Vermont dentists fear the coronavirus pandemic is an existential threat, and say the state’s response to help them survive has been inadequate.
In a recent conference call with Rep. Peter Welch, dentists said in a state already struggling to meet the needs of a rural and impoverished population, the pandemic may push some dental practices into bankruptcy.
Emily Hill, a general dentist at Timberlane Dental Group in South Burlington, told Welch that 75% the children she sees are covered by Medicaid, which only pays her about 40 cents on the dollar.
“We’re all small businesses, not hospitals with hospital budgets,” Hill said. “Trying to pass on costs when we’re already getting 40 cents on the dollar, we can’t afford it. It was hard enough before all this happened.”
In a subsequent interview, Tom Opsahl, president of the executive board of the Vermont State Dental Society, told the Burlington Free Press dental practices have had a hard time getting personal protective equipment from state stockpiles.
“For at least 11 weeks we were in the position of trying to get the proper PPE (personal protective equipment),” Opsahl said. “We were not first in line at all. We didn’t have very good communication between the Office of Oral Health and the Department of Health.”
Loren Peck, president-elect of the executive board of the Vermont State Dental Society, characterized the situation as particularly “precarious” for younger dentists, who were blindsided by the pandemic.
“I think we’re going to lose dental practices in a state already suffering from workforce issues,” Peck said. “It’s not going to be good.”
Masks in short supply
Steve Rayes, a pediatric dentist in Norwich, spent more than $800 to purchase 60 masks at $14 each on eBay. Before the pandemic, those masks would have cost about $1.95 each.
“The state sent us some N95 masks,” Rayes said. “Unfortunately in my case only one member of my entire team fit-tested adequately to the masks they sent. That takes care of one. I have eight others to get fit tested adequately, including myself.”
Rayes explained that unless a mask forms a tight seal on a person’s face, it does not protect against the coronavirus. The fit test kit is supplied primarily by 3M, which makes the N95 mask. Rayes said dentists face the same supply problem with the test kits as they do with the masks, as the kits are “few and far between.”
“The hope is eventually the supply chain will open up and I can hold out that long,” Rayes said. “For now I’m eating the extra cost, but I don’t know how long I can last.”
Rayes said he knows at least one pediatric dentist who chose to retire rather than reopen from the pandemic. He said he also knows of between 9 and 11 associate dentists who were furloughed, and he’s not sure how many of them will come back to work.
Health Department spokesman Ben Truman acknowledged that demand has exceeded supply for the state’s stockpiles of personal protective equipment, but said dental practices are included in the state’s priority allocation system.
Vermont is currently providing personal protective equipment only for urgent and emergency medical and dental health care procedures, Truman said.
In neighboring New Hampshire, Rayes said, dentists are supplied masks free for all procedures.
Robin Miller, director of the Office of Oral Health, confirmed that New Hampshire provides masks free to dentists even for routine procedures, and said she’s mystified.
“As oral health director of Vermont I know for a fact all states have this issue (with personal protective equipment), this is a national problem,” Miller said. “I don’t know how New Hampshire is able to offer PPE for dentists for elective procedures.”
A luxury, not health care?
Miller said she understands where dentists are coming from when they say they feel overlooked.
“There’s been a long-standing separation in this country between medicine and dentistry,” Miller said. “When it came to COVID-19, we’re seeing a symptom of that. I agree with them that oral health care is not seen as health care. Oftentimes it’s seen as a luxury. I see why they feel they way they do.”
But Miller rejected the notion that she has not been communicating with dentists, or looking out for their interests.
Miller said in mid-March she formed a working group with Vaughn Collins, then executive director of the Vermont State Dental Society, as well as the Board of Dental Examiners and Vermont Emergency Management, to address the pandemic and its effect on dental health care providers.
Among the steps the group took were to develop health alerts for the dental community to keep dental health providers updated on state policies regarding dental procedures, as well as putting together a network of practices to deal with dental emergencies.
Dentists shut their practices voluntarily on March 16, before the state mandated they close four days later. They made themselves available at the state’s request for dental emergencies, so hospitals wouldn’t be overrun.
“I was emailing and texting that group on an almost daily basis for two months,” Miller said.
A weak federal response
In their call with Rep. Peter Welch, Vermont dentists asked about the difficulty getting personal protective equipment. Welch offered an explanation, but said unfortunately he couldn’t give them a solution.
While the federal government did have a strategic stockpile of medical supplies including personal protective equipment, Welch said, it proved inadequate.
“When COVID started the cupboard was not bare, but it wasn’t full,” he said. “The supply we needed wasn’t there.”
On top of that, Welch said, the federal response to the COVID-19 crisis, and the need to ramp up distribution of personal protective equipment at the national level, was weak.
“To be blunt here, the Trump administration did not accept that responsibility,” Welch said.
Instead, states were left to fight over supplies of masks, gowns and gloves.
“Each governor was desperate to protect the well-being of the citizens of the state and was competing with other governors,” Welch said. “That makes no sense. Gov. Cuomo and Gov. Scott should not be competing. It’s very frustrating to us that the administration hasn’t taken on a central role.”
Even though Congress passed $75 billion to procure personal protective equipment as part of the CARES Act, Welch’s office said, the administration continues to do a poor job of centralizing and administering the distribution of the equipment to states. States are still competing with each other, prolonging the shortages of personal protective equipment, despite the investment to purchase the equipment in the CARES Act, according to Welch’s office.
“Dentistry is very challenging in Vermont,” Welch said. “Rural Vermont and rural America has incredible need for the services you provide.”
Contact Dan D’Ambrosio at 660-1841 or firstname.lastname@example.org. Follow him on Twitter @DanDambrosioVT. This coverage is only possible with support from our readers. Sign up today for a digital subscription.
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