Pioneering NHSC Dentist Builds Access to Oral Health for Underserved in New Mexico

Steve Beetstra, D.D.S., NHSC alumnus, and assistant professor with the Division of Dental Services, University of New Mexico (UNM), believes that being entrusted with the medical or dental care of another human being is, above all, a privilege. “It is a privilege that we pay back with service to the community, volunteerism, and by ensuring access for those who would otherwise go without care,” he says.

Beetstra has more than earned the privilege of practicing dentistry during his many years of providing treatment to the underserved across the Nation. At the beginning of his professional career he worked in Pelton, Oregon, for the Indian Health Service. Later, as an NHSC Loan Repayor, he served in Belle Glade, Florida, which has a predominantly Hispanic and migrant population. “The experience was both challenging and wonderful,” Beetstra recalls. “Many of my patients were HIV positive at a time when dentists did not know as much as they do now about transmission and care.”

From there, Beetstra moved to Hendersonville, North Carolina. In the midst of crushing poverty—alongside dazzling wealth—he started a dental school, and built a dental facility to serve the needs of all residents. Beetstra also spearheaded a drive to fluoridate Hendersonville’s water supply, which, at the time, made it the largest rural community in North Carolina to do so.

In 1999, Beetstra was invited to New Mexico to expand dental outreach to rural residents in the State. That turned out to be a formidable challenge. Two-thirds of New Mexico’s population live primarily in rural areas while the majority of health care clinicians are concentrated in the State’s urban centers. The poor geographic distribution of health care services is further compounded by the fact that many of those employed in low-paying jobs do not have the option of dental benefits.

Beetstra focused initially upon the chronic and worsening provider attrition rates in New Mexico. His top priority was to start the first and only dental school in the State, within UNM’s School of Medicine. The next step was to create contractual relationships, through UNM’s Center for Community Partnerships, with local community health centers, Indian Health Service sites, and the New Mexico Department of Health, to address oral health problems throughout the State. Within 4 years the dental division has grown to 8 faculty members, and has organized student practicums and residencies across the State to address the dental care needs of remote communities, and to foster dental careers among the underserved.

Beetstra and other community partners have devised a model of practice called the “health commons” approach that aims to concentrate and maximize the effectiveness of health delivery systems where needed most. The health commons model involves pooling resources from public and private entities to address complex and multidisciplinary health issues that cannot be solved by any single provider. Health commons facilities are enhanced community-based, primary care safety net practices that include medical, behavioral, social, public, and oral health services.

To illustrate the model, Beetstra points to Lordsburg, “at the bottom of the boot of New Mexico,” where a population of roughly 6,000 people had been without a dentist for 30 years. Patients typically did without care because they couldn’t afford it, he notes, or traveled more than 65 miles for dental emergencies. Beetstra began by sending dentists from UNM’s faculty in Albuquerque to conduct weekly clinics. At the same time, he also took on a leadership role in building a new health commons facility in Lordsburg. Once the facility was built, Beetstra recruited two dentists from the UNM Division of Dental Services to provide fulltime services at the clinic.

In Roswell, New Mexico, Beetstra also rallied the local community to solve its dental care crisis. The solution involved coordinating private and public agencies, developing them into partnerships, and winning grants from the Kellogg Foundation and Community Voices to build and staff a community health commons site. In 4 years the facility has grown to serve 30,000 patients, “including alien life forms,” Beetstra quips, alluding to Roswell’s reputation among UFO buffs.

Next year he will take the Roswell experiment a step further by establishing a UNM Division of Dental Services residency for dentists working with medically-compromised patients. This program will focus on helping the residents acquire skills in cultural competence. It will include daily Spanish lessons along with seminars, led by tribal elders and members, on the special cultural needs and sensitivities of local American Indian tribes.

“Fun” is the word that Steve Beetstra uses to describe the grueling pace of his work and the daunting challenges that he faces every day. But it is not surprising that someone as gifted and dedicated as this NHSC alumnus would view as fun the task of promoting his vision of quality oral health care for all.