Practice patterns of postgraduate trained dentists in the United States

Abstract

ObjectivePostgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD‐trained dentists.Study designIndividual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD‐trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC.ResultsIndividual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign‐trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high‐poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC.ConclusionFederal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.

Postgraduate education to expand access to dental care: A roadmap to community dental program development

“…3 Another recent study demonstrates that dental trainees participating in an HRSA-funded training program or in a communitybased training program are more likely to practice in an FQHC or provide services to children with Medicaid. 4 Incentivizing service for low-income populations is critical since affordability is a significant barrier that can compound access challenges. 6 Thus, postgraduate programs that emphasize care for rural and underserved populations or place learners in underserved communities and community-based training programs are a key strategy to address access challenges and improve public health outcomes.…”

“…3 This problem is compounded by a maldistribution of the dental workforce, as well as an insufficient supply of dentists practic-ing in Federally Qualified Health Centers (FQHCs) and accepting Medicaid reimbursement, exacerbating access challenges for low-income populations. 4 Lack of access to dental care for adults and children is linked to adverse outcomes across measures of health and well-being. 5 Poor oral health can result in malnutrition, infection, and speech difficulties in children, while adults have reported severe limitations such as the inability to participate in a job interview.…”

“…Rural areas, which have a higher proportion of dental providers nearing retirement than their urban counterparts, are additionally vulnerable 3 . This problem is compounded by a maldistribution of the dental workforce, as well as an insufficient supply of dentists practicing in Federally Qualified Health Centers (FQHCs) and accepting Medicaid reimbursement, exacerbating access challenges for low‐income populations 4 …”

“…A 2020 study found that graduating from a dental postgraduate program at an institution that received Health Resources and Services Administration (HRSA) funding was positively correlated with practice in a rural location 3 . Another recent study demonstrates that dental trainees participating in an HRSA‐funded training program or in a community‐based training program are more likely to practice in an FQHC or provide services to children with Medicaid 4 . Incentivizing service for low‐income populations is critical since affordability is a significant barrier that can compound access challenges 6 .…”

Heightened vigilance and perceived discrimination in dental trainees’ readiness for clinical practice

“…Understanding the effects of racial discrimination on dental trainees’ career readiness is essential to 1) address the severe and persistent underrepresentation of minoritized dental providers 34 to ensure an adequate and relatable dental workforce that prioritizes care for underserved patient populations given minoritized providers’ disproportionate high volume of service delivery to underserved patient populations 35 ; 2) support minoritized dental trainees’ preparation for professional development and advancement 8,9,35 …”