Salaries and Job Satisfaction of Health Center Dental Providers: 2013 Trends Kenneth A Bolin, DDS, MPH
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Learning Objectives Understand the characteristics of current practitioners in Health Center dental clinics Learn about job satisfaction indicators of dental providers and ranges of salaries currently being offered Identify the factors which contribute to career change decisions among dental providers in Health Center practices
Origins of Study NNOHA obtained funds for survey from HRSA Cooperative Agreement NNOHA wanted to do an update of previous survey conducted in 2009 Prior instrument needed additional questions regarding demographics, and comparisons to prior surveys were of interest
Survey Design Health Center master e-mail list obtained by NNOHA for all Executive Directors Survey questions derived from survey designed by former Health Center Dental Director Input from NNOHA Workforce Workgroup and staff
Survey Methods Survey was administered electronically. Link mailed to all Health Center Executive Directors Introductory message included message from NNOHA Project Director 4-5 weeks later a USPS postcard reminder was mailed to all Health Centers in U.S. with links for providers and Executive Directors respective surveys
Response 650 Dentists/Dental Hygienists 246 Executive Directors 246/1120 (22%) Response rate for providers unknown due to unknown denominator Response slightly lower than paper survey of 2009, but denominator much higher
Data Entry and Analysis Data analyzed using SPSS 21.0 Frequency Analysis performed for each variable Association tests performed on key variables Chi-square cross tabulation; p values T-test for independent samples Logistic Regression to obtain Odds Ratios with 95% CI to determine validity
Demographics Year of graduation Range 1955-2013 Mean = 17.2 years All 10 HRSA Regions represented Mean years since graduation from school Dentist= 15.8 RDH= 14.2 Median years since graduation Dentist= 13.0 RDH= 10.0
Demographics Dental Director 224/650 34.5% Staff Dentist 233/650 35.8% Dental Hygienist 144/650 22.2% Unclassified/missing 49/650 7.6% Gender Dentist 55.2% Female RDH 95.8% Female
Activity Prior to Health Center Employment Dentist Frequency Percent Private practice owner/partner/associate 124 28.5 Private practice employed dentist 81 18.7 Dental student 108 24.8 Local, state, public health agency/other community 54 12.4 dental center Grad dental program/specialty program 44 10.1 Commissioned Officer PHS/Military 21 4.8 Retired 3 0.7 Total 435 100 Dental Hygienist Private practice associate or employee 84 62.8 Dental Hygiene student 32 23.8 Local, state, public health agency/other community 16 11.9 dental center Graduate program 2 1.5 Total 134 100
Scholarships and Loans Received NHSC Scholarship Dentist 8.5% RDH 2.2% NHSC Loan Repayment Dentist 37.0% RDH 15.9% State Loan Repayment Dentist 11.8% RDH 9.4% Loan repayment completed 2009-2013 Dentist 31.8% RDH 72.3%
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
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
Highest Response Rate Responses from dentists Felt a mission to the underserved 42.2% Loan repayment available in HC 19.9% Wished to practice dentistry in HC 10.3% Responses from dental hygienists Felt a mission to the underserved 43.1% Wished to practice DH in HC 22.2% Attracted by work schedule/leave 16.0%
Perception of Autonomy Dentist Number Percent Full Autonomy 225 50.2 Limited Autonomy 223 49.8 Dental Hygienist Full Autonomy 88 62.4 Limited Autonomy 53 36.8
Perception of Limited Autonomy Top three reasons reported for dentists Level of patient compliance with treatment Limitations on types of services due to $$ Scope of treatment offered at HC practice Top three reasons for RDH Level of patient compliance with treatment State s Medicaid policies/requirements Amount of access to specialists
Availability of Specialists Type of Specialist N % Oral Surgeon 93 14.3 Pediatric Dentist 117 18.0 Periodontist 29 4.5 Prosthodontist 23 3.5 Orthodontist 4 0.6 Other (incl. Endodontists) 18 2.8 No Specialists Available 389 59.8
Perception of Admin Time Mean time reported 9.7 hrs Enough time allowed 40.0% Some but not enough time 47.1% No time allowed 12.9%
Are Benefits Adequate? % Answering Yes Dentist RDH Leave Time (PTO) 74.8% 66.7% Medical Insurance 71.8% 72.6% Retirement Plan 91.3% 94.2% Employer Match 66.7% 78.8% Production Incentive 34.2% 19.1%
Vacation/PTO Dental Director Median # days = 27 Staff Dentist Median # days = 23.5 Dental Hygienist Median # days = 20
CE Allowance Dentist 5.0 Days (Median) RDH 4.0 Days (Median) Dental Director $1849 (Mean) Staff Dentist $1789 (Mean) Dental Hygienist $1048 (Mean)
Length of Time in HC Dentistry Dentist Number of Valid 436 Number of Missing 21 Mean 8.19 Median 5.00 Mode 3 Percentiles 25 3.00 50 5.00 75 11.00 Hygienist Number of Valid 133 Number of Missing 11 Mean 6.28 Median 4.00 Mode 1 Percentiles 25 2.00 50 4.00 75 8.50
Years in Health Center (Dentist)
Years in Health Center (RDH)
Total Years of Practice Provider Length of time Frequency Percent Dentist Less than one year 16 3.5 1 to <5 years 86 18.8 5 to <10 years 90 19.7 258 10 years Missing 56.5 1.5 7 Total 450 100.0 Hygienist Less than one year 4 2.8 1 to <5 years 34 23.6 5 to <10 years 30 20.8 74 10 years 51.4 Missing 2 1.4 Total 142 100.0
Years of Total Experience Dentist RDH 3.5% 2.8% 56.5% 18.8% 19.7% 51.4 20.8% 23.6%
Perception of Facility Provider Frequency Percent Dentist Very good 183 40.0 Good 134 29.3 Adequate 68 14.9 Needs improvement 40 8.8 Poor 7 1.5 Missing 25 5.5 Total 457 100.0 Hygienist Very good 61 42.4 Good 41 28.5 Adequate 18 12.5 Needs improvement 10 6.9 Poor 2 1.4 Missing 12 8.3 Total 144 100.0
Perception of Equipment & Supplies Provider Frequency Percent Dentist Very good 148 32.4 Good 153 33.5 Adequate 89 19.5 Needs improvement 44 9.6 Poor 1 0.2 Missing 22 4.8 Total 457 100.0 Hygienist Very good 44 30.6 Good 39 27.1 Adequate 28 19.4 Needs improvement 22 15.3 Missing 11 7.6 Total 144 100.0
Perceptions of Support Answering Adequate %Dentist %RDH Number of DAs 65.9 68.8 Quality of DAs 72.6 70.8 Clerical support 58.4 52.8 Admin support 65.6 68.1 Number of Dentists 69.8 61.1 Number of RDHs 63.5 72.2 Number of EFDAs 29.8 40.3 Assistant to Dentist ratio 63.7 74.3 Interaction with Medical 60.8 61.1
Dentist Salaries Reported 40 35 30 25 20 15 10 $95K $95K-$110K $110K-$125K $125K-$140K >$140K 5 0 Dental Director Staff Dentist
RDH Salaries Reported Dental Hygienist Salary Distribution 35 30 25 20 15 10 5 0 $40K $40K-$50K $50K-$60K $60K-$70K >$70K
Dentist 2009 vs 2013 Distribution of Dentist Salary by Survey Year 30 25 20 15 10 5 0 2009 2013
RDH 2009 vs 2013 Distribution of Dental Hygiene Salary by Survey Year 40 35 30 25 20 2009 2013 15 10 5 0 $40K $40K-$50K $50K-$60K $60K-$70K >$70K
Non-Salaried Personnel Dentists Mean hourly fee $66.84 Median hourly fee $62.00 Dental Hygienists Mean hourly fee $32.44 Median hourly fee $34.00
Memberships Dentists #1 ADA 61.3% #2 NNOHA 40.0% #3 AGD 19.5% #4 None 14.2% Employer reimbursement YES= 60.5%
Memberships Dental Hygienists #1 ADHA 46.5% #2 None 30.0% #3 NNOHA 25.0% Employer reimbursement YES= 49.2%
Encounters Required? All providers were asked if encounter quotas were mentioned by administration of Health Center: Yes= 64.5% Average # reported Mean # 2,667 Median # 2,600 Mode # 2,500
Intend to Remain in CHC Dentists 83.6% 362/433 Dental Hygienists 93.9% 123/131 Of those intending Dentist RDH to leave Leaving in 2-5 yrs 37.5% 33.3% Within one year 29.2% 22.2% ASAP 33.3% 44.4%
Executive Director Survey FTEs Unfilled positions Salary information Benefits information Recruitment methods
Vacancies Dentist Frequency Percent Valid Percent Less than 6 months 29 11.8 64.4 6-12 months 10 4.1 22.2 >12-24months 2 0.8 4.4 >24 months 4 1.6 8.9 No Vacancies 110 44.7 Missing 91 37.0 Total 246 100.0
Recruitment Methods For Dentists Working with NHSC 11.4% Networking PCAs 9.3% Newspapers 9.3% Dental Schools 8.1% NNOHA Website 2.8%
Hygiene Vacancies Frequency Percent Valid Percent <6 months 7 2.8 50.0 6-12 months 4 1.6 28.6 >12-24 months 2 0.8 14.3 >24 months 1 0.4 7.1 No Vacancies 139 56.6 Missing 93 37.8 Total 246 100.0
Salaries: Dentists and Dental Hygienists by Level of Experience Dentist Mean Dentist Median RDH Mean RDH Median Entry to 1 yr >1 yr-5 yr >5 yr-10 yr >10 yr Fringe % $108,927 $111,514 $122,304 $125,518 23.6 $110,000 $112,500 $131,000 $135,000 25.0 $52,093 $48,287 $55,870 $60,953 20.2 $48,200 $49,000 $54,000 $62,500 23.0
Use of Contract Labor Contract Dentist (Used in 17.6% of HCs) Lowest Mean/Median $75.19/$70.00 Highest Mean/Median $81.21/$75.00 Contract RDH (Used in 5.5% of HCs) Lowest and Highest Mean $35.20/$40.17
STATISTICAL ANALYSIS OF ASSOCIATIONS
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 Etc.
Significant Associations Years of Health Center practice Years of total experience Level of autonomy in practice Pre-existing value of loan repayment Administrative support/clerical support Quality of facility/condition of equipment and supplies Number & quality of dental assistants Number of EFDAs employed Interaction with medical colleagues in Health Center practice
Significant Associations Experience Overall 10 or more Reference group >5 but <10 OR=2.71 p=.001 >1 but <5 OR=2.56 p=.003 <1 year OR=3.57 p=.022 Using logistic regression model
Associations Years of CHC Experience Intend to Remain 8.04 yrs Intend to Leave 5.33 yrs t-test <.001
Associations with Intent to Leave Health Center Practice Autonomy OR 3.30 p<.001 Loan repayment OR 2.06 p=.032 No. Assistants OR 1.76 p=.024 Quality Assistants OR 2.67 p<.001 Number of EFDAs OR 2.20 p=.008 Admin Support OR 1.97 p=.006
Associations with Intent to Leave Health Center Practice Clerical support OR 1.74 p=.021 Rating of facility OR 2.00 p=.006 Rating of equip OR 2.29 p=.001 and supplies Interaction with OR 2.86 p<.001 Medical Colleagues
Summary and Discussion Trends appear to be similar in 2013 with a few important changes Wages and benefits are improving Workforce in HC seems more stable Non-response bias Unknown numbers of providers in HC dental components
Contact Us! Ken Bolin, DDS, MPH Associate Professor and Graduate Program Director Department of Public Health Sciences Baylor College of Dentistry kabolin@sbcglobal.net NNOHA 303-957-0635 info@nnoha.org www.nnoha.org
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