Voices from the Field: Dr. Alayna Schoblaske on Improving Access to Care

While most kids hated wearing braces in fifth grade, Alayna Schoblaske, DMD, was the exception. That was when she realized she wanted to be a dentist.

“I haven’t turned back since,” she says.

Schoblaske came from a family of engineers and teachers, so the idea of working with her hands while educating patients about their oral health felt like a great fit. And she was fascinated by the impact teeth could have on a person — which led her to her ultimate calling of community dentistry to help patients in underserved areas.

“I decided I wanted to be part of the community of dentists finding ways to help more people receive great dental care,” she says.

Today, Schoblaske works as a general dentist and dental director at La Clinica, a Federally Qualified Health Center (FQHC) that serves all people in Jackson County, Oregon. During her time there, she’s seen her fair share of the hurdles and obstacles blocking access to care for patients in underserved populations.

Schoblaske talked to CareQuest Institute about what those barriers to access are, how La Clinica limits those barriers, and what she learned while working with people of various backgrounds and socioeconomic statuses.

Can you tell us more about La Clinica and what you do for the FQHC?

I work in the dental clinic, where we provide comprehensive dental care to patients of all ages. Our mission is to “serve the people who need us most through exceptional, affordable, and compassionate care, inspiring all those we touch to lead full and healthy lives.”

Specifically, La Clinica helps people by offering dental, medical, behavioral health, educational, and support services to patients who have traditionally faced barriers to care — for example, financial limitations, houselessness, speaking a language other than English, immigration status, gender identity, and more. We provide a full scope of dental care, from child knee-to-knee exams to restoring dental implants.

What are the barriers to access to care that you see patients face?

There are so many! Here are some that come to mind:

• Transportation: Many patients share a car with their family or rely on friends for rides. Some also use public transportation, which can be unreliable in our suburban area.
• Childcare: This may be a parent finding childcare while they have a procedure done or arranging for childcare if one of their children has an appointment and the others do not. Either way, childcare is very hard to come by in our community, and patients usually must rely on family or friends.
• Housing status: Patients who do not have homes may not have access to a phone for scheduling appointments, or they may not have an address at which to receive treatment plans or insurance notifications. Being houseless can also impact a patient’s ability to care for their teeth. Without predictable access to clean water or a reliable place to store their toothbrush, oral hygiene becomes much harder!
• Wait times: I have heard from some patients that other clinics have a 3–4-month wait time for appointments. Or, that they may be seen for a limited exam to diagnose the source of tooth pain, but that treatment to address the pain cannot be completed for another 2–3 months.
• Language and immigration status: Some offices don’t have robust language support, so this can be a barrier for some patients. Other patients are fearful to seek care or apply for Medicaid because of their immigration status.
• Anxiety: So many of our patients have dental anxiety and may avoid the dentist for months or years because of this.

Do you have a story that stands out to you about how a patient faced barriers to access to care before going to your FQHC?

A couple of weeks ago, I saw a patient who was having a toothache. She said that the tooth had been hurting for over a year, but she was too anxious to come into the clinic. Finally, her spouse called and made an appointment for her because the pain was impacting her ability to sleep and eat. We have an embedded behavioral health team member in our dental clinic, so he was able to meet with the patient and put together a plan to manage her anxiety. We were able to build rapport during that first visit, and I removed her tooth four days later without any additional sedation. It felt like such a win for everyone involved!

How else does La Clinica try to limit barriers to care?

A few ways come to mind:

• We take Medicaid and most other insurances and offer a sliding fee scale for patients without insurance.
• Just over 20% of our patients prefer a language other than English. Many of our staff are bilingual and are trained as Spanish interpreters, so our patients can easily communicate in Spanish, our most common patient language after English.
• We have community resource specialists on our staff who can help patients get free bus passes or arrange for medical transport. That helps a lot with the transportation barriers.
• Also, our dental clinic only opens our schedule two weeks at a time, so appointment wait time is never too long.

What else can be done across the industry to limit those barriers for underserved populations?

I would encourage clinics that want to care for traditionally underserved populations to prioritize hiring bilingual and bicultural providers and staff. I am white and monolingual, and I have seen that my colleagues who speak Spanish (or another language such as Ukrainian, Tagalog, or Mandarin) and may have grown up in that culture are able to connect with patients on a deeper level and, often, reach a greater level of comprehension and care.

It is also important for health care organizations to be advocates in their community for the various issues that impact our patients’ access to care. Build partnerships with your local housing authority or pay attention to legislation that funds childcare programs. We so often hear that we are part of a safety net — FQHCs are just one thread in that net. We need to talk to the other people who care for our patients to make sure that we are working together to “maintain the dignity and value of all people.”

How do tools like integrated electronic health records (EHR) help limit barriers to access to care?

I completed a residency at a Veterans Affairs hospital, where they use an integrated electronic health record, so that prepared me for the integrated EHR software that we use at La Clinica — Epic Wisdom. Integrated EHRs allow me to see patients’ complete medical history and get more comfortable understanding if and how I need to modify my dental treatment to keep them safe.

We have not yet utilized our EHR to significantly impact patient access at La Clinica, but we are hoping to explore a system for internal referrals in the year ahead so that a patient seeing a medical provider could be referred directly to a dental provider for oral health concerns. We do have some dentists colocated in the same building as our medical providers, and we are still working toward a truly integrated system.

Why is moving to an integrated care model important?

I think it’s the wave of the future because, of course, our mouths communicate with our bodies (through inflammatory markers, microbiota, and more), and so our health care system will work best when our oral health teams communicate with our medical teams.

Why are dental assistants integral to the integrated care model?

Dental assistants and dental hygienists are some of the greatest advocates for our patients, and often have the time to dig deeper into a patient’s health history or identify social determinants of health that could be addressed to better treat a patient’s overall health. Most of the time, if we make a referral to a medical provider or a community resource specialist, it is because of a conversation that a dental assistant or dental hygienist has first had with the patient.

Anything else you’d like to add?

If anyone wants to follow along what I do as an FQHC dentist and a leader in organized dentistry, they can find me on Instagram @alaynathedentist.