Background:
Access to dental care is a growing problem for many subgroups in the country. Present trends in California help elucidate the scope of access issues that are burgeoning nationwide. Challenges to ideal provider-to-population ratios have emerged in outlying areas as providers are lured to cosmetic-oriented urban areas, while urban sprawl and a sharp rise in the Latino population trigger tremendous non-urban population growth. The result is that “projected oral health workforce shortages are already evident in many rural locales”, as indicated by the Surgeon General’s A National Call to Action to Promote Oral Health report.
The Promise of AEGD Training -- AEGD (Advanced Education in General Dentistry) training can empower the general dentists to be a much more effective and efficient provider than the non-AEGD counterpart. In provider-poor areas, like those with emerging need secondary to population growth, the AEGD-trained dentist has the potential to be a tremendous resource, effectively reducing patients’ dependence on specialists for advanced care. This potential has been recognized and supported by primary funders, like the Bureau of Health Professions at HRSA (Health Resource Service Administration), which works to provide the “highest quality care for all” through workforce distribution measures, among other things.
The Primary Study Question -- Are AEGD-trained dentists locating in areas of emerging need, like California’s growing, non-urban population centers where dental services are lacking?
Methods
California counties were categorized by relative growth and need through a “Composite Need Index” and “Emerging Need Profile”, which were both created specifically for the study.
Locations of AEGD graduates trained in Northern California programs were geoprofiled and geomapped through zip code analysis.
Surveys were created to assess understanding of AEGD program objectives from the perspective of current residents and program directors.
Findings:
Regardless of training site, a preponderance of the AEGD graduates sampled remained in the Bay Area once training was completed. Zip code and need indicator analysis revealed that specific areas represented by graduates were largely urban, coastal, and experienced less population growth than rural counterparts from 1990-2000. When compared to non-AEGD counties, AEGD counties had more favorable economic standing, though they appeared equally diverse. Only 5 of the 139 graduates in the sampling frame chose locales designated as Dental Health Profession Shortage Areas. Survey responses revealed that current residents are generally uninterested in working in rural or geographically isolated areas. Additionally, there appears to be little curriculum emphasis on post-graduation needs to serve in rural areas. Lastly, post-graduation job placement assistance to such areas is absent.
Conclusions:
AEGD-trained dentists are not generally locating in California’s rural areas that have growing, unmet dental need.
Recommendations:
Stronger outcome monitoring is needed by dental schools and the Bureau of Health Professions.
AEGD programs should be marketed differently to attract students likely to live and work in non-urban areas.
Curriculum modification should be considered to increase resident exposure to the geographically underserved.
A demonstration project using a rural-based community health center as a satellite teaching facility should be funded.
