Dr. Chris Bryant has never needed a fancy dental office to do his job. For more than 30 years, he has been caring for teeth in Sooke, working primarily out of a modest-sized house on Sooke Road.
Which is not to say it isn’t nice – it is. But if it weren’t for the sign in his front yard, you might never know someone was inside polishing teeth.
The same may be said for Bryant's new office – an ex-BC Transit Arboc-style model on a GMC 4500 chassis with a Duramax diesel engine and an Allison transmission, or as it’s otherwise known – a bus.
On the outside, it looks like a regular bus. On the inside, it’s a mobile dental clinic. It's part of Bryant’s strategy to bring much-needed dental care to rural communities, particularly to Indigenous communities such as Pacheedaht First Nation, located about an hour outside of Sooke.
“I’m doing this for the community that’s traditionally not had access to health care,” he says, emphasizing that the clinic is not for taking house calls to suburban driveways.
“For the last 10 years, there’s been an enormous shift in the growth of private equity finance and the rise of what are called dental service organization practices, or DSOs,” says Bryant, explaining that DSOs have been buying up dental offices with a focus on operating primarily in urban and suburban communities.
“The more that form of health care grows, the reality is small rural communities are going to become deserts for health care. And this is not just in dentistry – it’s health care in general,” Bryant says.
"It’s made those people living in those small communities have to travel hours to get access to health care.”
Reilly Morgan, a third-year dental student at the University of British Columbia, says he and his classmates are encouraged to find work in rural communities.
“They definitely encourage and incentivize us to go rurally,” says Morgan.
“There’s more opportunity. The cities are more saturated, there are more dentists per person, so there is an incentive for us to go where there is less saturation. Especially as students, we're still developing our skills.”
While Morgan says getting young dentists into rural communities is no challenge, keeping them there is a different story.
“A lot of people are thinking, ‘OK, I'll go for two to three years and do my time, essentially,’” he says.
“Most people aren’t going there to lay down roots and live there.”
Bryant says it didn’t take long to realize that something different would need to be done to address the need in rural communities. When he began conversations with Pacheedaht First Nation seven years ago, they decided mobile was the way to go.
It's been a lengthy process that's taken patience and sensitivity. Relationship building, Bryant says, is 80 per cent of the process, and so far, the relationships he’s built have been “really positive.”
Other than the number of chairs, Bryant says there is no difference between his mobile clinic and a fixed clinic, with no compromise on quality – the two remaining bus seats even make for a modest waiting room.
“We didn't want it to be a ‘less than',” says Bryant. “I want it to be exactly the same level of service we provide in my office.”
In fact, the biggest challenge in maintaining quality has little to do with the equipment or the limited space.
“The only thing that's going to limit us in providing care is access to high-speed internet in rural communities,” he says. While limited in how much equipment he can bring on the bus, with Wi-Fi and cloud technology, Bryant can easily send data back to his home office, where it can be utilized without compromise.
The rough cost of Bryant's mobile clinic was about $150,000, which he says is on par with the cost of developing a fixed clinic. The cost of a three-chair dental office, he says, would be around $450,000 – but according to Bryant, such things are seldom built, with priority placed on larger offices.
Bryant says his mobile model is attracting interest from young dental students discouraged by the current landscape, with many reaching out to him to learn how they can establish their own alternative clinic setups.
“I can definitely see that being something that’s interesting to people,” says Morgan.
“I think especially on the hygiene side of things, or I’ve heard it’s great for accessing geriatric populations that can’t really make it to the dental office.”
While Bryant has not taken his mobile clinic out on the road just yet, he has had people in the chair a couple of times to test it out, which has gone well so far.
As Bryant continues to refine his mobile clinic – and if interest grows among future dentists – time will tell if mobile clinics can fill the cavity in rural health care
