each with their own attending dentists. “Now,” she says, “If you talk to Swedish they would say that we’re keeping people out of ERs, we’re taking care of people before they get to ICU, we’re making people healthy before they go in for cardiac surgery and transplant, and we’re improving the lives of their cancer patients — making it possible for them to successfully tolerate their treatments — which is critical for success. And now we can show other hospitals how these programs can be successful.” Johnson adds that while any community can benefit from their model, not every community will have a need for a practice treating the same patient population as theirs does. He says, “Our role in the community is that we take care of patients who are really challenging from a medical, behavioral, and physical standpoint, and we serve as a resource for the dentists and the medical doctors in this community – that’s the niche we fill for Seattle. The residency model is powerful because it allows different communities to identify what their needs are, and then building a residency that fills those needs. So I know the core model can certainly be duplicated, but the types of patients and the mission will be dependent on the geographic location.” Dr. Taylor Berry, who is finishing up his year of residency at the Swedish GPR, says, “The quality of health care providers that these programs produce is so far above what comes out of dental school that I think it benefits everybody. We have new skills that we’re using, we’re more competitive in the job market, and we’re better educated and informed — which benefits the community. I can’t imagine having gone straight into private practice without the benefit of a program like this.”
What’s next
So where do the residents go once their programs end? In Yakima, Koday did a survey a few years ago, and of the 40 graduates they were able to contact, about 70 percent had stayed in dental Health Professional Shortage Areas, including CHCs, and rural areas. “I think that more would have gone to that type of practice,” he says, “But when the economy fell and dentists weren’t retiring out, some of our graduates ended up in corporate practices because those were the only places hiring. We believe, as they do in the Regional Initiatives in Dental Education (RIDE) and Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) medical programs, that when you train residents in rural areas, a much higher percentage will stay in those areas.” In Seattle, Winston and Johnson have seen their residents go into many different types of practices — “Two went on to specialize, one in pediatrics, one in orthodontics, the others have all become general dentists,” Winston continues, say-
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ing, “One went on to set up a practice very much like ours on a much smaller scale in rural Montana, working with cancer patients and doing general anesthesia. He’s bringing something to that Montana community that didn’t exist before — which is the ultimate goal of our program. The educational piece is huge – we’re laying the framework for the future of our profession. We’re providing care to the underfunded, and the program is incredibly educational. The investment is exponential, when you consider the number of graduates who will go out and do this type of work in private practice and have the skills to do it right.” Danny Tremblay, who has spent the year commuting between Yakima and Seattle so that his wife, Rikki, could continue as a CPA in the city, is looking forward to becoming more involved in organized dentistry at the state and component levels. He hopes to join a private practice when he graduates, but not with just any dentist — he’s looking for a dentist who will continue to mentor him through his first years of practice, saying, “I believe that is so fundamental to the practice of dentistry — we’re always learning, and when you have someone who is willing to mentor you as I’ve been mentored this past year, you can have an even better experience in dentistry.” Tremblay also said that because of his experience in the CHC system, he’ll always make time to volunteer his expertise to them. Taylor Berry has accepted a position as an attending dentist with the Swedish SCSC extraction clinic, and fellow resident Spivey is looking for an associateship here in Washington, preferably one where she can continue to use the complex skills she has acquired. In Spokane, Dr. Peter Dang has already begun working part time in a practice, and would like to continue to working in the community health system, as well. Fellow Spokane resident Dr. Kim Siler has signed a contract to be at a private practice in the area. Each of the state’s residents is now armed with insight, education and skills they could never have received in dental school, creating scores of opportunities for access to populations that are woefully underserved. In contrast, midlevel providers offer only a narrow range of procedures without the benefit of the robust education a dental school provides. In Washington state, we’ve begun a dialogue about whether residency training should be mandatory and welcome your comments. Regardless of the outcome of that conversation, we’d like to ask you to join with WSDA in helping to create residency opportunities across the state — your voice will help make expansion of this program a reality. To find out how you can be involved, contact Bracken Killpack at bracken@wsda.org.
cover stor y residencies: their benefit to patient populations
tick in the quality of dentists applying to work in their clinic — skilled dentists from the private sector who were excited about teaching and mentoring the new generation of dentists. The gamble had worked. Having better dentists on staff benefits their patients, and it affects the staff in a good way, as well — and stabilizing the staff led to better continuity of care. Now, Koday has dentists on staff producing between $800,000 and $1 million in gross production a year — something they had never done before. “We’ve figured out what we were doing right and what we were doing wrong,” Koday says, “And we’ve been able to fine tune the system really well, which also is good for the patients and the residents. For some time we had a revolving door — dentists would come for loan repayment and maybe stay a year or two. We no longer have that problem.” Additionally, Koday says, “Before we started the residency I felt that I was isolated from organized dentistry — you had private practice, you had education, and you had community health — and the three practically never talked to each other. The thing that I really like about the program is that it is a combination of all three — we couldn’t do it without the private dentists who help us with the teaching, we couldn’t do it without the University of Washington, so it’s a dentist-driven team effort. I’m really sold on it as a way to increase access in the state of Washington.” At the clinic, they see two types of patients — emergencies, which they see every day — and patients of record, as you would see in any private practice. Having residents has enabled the facility to take more emergency patients, see more adults after the loss of adult dental Medicaid, and expand treatment to patients of record. Koday adds, “We never could have considered introducing implants or a number of the upper end procedures that we now offer without the residency program.” When Bart Johnson and Amy Winston first submitted their proposal to Swedish, administrators there were not sure what to think. They were open minded to the concept, but wondered, “We’ve been around 100 years and never had a dental program, why do we need one now?’ Winston smiles as she relays the story — she and Johnson were undeterred, and the first year they did everything by themselves — including all of the emergency room and inpatient services. But after that first year, Swedish was sold — their hospital services and the cancer center had seen so much improvement that the Swedish doctors went to bat with the administration for the pair. Today, residents in the program are based in their private practice, with rotations at the Swedish SCSC extraction clinic, the Odessa Brown Pediatric Clinic, an anesthesia rotation, and an ER rotation at Swedish First Hill,