“I always knew I would have a career [where I] worked with kids with high needs. My mom was a school nurse, so I grew up in a home where I saw her helping underserved kids.”
These are the words of Dr. Jessica Meeske, senior partner at Pediatric Dental Specialists of Greater Nebraska. Dr. Meeske leads a group practice with four locations in diverse cities throughout Nebraska, serving pediatric patients who are on Medicaid.
She is also part-time faculty at University of Nebraska Medical Center College of Dentistry, where she teaches dental students and residents in pediatric dentistry, as well as a graduate of Hastings College and the University of Missouri-Kansas City College of Dentistry. Dr. Meeske completed further training in pediatrics and public health at the University of Iowa College of Dentistry’s Leadership in Pediatric Dentistry and Dental Public Health Program, where she received her master’s in dental public health. She is board certified by the American Board of Pediatric Dentistry and also is a past ASDA president.
Here, Dr. Meeske discusses the challenges and rewards of working in her practice.
ASDA Blog: Why did you decide to start a pediatric practice that primarily serves Medicaid patients?
Dr. Jessica Meeske: This was very much a function of my education. When I was at UMKC dental school, I was drawn to the clinics that helped underserved kids. Our Lowry Clinic was a partnership with the Kansas City schools where they bussed in kids and we took care of them. From there, I did my residency at the University of Iowa, and my program was totally focused on the how to take care of underserved kids. That’s where I really learned the skills and tools to not just perform the dental treatment that was needed, but learn how to work with the family, social determinants of health, and how to manage more challenging behavior and family dynamics, etc.
What obstacles did you face when starting up?
Finding other specialists to refer to when I needed help for my patients on Medicaid. I had difficulty finding an endodontist, orthodontist and other dental practitioners who I could matriculate my older kids or special needs patients to. Other barriers include finding more efficient ways to provide care because, in many cases, Medicaid fees are lower.
How have you been able to work more efficiently?
I was able to work on a legislative bill to legalize expanded function dental assistants so I could delegate more clinical duties in my practice and have all my clinical staff work to the top of their license. My hygienists can anesthetize patients and do sealants, while the EFDAs can place simple fillings. This was controversial, and it took 10 years to get the bill through.
Educational loans are a major concern for many students right now. Did you have similar concerns with the decision to pursue your practice?
When I said I was going to rural Nebraska and take care of kids on Medicaid, I was able to negotiate my own loan repayment plan through my state so that was a great way to start off and reduce my debt. We have a rural Nebraska Health Commission, and they had loan repayment programs for physicians. My husband was a physician who qualified, but they didn’t have anything for pediatric dentists going into underserved areas. I thought it was a long shot, but I wrote a proposal letter with the demographics of the area I was going into, and they gave me the same loan repayment. In the end, it wasn’t just for me, but it was for every pediatric dentist who came after me and was willing to go to a rural area.
From there, as far as learning business, I was fortunate to go in with an experienced pediatric dentist who already had a good business model, and he was able to teach me a lot of different things.
How do you build a patient base, and how do you approach marketing across multiple locations?
Part of my practice is comprised of healthy families who just need a primary care place for their children to receive dental care, and the other half of my practice is comprised of children who are referred by general dentists. A lot of marketing is done internally through word of mouth as well as search engine optimization. Other marketing efforts are meant for my referring dentists to make sure they know they have a place to send a child who may be very young, potentially uncooperative or possibly has severe dental issues.
Describe a typical work day.
I see patients four and a half days a week — three and a half days in the clinic and one day in surgery. Within my day, I see new patients, recalls, operative procedures, surgeries and quite a bit of orthodontics.
Do you have plans for expanding your office?
We are always looking to grow, but right now we are focused on getting through COVID-19 and making sure that our newer practice has all the support it needs. Right now, we are involved in mentoring our new associate there, renovations, training the staff and getting systems up. Then we’ll start to look for our next practice.
Are there any misconceptions regarding your patient population?
I think a lot of people think that parents with children who have Medicaid as their insurance are parents who don’t work or who don’t care about their child’s health or don’t value dental health. But in most cases, they absolutely do; they just have smaller incomes. We tend to judge and label them, but I have found that they’re some of the most thoughtful and appreciative patient families in many cases.
Is the population you treat really as unique and different as people think?
I don’t think so. I think we just have more policies and systems and tools in our toolbox to work with families who have a lot of needs. We are just big believers that we meet kids and parents where they are in life, and try to help them from there instead of being frustrated that they’re not where I am and that they don’t understand the cause and effect between oral hygiene, diet and tooth decay. You back up a few steps and start back at the beginning to phrase things to them.
What advice would you offer dental students regarding Medicaid and pediatric patients?
Get comfortable with seeing kids because it’s an opportunity to shape their lives and turn them into great dental patients. Don’t cherry-pick your patients when they are children because they grow up to be adults who, if they have positive dental experiences when they are young, will be good patients who will come in for routine preventive care.
What is your best memory related to starting and working in your practice?
I was at a dental meeting with my team and was visiting with one of my business staff members. She was a social worker by education, and I asked her, “Why do you work in our office?” She said when she was a kid, she was a patient of my retired senior partner, Dr. Lockwood. Her brother had hemophilia in the 90s and got HIV through a blood transfusion. At a time when their mom was scared that no one would see her HIV-positive child, she called Dr. Lockwood and he said, “Of course, bring him in. It’s his regular six-month check-up — why would we stop seeing him just because he has a blood disorder? We’ll be happy to see him. This is the first time we’ve done this, but we’ll figure it out as we go along. I want to make sure I take care of him as long as he needs me.”
And that mother turned to her daughter, my staff person, when she was in high school, and said, “I hope you can work for somebody as kind as Dr. Lockwood someday.” And that’s how she came to work for us. It was very powerful. Dr. Lockwood didn’t know this story, and I told him years later, after the boy had passed away from HIV. He never knew he had that kind of impact on his patients.
Any closing advice for dental students?
One of the biggest misconceptions about treating patients with Medicaid is that you can’t make money from it, but you absolutely can. Just like anything else, you have to know what you’re doing. Find a good mentor and be willing to understand the rules so you do things correctly. I think there are plenty of dentists who would love to mentor those who would like to learn more and learn how to do it better.
~Joell Chen, Roseman ’21, ASDA Council on Professional Issues Chair