Dentist on Display: Stephanie Katz, D09
During her final year in dental school, Stephanie Katz, D09 was confident about her job prospects. “The plan was to graduate and join my dad,” she said. Katz initially spent three and a half years practicing dentistry at her father’s private practice in West Hartford, CT. But while she enjoyed practicing dentistry there, she did not enjoy the stress of the managerial aspects of the position. It was a prison – Osborn Correctional Institution in Somers, CT – where she found a better fit.
Working in Private Practice
Although Katz felt prepared entering private practice, the transition from dental student to professional dentist was still difficult. While in the office, she would see as many patients as she could, and initially, one of her biggest challenges was finding alternative approaches to treating patients when the first approach didn’t work.
“That’s when it was really great to have my dad,” she said. “I loved working with [him]. He was an excellent mentor. I learned so many things that I didn’t learn in dental school.”
However, there were other elements of the position that Katz had not anticipated. “The dentistry part was fantastic, but the business part was not my cup of tea,” she said. “It was much more difficult managing staff and trying to deal with the money aspect.” She hadn’t realized how little she understood about how to work with insurance. She also mentioned the additional challenges of supervising staff members and marketing herself in order to grow her patient base. Katz’s typical schedule had her working 8:30 am to 5:30 pm, four days a week and every other Saturday, but ultimately she was on-call “24/7.”
Making a Career Shift
Katz’s decision to apply for the dentist position at Osborn was not completely happenstance. She had previously considered working at a correctional facility in dental school and had first heard about dental careers in correctional facilities from her father.
“Dad’s first job was in a correctional facility in Englewood, CO. He never made it seem like a frightening experience. It seemed like it could be enjoyable.”
After deciding to make a change from private practice, Katz regularly looked for posted opportunities. When she saw an opening for a dentist position at Osborn, she submitted her CV and letters of recommendation. She was pleased to learn that the Dental Director of Correctional Managed Health Care is Tufts Dental alum Richard Benoit (D90). Katz has now been working at Osborn Correctional Institution for two and a half years.
Working at Osborn Correctional Institution
Osborn, a men’s facility, is one of the 18 correctional facilities in the state of Connecticut. The facility holds 1500 inmates. On a regular day, Katz sees between 8-10 patients, between 8:30 am and 2 pm. On Fridays, she focuses on dentures and may see 14-15 patients.
Katz begins and ends each day by counting her instruments to ensure none of them have been taken.
“I know where I work,” she said. “I’m aware that I need to pay attention at all times, [but] I’ve never felt threatened.”
Unlike working in private practice, Katz is the only dentist at Osborn. “I like running the clinic by myself and being the only dentist there,” she said. “I like the autonomy. I like the amount of surgery [that I get to perform].”
The dental team at Osborn consists of a dental director, a health services administrator, a dentist (Katz) and a dental assistant. Osborn is the only facility which also has a dental hygienist, who joined Katz a year and a half ago as part of a pilot program. Katz believes that the addition has worked well.
“She sees guys for cleanings, [and] helps with triage,” she said. “Guys have poor oral health when they come in. They have a lot of abscesses and need cleaning in general.”
Oral Health Challenges at Osborn
Katz sees patients by request, unless the inmate is referred to her by medical staff. Inmates are able to have one exam and cleaning per year. Each dental service costs patients a standard fee of $3. If patients are unable to pay the cost of service, they still receive treatment. Katz stated that she most frequently performs extractions and restorations, as well as some dentures. However, there are some limitations to the dental work that can be performed.
“I’m not allowed to perform posterior root canals. I can’t do crowns,” she said saying both procedures are viewed as cost-prohibitive by prison policies. “If [the tooth is] to that point, it’s just cheaper to take it out and down the road get a denture.” When lab work is needed, primarily for dentures and night guards, Katz sends everything to an outside lab in Connecticut.
Katz described limitations of care as one of the most frustrating parts of the job. “I can’t provide the same level of service,” she said. In some instances, “the tooth can be saved, but it’s cheaper to give a partial denture.” She stated that it’s especially challenging if she is treating a younger patient. Another major oral care issue she has noticed is the abundance of sugar in the inmates’ diets.
“The biggest thing is that their diets are terrible,” she said. She explained inmates have access to a commissary, where they can purchase candy. They also have access to hot pots, where they melt down Jolly Ranchers, Kool Aid and Now & Laters to create a candy concoction. They also often add sugar to their coffee.
“I try to go over as much as I can in terms of oral hygiene,” Katz said. “It’s so hard because we’re so understaffed to get any preventative program in place. It’s hard to put anything in place on our end. I have models, and I try to show them as much as I can.”
The most frequent dental emergency that Katz sees are dental infections. She also regularly sees patients with caries and bad decay, periodontal disease, tooth pain and tooth trauma. Many of her patients have not previously received regular dental care.
Despite these challenges, Katz likes being able to create positive dental experiences for her patients. “I can change the perception of what it’s like to go to the dentist so that when they’re out [of prison], they can follow through.”
Working in a Private Practice vs. Working with Correctional Managed Health Care
There are unique differences between working at Osborn and working in private practice, but ultimately Katz finds Osborn to be a better career fit.
“There are different stresses, but much less stress overall,” she said. “When I walk out of the door, I’m done for the day. I don’t have to think about it.”
There is no longer pressure in terms of production; even on days in Osborn when the prison is on lockdown and Katz sees no patients, she is still compensated. Katz is not allowed overtime, so she must make determinations about whether patients can wait until the next day to receive treatment or whether they need to be transported to the medical wing for more immediate care. However, Katz still finds herself doing more administrative work than while working in private practice.
“At Osborn, because there are so few of us in the clinic, it falls on all of us to do more in terms of scheduling and administrative work. I never had to do that in private practice.”
Another change is managing staff. At Osborn, the dental assistants are employed by the state; therefore Katz does not control staff selection or termination.
“Now I have no control because I’m not the boss,” she said.
Katz still does miss some aspects of working in private practice. For example, she used to have close-knit relationships with her patients. “I miss having certain relationships with patients where you really know about them and their families,” she said. Katz also worked with state-of-the-art equipment while in private practice. “I miss the toys,” she said laughing. “I had a lot of fun stuff that I miss, but I don’t miss the stress.”
Katz enjoys the experience at Osborn and sees herself remaining at Osborn for the next 8-10 years. “I would love to have the dental director job,” she said. Eventually she wants to transition from day-to-day clinical work and focus more on the administrative side. Although Katz may not have initially imagined herself working at Osborn, she recommends that current dental students stay open-minded about their dentistry careers. “While you’re still in dental school, explore all of your options.”
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