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Business North Carolina: Pillars of NC: Dr. Bill Milner devotes his life to providing travel dental care

Dr. Bill Milner (Asheboro) dedicates his life to public health and providing dental care to seniors and people with developmental and intellectual disabilities. Recently, he received the American Dental Association's Humanitarian Award for his service.

Dr. Bill Milner knew as a teenager volunteering at a Fort Worth, Texas, hospital that he wanted to pursue dentistry. The work of oral surgeons fascinated him, leading  to biology and dentistry degrees at Baylor University.

Most of his dental school classmates headed to private practice after graduation in 1975, but Milner saw gaps in care within communities. More people with disabilities were being dismissed from institutions, and lots of stigmas existed for elderly patients and those with intellectual and developmental disabilities and HIV. The newly trained dentist was impressed by barefoot doctors in China who traveled from village to village and Dr. Paul Farmer’s work among Haiti’s impoverished population.

He and his wife, Susan Milner, moved to Asheboro in 1975 for a staff dentist position with the state of North Carolina. He was an itinerant dentist for five years, moving among public schools, with antiquated equipment and no X-rays. 

For the next 20 years, he worked four days a week as the director of Randolph County’s dental program. On Fridays, Milner and his hygienist, Betsy White, carried portable equipment in the trunk of his Ford Taurus and provided dental care for residents at six facilities in Guilford and Randolph counties through their own private practice.

In 2000, Milner and White founded Access Dental Care as a nonprofit bringing comprehensive dental care to people with intellectual and developmental disabilities and seniors living in 25 group homes and nursing centers. Cone Health Foundation in Greensboro gave $365,000 for start-up costs, enough to purchase a truck and equipment and operate for six months. 

At each facility, the physician-hygienist team unloads the equipment and works in a familiar environment to the patient, such as an activity room.

In 2022, Access Dental Care’s annual budget reached $3.3 million from grants for capital expenses, insurance programs, Medicaid reimbursement, private pay and fees from facilities. The group now serves 160 facilities in 60 counties with five teams each seeing 15 to 18 patients a day, or more than 6,200 in 2022. The plan is to increase it to 10 teams and cover the entire state in the next five years.

States are required to provide dental services for people under 21 with Medicaid insurance, but there are no minimum requirements for adult coverage under the government program. About a third of adults ages 19-64 do not have dental benefits, according to the American Dental Association. 

Dr. Milner has a degree in public health from UNC’s Gillings School of Global Public Health. He received the American Dental Association Humanitarian Award this year, and received the North Carolina Dental Society Distinguished Service Scroll Award in 2021.

Milner, 73, shows no signs of stopping. He gardens, travels, sculpts and enjoys photography. He and Susan, married 49 years, have two grandchildren and one son, Dr. Joe Milner, a family medicine physician with Atrium Health in Monroe.

Everyone in dental school thought I was nuts. I was looking at health systems and trying to get a bigger perspective. 

I walked into my first nursing home in 1976, here in Asheboro. There weren’t any training programs in North Carolina for dealing with populations who couldn’t access a regular private practitioners’ office. 

Four days a week I chased kids at the (Randolph County) health department and on Fridays, Betsy (White) and I would take care of five nursing homes and one day program. I was getting my feet wet before starting Access Dental Care.

In 1984, I’d written a paper that said we need to establish a statewide special care program. In 1997, Dr. Ford Grant and I wrote a grant and the Duke Endowment funded Carolinas Mobile Dentistry under Carolinas Medical Center (now Atrium Health.) That was really the first program in the state to incorporate the nonprofit model.

When we started Access Dental Care, 80% of our folks were Medicaid. Reimbursement at the time we started was about 40 cents on the dollar. (It’s now 42 cents. In 2023, 72% of the group’s patients have Medicaid insurance). Obviously, there wasn’t a profit motive. The only way I figured I could make it work was to start a nonprofit and depend on very generous health-leaning foundations to supply the capital expenses — the truck, the dental equipment, anything else we needed to get the program started.

We worked six days a week the first two years. It doesn’t make any difference whether it’s profit or nonprofit. We had to make a profit to stay alive. We had to charge every facility a retainer fee. We are a fee-for-service business. 

There is a very small number of people who want to do this kind of work. We require dentists to have worked in a hospital general practice residency program for a year. Our dentists also go into the operating room because some patients can’t be treated in a regular dental chair.

You can’t do this job without specialty training. It takes us six months to a year to train somebody who has completed a residency program. We’ve reached that tipping point — training needs to be financed differently and folks need to be trained.

We never have to advertise (our services). It’s all word of mouth. People have heard about us for 30 years. 

It’s taken a community to do what we’ve done. People have been very kind to recognize what we have done. The American Dental Association Humanitarian Award has really put a spotlight on North Carolina, on the concept of care for this group, and the support that has been provided by special care organizations and practitioners in the state. We will continue to lead with special care programming. 

Down the road, there will be plenty of people who will want
to continue the leadership [of Access Dental Care]. I am still able to do clinical work. For right now, I am just having a ball. 

Source: Business North Carolina