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Filling the gapFilling the gap

Agencies work together to successfully bring dental care to rural Iowa.

Darin Leach

January 10, 2018

6 Min Read
USDA HELPING: Farmers Mutual Cooperative Telephone Co. recently received a $300,000 USDA Rural Development Rural Economic Development Grant to help with the expansion of Harlan Dental.

From an early age, we are taught that having healthy teeth and gums is essential to the overall well-being of the entire body. “Your mouth is a window to what’s going on in the rest of your body. It often serves as a helpful vantage point for detecting the early signs and symptoms of systemic diseases, such as diabetes,” says Dr. Alison Shields, with Harlan Dental in Harlan, Iowa.

Having easy access to a dental professional is a challenge many rural Iowans face. Nearly 40% of the state’s counties are home to just four or fewer private-practice dentists, and 10% of the counties have just one dentist. “If you live in rural Iowa, or basically anywhere across much of rural America, chances are your community is considered a dental health professional shortage area,” says Annette Sweeney, state director for USDA Rural Development in Iowa.

Shortage of dentists in rural areas
This dental shortage was illustrated in recent research by the University of Iowa’s Public Policy Center, which found that only 36% of dentists work in rural communities, compared to 49% just 20 years ago. “When you combine this with the fact that nearly half of the dentists in Iowa today are more than 50 years old and quickly nearing retirement, it is clear that access to dental care in rural Iowa will only become more challenging,” Sweeney says.

To help reverse this downward trend, USDA Rural Development has been working with rural electric and telephone cooperatives for the past 12 years to help bring new dentists to rural Iowa.

DENTAL SHORTAGE: A University of Iowa study found that only 36% of the state’s dentists work in rural communities, compared to 49% just 20 years ago. Access to dental care in rural Iowa is becoming more challenging.

Since 2006, USDA Rural Development has provided nearly $3 million in Rural Economic Development Loan and Grants to 13 rural electric or telephone cooperatives that have provided pass-through loans or revolving-loan fund dollars to dentists to help establish their practices or expand services in rural Iowa.  

Creation of the FIND program
About 10 years ago, state health care and economic development leaders created a program called Fulfilling Iowa’s Need for Dentists. The goal of FIND is to alleviate the critical shortage of dentists in underserved Iowa counties. The program assists dentists with the repayment of up to $100,000 of dental education debt in exchange for allocating at least 35% of patient services to underserved populations over a five-year period.

USDA Rural Development funding has played an important role, supporting FIND in its quest to help new dentists meet the costs of purchasing buildings and equipment to establish or grow their practices. “The FIND program is just one example of our commitment and desire to collaborate with our partners to keep vital services available in our rural Iowa communities,” says Cheri Monahan, manager of growth strategies at Central Iowa Power Cooperative (CIPCO).

RURAL ATTRACTION: Dr. Alison Shields was drawn to a dental practice in a rural community because she wanted the opportunity to get to know her patients and create a sense of family with those she served.

Key partners assisting USDA Rural Development with this initiative to boost the number of rural dentists in Iowa have been the Iowa Area Development Group, Delta Dental of Iowa, Iowa Department of Health and the University of Iowa College of Dentistry and Dental Clinics.

“Whether joining an existing practice, investing in new equipment and technology, or starting a practice from the ground up, initial investment costs in a dental practice are significant, with an average investment of more than $300,000 needed,” says Jeff Russell, president and CEO for Delta Dental of Iowa. “In addition, most dentists graduate from dental school today with more than $240,000 in educational debt.”

Program brings dentists to rural Iowa
During the past 10 years, the FIND program has helped place more than 40 dentists in rural Iowa. “With an overall shortage of dentists, and many active dentists facing imminent retirement, it is imperative that rural Iowa communities actively recruit new dentists to serve coming generations,” says Bruce Hansen, vice president, business development, Iowa Area Development Group.

The idea for FIND originated during conversations in 2008 at an open house to celebrate the opening of Fuller Family Dental, a business that was a recipient of USDA Rural Development funds through CIPCO. Community and state developers were amazed and heartened at Dr. Maria Fuller’s desire to start her practice in such a rural area.

Prior to settling on Corning, Iowa (population 1,400) for her practice, Fuller and her family toured 10 communities across Iowa to see which one would be the best fit and where she could provide the most assistance.

“Dr. Fuller’s desire to serve rural Iowans was the spark that brought awareness to the need to bring young and talented dentists to rural Iowa,” Hansen says. “FIND is a true partnership that begins as we form relationships with students in their early years of dental school and continues with community leaders who develop recruitment strategies and develop financial resources to attract the right dentist to their community.”  

USDA Rural Development helping
USDA Rural Development’s participation in FIND is continuing to make a difference for better health in rural Iowa. In 2017, it awarded a $300,000 Rural Economic Development Grant to Farmers Mutual Cooperative Telephone Co. to help with the expansion of Harlan Dental in Harlan, a community of 4,900 people.

A GOOD START: Dr. Mary Hoch (left), a Harlan native and recent graduate of the University of Iowa College of Dentistry, has joined Harlan Dental as the practice moves to a new and expanded location.

Harlan Dental is owned by Dr. Alison Shields and Dr. Stephen Allen. Shields received her doctor of dental surgery from the University of Nebraska Medical Center College in 2009. She and her husband moved to Harlan after graduation, where she worked as an associate dentist for six years.

Allen, who also received his dental degree from UNMC, has been practicing in Harlan for more than 30 years. Shields joined Allen as a partner in 2015.

“One of the main reasons I wanted to become a dentist was to help people,” Shields says. “After graduating dental school, I compared practices in large communities vs. rural areas and decided the greatest need was in a rural environment. I really wanted to get to know my patients and create a sense of family, and I felt being in a smaller town would accomplish that.”

Shields and her husband, Brett, and their five young children enjoy living in Harlan. “I like living and working in Harlan because of the people and the community,” Shields adds. “Harlan is a great place to raise a family.”

Construction on the new Harlan Dental office is expected to begin in early 2018. This expanded space and business growth allowed Dr. Mary Hoch, a Harlan native and 2017 graduate from the University of Iowa College of Dentistry, to join Shields, Allen and Dr. Nathan Sommers at the clinic. 

Leach is public information coordinator with USDA Rural Development in Iowa.

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