day weekend. "I treated walk-ins this evening; that's why I stayed late. If you're in pain, that's my job. That's why I went into this profession."

Dr. Lee is still waiting to for final approval of the loan repayment program, but he has received $10,000 from Upper Iowa University, which is located in Fayette, and $10,000 from the town.

"I did it because the city of Fayette and Upper Iowa University made contributions and said, 'We want you here; we need you here,' " he stated.

Dr. Lee is currently working six days a week, finishing his tenure at Aspen Dental in Waterloo in addition to treating patients at the Fayette practice. He also does house calls at a retirement center/hospice on weekends.

"I deliver dentures, which is what they all look forward to," he said. "I gave dentures to one lady, and, oh my goodness. One of her friends was so jealous and wanted dentures of her own, so she called me up to do impressions. It was like, wow!"

Due to the dentist shortage, many patients have trouble getting an appointment, Dr. Lee said. But he is committed to providing care to every patient he can. His motto is reflected on the postcards he sends out: "Finally, comprehensive care when you need it."

"I vowed to put people in the schedule when they need to come in," Dr. Lee said. "If you're in pain, you can come in right away. If you have not seen a dentist in a long time, I'm going to get you in and get you an x-ray sooner than later."

Oral hygiene and education

Most of Dr. Lee's patients are older and include area farmers. He does a lot of mini-implants, endodontics, oral surgery, and removing and repairing crowns and bridges. But these days, much of his focus is also on preventive care.

"That's the thing this area of the country has forgotten -- there are a lot of periodontal problems," Dr. Lee said.

He's doing a lot of prophy fluorides, but said many patients really need scaling and root planing.

"I'm doing more educating than anything else," Dr. Lee added. He described a recent case doing a prophy fluoride: "After doing it, I spent 35 minutes talking to her about oral hygiene. She said it was the best cleaning experience in a long time, and I was happy with that."

One of the best advantages of working in Fayette is being with his wife and baby, he noted.

"That's one thing I'm happy with: Before I wasn't able to see them all day, and I hated that," he said. "But here I can have them at the office; I can spend time with them. That's what life is all about. I plan to be doing this when I'm 70 years old."