Beyond Private Practice: Exploring Public Health Dentistry Careers

You're listening to the Phil Klein Dental Podcast from Viva Learning.com. Working as a dentist in a community health clinic is not for everyone, but Dr. Khushbu Shah really loves it. In fact, she enjoys it so much, she convinced her husband to leave private practice and work in a community health center himself. Having immigrated to the U.S. at the age of eight, Dr. Shah feels like it's been a journey coming full circle. Being able to give back to the community and serve such a varied patient population brings her immense joy and fulfillment. To give us some insight into what's going on in her life as a practicing dentist in a community health center is our guest, Dr. Khushbu Shah. We're very happy to have her on the show. Dr. Shah, thanks for joining us. Thank you, Phil. So, yeah, I mean, we're very happy to have you. And, you know, we don't do a lot of interviews with dentists that are in the community health sector. And I think it's important for our audience to know what opportunities are out there in that sector. And besides being an incredible service to the community members, there's also a lot of career fulfillment on your side, which I want you to talk about with us and other opportunities as well. But to begin. What was your inspiration for going into public health versus private practice? Well, during my fourth year in dental school, I went on a rotation to a rural village in Guatemala for a month. It was an amazing experience that really opened my eyes. We treated people of all ages, and it was just shocking to see how different dentistry was there. We made do with basic, very basic equipment, and one of them included a cardboard dental chair, buckets of water for cleaning, and a calvicide spray. That's it for sterilization. My experience in Guatemala made me realize how much I wanted to help people who have limited access to dental care. And while I'm grateful for everything I learned in prior practice, I decided to pursue a path in public health. And it's really allowed me to provide care to patients most in need who have limited access to care, regardless of their financial situation. Yeah, so you worked in private practice for one year. So tell us about that. Tell us about that one year in private practice, how that went. And then since then, which is what, 2013? Correct. You've been working at the public health clinic. Yeah. So in private practice, you know, of course, it was a different experience because it was more production based and it was just a different mindset. And over in public health, I realized the biggest change was I can focus more on patient care and fully be. indulge in just patient care and not having to worry so much about everyday production. Obviously, this has given you tremendous career satisfaction. Yes, definitely. I mean, I've been there for over a decade and, you know, I love it. I absolutely think it's a great path and it's the right one for me that I chose. So when a dental student graduates dental school, they're saddled with... whole ton of debt, usually, unless they have a trust fund or a rich father or mother or whatever, if they're lucky. But in most cases, I know I had a lot of debt. How do you reconcile that? How do you deal with that debt going into a community health clinic where you're not going to be compensated as much as you would be in a private sector or private practice? Well, I think one of the wonderful things that being in public health, They provide a public service loan forgiveness, and that's a program that I believe is in all states. But in Illinois, we have a public service loan forgiveness program, and it allows, if you dedicate 10 years to public health, they help you forgive your student loans. Did you have debt from college as well? I did, minimal comparatively. Yeah, to dental school. So someone told me that. The school that I went to, which was University of Pennsylvania, because his daughter just got into dental school recently. She was just accepted. She's going to a state school in Texas, UT, San Antonio, I think she's going to end up going to. But he told me that tuition at Penn Dental School is $130,000 a year. Is that correct? I know it skyrocketed. Last I understood that NYU was one of the most expensive dental schools, but yeah, I wouldn't be surprised. I think UPenn is up there. Yeah. So I'm just wondering whether or not these high tuition universities and the tremendous debt that... young people are burdened with when they get out, you know, their main goal is to get out of the encumbrances of the debt. And the last thing they would think about is even if they wanted to work with the health clinics, they would say that they just can't make it work. But you're saying that they can actually forgive those loans based on a certain number of years working in the clinic, which is really quite amazing. Yes. And also throughout while you're... Working in public health, they have national health scholarships that help you throughout. So, you know, either it is subsidized or, you know, the scholarships will help you pay off the student loans throughout the 10 years. All right, that's great. So what are some of the challenges and rewards of working at a community health center? And what strategies have you implemented personally to ensure that you're providing the best care and you get the highest patient satisfaction? Well, community health centers, you know, it can often be challenging providing comprehensive dental care because we do limited procedures. And at health centers in general, factors like funding and staffing can be challenging. A big challenge that comes to my mind is referring to specialty care. So in turn, it requires us providers to manage a broader range of dental issues. Many patients present with very difficult cases and have years of dental neglect. So sometimes we find ourselves performing what we call heroic dentistry. So that can always be a little bit challenging. Rewards, I mean, that's, where do I start? There are so many rewards. One of them being... opportunity to make meaningful difference in the lives of underserved individuals and communities. I've seen firsthand how it contributes to their overall well-being. At our health center and many health centers, we have medical, dental, behavioral health, allowing the patients to take care of all their medical needs in one building, and it gives you a very wonderful overall better health outcome. So we talked briefly about this offline, Dr. Shah, that many of the public health centers face severe budget constraints, budget problems. That, of course, affects some of the treatment modalities that you can offer your patients under those circumstances. And you mentioned that you often use composite for the restorative work and you actually like single-shade composite for efficiency. So tell us a little bit about that and how that's helped you manage. the cost constraints, as well as deliver really good dental care to the patient? Well, first and foremost, I would say is cost effectiveness. Single shade composites are often more affordable than alternative restorative materials. So it allows us to stretch the budgets further and provide care to a larger number of patients. And versatility is definitely one of the things that, you know, I love about single shade composites because it allows me to use for restoration of anterior and posterior teeth, so it addresses both cosmetic and functional concerns. And most patients nowadays, they prefer tooth-colored restorations due to their natural appearance, so using single-shaped composites improves patient satisfaction and, of course, more importantly, compliance with treatment recommendations. Again, we talked offline about a case that you treated in the clinic of a patient from Africa that had a severe case of fluorosis. Tell us about that. Yeah. So, you know, one of the most interesting cases I had was I had a eight-year-old patient who was born in Africa. So he had a case of fluorosis, which I had never seen before. And it was so amazing for me to see the transformation because he was about to enter third grade and he was so nervous coming in. And I told him that, you know, he had like five different shades of enamel, like from brown to extra white, you know, just very severe fluorosis. I used Omnichroma on his. four anterior teeth and when he left my clinic and the the way that the patient felt and the dad felt they were so extremely surprised and happy was pretty much i did composite veneers with omni-chroma on all of them and he was just smiling and he was so excited to start third grade and he was just I was in awe of how amazing Omnichroma transformed his smile because I thought since there were so many different shades of enamel, this may or may not work. I wasn't sure. But with Omnichroma, I was able to give him a perfect smile. Those front four teeth transformed. Also, I love that single-shade composites can be used for conservative repairs of chipped, fractured, or decayed teeth, avoiding the need for more extensive and costly procedures. So this conservative approach aligns with the principles of public health dentistry and emphasizes prevention and minimally invasive interventions. So when it comes to treating your patients, Dr. Shah, at the clinic, is patient education a priority as far as instilling in them how important it is for them to visit the dentist on a regular basis and what they should be doing at home as far as compliance? Yes, yes, definitely. So the biggest thing is patient education. You know, at my clinic, We have a very, very diverse population. Majority are new immigrants and refugees from more than 55 countries. And more than 80% of our patient population are better served in a language other than English. So most of our providers and myself, I fluently speak three different languages and conversational Spanish. So it really helps build trust and satisfaction. So it requires a very tailored approach to care. Most important thing is patient education. Since they come from all different parts of the world, I want to make sure that I'm starting when they're young. We start telling them to bring them as soon as their babies are one year old. And I see so many, you know, families, so siblings. And it all starts, it all starts at the... young age for sure most of them are shocked they're surprised they're like oh you go to the dentist every six months like they just don't have that concept because in their countries they only used to go when there's pain so you work in a community health center in in chicago's north side um correct so do you have a shortage of these health clinics that provide dental care where you're backed up for months and months and months and you're not able to see these patients as regularly as you would like or Is there adequate care for these patients? Yeah, I mean, that's definitely is very challenging because, you know, we are very, I mean, my clinic, we have four locations, two in the suburbs and two in downtown, just a block away from each other because we have such a high patient need. So it's definitely difficult. And, you know, we are very busy. So patients don't get comprehensive treatment as quickly as you would in private. practice setting but you know we do our best and it's kind of like we work with what we can. So how many dentists work in your clinic? I'm the only dentist at my clinic but we have four dentists total at all our different sites. Okay so the FQHC Community Health Center has four different sites? Yes so FQHC is a federally qualified health center so in general that's what they're all called but our clinic is called AHS Family Health Center and we have Four locations, two in Chicago and two in the suburbs of Chicago, northwest suburbs. Okay, so you're the only dentist at your clinic. At my clinic, yes. Wow. What happens if you have a question, you want to ask a colleague a question about something, where do you get the... Oh, well, we have another clinic down the street, I mean, a block away. So, you know, we all work together, all as dentists, we collaborate and we can ask each other clinical questions. It's really nice little dental community we've built. So we started off with one dentist and now we've grown quite a bit. I mean, in general, AHS has grown and... know, we used to have five MDs and now we've doubled the size. It's really amazing to see. Now, do you treat any developmental disabilities among these patients? And how do you handle that if you do? Yes, we do as much as we can. But, you know, of course, we have a few specialty referral offices that we sent patients to. UIC dental school is very close to us. So we also sent to the dental school if we need to. That's pretty much our large referral base. You mentioned that some of the challenges that you're facing at the health clinic is specialty dentistry. Has that made you like a super general dentist, a superstar general dentist? Because you've now had to, you know, you've had to now take on some of the specialty work that you would typically. uh prefer maybe to send out such as endodontics like maybe do a bicuspid or a molar and also oral surgery how much oral surgery do you do yourself because a lot of dentists would prefer to send out some of this stuff but you don't have that luxury so without that luxury how do you handle that what are you up to as far as that goes yeah so um you know at my clinic specifically we don't do endo but you know we do refer out to where we can. UIC, like I said, is one of our big ones. But in terms of oral surgery, we do take on a lot more surgical extractions than, you know, I would have ever done in private practice. But you end up, you know, even if I refer them, a lot of times I'm thinking, oh, my gosh, this patient's going to have to wait another. you know, X amount of months to get in and I don't want them to have to go through this. So then you take on something, you know, build the courage and just take it on and hope for the best. But most of the time, one of the things I love is most of our patients are just so grateful to have somewhere to go to that even if sometimes things don't go as planned, they're very, very, you know, kind and understanding. So that makes you feel good at the end of the day. Yeah, no, it's amazing work that you're doing. I can't tell you how impressed I am. just speaking with you about the service that you're offering the community. But when you mentioned you were sending out to the dental school, it reminded me when I went to dental school, I was in grad endo at Penn. You know, it wasn't a big deal to do the endo as a graduate student, but if the patient was referred to the dental school for an undergraduate to do a root canal, my gosh, that would take months. One molar root canal would take someone, you know, three months to do or more. So that's, you know, one of the downsides. having the expertise that you've developed on the oral surgery side certainly must help things move along as far as the treatment plan. So for anyone listening who is considering public health, what would you recommend they consider to do before making any kind of commitment in that direction? Well, first of all, I would definitely say take the time to research different areas within public health to gain a better understanding, whether it be clinical setting or maybe even working for the Department of Public Health. And if there's a specific clinic or state you want to work in, I would research the clinic, look up demographics in that zip code, how the clinic receives funding, location of the clinic, and most importantly, provider turnover. I would also recommend them to connect with professionals, network. In public health, there's a lot of information you can get just by talking to people who are in the field through networking events, informational interviews, or professional organizations. with individuals who are working in public health can really provide valuable mentorship, advice, and potential career opportunities. Do you find yourself overworked because of the shortage of these clinics where you are exhausted at the end of the day? I mean, definitely there's a, you know, minor percentage of provider burnout that can happen, but I think that can be very, it's a personal choice, you know, that can happen in private practice as well. It's what you want to take on. At my clinic, I have lots of flexibility. You know, we also get benefits such as PTO and things, benefits that you may not get in prior practice. So that's really nice. Tell us how your younger days as a child coming to this country as an immigrant affected you in a way where it's actually influenced you as an adult, an adult dentist to serve the community in a community health center. Yeah, so I myself moved, or my family and I, we moved when I was eight years old. So we moved from India. And so the area that I work in is... kind of called mini India town where my clinic is located. So it's a very, it's like a full circle for me. I really love it because our clinic, the demographics in our area is a huge Asian population. So all different types of patients from Asia. But for me, it was a full circle moment because I can also use the languages that I grew up learning and be able to speak to my patients. And I know where... The difficulties being an immigrant family, you know, I know where it comes from. I know that, you know, their concern is to put food on the table that night. You know, they're not looking to spend $3,000 on an implant and things like that. So knowing where I came from, I understand the challenges that go for an immigrant family. So that's really nice full circle moment for me. Yeah, no, that's beautiful. So basically your clinic takes Medicaid, right? That's how you're reimbursed. Yes. So we are, we accept Medicaid. income, sliding income fee scale. So depending on the patient's income, they pay very nominal fees for dental procedures if they don't have Medicaid. Well, we need more of those health centers and we need more dentists as dedicated as you that are offering the community just an amazing service and making a lot of people happy. Patients that come in that have these challenges with their teeth affects their personality. They don't make friends as easily, especially as youngsters. And you're just making just such a huge difference for them for the rest of their lives. And it's a beautiful thing to see. So we really appreciate you being on the show, Dr. Shah. I hope you've inspired other people who are even thinking about this. And if somebody personally wants to reach out to you, is there a way that they could do that? Yes, my email address is kjshaw6 at gmail .com. So definitely, please feel free to reach out. I would love to. have new grads or even existing dentists who are thinking about pursuing public health. I actually want to I do want to share that I convinced my husband to also go into public health after I was in it for five years. So I was really he was in private practice for much longer. So, you know, I think he also saw the benefits. So we're both in public health and it's just it's really it's a very nice option to have. Phenomenal. Great story. Thank you for sharing it with us. Thank you so much for being on our show. And we hope to hear more from you down the road as far as how this is all progressing and how your clinic's going. Thanks for joining us. Thank you. I really appreciate it. Thank you, Dr. Klein. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.