Dental Student, Resident, and Faculty Attitudes Toward Treating Medicaid Patients

Abstract

Failure to receive proper oral health care including both prevention and maintenance is influenced by myriad and complex social, economic, and dental factors, including access to care. Reducing oral health disparities requires changes in the preparation of future dentists as well as measuring and influencing the attitudes and knowledge of practicing dentists. The aim of this study was to determine the likelihood that future dentists (students and residents) and faculty members at one U.S. dental school would treat Medicaid participants. Attitudes were measured using the Deamonte Driver scenario survey, which assesses factors affecting dentists' participation in Medicaid. In October 2012, all 113 full-time faculty members were invited to participate, and 60 completed the survey, for a response rate of 53.1%. In January and February 2013, all 18 residents in the dental clinics and university hospital were invited to participate, and 16 completed the survey, for a response rate of 88.9%. From 2013 to 2015, all 267 students in three classes were invited to participate: first-year students in the Classes of 2017 and 2018 and fourth-year students in the Class of 2015. A total of 255 students completed the survey, for an overall student response rate of 95.5%. The results showed that the students were more likely to participate in caring for Medicaid patients than the faculty and residents. The white and male students had stronger negative stereotypes about Medicaid patients than the females and underrepresented minority students, while residents had stronger negative stereotypes about Medicaid patients than the students and faculty. Overall, the cultural competency skills, beliefs, and attitudes of these faculty members and residents were less developed than those of their students, signaling a need for broad educational and faculty development programs to fully prepare the future dental workforce to care for these patients.

Dental Students' Attitudes About Treating Populations That Are Low‐Income Rural, Non‐White, and with Special Needs: A Survey of Four Classes at a U.S. Dental School

“…Prior studies have found varying effects of gender in treatment of populations that are underserved 22, 30, 32 . In our study, women reported greater perceived professional responsibility for populations that are rural and minority, which is consistent with other research 22, 30 .…”

“…Intent to serve at‐risk patients did not appear to change much as the students progressed through dental school. Some prior research indicated a negative effect of dental education and practice on provider attitudes about service to at‐risk populations 22, 30 . In Habibian et al's study, students reported feeling personal responsibility and impact‐potential for treating populations with low income, although their self‐reported capability declined over time 22 .…”

The association of dental education with pediatric Medicaid participation

“…17 One study suggests dental students become less supportive of care for Medicaid patients as they advance through dental schools and into their residencies. 18 To stimulate interest in serving disadvantaged patients, some dental schools include community-based experiences, such as rotations through federally qualified health centers (FQHCs), as part of dental education. 19 The Health Resources and Services Administration (HRSA) offers grants to dental schools and residency programs that promote community-based training and care for vulnerable populations, 20 and recent evidence suggests graduates of schools receiving Title VII funding are more likely to practice in rural areas.…”

How are the social determinants of health being taught in dental education?

“…Attitudes towards those in poverty and the underserved were examined by several of the papers, which reported negative attitudes among students and residents towards Medicaid patients 43 . Reported negativity towards underserved populations was also shown to increase as students progressed through their dental school careers 17 .…”