If you live on Molokaʻi and need to see a dentist, you may have to wait as long as one year. The Molokaʻi Community Health Center is one of just two dental providers on the island, and right now, its wait list is 10 pages long.
“The most common metric that we look at for access, how many months wait does a new patient put on a list when they walk in and say, 'I have tooth problems. I need help,'" said Dr. Don Sand, a public health dentist on Oʻahu who's been working with the health center to find solutions.
“So right now in Hawaiʻi, the average waitlist is around 10 months. So I think Molokaʻi is probably around 12 months,” he explained.
The health center has been working for the past several years to come up with a plan. CEO Milton Cortez said they're nearing completion on a major expansion of their dental facility.
“So initially we had three chairs there, and now they've gutted the whole facility, and we'll put six chairs — two for the hygienists and four for dentists,” Cortez said.
The nonprofit health center offers a variety of health care, including medical, dental, and mental health and wellness services, to the island’s more than 7,000 residents, regardless of their ability to pay.
Construction of the renovated dental facility is funded by a $1.2 million federal grant from the previous administration. The new facility will be completed in July, and a grand opening is planned for August.
“So what you're seeing here, it's basically the skeletal shape of the new health center [dental building],” said Cortez, walking through the construction zone. “We're going to have the six rooms… This is going to be the lab. We've got a significant donation from HDS Foundation, and we'll be investing in new lab equipment.”
Historically, the health center has relied heavily on visiting or temporary dentists.
“In 20 years, we've had over 25 dentists because we burned them out,” Cortez said.
Recently, the load has been especially great.
“They were seeing 24 to 28 patients a day, in a 10-hour day,” he explained. “That is unsustainable. So we're gonna scale back once we address the emergency — the 10-page list — and create a true program that does not burn out the provider, that provides them with a good work life balance.”
The health center has hired a full-time dentist who will live on Molokaʻi. Dr. Paula Gardner worked there about seven years ago, and is looking forward to returning long term, Cortez said.
For residents, that’s great news.
It’s also a relief for Molokaʻi private practice dentist Dr. Boki Chung. Two out of three private practice dentists on Molokaʻi have retired in the past year, and she’s the only one left.
Chung said it’s important to her to see the health center’s dental program succeed, and she’s been volunteering to help during the expansion efforts.
“I think it's in my best interest to find a dentist that is good for the island, that would stay on the island and would continue to serve the island, because then, then I can have a dentist on the island,” she told HPR. “I don't have a dentist [here], I have to fly off island.”
Chung said that attracting long-term health care providers to the island is challenging. But she’s willing to do whatever she can to help.
“I think the health center is very critical in filling the need for our community, because a lot of our population is under-insured or not insured, or they're on Medicaid. And with Medicaid insurance, the reimbursement rate for federally qualified health centers is very different from how private practice offices get reimbursed.”
Many private practice dentists no longer accept Medicaid patients because the government reimbursement system makes it difficult for private practices to break even financially, Chung said.
Yet Sand said Molokaʻi's need for dental services is critical.
“I have been on every island doing outreach work. I would say Molokaʻi's severity of how rapidly dental decay is going is the worst I've seen,” he explained.
"Another metric is, how often does the average patient access the ER? And I know after when I came to do a locum in January, there had been no dentist there for six weeks. I would say every third patient either had been in the ER or were likely to end up in the ER if we didn't do a diagnosis… and start some kind of treatment.”
As the health center rises to address that need, Cortez said it won’t all be smooth sailing.
Hawaiʻi's 14 federally qualified health centers are preparing for proposed slashes to public health funding, particularly through the U.S. Department of Health and Human Services.
“We're all expecting a 10% to 15% cut. We’re all preparing,” Cortez said.
In the meantime, there’s progress to celebrate.
“I think that we've turned a corner, but it's going to take time, because we have to show consistency,” he said. “Our Aug. 9 grand opening, I think that's kind of our kind of coming out and saying, 'Here's what we've built for this community, and help us make it better.'"
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