In-state graduate retention for U.S. dental schools.

Currently, dental school graduates are viewed as a resource by their institutions and those who underwrite their educational costs. The purpose of this study was to determine the percentage of dental school graduates who practiced dentistry in the same state as their dental school. Using the American Dental Association database of approximately 35,000 graduates between 1985 and 1995, the data were analyzed to determine the percentage of graduates who were retained and currently reside in the state of their dental school versus those located outside of that state ("exported"). It was also possible to calculate the number of dentists who moved into each state but were educated elsewhere ("imported"). The ratio of imported to exported graduates was calculated and indicated a positive flow into the state when greater than one and an outflow when less than one. Overall, mean graduate retention was 67.3 percent, 65.4 percent, and 44.3 percent for public, public state-related, and private schools, respectively, while the median graduate retention of 71.1 percent and 71.6 percent for public and public state-related schools made them indistinguishable. The mean import-export ratio for public school graduates was 2.9, indicating that on average nearly three dentists were imported to a state for every public dental school graduate exported. States' total import-export ratio for all types of graduates was 2.2, indicating that on average a little over two dentists were imported to every one exported by a state with a dental school of any kind. The medians for all these ratios were much more modest (0.95 and 0.80 for public dental schools and states with dental schools), indicating that they sent more students out of the state than they imported. Six public dental schools exported greater than 50 percent of their dental graduates, while five public schools retained more than 85 percent of their graduates. Only one private state-related school retained less than 50 percent of its students. In view of these results, it is apparent there is great variability in graduate retention, and the total yield of new dentists for each state is determined by both the retention rate for graduates and its import-export ratio. Most public and public state-related schools do a good job of retaining graduates. When they do send graduates out of state, the median shows they do not gain quite enough to offset those exported. In most instances, this becomes highly problematic only when a low retention rate is paired with a low import-export ratio. Each state must consider its unique situation carefully and consider its yield, the types of problems that face the state in terms of dental workforce, and possible solutions.