Hiring challenges limit nonprofit’s ability to deliver dental care


Valley News Staff Writer

Published: 01-01-2023 9:06 PM

SOUTH ROYALTON — HealthHub now has funds and equipment sufficient to double the dental care it was providing to school children in the White River Valley last year, but instead it has reduced the amount of care it is providing to just 20% of what it was last year, according to the South Royalton-based nonprofit’s president.

The mobile clinic’s full-time hygienist retired this summer and the nonprofit has been unable to find someone to replace her. As part of a planned expansion, the clinic also had hoped to hire a dentist or dental therapist to staff another mobile unit, as well as another mental health provider, but has so far been unable to do so.

“It’s all really frustrating,” Dr. Becky Foulk, a retired pediatrician who was one of HealthHub’s founders and is its current president, said.

Since the departure of HealthHub’s full-time hygienist, Janine Reeves, the organization has been relying on one day a week from a dental hygienist, Sarah Adams, who works the other four days for a dental practice in Hanover. Adams is able to clean the teeth of about five children per school day. Last year, the program cared for nearly 500 children, but with just a part-time hygienist it is on track to reach just about 100 this year.

“I think the big story in public health efforts right now is the serious shortage of providers,” Foulk said.

HealthHub is not alone in having difficulty recruiting. A Randolph dentist who accepted Medicaid also retired earlier this year. The Ammonoosuc Community Health Services dental clinic in Littleton, N.H. has closed due to staffing shortages, and the Mascoma Community Health Center in Canaan suspended its dental service indefinitely in July after the dentist there left and it was unable to recruit a dentist or a hygienist.

“If at some point the dental professionals ‘market’ turns positively, we will consider re-instituting the service,” Sandra Hayden, chairwoman of the Mascoma health center’s board, said in a mid-December email. “...It has now been five months (...) since we attempted any dental recruitment at our health center.”

HealthHub first began recruiting almost a year ago when the board first learned of Reeves’ plans to retire, Foulk said. Pay is $50 an hour for a flexible work week that averages 35 hours, according to the job posting on HealthHub’s Facebook page. The position also includes benefits and personal time.

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The work includes providing care to children ages 2-17 as well as adults in the Vermont communities of Randolph, Rochester, Bethel, South Royalton, Sharon, Strafford, Stockbridge, Tunbridge and Chelsea. In addition to cleaning teeth, the job includes looking for cavities, providing silver diamine fluoride, which can be applied to teeth to prevent cavities from growing; applying sealants, and educating patients in patient education for the use of povidone iodine, an antiseptic, at home.

“We got some nibbles,” Foulk said of HealthHub’s recruiting efforts. “Mostly they were not really strong candidates (or they were) people who lived a long ways away who really didn’t want to relocate.”

At one point, HealthHub’s board thought it had found someone, but after she initially accepted the job, she later turned it down. Foulk suspects the candidate went back to her current employer and the employer said, “whoa, we can’t afford to lose you.”

HealthHub also had wanted to attract a dental therapist, which is somewhat analogous with a nurse practitioner or physician assistant in medicine, but there aren’t yet any practicing in the state.

“We were hoping to be the first program in the state to have a dental therapist and kind of pioneer that model,” Foulk said.

The workforce challenges have not escaped the notice of the Vermont Department of Health, which recently released its annual oral health plan. The health department has a grant to support a dental recruiter to recruit both dentists and hygienists, Robin Miller, the state’s oral health director, said.

Various efforts are taking place on the education front. The dental internship program at the University of Vermont Medical Center also has recently expanded, Miller said. The state’s technical career centers have launched dental assisting programs and a dental therapy program is in the works at Vermont Technical College, which is soon to become part of Vermont State University. VTC also has made changes to ensure it is graduating full classes in its hygienist program, for which there is a waiting list, Miller said.

To stretch scarce resources, the state also is encouraging oral health providers to be working at the top level of the things they are qualified to do and to prioritize patients based on their level of risk for oral disease.

“Does everybody need a dental cleaning every six months?” she said. “It has been said that we are over treating (...) That’s chair time.”

As cleanings may be less frequent, Miller said it’s important to remind people of the basics: tooth brushing and flossing.

“That is what is going to help you maintain oral health,” she said.

She noted that one of the ways of teaching healthy hygiene practices is through programs such as HealthHub, which brings preventative care into public health settings and also provides medical health care alongside oral health care. But they “do have to have people to do the work,” she said.

Foulk, a retired pediatrician who owned the South Royalton Health Center, and Frank Lamson, a pediatric nurse practitioner who also worked at the health center, founded HealthHub nearly three decades ago as a way of providing care to children in school settings, helping to ensure that children got the care they needed with minimal interruption to the school day.

“We started with the idea that this would be kind of a full-service operation for kids who didn’t have access to care,” she said. “...That has continued to be a big need in our communities.”

On the oral health side, an initial community needs assessment found that a large proportion of the children, who either had never been seen by a dentist or who were infrequently seen by a dentist, were covered by Dr. Dinosaur, the children’s Medicaid program, and couldn’t find a dentist who would take their insurance.

Initially, HealthHub’s hygienist just did screenings and education because hygienists weren’t allowed to provide care without direct supervision from a dentist. That has since changed to allow hygienists to provide care under indirect supervision.

HealthHub has become “the only source of care for quite a few kids,” Foulk said, it alleviates the need for parents to take time off work to take their children to appointments or to navigate transportation difficulties.

“We just have such a big need,” Foulk said. “I wish I could go to all the dental programs and the medical schools (and) give people a pep talk: ‘It’s not about making money. It’s about meeting human needs and you still make a good living.’ ”

On the mental health side, HealthHub recently had a part-time therapist retire, bringing it down to just one full-time mental health counselor, amid an increase in demand amid the opioid crisis, the COVID-19 pandemic and a general increase in anxiety among children. The organization plans to advertise for another mental health provider, amid a similar workforce shortage in that field.

“My goal is to get things in a strong enough place, so that I can step back,” Foulk said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.