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Not so isolated: Company supports dentists in rural settings

March 21, 2016 Editor's note: This is the third installment of an ongoing series, Innovation Spotlight, featuring dentists who are using innovative ways to change their dental practice. A 2013 environmental scan of the dental industry showed Americans have been visiting the dentist less frequently and spending less money on their oral health, pushing the profession into a new normal when it comes to U.S. dental spending, according to the ADA Health Policy Institute. The ADA News will spotlight dentists who are adjusting to this new normal and finding ways to prepare their practices and themselves for the future.

Norfolk, Neb. — The landscapes of Nebraska and Iowa are as such that you can drive hours before you see a dental practice.

There are larger cities in Nebraska like Omaha or Lincoln and Des Moines and Sioux City in Iowa but otherwise, you'll see a lot more corn than you will dentists.  

Take the town of Wausa, Nebraska, where Dr. Charles Skoglund's grandmother lived for nearly 70 years. In the town of a little more than 600 people, the dentist's office — there was only one — was a focal point for residents.

"That was always kind of a directional place if you were giving someone directions in town. 'Take a left at the dentist's office,'" Dr. Skoglund said.

When he heard the Wausa dentist was planning to retire, Dr. Skoglund jumped at the chance to preserve a practice he believed was the lifeblood of the community.

"I didn't want to see that town without a dentist," Dr. Skoglund said. "It was in my mind we were going to be losing a focal point in the community."

Letting dentists be dentists: Dr. Charles Skoglund founded Family 1st Dental to help place dentists in practices in rural Iowa and Nebraska.
It was the second dental practice purchased by Family 1st Dental, a company owned and founded by Dr. Skoglund, which operates 35 dental offices throughout western Iowa and rural Nebraska.

"The goal is to keep dentists in rural areas and Family 1st Dental's professional management team provides the resources and expertise to run the business side of the dental practice," said Dr. Skoglund, who describes Family 1st Dental as a hybrid group practice.  

The business model works like this: Family 1st Dental purchases a dental office on behalf of a dentist who will practice there; renovates it to bring it up to date; and handles the business aspects so the dentist can focus on the clinical side while learning how to run the business of a practice. At the end of three years, the dentist has the option to buy the practice or continue their arrangement with Family 1st Dental. 

"They can just be dentists and that's the biggest thing," said Dr. Skoglund, who employs a CEO, clinical operations officer, chief operations officer, a director of clinical development and regional coordinators as part of his management team.

It's also important to the company that they don't intrude on the existing dynamics in a community.

"We will never go into an area unless we're invited," Dr. Skoglund said. "Any office that we have, we have been invited into the community; either by a transitioning dentist or by the community itself if they didn't have a dentist. We're not going to upset the apple cart and don't want to burn a bridge and just come in and take over."

The goal is to find dentists who want to stay in a community and be a part of it. That means for dentists who are married or in relationships, their spouses or partners are invited to the interview because it's as much their decision as the dentist's to move to and live in a community, Dr. Skoglund said.

With 38 dentists spread out around a large geographic region, Dr. Skoglund said he likes to think he's helped access to care issues in Iowa and Nebraska. Before he formed Family 1st Dental, Dr. Skoglund treated a lot of special needs dental patients in Norfolk, Nebraska. Some of his patients were traveling 150 miles just for an appointment, taking time off of work and putting wear and tear on their car. So he's seen what being so far away from a dentist does to families.

"By being in some of these communities, I feel that we've addressed dental needs earlier," Dr. Skoglund said. "What I tell our dentists and our prime directive is, 'You do what is best for the patient and tell the patient what they need and what would be best for them.' I want them to feel cared for, safe and taken care of."

Dr. Skoglund spoke at ADA 2015 – America's Dental Meeting in Washington, D.C., about his practice model. Visit the ADA Center for Professional Success at and search for "Group Practice Forum 2015: Hybrid Group Practices" to watch a video of Dr. Skoglund's presentation.