If you live in rural Minnesota, there's a good chance going to the dentist may mean a trip to another town.
A 2008 survey by the Minnesota Department of Health Office of Rural Health and Primary Care reported that although rural Minnesota has 13 percent of the state's population, it has only nine percent of the state's practicing dentists. The ORHPC lists more than Minnesota counties - including Lincoln, Lyon, Murray, Redwood and Yellow Medicine County - as areas with a shortage of dentists.
Why are there fewer rural dentists? It could be because of a number of factors, from the challenges of having a rural clinic to the kind of lifestyle the dentist wants, local officials and dentists said. Helping to solve the problem may mean offering incentives for new dentists, or finding dentists looking for the small-town life.
"It's harder to get (dentists) to stay, unless they're originally from the area," said Tracy EDA director Robert Gervais. The city of Tracy has been without a private dental clinic for a couple of years, Gervais said and an EDA committee has been working to try and attract a new dentist to town.
"We've had people in the community tell us how important it was," Gervais said. In the meantime, he said Tracy has been lucky in that there are dentists nearby in Walnut Grove and Balaton.
Venkatraman Duraiappa, a dentist who began practicing at the Dental Health Center in Marshall this summer, agreed that it can be hard to keep a new dentist in a rural area. Duraiappa practiced in Morris and St. Charles, Minn., before moving to Marshall.
"The problem is not recruitment, but retention," Duraiappa said. Rural dentistry can have financial and practical challenges, he said. Location of the clinic is one.
In rural areas Duraiappa said, "people generally have to drive some 30 to 40 miles" to go to a dental appointment, and specialists for procedures like gum surgery or root canals are even farther away. Duraiappa said this means he works to maintain a wider variety of skills than he probably would practicing in a bigger city - it's not always feasible for patients to go to Sioux Falls or Mankato for a root canal.
"There's a cost for the patient to drive out there for a whole day," he said. In rural areas, he also tends to see more people on medical assistance.
Gervais said part of the Tracy EDA's strategy is to find a dentist who is already invested in the area, Gervais said. They think the community may have more opportunities to offer a younger person with family nearby.
Gervais said the EDA has been talking to one possible dental recruit who grew up in the Tracy area. However, he said that candidate is still in dental school and wouldn't be practicing for another three years.
Family and a desire to live in a smaller community were among the reasons both Duraiappa and Brandon Wilcox, a new dentist at Camden Dental Care in Marshall, said they chose to come to the area.
Wilcox grew up in Boulder, Colo., but he said the pace of life is faster there.
"There are a lot of opportunities in a bigger city, but there's also a lot more competition," Wilcox said.
Practicing in a smaller community also allows more of a chance to get to know your patients, Duraiappa said.
Wilcox said personal preference probably has a part in where dentists choose to practice. He said many of his classmates in dental school were from "big-city" areas, and it's possible they felt more comfortable there.
"A lot of professors try to influence you toward rural areas, because the need (for dentists) is highest in rural areas," Wilcox said. There are also scholarships and other opportunities geared toward rural dentistry, he said.
Gervais said Tracy is also trying out financial incentives for a new dentist. An incentive package that recently met with approval from the Tracy City Council included a total of $75,000 in loans over three years to start a private dental practice. The loans would also be forgivable at 10 percent a year for 10 years, unless the practice closes.
Wilcox said he had heard of incentive programs for rural dentists "a couple of times. South Dakota has a repayment program for student loans." The program covers a percentage of a dentist's loan payments if he or she stays in a rural practice for at least five years, Wilcox said. "I've also heard of public health clinics offering a repayment program."
Incentive plans for new dentists could work out to be effective, Duraiappa and Wilcox said, especially with a time commitment involved. Financial incentives might be even more attractive in light of the economy, Wilcox said.