May 9, 2008
ENCORE JOURNEY: Dentist spearheads low-income clinic
Seymour Rettinger was devastated when his orthopedic surgeon looked at his arthritic fingers and told him he had to stop practicing immediately. Rettinger had been a dentist for more than three decades.
Now he has a new career heading a nonprofit dental clinic for low-income families in Middlebury, Vt.
He is amazed to find himself doing things he never imagined, like writing business plans, meeting with local funders to solicit grants and combing census data. He’s now working more than full time and loves his new career.
“The need is here,” he said, “and uniquely, I fill that void because I have the skill, the motivation and the time. And the time is the most important. I can give all my time to this.”
Back in July 2001, Rettinger had reluctantly followed his doctor’s advice to close down his New York City practice. “I reacted badly,” he remembers. “My world ended. I had four fingers that just wouldn’t work.”
After identifying himself as a dentist for his entire life, dramatic change seemed in order. “I felt I really needed to reinvent myself,” Rettinger said. “If we had stayed in New York City, I really would have been traveling in my own shadow, feeling like the ghost of Hamlet’s father.”
He found his new start in Middlebury, Vt., where he had and his wife had enjoyed a summer home for a number of years. It suddenly seemed possible to live there full time, particularly as their son was now teaching at Middlebury College. The Rettingers made the leap, selling their summer home and buying a home to live in year-round.
Once part of the Middlebury community, Rettinger started sniffing around for something to do. He joined the board of the local free medical clinic and discovered an unmet need for dental care for low-income and uninsured patients. Local dentists were turning away Medicaid and uninsured patients, simply unable or unwilling to absorb them. Many were scaling back their practices as they approached retirement, unintentionally exacerbating the problem.
Rettinger knew of another dentist in Brattleborough, Vt., who had started a practice offering dental care for Medicaid and uninsured patients offset by fees paid by full-service clients. The clinic was a success, enough so that a second clinic had recently opened.
He thought a similar practice could work in Middlebury. He looked into census data and learned that 9,000 men, women and children locally covered by Medicaid were in need of dental care, and only 23 percent of them were receiving any dental services.
Rettinger was named president of a new nonprofit, Addison County Dental Care (ACDC), and set to work making his dream into reality. The organization secured space and put in place a plan to hire a dentist to run the ACDC-owned practice as if it were his or her own. When it opens, the practice will be fully equipped with top-grade medical care and will have a dental assistant.
The dentist who runs the practice will both treat Medicaid and uninsured patients, who will account for 40 to 50 percent of clients, and make a decent living through the paid-for-service paying patients. “It’s a chance to be entrepreneurial,” Rettinger explained. ACDC aims to treat 900 new lower-income clients in the first year.
ACDC has raised $300,000 so far. To get the operation running, Rettinger needs to raise another $150,000. “We absolutely believe it will work here,” he said.
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Dr. Rettinger Is on to Something Important!
Dr. Rettinger’s Encore work in Vermont, and the clinical work of the Brattleboro, Vermont dentist, suggests to me that a significant unmet need has been identified. On April 28, 2008 the NY Times had an article of a rural Alaska community finding ways of meeting dental needs without dentists. That too confirms the importance of Encore work and the creation of public purpose jobs for experienced older people.
Three items come to mind:
1. Just as we had medical students have loans forgiven if they went to areas depleted of doctors, we can do the same for dentists.
2. In Alaska dental therapists—trained people—are doing the work well. This has been confirmed by a Baylor University Dentistry school study. Therefore state law restrictions on people doing such dental therapy, who are properly trained, are unwise.
3. Encore work can be done by people identifying those with unmet needs, including children and seniors. Such identification will encourag people to get dental care in underserved rural, urban and near suburban locations throughout the US.
more dental care encore careers
Dr. Richard Niederman is a 2007 Purpose Prize fellow. Here’s a description of ForysthKids, his project for prevention and detection of tooth decay and dental infections.
As a practicing dentist, Dr. Richard Niederman was all too familiar with the threat untreated tooth decay poses to underserved populations, especially children. Dental infections are the most common chronic early childhood disease – five times more common than asthma – and they are preventable. Moreover, dental disease can seriously affect a child’s ability to eat, speak, and learn, and is entirely preventable.
To address this challenge, Niederman developed ForsythKids, an evidence-based, comprehensive, cavity prevention program for at-risk elementary school children. Children enrolled in ForsythKids – more than half of whom are eligible for free or subsidized lunches – receive free dental exams, tooth cleaning, comprehensive preventive care (including fillings without drilling), and oral health education twice a year — all at their school sites.
During the 2006-2007 school year ForsythKids secured funding for and collaborated with 12 Massachusetts schools. For the 2,500 children who participated, 73 percent had untreated cavities and 12 percent had acute infections or abscesses. With one round of prevention, children had a 50% reduction in new decay.
For the 2007-2008 school year, the program is expanding to 33 Massachusetts schools and offering the care to 20,000 children. New program models are in development in New Hampshire, Colorado, and Arizona.
David Bank
Editor, Encore.org