More dentists won't solve financial problem

Another report on the scarcity of dentists in rural areas of North Carolina will feed the arguments of proponents of a new dental school and expanding the state's one dental school. It shouldn't.

Yes, some residents of North Carolina have a difficult time finding dental care. There are two reasons: Either the care is too expensive or there is no dentist within close proximity. Four counties have no dental practices.

But the answer to this problem is not "Crank out more dentists." The answer is to develop programs to attract more dentists to rural communities and make it financially feasible for them to practice there. Simply increasing the number of dental graduates in North Carolina will not help rural communities. Dentists will flock to areas where they can make a decent living -- places like Charlotte, Raleigh or the Triad. Rural counties, where few people have dental insurance through their employers and where many residents rely on Medicaid reimbursements for dental care, will continue to be underserved. Many rural counties are also poor counties. Large numbers of their residents rely on Medicaid for medical and dental care. But Medicaid's reimbursements to dentists, as the new study points out, is far below the usual and customary charge, Most dentists say they cannot afford to provide care at a price below their cost of keeping the office open, so they refuse Medicaid patients.

Rather than just increasing the number of dental school graduates, North Carolina should concentrate on subsidy programs for dentists who are willing to practice in rural, underserved areas. These subsidies would help dentists pay off their graduate school debt, which the new study points out often exceeds $100,000. Setting up a dental office with all the requisite equipment costs several times that amount. No sane dentist is going to invest that kind of money in a town where he can't meet his debt payments.

Rather than investing millions of dollars in a new dental school at Greenville and an expansion of the school at Chapel Hill, the state could put that money into subsidies that would make dental practices in high-poverty rural areas financially feasible. In fact, the state could save a lot of money and have a far greater impact on rural dental care. The second action the state could take would be to increase Medicaid's reimbursement level for dental care. That would make more dentists willing to accept Medicaid patients and would make dental practices in rural communities more financially viable.

As the state seeks ways to save money to plug a $2 billion budget shortfall, dental school expansions are one practical and fiscally prudent means of cutting spending without hurting services. If the state would put a portion of the planned capital investments for dental schools into a well-planned rural dental subsidy program and an increase in Medicaid reimbursements, the state would save money and improve dental care.