Serving Vulnerable Patients in the Inland Northwest
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Tom Fernandes, DDS, distinctly remembers the influence his general practice residency at Denver Health Medical Center had on his own career path.
“It was the most fun I’ve ever had as a dentist. I just liked being in the hospital – being a part of that world,” he said. “The mix of procedures – a lot of surgery – more medically complex patients were more interesting to me.”
Now, as the assistant program director for the Providence Dental Residency Clinic in Spokane, he’s helping other dental residents have a similar experience in building their skills and career paths.
SERVING THE INLAND NW
Although hospital dental residencies are increasingly common in major medical centers in the United States, Spokane’s was the first in eastern Washington.
Located on the campus of Sacred Heart Medical Center in partnership with the Community Health Association of Spokane (CHAS), the residency program is designed to give recent dental school graduates a chance to enhance their abilities to care for more medically complex patients than they managed in dental school.
The Providence program offers six, one-year residency positions offering ample opportunities for dentists to work on a variety of patients and provide a wide range of care. Because of their partnership and proximity to Sacred Heart, residents also participate in off-site clinical rotations under the supervision of Sacred Heart medical staff, which will include internal medicine, emergency medicine, cardiology and anesthesia. As a result, residents gain valuable experience managing patients in a hospital setting.
The clinic itself includes six operatories, one of which is a large surgical suite. Residents typically see between one to four patients an hour, and there are always one to three residents on site.
After initially opening its doors in 2019, the clinic was forced to close as a result of COVID. This also delayed the start of the residency program, —residents were scheduled to begin in July of 2020. This impacted residents’ time in the operating rooms, which were off limits due to the pandemic and the ban on elective surgeries. The first group of residents ultimately came on board last summer, in July 2021, to begin serving many of the thousands of vulnerable and mentally and physically challenged patients in need of dental care not just in Spokane, but from all over eastern Washington.
“We want our residents to be in the OR a lot so they will be comfortable in their next community,” said Fernandes. “Because of all the shutdown orders, the bans on elective surgeries, we had a heck of a time to get the OR time to treat these patients. And I don’t imagine we are alone, but that has been the biggest impact – just scrambling for that OR time,” he said. “Hopefully we are tuning the corner and it’s getting better.”
In Spokane alone, it’s estimated that some 95,000 adults on Medicaid lack access to dental resources, making a clinic like the Providence Dental Residency an important part of the community health system. The clinic eventually becomes a dental home for these patients, said Fernandes.
“We get referrals from all over eastern Washington,” said Fernandes. “Residents get plenty of one-on-one time with patients. Six is a great number – it’s large enough to feel like a group but small enough to provide a quality experiences.”
EXPANDING MEDICAL KNOWLEDGE
Patients generally fall into one of three categories, Fernandes said. The first are patients with developmental disabilities or cognitive impairments who are often referred by other medical providers in the community. The second set of patients are medically complex – patients with pre-existing conditions or other medical diagnoses, such as cancer of the head or neck, which complicate their care. Another third are low-income, community health care system referrals or referrals from an emergency room or urgent care visit.
Fernandes said the first class of residents have embraced the residency experience, benefitting directly from working in a hospital setting and as a community health provider.
Yuhong Lin, a current program resident, said the advanced general dentistry training at Providence Dental Residency Spokane and CHAS Health has strengthened her skills as a general dentist, helping her become more capable of taking on more complex cases and more confident in treating more challenging patients.
“On the whole, the experience here made me more equipped to treat and manage complex dental needs while maintaining and improving patients’ overall health, especially those whose health is compromised. The experience of interacting and treating developmentally delayed patients in the operating room has given me the opportunity to learn more about this group of patients and their dental needs,” said Lin.
“I like that this residency incorporates a community health dentistry component in it. I got to pick some of the dentists’ brains and learned from many of them. I also got to see a large volume of patients daily, which has allowed me to learn from the vast variety of cases,” she said. “I have become more effective and efficient in addition to the training at CHAS. The medical rotations tremendously expanded my medical knowledge and motivated me to think like a doctor of the oral cavity rather than a fixer of teeth.”
In addition to filling a genuine need in the community, Fernandes said the program is simultaneously helping create the next generation of dentists while also giving veteran dental providers a chance to give back as supplemental faculty.
“If you’re a new graduate and you’re undecided about what to do, a residency is an exceedingly worthy way to spend your time, expand your skill set and serve people who might otherwise not get care,” he said. “And if you’re a late career dentist, getting on board with a clinic like ours for a day a month keeps you engaged; you get to teach people and help patients,” he added.
“My residency had such a big impact on me to the extent that it gave me a home in dentistry. I don’t know what I would be doing if I wasn’t doing this job.”
This article originally appeared in the Summer 2022 issue of WSDA News.
