1. Kenneth Anthony Bolin, DDS, MPH
NNOHA Nationwide Community Health Center Dental Provider and Executive Director Survey November 2009
Kenneth Anthony Bolin, DDS, MPH

2. Origins of Study NNOHA obtained funds for survey from HRSA grant
Author a Dental Public Health residency director and published previous survey
Prior instrument needed additional questions regarding demographics

3. Survey Design
Dental Director and Executive Director listing obtained by NNOHA from HRSA
Survey questions derived from survey designed by former CHC Dental Director
Input from NNOHA committee
Survey approved by Texas A & M Baylor College of Dentistry IRB

4. Survey Methods
Surveys mailed to all CHC Dental Directors and Executive Directors
4-5 weeks later a second mailing
First and second mailings included self-addressed stamped envelopes
4 weeks later a reminder postcard

5. Response 701 Dentists/Dental Hygienists 338 Executive Directors
Unduplicated 406/790 (51.4%)
338 Executive Directors
338/784 (43.1%)

6. Data Entry and Analysis
Data analyzed using SPSS 15.0
Frequency Analysis performed for each variable
Association tests performed on key variables
Chi-square crosstabulation
T-test for independent samples
Logistic Regression to obtain Odds Ratios

7. Demographics Year of graduation All 10 HRSA Regions represented
Range Mean = 17.2 years
All 10 HRSA Regions represented
Majority from metropolitan areas
DDS=63.2% RDH=55.6%
Majority practicing for >10 years
DDS=59.8% RDH=52.5%

8. Demographics Dental Director 317/701 45.5% Staff Dentist 259/701 37.2%
Dental Hygienist 120/ %
Gender
DDS 53.3% Male/46.7% Female
RDH % Male/95.8% Female

9. Activity Prior to CHC Employment
Dentist
Number
Percent
Dental Student
134
23.9
Graduate dental program/specialty program 46
8.2
Private practice owner/partner/associate
179
31.9
Private practice employed dentist
104
18.5
Commissioned Officer PHS/Military 36
6.4
Local, state, public health agency/other community dental center 57
10.2
Retired 5
0.9
Total
561
100
Dental Hygienist
Dental Hygiene Student 29
24.6
Private practice associate or employee 83
70.4 6
5.0
118

10. Scholarships and Loans
Received NHSC Scholarship
DDS 10.3% RDH %
NHSC Loan Repayment
DDS 19.5% RDH %
State Loan Repayment
DDS 14.3% RDH %

11. Reasons for choosing CHC
Felt a mission to the dentally underserved population
Wished to offer oral health care within an interdisciplinary environment
Wished to practice dentistry in a community based setting
Did not want to invest capital in a private practice

12. Reasons for choosing CHC
Attracted by work schedule/leave policies of Community Health Center
Loan repayment was offered or promised to you in Community Health Care dentistry
Sold private practice, or retired from government service
Dissatisfied with associate/employee dentist arrangements currently available

13. Highest Response Rate Responses from dentists
Felt a mission to the underserved %
Loan repayment available in CHC %
Attracted by work schedule/leave %
Responses from dental hygienists
Felt a mission to the underserved %
Attracted by work schedules/leave %
Wished to practice in a CHC setting %

14. Perception of Autonomy
Dentist
Number
Percent
Full Autonomy
245
42.7
Limited Autonomy
329
57.3
Total
574
100.0
Dental Hygienist 56
47.1 63
52.9
119

15. Perception of Autonomy
Top three reasons reported for both dentists and dental hygienists
Degree of patient compliance with treatment recommendations or attendance
Limited access to specialists
Restrictive Medicaid policies/requirements

16. Perception of Admin Time
Enough/More than enough 29.0%
Not enough time %
No time allowed %

17. Are Benefits Adequate? % Answering Yes DDS RDH
Vacation/Sick Days 84.6% 82.4%
Medical Insurance 79.6% 77.1%
Retirement Plan 89.7% 87.0%
Employer match 66.7% 64.8%
Production Incentive 34.8% 24.6%

18. Vacation/PTO Dentist Dental Hygienist Mean and median days ≈ 26
Mean days --23
Median

19. CE Allowance Days Amount Mean DDS 5.3 $1,828 Median DDS 5.0 $2,000
Mean RDH $893
Median RDH $800

24. Years of Total Experience
5.0%
6.8%
22.5%
18.4%
52.5%
59.8%
15.0%
20.0%

25. Current Employment Status
DDS RDH
First and only position % %
At least one prior % %
Two or more prior % %

26. Perception of On-Call Duties
304
417
147 97
151
151 18
101
101 18 18

27. Perception of Facility
%DDS %RDH
Very Good
Good
Adequate
Needs Improvement
Poor

28. Perception of Equipment & Supplies
%DDS %RDH
Very Good
Good
Adequate
Needs improvement
Poor <1.0

29. Perceptions of Support
Answering “Adequate” %DDS %RDH
Number of DAs
Quality of DAs
Clerical support
Admin support
Number of DDSs
Number of RDHs

30. 26.7%
26.7
24.6%
24.6%
19.0%
19.0%
15.5%
15.5%
14.3%
14.3%

31. 35.5%
35.5%
25.2%
25.2%
15.0%
14.0%
14.0%
15.0%
10.3%
10.3%

32. Non-Salaried Personnel
Dentists
Mean hourly fee $63.17
Median hourly fee $60.00
Mode $50.00
Dental Hygienists
Mean hourly fee $29.64
Median hourly fee $30.00
Mode $30.00

33. Memberships Dentists #1 ADA 69.1% #2 AGD 22.4% #3 None 20.0%
#4 AAPHD 6.9%
#5 NDA %
#6 HDA %
#7 APHA 2.4%
Employer reimbursement YES=60%

34. Memberships Dental Hygienists #1 ADHA 53.3% #2 None 43.3% #3 HDA 1.7%
#4 AAPHD 0.8%
Employer reimbursement YES=36.8%

35. Intend to Remain in CHC Dentists 80.2% 449/560
Dental Hygienists 93.3% 111/119
Of those intending to leave CHC
Leaving in 2-5 yrs 61.% 75.0%
Within one year 29.2% N/A
ASAP % 25.0%

36. Executive Director Survey
FTEs
Unfilled positions
Salary information
Benefits information
Recruitment methods

37. Vacancies

38. Recruitment Methods For Dentists Working with NHSC 28.1% 95/338
Networking PCAs 24.9% 84/338
Postings at schools 22.8% 77/338
Newspapers % 69/338

39. Salary DDS Mean $124,765 Median $122,209 75th percentile $135,699
Fringe benefits = 24% additional
Med/dental insurance % Yes
Disability/life insurance 90.2% Yes
No. paid holidays 10 (med & mode)
No.PTO days (med & mode)
Retirement plan offered 92.6% Yes
Dental license reimbursement 78.3% Yes
Drug license fee reimbursement 9.9% Yes
Continuing Education allowance $2000 (median)

40. Hygiene Vacancies

41. Recruitment Methods Newspaper 10.1% 34/338 Work with NHSC 7.1% 24/338
Network PCAs % 36/338
CHC web postings 5.9% 20/338

42. RDH Salary Mean $57533 Median $58120 75th Percentile $66657
Fringe benefits= 22%
Medical/dental insurance 97.1%
Other insurance/disability 91.8%
No. paid holidays 10 (median)
No. PTO days (median)
Retirement plan offered 93.3%
License fee reimbursed 74.0%
Continuing Ed allowance $1000 (med)

44. Statistical Analysis of Associations

45. Intent to leave and … Salary HRSA region Population NHSC scholarship
Federal loan repayment
On-call duty perception
Number of dental assistants
Experience/Quality of dental assistants
Number of dentists employed
Number of dental hygienists employed

46. Significant Associations
Gender
Years of CHC practice
Years of total experience
Adequacy of administrative time
Level of autonomy in practice
Pre-existing altruistic motivation
Pre-existing value of loan repayment
Receiving state loan repayment
Administrative support
Clerical support
Quality of facility
Condition of dental equipment and supplies

47. Significant Associations
Experience Overall
10 or more Reference group
>5 but <10 OR= p<.0001
>1 but <5 OR= p<.0001
<1 year OR= p<.0001
Using logistic regression model

48. Associations Years of CHC Experience Intend to Remain 8.12 yrs
Intend to Leave yrs
t-test p<.001

49. Associations with Intent to Leave CHC Practice
Autonomy OR 2.6 p<.0001
Altruistic motive OR 2.6 p<.001
Pre-existing
Loan repayment OR 3.6 p<.001
Pre-existing value
State Loans OR 1.9 p=.008
Actual receipt of loan
Gender OR 1.6 p=.02

50. Associations with Intent to Leave CHC Practice
Admin support OR 2.3 p<.0001
Clerical support OR 1.9 p=.001
Rating of facility OR 2.2 p<.0001
Rating of equip OR 2.9 p<.0001
and supplies