Practice patterns of postgraduate trained dentists in the United States.

OBJECTIVE: Postgraduate 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 DESIGN: Individual 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. RESULTS: Individual 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. CONCLUSION: Federal 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.

Trends in postgraduate dental training in the United States.

OBJECTIVE: This study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training. METHODS: Individual dentist records from the 2017 American Dental Association Masterfile were linked with pre-doctoral training attributes and state-level dental policy factors. Generalized logistic models, adjusted for individual, educational, and policy factors, were used to predict: (1) attending any PGD program, and (2) primary (i.e., advanced general practice, pediatrics, or dental public health, per the Health Resources and Services Administration [HRSA]) versus specialty care. RESULTS: The majority of new PGD residency slots (77%) were in primary care. Women held 56% of primary care slots; men held 62% of specialty slots. Individual characteristics that predicted PGD primary care training included being Black, Hispanic, Asian, or other race; being male or older age reduced the odds. Pre-doctoral school characteristics that predicted PGD primary care training included having a pre-doctoral HRSA grant, affiliation with an academic medical center, and being a historically Black college/university; being a private school or in a small metro area lowered the odds. At the policy level, the strongest predictors of attending PGD primary care training are a residency requirement in the state you currently practice in and federal graduate medical education (GME) investment per residency slot. CONCLUSION: Pursuing PGD training is variable based on the race/ethnicity/gender of the dentist. Federal investments in pre-doctoral dental education and GME can drive equity, as they significantly increase the odds that dentists will go on to PGD training, as do state licensure requirements.

Does California Project the Future of Dentistry?

If trends continue, the majority of U.S. dental students will soon be women. However, there is little empirical analysis examining gender differences in the labor supply of dentists and the potential effects on the dental care sector. We help fill this data void by examining differences in dentists' hours worked by gender, how this has changed over time and the potential implications for the current and future aggregate labor supply of dentists in California.

An analysis of dentists' incomes, 1996-2009.

BACKGROUND: The U.S. economy is beginning to recover from the most significant contraction since the Great Depression. Several sectors, including dentistry, have experienced reduced consumer demand and reduced earnings. Focusing on general practitioners, the authors analyzed trends in various factors that drive dentists' income to identify which of these factors are most important in explaining the recent decline. They then offer their views on future trends in dentists' net income levels. METHODS: The authors used data from a nationally representative survey of dentists maintained by the American Dental Association (ADA) and data from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey to analyze trends in real gross billings per visit, rates of collection of gross billings, number of visits to a dentist, percentage of the population who visited a dentist, population to dentist ratio and average real practice expenses. RESULTS: The authors found that the recent decrease in dentists' net income levels was driven primarily by a decrease in utilization of dental care on the part of the population. Moreover, this decline in dental care use, although most pronounced during the economic downturn, appeared to have started before the downturn began. This suggests that more factors than solely the economic recession are affecting changes in dental care utilization patterns. CONCLUSIONS: The authors' findings suggest that average real net income for dentists may not necessarily recover to prerecession levels once economic conditions in the United States improve. This finding, combined with the potential implications of health care reform for dentistry, causes the authors to believe the future prospects related to dentists' net income levels remain uncertain.

A look at allied dental education in the United States.

BACKGROUND: The American Dental Association conducts surveys of educational programs in dental assisting, dental hygiene and dental laboratory technology. The 2002-2003 survey included questions about enrollment, graduates, program information and trends. METHODS: The ADA Survey Center mailed the Survey of Allied Dental Education to 548 program directors of dental assisting, dental hygiene and dental laboratory technology educational programs. They also sent several follow-up notices as a reminder to complete the survey. A 100 percent response rate is mandatory for continued accreditation by the Commission on Dental Accreditation. Association staff members resolved inconsistencies in the data and analyzed them before producing a final report. RESULTS: The number of applications to, first-year enrollment in and number of graduates in dental hygiene and dental assisting educational programs have increased during the last five years. During the same period, the number of applications to, and graduates of, dental laboratory technology educational programs decreased, but first-year enrollment increased slightly. CONCLUSIONS: Results from these surveys help address the concerns of the public and the profession regarding allied dental manpower levels. They also provide information for those interested in applying to individual allied dental educational programs. PRACTICE IMPLICATIONS: Private dental practices employ the majority of graduates of allied dental educational programs. Recent graduates of dental assisting and hygiene programs continue to supply the office staff members needed to support the delivery of dental care.