State, dental schools start pilot program to forgive loans of dental graduates who set up practice in Appalachian Kentucky

By Al Cross
Kentucky Health News

ANNVILLE, Ky. – Two to five new graduates of Kentucky’s dental schools will each have up to $150,000 of their tuition debt forgiven if they practice dentistry in Appalachian Kentucky, under a pilot program state and university officials announced July 21.

Gov. Steve Beshear said the money will come from existing funds in the state Department of Public Health and will go to the dental schools at the University of Kentucky and the University of Louisville.

The shortage of dentists in Appalachian Kentucky is often cited as one reason the region and the state have such poor oral health.

“The lack of oral health care is a very serious problem in the commonwealth,” Beshear said, noting its appearance in news and reality shows: “Too often the face of our state is represented by a person with a number of missing teeth.” He said that’s an incorrect stereotype, but noted that only three states have a higher percentage of residents missing six or more teeth.

The pilot program will run for two years. It will cover up to $100,000 in outstanding dental-school loans for a new dentist who practices two years in Appalachian Kentucky. The commitment can be renewed for one to two more years to get another $50,000 in debt relief.

“We think this is going to be a very attractive program,” Beshear said, noting that the average debt of a U.S. dental-school graduate is about $280,000. U of L Dental School Dean John Sauk said starting a dental practice costs about $500,000, so “Going home to serve the communities in which they grew up is often not an economical option” for new dentists.

The program will give priority to students from Eastern Kentucky and graduates who practice in economically distressed areas.

“A lot of our graduates at UK and U of L really want to return home to practice,” said Dr. M. Raynor Mullins, project leader of the Appalachian Rural Dental Education Project of the UK Center for Oral Health. “I hear that from them every day, but high student debt is a real barrier.”

Dr. M. Raynor Mullins speaks as Gov. Steve Beshear (far left) and other speakers (right) listen.

U.S. Rep. Harold “Hal” Rogers said the program should send some in his Fifth District back home. He said dental-care access has been poor because “We’ve shipped out our talent for their education and the rest of their productive life” and given them little incentive to return. Meanwhile, more than half of Eastern Kentucky children aged 2-11 have tooth decay, he said.

Beshear said the program will save money in the long run by heading off more expensive dental treatment and costs for other health problems cause by lack of oral health.

Dentists in the program will be required to accept Medicaid patients. One obstacle to oral-health access in Appalachia is that many dentists won’t accept Medicaid, citing low reimbursements.

More dentists than ever are needed to treat the hundreds of thousands of Kentuckians newly covered by Medicaid after the state’s expansion of the federal-state program. State Health Secretary Audrey Haynes said 270,000 of the nearly 500,000 children enrolled in Medicaid visited a dentist last year.

“For our children, dental care has been particularly problematic,” Beshear said. “Hundreds of thousands of children don’t see a dentist regularly and many at all” and suffer pain, anxiety and low self-esteem “because dental problems can be pretty visible.”

Haynes illustrated the impact of the Medicaid expansion by reporting that fewer than 84,000 adults had a Medicaid dental visit in 2013, the year before the expansion, and that almost 184,000 visited a Medicaid dentist in 2014.

The announcement preceded a meeting of the executive committee of Shaping Our Appalachian Region, the bipartisan initiative started by Rogers and Beshear. Rogers’ endorsement of the pilot program suggests he may use it as the basis for federal appropriations or legislation to help other rural areas that need dentists or even doctors.

“When you put people first and politics second,” said UK President Eli Capilouto, “a lot can happen.” Capilouto, a dentist by trade, said the program “will make a big difference.”

Mullins said, “We now have a lot more assets in the Appalachian region that we’ve never had to work with,” including a dental education partnership with Morehead State University.

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