Kansas reporter shares rural perspective on dental care Date: 05/01/14
By Mary Otto
Along with coverage of everything from Congressional wrangling over the Farm Bill to livestock management to wildlife conservation, High Plains/Midwest Ag Journal’s senior field editor Larry Dreiling finds time to tackle health stories. He sees access to health services as essential to sustaining rural life.
He says his own search for treatment for hypertrophic cardiomyopathy, a thickening of the heart muscle, four years ago sharpened his insights into the challenges faced by many of his neighbors in rural America. They may live many miles from a needed specialist or emergency room. Or, as he points out, they may need to drive two hours to get to a dentist.
In Alaskan tribal areas and in Minnesota, technically-trained dental therapists are working under the general supervision of dentists to extend care to under-served and isolated communities. The model is now being explored in Kansas, as Dreiling has reported. As in other places, the idea has drawn strong opposition from some leaders in the state’s dental association who contend that only dentists should be allowed to perform procedures such as drilling and extracting teeth.
Yet in a long feature published last November, "Few Smiles as Rural Areas Struggle with Dental Care," Dreiling got a more nuanced view of the issue from rural dentists who said they believe dental therapists could be part of the solution to the care shortage in Kansas.
Dreiling followed up with a story in February on a new study that looks at how the model has worked in Minnesota and Canada headlined “Rural dental therapists help more patients.”
Dreiling was kind enough to take some time recently to talk about his coverage and to offer advice to other reporters about telling health care stories in rural America.
Here, in a somewhat abbreviated version, is our conversation.
Q: The High Plains/Midwest Ag Journal features stories about farm-related legislation, livestock, crops, irrigation techniques, veterinary medicine, but it looks like you have carved yourself a niche as a health care reporter there. What kind of feedback you get from your readers about your health stories?
A: I get a lot of interesting feedback mainly because we are out in rural America, everybody has a story dealing with the health care system, whether it is having to drive to find the right kind of specialist or in this particular case we are talking about, dental care. The dentists are in cities. They are not in small towns. And so access is really tight. In big cities, it’s about “what network should I choose?” In rural America there are very few options. It’s about just finding a health care provider that’s appropriate.
Another thing is emergency care. People work with very dangerous farm equipment. Where do I go if I have an accident? What kind of trauma care is there? The golden hour, getting from incident to surgery within an hour – we don’t have that. It’s the golden three hours if you are lucky. All these areas of reporting are completely different than what folks in big cities have.
Q: How has this focus on health journalism at the Journal evolved?
A: About five years ago we at the Journal decided to make it part of the whole idea of covering living in rural America. Whether you are going to have a grocery store or a convenience store or a gas station, or your church. Having a doctor. Having a dentist. Having one provider. One provider matters. Not having a dentist. This is a big deal. And so these are things I am particularly jazzed about covering … working toward making things better for those of us who stay on the land and love the land and want to take care of it, and do the best we can so that all the folks in urban America have the most inexpensive most plentiful, safest and abundant food supply in the world.
Q: In one of your recent stories you cited a report by the Kansas Health Foundation and quoted Steve Coen, the president of the group.
“We’re facing a dental crisis in the state,” he said. “Of the 105 counties in Kansas, 93 have too few dentists, and 13 have none. Too many adults and children are living in pain.”
You also mentioned a 2011 report done by researchers at the University of Kansas Medical Center that found at least 57,000 Kansans live in “dental deserts,” areas where the closest dental office is at least a half-hour’s drive from where they live.
One dentist you spoke with said that when getting care is such a trek, people are reluctant to make the trip for preventive care. But on the other hand that kind of routine care can help prevent the pain and need for extractions that dentists saw many of the more than 1,000 patients who showed up at the free Mission of Mercy clinic your colleague Dave Bergmeier covered recently in Dodge City.
A: If you look back at the history of our military, that was the thing that most of the guys who were GIs in World War II and Korea and Vietnam. That was the one thing they had to go through when they were going through their initial basic training. A lot of them had to go back and go to the dentist and get care that they had never received before. They had grown up never getting proper prophylaxis every six months. My dad grew up on a farm. He’s 93 years old. When he was a boy he never went to the dentist. And when he was in the Army, at 20 years old, he had to get 13 fillings, because they had never done prophylaxis on him.
Q: And your own journey through heart disease also gave you some very personal insights into the search for specialty care in rural places.
A: The folks at the Journal turned me loose on this and said “run with this kind of stuff.” It’s very well-received by a lot of people. For advocates out in the communities they say “did you see this newspaper article?” I don’t claim it’s due to any genius of mine but I do try to practice a little bit of advocacy journalism here.
Q: Well that brings us to Registered Dental Practitioners (RDPs). How is that debate unfolding in Kansas?
A: They are being used right now in Alaska and in Minnesota. In Hays we have a college with a big nursing school and a bachelors degree (program) in radiation technology. The school teaches radiation therapists and nurses. They want to be the home for this RDP program. They want to create a five-year program that would be an RDP program. Of course we are meeting roadblocks from the professional associations. But it’s not about politics. It’s purely geographic. It’s the rural west versus the urban eastern part of the state. The Kansas City suburbs, Topeka and Wichita – their natural fear is that these RDPs will set up a business model which will be cheaper and will basically be dental work. When it really wouldn’t be cheap dental work at all. Dental work is dental work. They need to do something. I am hoping we will see some movement on this.
Q: What is the status of this issue in the state legislature?
A: They took it up last year and it didn’t go very far. But its one of those perennial things now that gets brought up. People are beginning to advocate for it. There are people, administrators in these small town clinics that are really into this, trying to get this thing done for a lot people who need help.
In Chrysanne Grund’s clinic in Sharon Springs, there is a space there for a dental clinic.
As reporters we try to be fair but we also have to be advocates for ourselves. Because nobody is going to advocate for rural America but rural Americans.
Q: This dental workforce debate is coming to many states. Any advice for other reporters who may be hearing murmurs?
A: If they hear murmurs about this issue they need to pick up on it. As the cities are becoming much more urbanized it’s going to get lonely out here as our legislatures run out of rural legislators. It will be an all or nothing kind of thing and rural America is going to suffer for it. Urban America needs to fully appreciate rural America and what the American farmer does. You need to appreciate us.