As the COVID-19 pandemic continues to drastically affect the health center workforce, the second season of the STAR² Center Talks Workforce Success podcast dives deeper into the immediate and long-term effects of this crisis on health centers. In this episode, In this episode, ACU’s Michelle Fernández Gabilondo interviews Dr. Elizabeth Simpson, DMD, at Meridian Dental in Indiana to discuss how COVID-19 impacted the oral health workforce and the patients they serve.
Full Transcript: How COVID-19 Impacted the Oral Health Workforce
Introduction: Welcome to the COVID-19 installment of STAR² Center Talks Workforce Success, which features the voices of workforce leaders from health centers and primary care associations around the nation. We know this invaluable information will help in your journey to advance the workforce initiatives of your organization.
Michelle Fernández Gabilondo: Welcome, everyone. My name is Michelle Fernández, Gabilondo. I am the senior training specialist at the Association of Clinicians for the Underserved. I am here today and am very excited to be interviewing Dr. Elizabeth Simpson, DMD at Meridian Dental with Meridian Health Services in Indiana. Welcome, Dr. Simpson.
Dr. Elizabeth Simpson: Thank you. Thank you so much for having me.
Michelle Fernández Gabilondo: Yes. We’re very excited to have you and to have you bring in the dental perspective today. But what I do with every interviewee, I always ask them two standard questions. So the first one is always tell me a bit about your health center, where it’s located and the patients that you serve.
Dr. Elizabeth Simpson: Okay. So our health center, we actually have several locations with different services throughout the state of Indiana. We have behavioral health, we have primary care and we have dental. Our dental locations are in Richmond, Indiana, Muncie, Indiana, Anderson, Indiana, and Elwood, Indiana. Our patient makeup is we have probably about a third of patients that have private insurance, a third that have some form of Medicaid or state insurance, and then a third that are self-pay.
Michelle Fernández Gabilondo: Wonderful. Thank you so much for sharing that. And all of our viewers, they want to know, and this is why we always ask this other question as well, is what is your professional journey? So we really want to know how you got to your current role. How long have you been there and really anything else that you would like to share with us about you?
Dr. Elizabeth Simpson: Well, I went to dental school in Boston. I’m from Indianapolis, but I went to dental school in Boston. I did a one-year general practice residency at Meharry Medical College School of Dentistry in Nashville, Tennessee, and then I moved back to Indianapolis. My first job after my residency was actually a mobile job that went into different nursing homes around the state of Indiana. I don’t know how well people know Indiana that are listening, but my furthest home up north was in Fort Wayne, which was about two hours from Indianapolis. And then my furthest south was actually in New Albany, which is across the river from Kentucky. So I could see Louisville from when I went down to visit that home.
Dr. Elizabeth Simpson: And the neat thing about that is that working in nursing and rehabilitation homes, that is a underserved population that really unfortunately gets forgotten about a lot. So I worked there just for my first few months out of school. And then I ended up going into private practice for a couple of years, when I was working in a couple of different offices. My current boss actually reached out to me through a dental association in Indianapolis and needed somebody to work at a public health clinic about an hour outside of Indianapolis, just one day a week.
Dr. Elizabeth Simpson: And working there, I’m also not sure if people will be familiar with the Job Corps program. It’s a nationwide job training program for kids who have struggled in traditional high school. They go to Job Corps and they can learn different types of job training. The clinic where I worked was on the campus of this program. I really, really enjoyed working with those kids. I call them kids, but they were about 18 to, I want to say 24 years old. That was my first professional experience working in public health, was working with those kids. I found that the mornings that I was going to work there, I really looked forward to getting up and going to work in the morning, more than I looked forward to the private practice mornings. And I decided to start looking for a full-time job in public health.
Dr. Elizabeth Simpson: I got a job full-time with a large healthcare system that had dental clinics that were FQHCs, or federally qualified health centers for those who don’t know, and worked for them for a little while. Moved to another clinic in Indianapolis, and that clinic, we had students from Indiana University School of Dentistry that rotated through while they were getting public health experience for their dental school curriculum. So I was fortunate enough to be able to supervise dental students, which was a really neat experience. That clinic was located in a career center at a really large high school here in Indianapolis. The neat part about that job was that we had dental students from IU, so Indiana University School of Dentistry, that rotated through our clinic that I was able to supervise. And then we had the high school dental assisting students that we also supervised.
Dr. Elizabeth Simpson: So it was just a really neat environment of working with high schoolers and dental students, and the dental students being assisted by the high school students. And then also of course, being in public health. Then I ended up moving along to Meridian Health Services, who I work with now. So quite a journey. A lot of moving around.
Michelle Fernández Gabilondo: Thank you for sharing your journey. That was wonderful. And just to see the progression of the passion that you have for serving underserved populations and working in FQHCs and public health. It’s really great when we get to hear these stories, because our listeners really appreciate that, and they get to know better who we are interviewing. So thank you for sharing that. And I do have to admit, I’ve never been to Indiana and that’s one of my goals.
Dr. Elizabeth Simpson: Well, you have to come.
Michelle Fernández Gabilondo: Yes. I’m hoping once travel is back up, I will definitely be there. But I had to share that little piece about me. So as we now have a good sense of how you got to the role that you got to and currently working at Meridian Health Services, there’s really no one in healthcare, no health centers that have not been affected, or really anyone in the world I would say affected by COVID-19. Sometimes we may not think about that impact in regards to dental providers. So the next question is really as a dental provider in a health center, could you tell me about that toll that the COVID-19 pandemic has had on the oral health workforce?
Dr. Elizabeth Simpson: Well for us, many of us do very vividly remember how, when March of 2020 started, it was like things were changing every day. I remember talking to my boss and saying, “Do you think we’ll actually get to a point where we’ll be shut down and not seeing patients?” And he was like, “No way.” And pretty much a week later, we were shut down and not seeing patients. And that’s very daunting, because as a healthcare giver, to be in this position where something is so serious that you’re not able to see patients, it was really scary. At the time, I was traveling between our Anderson and Elwood locations, which are about 20 miles apart from each other. So I would be in one a couple of days and the other one a couple of days, and we shut down. Obviously we weren’t doing any type of hygiene, no simple procedures like crowns, bridges, no denture procedures.
Dr. Elizabeth Simpson: We would see emergency patients, and it had to be an emergency where the patient was in severe pain or they were swollen, but we still weren’t doing any treatment. And that went from, I want to say the middle of March to the beginning of May. We had days where one of us would go in because we ended up shutting down the Elwood location. So we had only one clinic that was open at the time, and one of the dentists would work and the other one would be on call. So it went like, patients would call in, we would triage. And I know this sounds horrible, we would triage the severity of their pain. The patient would come in. Our assistant would take an x-ray. And to preserve PPE, the dentist actually wouldn’t come out of the office. So we would check the x-ray in our office and then prescribe an antibiotic, something for pain.
Dr. Elizabeth Simpson: And then the patient, we would tell them, okay, we should be opening back up in the beginning of May here. And it just kept getting pushed out. Part of why it kept getting pushed out was obviously waiting for state recommendations, CDC recommendations, and getting equipment in because there were some things we wanted to have in place before we could safely open. But there were probably, I would say six to seven weeks that we weren’t doing any procedures. I think I didn’t have any teeth that I ended up pulling because for many of our patients, we didn’t think they would be simple extractions. It was things that were going to be complicated, and the recommendation was that dentists don’t do any procedures that create aerosols. Aerosols are the little microscopic droplets that get formed when we drill on something and it mixes with the air and the water and goes up in the air. So we weren’t supposed to do anything that was going to create that.
Michelle Fernández Gabilondo: That makes sense. As you talk about this, and we’re currently filming right now and we’re pretty much a year into the pandemic. So if anybody listens to this at a later time period and just to go back and think how everything shifted so rapidly. No one knew what to expect from one day to another. You brought up such good points, everything from the inability to do procedures, to not having the proper protection equipment, all of those things. And if it is okay with you, I wanted to just expand a little bit more on that question that I asked you, because as you were talking, you also see how much passion you have for the work that you do. Did that also take hold just on the wellbeing in general, of I’m a practitioner, I’m a dental provider, but right now I can’t provide the services that I love what I’m doing, but I can’t do it?
Dr. Elizabeth Simpson: Yes. There was a lot of fear of has anyone ever been in so much pain from a toothache that … And I know this may sound dramatic, but sometimes he would sit and think, has anyone ever been in so much pain from a toothache that they’ve died? Are we going to push this out so long and the pain will be so severe, we won’t be doing anything, patients won’t have anywhere to go. How bad is this going to get? When I did my residency at Meharry, and we actually would patients we would have to see in the hospital if an abscess got too bad. They would have to go under general anesthesia to have their abscess drained.
Dr. Elizabeth Simpson: And at the point we were at, it was like, well, if their abscess gets too bad, will they even be able to go to the hospital? So it was really, really scary. And then as recommendations would come out, mixed in with that once we went back to work, the first order of masks that we got, well, they were the KN95 masks. They weren’t the N95s. Then we were like, “Well, are we not supposed to work because we don’t have the N95 masks?” And it was like every day was something new that we weren’t sure how to handle. If it was maybe a tooth that you thought you could take out simply and not create aerosols, and then it broke and you were going to have to do a procedure that would create aerosols, should I just not do it?
Dr. Elizabeth Simpson: I remember probably that first month that we went back, so we went back, I want to say the first week of May, something would come up every day where we would be like, “Well, wait a minute. Are we supposed to change gowns? Well, we can’t change gowns because if we use too many gowns, we’re going to run out of gowns?” It was the weirdest feeling of wanting to be safe, wanting to treat people, wanting to treat our patients safely. And if they came in and maybe their temperature was close to the borderline, it’s like, “Well should we not treat them because they’re close to the borderline? Or maybe they’re just really hot.” It was just every single day something came up that we would be like, “We don’t know what to do. Maybe we shouldn’t see them.”
Dr. Elizabeth Simpson: It was a very confusing time. Even for dentists, we work with a mask on all day, and I know for other people in other professions where they’ve never had to wear a mask for any extended amount of time, it was really hard. But people have to consider for us, now when we’re at work, we wear a certain type of mask between patients, and then we had to do the N95s when we were seeing patients, and we weren’t used to that either. When we would walk out of work at the end of the day to take off this mask and be like, “So, this is what fresh air feels like again.” And I would just go home and just enjoy sitting and not being covered up with a face shield and a mask and a gown and gloves and shoe covers. It was a very surreal experience for quite some time.
Michelle Fernández Gabilondo: Thank you so much for sharing that. The way that you framed everything, it was such a powerful imagery that I think all of us have heard about and we’ve seen, but framing it from that personal experience, thank you so much for all that you’re doing, and just all dentists and all medical providers have been doing throughout this pandemic. It’s just amazing, the work that all of you do and that you’re still there fighting for patients. And that is your priority, along the complexities of the protection, your own families, your own wellbeing. There’s so much going on. So thank you so much for sharing that with us here today.
Michelle Fernández Gabilondo: And I see that also from the flip side, because as you’re talking about making those decisions, when is the pain so bad, when is the fever so bad, those type of things. I’m sure that patients on their end are probably thinking the same thing when they’re making those decisions to go in to a dental practice. So in terms of the patient’s behaviors and attitudes towards oral health during the pandemic, what are you seeing? Are you seeing any hesitancy? And then how would you really address those patients and what message would you like to impart on them about going to see your dentist during COVID?
Dr. Elizabeth Simpson: Well, I heard a statistic a while back. I’m not exactly sure where I heard it, but it was less than 1% of COVID outbreaks have come from a dental office. So I think going to the dentist, with all the precautions that we’re taking, it’s actually now one of the safest things that you can do. At least at our clinic, we’re still doing temperature checks for people. People still, they have to have a mask when they come in and we are still wearing all of our PPE. Like I said, the face shield, the mask, the gown. We’ve loosened up a little on shoe covers. That’s pretty much the only thing that’s changed.
Dr. Elizabeth Simpson: But when we do certain procedures, we have a new external suction outside of the one that we usually use that people are familiar with that feels like we’re going to pull your tongue out of your mouth. We have another suction that goes outside that creates this high vacuum so it catches any extra aerosols. There have been all kinds of products, if you look through a dental product magazine, all kinds of products that are created to shield and keep that spray from going too far. One of the things we also have our patients do, they come in and they do a rinse before we’ll even take an x-ray or anything on them.
Dr. Elizabeth Simpson: So, some of the changes that were made, we initially were like, “Oh, we can’t wait until we don’t have to do this anymore,” but part of what’s happened is that it makes us all feel so secure that nobody wants to go back to how we were before, even though, especially in the summer, it’s hot being covered in all of our PPE. Sometimes it takes a few more steps to do things, but everybody feels so safe and it makes our patients feel safe. So nobody wants to go back to how it was before.
Michelle Fernández Gabilondo: And I think that that idea of what things were like before are going to change so much across the board. I can see that, because it’s not just the safety itself, but also the mental component of, okay, I feel safe. It seems really clean. Everything seems to be taken care of really well. Even if it always was, just the appearance, I think can sway some of that nervousness that people may have. Well I do have to say, you make me feel way more comfortable about going to my dentist.
Dr. Elizabeth Simpson: Good, good.
Michelle Fernández Gabilondo: So, thank you for that.
Dr. Elizabeth Simpson: I haven’t had many patients, to be honest, I haven’t had that many people who didn’t come because they didn’t feel like they would be safe at the dental office. What I have found though, is it seems like a lot of patients didn’t know when offices were opening back up. So for us, like I said, we were only closed from the middle of March to early May. We started with very basic procedures that we were doing in May, but we’ve been open since last May. So we do have a lot of patients that will come in and they may not have been back since last February or even something in 2019, because they just weren’t sure when places were opening back up because of the pandemic. I hear that a lot.
Dr. Elizabeth Simpson: I’ve actually only had one patient who came in, had gone to another office, and he didn’t like how he felt like they handled things, so he didn’t want to stay at that office and he ended up finding us. But I haven’t had that from a lot of people, that they’ve gone somewhere else and didn’t feel like things were put in place to their standard of what they wanted to see.
Michelle Fernández Gabilondo: I definitely agree with you. I think that’s one of the biggest things that people just don’t know at this point, because even, as we were talking about in the beginning, things were changing so rapidly. We’re still a year out, but things are still changing very rapidly. And one of those things that I think is also causing that very rapid change of places opening, closing, whatever it may be, what the recommendations are in regards to PPE, are the vaccines. As we begin to wrap up today’s interview, I did want to ask you about that. With this rollout of vaccines, what is the role of the dental practice at your health center playing in regards to that, if any? And then when patients come in to see you, are you able to give them information about getting vaccinated? Are they able to get the vaccine on the same day? Is there any type of protocol that has been built in, in regards to oral health and the vaccine distribution?
Dr. Elizabeth Simpson: So our clinic, our company I should say, overall they do do vaccine clinics that’ll be like all day on a Saturday. They just opened up the state of Indiana so that dentists can give the vaccine. But I’m used to giving people shots in their mouth. And even though it seems like an arm would be a nice, big target, I would much rather go to training to know what I’m supposed to do. So I personally, I would give the vaccine if I got some training on it. And I think they are putting some things together specifically for dentists about how to give a shot in a deltoid because we’re used to giving a shot in a tiny little area of mouth. But our company is doing a really good job with putting together large scale events where people can come and get their vaccines. So I feel really good about that.
Michelle Fernández Gabilondo: That’s wonderful to hear. And yes, that’s what we’ve been hearing is that a lot of states are expanding to allow dentists to be able to administer the vaccine. But you’re right, it is a totally different thing, the arm to what you’re used to with the mouth. So, that training is incredibly important as well. So well, I really want to say thank you so much today, Dr. Simpson, for being here. This is absolutely wonderful and everything that you shared was so invaluable.
Michelle Fernández Gabilondo: And again, my name is Michelle Fernández Gabilondo. I am the senior training specialist here at ACU, and we were talking with Dr. Elizabeth Simpson, DMD, at Meridian Dental with Meridian Health Services in Indiana. Thank you so much, Dr. Simpson.
Dr. Elizabeth Simpson: Thank you so much for having me. And I hope that if people have been nervous to go to the dentist, I hope they feel better. Hopefully they can find somewhere where they feel safe and comfortable going.
Michelle Fernández Gabilondo: Absolutely. Follow those words of wisdom. Thank you.
Closing: Thank you very much for joining us today. We hope today’s conversation provided you with ideas, suggestions, and insights into ways you can approach, adjust to and mitigate the immediate and long-term changes COVID-19 brought to your health center. Also, check out all of our free workforce tools and resources found at chcworkforce.org.
More Resources on COVID-19
The Association of Clinicians for the Underserved is regularly updating our detailed list of resources on the coronavirus pandemic with new webinars, fact sheets, and other resources related to health centers, workforce considerations, clinical protocols and guidance, telehealth, and more. You can also view a variety of webinars on COVID-19 and its impact on underserved populations on our health equity webinar archives, including our session on Engaging Dental Providers in COVID-19 Response Efforts.