View south along U.S. Route 95 in Hawthorne. In online listings and conversations with prospective buyers, the Dows have tried to highlight the perks of living in the community — ample desert for offroading, nearby Walker Lake for boating, a one-hour drive to the gates of Yosemite National Park. (Photo: Famartin, CC BY-SA 4.0)
For almost four decades, Dr. Bruce Dow has filled cavities, pulled teeth and provided other essential dental health care in his hometown of Hawthorne, Nevada.
As his wife, Michelle Dow, describes it: “real, down-to-earth dentistry.”
The Dows are now looking to retire. But they are aware the dentist’s departure is likely to leave a tremendous void in central and western Nevada. Located about two hours south of Reno, Hawthorne itself has a population around 2,600. But Dow sees patients from other rural communities with no dental offices of their own. This includes Tonopah, Goldfield and Mina in Nevada, as well as several towns just across the California border.
“We are terrified to close,” says Michelle Dow, who manages the practice with her husband. “I want to be able to go to a dentist if I have a broken tooth.”
The Dows’ practice has been on the market for more than a year. Their struggle to find a successor underscores troubling health care disparities between rural and urban areas, which the state has only begun addressing.
“We always knew it was a possibility to not sell,” says Michelle Dow. “We don’t need to. We would like someone to take over.”
In online listings and conversations with prospective buyers, the Dows have tried to highlight the perks of living in Hawthorne — ample desert for offroading, nearby Walker Lake for boating, a one-hour drive to the gates of Yosemite National Park. They show off their practice’s full schedule, which keeps them and two full-time hygienists and three dental assistants busy. They talk about where they see potential for growth.
Michelle Dow says one prospective buyer — a younger dentist from Idaho — seemed to seriously consider it before his wife objected. Hawthorne felt too much like the rural locale they were looking to leave.
“Everyone wants to live in Caughlin Ranch,” adds Michelle Dow, referencing an affluent neighborhood in Reno.
“Some want to live in Lake Tahoe,” jokes Dr. Dow.
Dr. Dow adds that for most dentists it is simply a numbers game. The bigger your pool of patients, the more money there is to be made. Rurals will never win that game.
“I understand that,” his wife chimes in, “but we’re missing the human part of dentistry. It’s about taking care of people.”
In 2019, 35% of adults 18-64 had not had a dental exam or cleaning in the past 12 months, according to a July 2021 report from the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention. Adults living in rural areas were more likely to have skipped a dental visit than their urban counterparts.
Nationwide, 57.6% of adults in rural areas had visited a dentist in the past year, as opposed to 66.7% of adults in urban areas.
Access to dental health providers and disparities like that are receiving some renewed attention statewide.
“It’s not only a shortage,” says Dr. Ed De Andrade, a Las Vegas-based periodontist and president of the Nevada Dental Association. “It’s a complete lack of care.”
During the 2021 Legislative Session, NDA helped draft a bill it believed would expand oral health care through telehealth and dental emergency response programs. The Legislature passed the bill with bipartisan support, but it was quietly vetoed by Gov. Steve Sisolak, who wrote in his veto letter that he opposed a provision that would have created a new committee governing the practice of dentistry during an emergency.
De Andrade says the veto came as a surprise. He says NDA plans to lobby the next legislature to override the veto. In the meantime, the association also plans to work with the UNLV Dental School to better address access in rural communities.
De Andrade says making dental school more affordable would help because students with less debt would be more likely to pursue jobs in less lucrative areas. The Dows like the idea of a loan forgiveness program for dentists who commit to working in rural areas. They argue it would save the state money in the long run by reducing the costs of emergency dental situations, which can involve patients being life-flighted from rural areas or driven hundreds of miles in ambulances.
According to the American Dental Education Association, only 17% of dental school graduates have no student loan debt. The majority have racked up around $300,000 on average.
The Nevada Dental Foundation, the newly rebranded nonprofit arm of the NDA, is refocusing its efforts on oral health care in rural areas of the state. Their flagship project will be to open a dental clinic in Tonopah, where a few years ago another longtime dentist retired with no replacement to be found.
“We can have the facility,” says De Andrade. “We can furnish and equip a facility. But we’re going to need the manpower, the professionals to run the facility and provide the care to patients and the community.”
The foundation’s current plan involves dentists, hygienists and specialists rotating stints at the clinic — until a full-time dentist is recruited to the Nye County community of about 2,000.
Until that clinic is operational, Tonopah residents will have to travel for dental care. It’s about an hour and a half drive from Tonopah to Hawthorne.
“They’ll travel,” says Dr. Dow of the thousands of Nevadans living in rural areas. “In the rural areas people have to travel for all kinds of things. More and more medical things because smaller hospitals cannot support the infrastructure.”
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