QUESTION: Payroll figures which recently appeared in The Alamance News revealed that two of Alamance County’s five highest-paid employees are dentists in the local health department’s dental clinic. Who exactly picks up the tab for these dentists? Do they have private practices to supplement their income from Alamance County? Also, what role does the county have in funding, and operating, the clinic itself?
ANSWER: It might not make a trip to the dentist any more pleasant. But it appears that Alamance County’s health department isn’t asking taxpayers to “open wide” in order to subsidize the salaries of the dentists who work at the county’s pediatric dental clinic.
This clinic, which is situated at 1914 McKinney Street in Burlington, is part of the same complex of public buildings that also includes Alamance County’s health department as well as the county’s department of social services. But unlike the other agencies in this “human services” complex, the county’s dental clinic is meant to function more like a market-based business than a publicly-subsidized unit of government.
According to the county’s health director, Tony Lo Giudice, the dental clinic is one of those rare government operations that doesn’t require any taxpayer funds to make ends meet.
“The dental clinic generates enough revenue to sustain itself,” Lo Giudice went on to explain in an interview. “We don’t rely on tax dollars from the county to be operational.”
The clinic’s self-sufficiency is also noted in the proposed budget that Alamance County’s manager Heidi York presented to the county’s board of commissioners in the spring of 2024. According to this document, the clinic “is budgeted as a self-supporting unit, receiving no general revenue funds” to cover its operations.
This blanket declaration may seem to be undercut by some of the financial data that appears in the manager’s budget. In particular, the budget includes figures from the fiscal year that ended in June of 2023 that show the clinic received a “general revenue allocation” of $92,798 to supplement the $1,479,508 that it raised from its own operations. Yet, according to Lo Giudice, even this allocation was originally derived from the clinic’s excess revenues, which were squirreled in the county’s general savings until they were needed for a remodeling job in 2023.
In any event, the county manager’s budget observes that the dental clinic uses its revenues to provide a range of services for patients from birth to age 21. These services include “cleanings, fluoride treatments, infant oral care, nutrition counseling, sealants, fillings, crowns, extractions, and general oral care.”
The fact that fee-based services are housed in the county’s wheelhouse may seem a bit peculiar to some area residents. Even so, Lo Giudice, is emphatic that this county-sponsored clinic fills a crucial need which the private sector has been unable to meet on its own.
“Dental care is an essential local service – especially with pediatrics,” Lo Giudice went on to explain in an interview. “There’s a lot of demand for pediatric dentistry in the county, and not many providers. Our own demand is so high that the current wait time for appointments is 47 days.”
In order to underscore the private sector’s acceptance of this clinic, Lo Giudice pointed out that Dr. Rosyln Crisp, one of the few pediatric dentists in Alamance County, is also a current member of the county’s health board. The county’s health director added that the clinic’s two dentists – Ibraheem Ackall and Homayoun Sadri – work exclusively for Alamance County, whose personnel records place their respective salaries at $195,223.10 and $177,258.06.
Ackall and Sadri are ultimately the two highest paid members of the dental clinic’s 15-person staff. According to the county’s personnel office, the current salaries for these individuals total just over $1,022,000 – a figure that’s well within the dental clinic’s historical revenues as spelled out in the county manager’s proposed budget.
Lo Giudice went on to point out that the county’s dental clinic covers its personnel costs like any private business – relying on fees for service to fund these operational outlays. The county’s health director added that, by and large, the clinic doesn’t even receive state or federal subsidies to offset its expenses.
“We did get a grant for our mobile unit,” he elaborated. “But other than that we get no state or federal grants. All of the revenue comes from fees.”
Lo Giudice nevertheless stressed that the clinic’s fee-based M.O. doesn’t prevent it from making some accommodations on behalf of its less affluent clients.
“We take people without insurance, and we charge them on a sliding scale,” he explained. “We also take Medicaid – and not a lot of dentists take Medicaid.”
